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By ºìÌÒÊÓƵ¸ßÇåappÏÂÔØ Social Worker Stephanie Best

Anger is a normal and healthy emotion everyone feels from time to time. Dealing with an illness like chronic kidney disease (CKD) can bring up many emotions, anger being one of them. Many people feel it is unfair they became ill and are mad about it. People may also feel angry about the loss of control over their lives that renal disease and treatments such as dialysis or kidney transplant can bring.  Some examples of things people with kidney disease often feel powerless to control are:

• dietary changes
• dialysis schedule
• employment/income
• medication regime

The acts of receiving dialysis, taking medicines and other treatment routines remind people of their renal disease and loss of personal control. Performing these acts can make them feel angry and resentful. This anger can be directed towards many sources including dialysis caregivers, family and friends. Anger may also be directed inward, leading to feelings of depression and low self esteem.

Though feeling angry is normal and should be recognized as part of the adjustment process, it is important to learn healthy ways to express emotions and take back control. Keep in mind that getting angry raises heart rate and blood pressure, so handling anger can improve your physical and emotional health. In addition, finding productive ways to take back control is very important. Sometimes renal patients make dangerous decisions such as not taking their medicines or skipping dialysis treatment in order to create a sense of control. These things might make patients with kidney disease feel powerful, but this behavior will ultimately backfire by making them sick. 

Understanding that you are the most powerful person on your health care team is the first step in regaining control and releasing your anger. Only you can choose to care for yourself well. Your renal healthcare team can provide information, support and advice, but you are in control of your kidney disease and your overall health.

So, how can you better manage your anger and regain control?

Listed below are six ways to get you started on the road to controlling anger that is often brought about with kidney disease. You’ll also find suggestions on how to carry out each of them. You may think of more as you go along. Feel free to discuss any ideas you have with your healthcare team.

Relaxation

• Breathe deeply from your stomach. Breathing from your chest won’t relax you.
• Slowly repeat a calming word to yourself like “relax” or “take it easy.”
• Imagine a peaceful scene in your mind either from memory or imagination. An example might be walking on a beach. Hear the waves rolling in. Feel the sun.
• Exercise. Take a walk or do some simple stretches to relax your muscles.

Change the way you think about things

• When people are angry, they tend to believe they have been wronged in some way and typically view things as “always or never.” An example of this is, “You never remember to hand me my blanket.” “You are always mean to me.”
• Remind yourself that acting out your anger in hurtful ways will not get you what you want. You run the risk of turning away a person who wants to help you.
• Talk to the person who you want to help you using words and a tone that is more likely to get you the results you want. You might try, “I know you are really busy, but could you please hand me my blanket?”
• Remind yourself that frustration and powerlessness is a part of daily life for everyone and get out of the “victim” mode. Some common examples of how everyone suffers, regardless of their kidney health include: traffic jams, not getting a promotion, work schedules and school schedules.

Problem-solve

• Often, problems are very real and inescapable. For example, you have kidney disease and need dialysis treatment to sustain your life. No way of rethinking can change that. Instead of trying to “solve” this problem, however, make your goal to handle it well. You can’t change these circumstances, but you have total control over how to respond to them.
• When you meet a challenge that can be changed, like improving lab values, make a plan to solve it and mark your progress along the way.  Ask for assistance from a healthcare team member (in this case, a dietitian) who can help you.
• Get involved in your renal care by attending your care plan meeting where you can talk with your doctor, facility administrator, social worker and dietitian. Join a patient advocacy group like ºìÌÒÊÓƵ¸ßÇåappÏÂÔØ Patient Citizens or a support group to share problems and solutions with other renal patients.  
• Determine to give the task at hand your best shot and set small attainable goals. If you don’t make it, don’t get angry and punish yourself or fall back into the “all or nothing” way of thinking. Just re-group, set a new goal and make a new plan. Celebrate the successes along the way!

Listen before you leap

• When angry, people tend to jump to—and act on—conclusions, and often these conclusions are incorrect. So, the first step is to slow down and listen to what is really being said to you. Ask for clarification until you understand exactly what is being asked of you and why. 
• For example, instead of: “You put me on dialysis late every day. No one else has to wait. What is wrong with you?” Try, “It’s past my scheduled time to go on dialysis. What is happening to slow down things today? Is everyone getting on late or just me?”
• The answer might be simple and not personally directed at you.

Humor

• Remember the saying, “Laughter is the best medicine.” Staying positive and finding the humor in life, especially during treatment for kidney disease, will help you remain relaxed and handle stress better. 
• Watch funny movies or tell funny stories to fill your time with positive thoughts instead of negatives.

Change your environment

• Surround yourself with calm, positive people. Whenever possible, avoid people or situations that tend to anger you. Trying to change someone or something will usually prove futile and only make you angrier.
• Bring an uplifting book or other means of distraction with you to dialysis treatment.

If none of this helps, you might try counseling

If your feelings of anger are out of control or if your anger is affecting your relationships with others and/or your health (blood pressure, stomach problems), you might consider counseling. Your Social Worker is an excellent resource.  S/he can help you develop some of the techniques outlined here, or refer you to someone outside of your center.