This episode was prerecorded as part of a live continuing education webinar. On-demand CEUs are still available for this presentation through all CEUs. Register at allceus.com slash counselor toolbox. I'd like to welcome everybody to today's presentation on anger management. And we're going to be talking about a nine to 12 session protocol. And basically we're going to go over the nine things that you need to cover. But depending on how participatory your group is and you know, a variety of other factors, you may decide at a certain point that you want to expand it a little bit and either put in some consolidation sessions where you actually have a whole group where you don't teach a new skill or you split some of the things that we're going to talk about into two different groups. So we're going to learn about anger and its functions, explore events and cues that can trigger anger. We're going to learn how to help clients develop an anger control plan. We'll learn about the aggression cycle and how to help clients change it. We'll review the ABCD ease and thought stopping. So basically some techniques to help people address their anger. We'll discuss assertiveness and conflict resolution skills. We'll review alternatives for expressing anger. Look at relaxation interventions and explore how past learning from your family of origin can influence current behavior. So in session one, what we're going to do is basically introduce everybody and we're going to talk about what is anger and help people realize that anger really doesn't have to be unhelpful. Anger is a helpful emotion if we just understand it. It's an emotion that's triggered by a perceived threat which prompts the fight or flight reaction. So the fight reaction is our anger reaction. Flight is fear and we talk about different things. When I do this group that might prompt somebody to fight or flee. You know, you run into a mugger in an alley. Are you going to fight or are you going to flee? And what differentiates when you fight versus flee? So you can talk about that and help people start recognizing that when they feel either one of these emotions, it's their body triggering them that there may need to be something done. There may be something amiss. So to pay attention, but it doesn't necessarily mean that's the case. Hostility refers to a set of attitudes, thoughts and judgments that motivate aggressive behaviors. So if we're working with somebody who's hostile, you know, they're going to tend to have attitudes and perceptions that are more negative. So we're going to work on maybe addressing those. Aggression is a behavior that's intended to protect the person by causing harm or injury to another person or damage to property. So this is the fight or flee. And you know, sometimes the harm to a person, it doesn't have to be physical harm. It can be emotional harm if you lash out at somebody in anger verbally. You know, there can be harm associated with that. So helping people see that aggression is the response. When you say there's a threat, I need to protect myself. Now what do I need to do? Do I need to run or do I need to push that threat away or push that threat down and gain control over it? Many times what people initially perceive as a threat really isn't one. It's just past stuff coming up. So for example, Google sent me a message the other day that I needed to declutter my inbox. And clutter is a term that my mother always uses whenever she comes anywhere. It doesn't matter how clean I think the house is, she sees clutter. So anytime I hear clutter, I'm just like, Oh, and so I got that from Google. And I'm like, how dare Google tell me that I need to declutter. And I'm like, really? I'm getting mad and automated thing. But I help people and I give people examples of times that I've had anger or irritation or whatever degree of anger triggered by stuff from my past that was really not worth getting upset in the present. So we start talking about things that trigger your anger over the past week. And what triggered your anger? And I put up an anger meter and we go from mild irritation to all outrage. And we mark some anchor points along there with anger itself being like in the middle. And I tell people, talk about some things that irritated you this week. Talk about some things that made you angry. And we put them along the anger meter.  Or if it was something from their past that they were just, they were reacting to more strongly. Maybe somebody said something and they got angry. And the person didn't intend to hurt their feelings or insult them, but they reacted with anger because it reminded them of being bullied when they were little or whatever. So we talk about those things. We talk about the cognitive triangle, how thoughts, behavior, and feelings all influence each other. So when something happens, when you do something, you feel a certain way about it. Like I went to the gym this morning and I felt great about it. And I had positive thoughts about it. Other times, you know, you might do something and then you feel regretful about it. And then you have self-depreciating thoughts afterwards, you know. I really shouldn't have done that. I said I wasn't going to lose my temper anymore. And then we'll talk about, okay, maybe it starts with a feeling. You're feeling angry. So you start having angry thoughts that correspond to that. And then you may do things out of anger that are more impulsive. And it may be, I remember one day when I was working at the clinic, it was just a really hectic day and I was just in an awful mood. And somebody came up to me and, you know, startled me a little bit and said something. And it was just like, can you not see that I've got a whole bunch of stuff sitting on my desk and I'm working. And I was irritable and I kind of bit her head off. So my behavior, I lashed out. That was my behavior because I was feeling already irritable. It wasn't anything that she did. But she just kind of happened to be the straw that broke the proverbial camel's back. And so being aware of, it may not be something somebody does. You know, you could be in awful mood from your day at work and your kid comes home and, you know, daddy, daddy, daddy, daddy. I want to show you something.  And the child's like, what did I do? So we talk about that. And then we also talk about thoughts. If you're having negative thoughts about people, if you're dreading going to this meeting or dreading going to this reunion or whatever it is, then it might start bringing up feelings, you know, of dread. If you think that you're going to go there and it's going to be an awful time and yada, yada. Then you start having those feelings of dread and irritability that, oh, you know, I have to go to this. It's mandatory fun. And then the behaviors, you can kind of create a self-fulfilling prophecy. So we go over all of these with each, you know, starting at each different point in the triad. So people can see that it's not just a behavior, not just a feeling that can lead to problems. But the good thing is you can intervene in any place. So if you're having negative thoughts about this upcoming class reunion, you know, you're getting ready to go to your 30-year reunion or whatever. And so you're having these feelings of dread and you just don't want to go and you're procrastinating packing or whatever. What can you do? You can change your thoughts. You know, what could possibly good come out of it? What things, you know, could you focus on that could help you feel less impending dread and irritability? Because a lot of times you start focusing, people start focusing on stuff from the past. You know, done me wrongs from high school that never got resolved, so then you start getting irritable. Okay, that's fine. But we want to help people figure out, do you want to focus on those negative thoughts? Or what would happen if you started having optimistic thoughts? Like, well, at least it's 72 hours away from the kids in the farm and everything else where I can just kind of cut loose. I don't have to spend a whole bunch of time at the reunion. I can hang out in my hotel room if I want. So encourage them to change their thoughts, to change their feelings and potentially change their behaviors. We talk about misperceptions and I alluded to that a little bit earlier.    But my dog would lose her mind. She would just absolutely lose her mind. Well, I'm sure the fire alarm sound hurts her ears. So after that, you know, we fixed the fire alarms, but after that, whenever it would be a breezy day and we would have the windows open, she would just start shaking and quaking and whining and trying to burrow under things. So because of her past experiences with it, you know, setting off the fire alarms and that being unpleasant, whenever it would start to get breezy now, she associated that so she would have that same, she would have the fear reaction. She wouldn't get angry. Another example, my son and his best friend were outside and they were practicing martial arts, which, you know, they're both black belts now, so wonderful. But our dog perceived danger.  But my dog lost his mind and he was just like, somebody's after, somebody's after Sean and all his hackles went up and started barking. And so after that, it took multiple times of Elias coming over to the house and us reintroducing him and Elias giving him peanut butter because he loves peanut butter before he realized that okay, Elias isn't a threat.  But, you know, we have these things that we experienced in the past is dangerous. You know, we think this is a problem. And then in the future, it can trigger misperceptions. Another example with rescues and I use rescues a lot because most people can relate to animals. I've gotten a lot of animals that have come in where and unfortunately a lot of times it has been a male who has hurt them, you know, been a little bit more aggressive. And so these rescues don't respond as well to male adopters. Or it takes a little longer for them to warm up and one of the criteria we have is does the person do well with men does the person do or not the person sorry does the animal do well with men does the animal do well with children. Because we don't know necessarily what his prior experiences were before they came into rescue. And finally domestic violence and obviously that's humans. Initial experiences if somebody was raised in a household where raised voices led to violence you knew if you heard dad come home and he started screaming, you know, the stuff was about to hit the fan. Then in the future, when somebody raises their voice, you may perceive it as a threat. Now intellectually you may know, you know, I'm bigger now and whatever yada yada. But there's that microsecond where you may flash back to is this a threat or not. And that's okay.  Are you safe? Is this a threat? Is this something you need to worry about? Anger tells us to be aware. It doesn't tell us we have to act. It just tells us to be aware and look around and see if there really is a problem. I call it our threat response system tells us that there might be a problem and to look around. Anger becomes a problem when it's felt too intensely, too frequently or is expressed inappropriately. So another thing that we sometimes talk about in session one and you can break this off here and make this session two if you need to. How does anger affect you? And then we go through each one in stations usually because I like to have people not have to just sit there in a circle and look at me because I find it's better if people can move around. But physically, you know, does it affect your sleep? Does it increase your pain? Does it affect your gastrointestinal stuff? Does it affect your immunity? And I have a handout that I create for clients and I give them at the end of this session that talks about the different effects of anger on all these things. But I want them to think about it for themselves before I hand it to them and go, well, research says because I don't know how it affects them. I have a I can probably guess, but I don't know how it affects them specifically. So I want them to start really thinking about the far reaching impact of excessive anger. Emotionally, you can have regret.   That's okay. But it's what you do with it that you tend to regret. And I try to help people separate that, that concept. Anger is a natural emotion. It happens automatically. You know, no need to regret that. That's just your body going, hey, pay attention. It's what you do with it from that second forward that you may regret and that you have the ability to alter. People can have feelings of guilt about being angry all the time or feel helpless if they feel like their anger is just overpowering and they don't have any control over their temper. It can lead to a feeling of helplessness and powerlessness. And when you feel helpless and powerless, what happens? You tend to feel like you're in a threat situation because none of us like to feel like that for the most part. So people tend to get angry that they feel helpless over their anger and it just spirals. Socially, anger impacts our relationships. Yeah, you can have people do what you want, but is it fear or is it respect? So we can spend some time talking about the difference between do you do things or do you want people to do things for you because they respect you or because they're terrified of you. Think of the parent who used to walk around with the switch or the belt or whatever and the kids were like, I just don't do it. Versus the children who did their chores and did what they were supposed to because they respected their parents and wanted to make them proud. It has a lot of other negative impacts on relationships because if you have uncontrolled anger, your social supports, you know, your close people as well as your distant friends may kind of walk on eggshells because they don't know what's going to trigger you. Or they know, you know, there's a couple of family members that we know there are certain topics you just don't even bring up because that vein in the side of their neck will start pulsing and they're going to turn red in the face. So being aware of how it impacts your interaction with people. Occupationally, it may affect who wants to work with you and how well you do customer service.  Obviously, that's probably not a good fit for you if you're looking at it going, really, you're bringing this to me.  Spiritually, how does anger affect people's sense of connectedness to an impact with the world? You know, do you feel like you're part of the world and it's a happy place to be?   Talk about different concepts of spirituality and how anger impacts that. And I mean, look at some of the spiritual literature and in all of the spiritual literature, there are evidences of anger. So how is anger handled in Christianity and Judaism and Buddhism and in these different religions, if that seems appropriate? And environmentally, anger can affect your environment because you may break stuff. I had a boyfriend when I was in college, whenever he would get angry, he put his fist through things. And the last time he got angry, thank goodness it was never at me, but he put his fist through the windshield of his car and he broke three knuckles and obviously needed a new windshield and, you know, drywall is a lot softer than a windshield. So things can be problematic, but even if it doesn't get to that extreme, I think we know people or we've even done it where you get in a fight with somebody, you break up with somebody and you just start throwing things out impulsively.  You know, the nice thing with digital pictures now is even if you delete them, somebody probably has a backup or Facebook does. But, you know, these sorts of things, when you're angry, you can start purging things and then regret doing it later. Anger initially has apparent payoffs by releasing tension, controlling people, helping you get your own way. But in the long term, payoffs lead to negative consequences. So examining the benefits and payoffs for anger for our clients. You know, what's the benefit? And generally you don't need to do stations for this. You can have people just kind of shout out what the benefits are and then shout out what the drawbacks are. We've already gone through a lot of the drawbacks when you went through the section on how anger affects you. Habits are things we do almost automatically. So another way you can look at it is talking about in what way is anger a habit for you? Sometimes people know that if they get angry, they get their own way. So it's just kind of a habit.  Most of the time that's not on a conscious level. It's subconscious that behavior has been reinforced so they do it again. So we want to ask people to start practicing and trying to use mindfulness to break the habit of anger. So when they get angry, you know, they got to check in and they say, okay, I think I'm angry. Am I angry? Yeah, I'm angry. Got it. What am I angry about? Is this actually a threat to me right now? And what is the best response in this situation to help me achieve my goals? If I was getting angry about this, a good use of my energy would be another way to put that. And have people just start thinking about how much energy they're using. You can even do an anger pie and have people identify what proportion of the day and what proportion of their energy they spend on anger versus happiness, relaxation, stress. Encourage people to identify anger control strategies they've used in the past. Look at which ones worked and why they worked and which ones didn't work and why they didn't work. A lot of times I'll have people do this as part of their homework because they start brainstorming and why a particular intervention works or doesn't work for a person is going to be very personal to that person. And then we can talk about it in the next session when we talk about anger management strategies. And then people can say, well, sometimes I go on a walk and three other people may go, yeah, I do too. And one person may go, I tried that, but it doesn't work. And we can start having a discussion about why it may work for some, why it may not work for others. The homework, keep a log of your anger intensity in the next week. Keeping a log helps people become more aware of their triggers and cues and helps them see their progress. So I have them on the top of the page and you can print out pages with this if you're doing it in a group. Put the date and use a different page each day. That way people, it doesn't get as jumbled. And have three columns on the page. The episode briefly what happened. The intensity was it mildly irritated, moderately irritated, angry or enraged. And then the duration and why do we look at the duration? Well, because do they get over it quickly?  Did you stew on it for less than an hour? Did it bother you for a couple of hours or did it completely ruin your day? So we're getting a look at the intensity and duration. Because sometimes when people start addressing their anger, their intensity may not go down right away, but the duration may. They get really angry. That knee-jerk reaction is just, wow, really intense. But then they can start using some of their skills and the duration goes from it ruined my day to, yeah, it knocked me off balance for an hour or so. And that's progress. So I want people to be able to see that. So in session two, you're going to start every week they're going to use this log. And that's important for them to do every week because we're going to start building on this and not only identifying what the anger triggers were, but what did you do to try to address it, what worked, yada-yada. And yes, when one of you pointed out when people get angry, another question you can have them ask themselves. Themselves is, what am I getting out of this? If you're getting angry at somebody, what is it that I'm getting out of it, except for worn down, exhausted and an ulcer? So session two, when you get angry, it's often because you've encountered something that has made you feel threatened or provoked you. I don't like the term provoked. They used it in the text in your class. That feels less controllable to me for some reason. So I don't like that word, but that's a personal choice. So I encourage people to identify some general situations that made you irritable. And, you know, you can do that anger line again. And I say, look back over the past week. What are some general situations that made you irritable? What are some things that made you angry and enraged? And as we get to, once we get to vulnerabilities, we're going to start looking at if you have a bunch of stuff that's making you irritable, it's a lot easier to get angry and enraged because it's cumulative.  Many times specific events touch on sensitive areas. These sensitive areas or red flags usually refer to long standing issues that can easily lead to anger. For some people, a loss of control. You know, if they feel like they're not in control of their situation or if they feel like they're not in control of their reputation, for example, they may become enraged. Rejection or isolation, and generally it's more on the rejection end where people feel like their ideas or their help or themselves were rejected by someone.  You know, if somebody, if you lose face to somebody, a lot of times it'll make people angry. And then failure. If something happens and it makes somebody feel like they failed, they may initially get angry if they don't get a job promotion they wanted. They may get angry at their boss or something and go, you know, how dare you? Or get angry at themselves for not getting that promotion. So encourage people to look at each of these sensitive areas and identify which ones make them feel threatened or trigger their anger. Because some are going to be more salient for some than others. When you're identifying triggers and events, you know, encourage people to put up whatever they can think of on the board. But I have some suggestions, long wait to the doctor. You have an appointment at 10 o'clock and it's 1040 and you still haven't been called back. Traffic, a friend joking about a sensitive topic, somebody not paying back money that they borrowed from you, being wrongly accused of something, having to clean up after someone. And I've got teenagers at home. So this is one of my triggers. But you realize at a certain point that getting angry about it and stewing on it isn't going to do any good. So the question is, what do you do to change the situation? Having a neighbor who plays the stereo too loud, if you've lived in an apartment, you know how that can be annoying when you're trying to sleep and it's 2am and they're just thumping away. Rumors being spread about you being placed on forever hold. Oh, I hate being placed on hold. Having something stolen in gratitude or someone openly contradicting you. So those are some things that I'll throw out there if I need to kind of seed the list a little bit to get people thinking about a wide range of things that might trigger their anger. Cues are indicators that they're getting angry and can be broken down into four categories. Physical cues, how your body responds, the increased heart rate, tightness in your chest, feeling hot or flushed.  Emotional cues, which are other feelings that may occur along with anger such as hurt, jealousy or this feeling of being disrespected. And cognitive cues, what you think about in response to the event such as hostile self-talk. I'll fix her a little red wagon if she comes around here again. That's what my mother always used to say, I'll fix her a little red wagon. I don't know what a red wagon had to do with anything, but I digress. Or you might start having cognitive images of aggression and revenge and all how good it would be just to get revenge. Linda Lambert had a song called Mama's Broken Heart and that's just kind of one of those songs about anger that you can look at and use to identify certain cues of anger and aggression. At the end of session two, review the anger log from the last week and identify common cues because for most people there are going to be some common ones. When you start to get angry, what happens to you personally, physically, behaviorally, emotionally and cognitively? So they can start developing a cue awareness. And what strategies can you use to become more aware of and deal with these cues? So how can you become more mindful basically? Vulnerabilities is what we start on with session three. Vulnerabilities are things that make you more likely to respond with anger. So for example, emotional vulnerabilities. If you're already feeling overwhelmed, you may be more likely to get angry or irritable or defensive. When you're feeling pulled in six different directions, you know, you feel kind of like you're drowning, which can make you feel threatened. If you're already irritable about something else, you know, then the dog walks in and starts barking. You know, you may just scream at Fido and Fido's looking at you going, what I do?  All these things can make you more vulnerable to getting angry about other stuff.  Physically, low blood sugar. When our blood sugar gets low, our HPA axis kicks in and releases cortisol to get blood glucose into the system. Well, we're not really processing all that. We just kind of realize we may be feeling a little bit jittery or irritable. And, you know, so sometimes when people have low blood sugar, they can be cranky. My husband gets hypoglycemic. And whenever he was on patrol, if he drew a complaint, you could pretty much guess that he hadn't eaten in a while because he's usually really level, level mood. But whenever he wouldn't eat, yeah. So low blood sugar was a cue for him that he had to pay attention to. Alcohol is a disinhibitor so it can make people more likely to get angry. Too much caffeine is a stimulant. So if you're already revved up, you may respond with more irritability, more anger. Pain. I don't know about you, but when I'm in pain, I tend to be at cranky pants. And illness, same thing. Or insufficient sleep. If you're groggy, you may be more likely to be less patient and less tolerant, which leads to more irritability. Socially, being in situations that make you feel more on edge. So have people identify what kinds of situations make you feel on edge.   So those things make me feel a little bit more on edge. Whereas there are other places that I feel more comfortable. And if there are people that being around makes you feel more on edge or makes you feel more negative, then it's important to be aware of that. If there are people that make you feel bad about yourself, not because they're trying to, but you just have this cognitive thing going on, knowing that when you're around them, you tend to be more irritable is important because then you can start mitigating and preventing. Again, go over the homework from last week and I said we were going to build on it. So this time we talk about when look at your anger episodes. What was the highest number that you reached? You know, hopefully we're seeing it go down a little bit, but as far as intensity and duration, what was the highest number you reached? What triggered that episode? The worst episode last week, what triggered it? What were the cues associated with it? Physical, behavioral, emotional, cognitive, and we talk it out because I want people to get used to going over this so they don't need the paper. You know, they can stop and go, okay, I'm starting to clench my fists, so this is probably a not great situation. What strategies did you use to avoid reaching 10 on the anger meter? And actually my anger meter is four, so I need to change that. But for people, you know, what strategies did you use so you didn't explode? Are there particular threat themes, those sensitive areas that you notice like rejection or isolation? And what vulnerabilities may have existed that day that may have predisposed you to getting that angry? So having people become more aware of the precipitants as well as the triggers and the aftermath. An effective anger control plan is the next step. It should include immediate and preventative strategies because obviously when you're in the heat of it, you need to have some immediate strategies to start calming down. So last week, you know, in the homework, we asked them what strategies have you used because I want to know what they already have, what strengths, what tools do they already use. Now, we're going to start building on those in session four. What are your immediate strategies? So we'll talk about some, like timeout, when might you use it and how might you use it? Obviously as a 50-year-old woman, I'm not going to go sit in a chair in the corner. You know, that's not how I do timeout. So we want to talk about it in terms of how can you take a timeout for yourself? What does that look like? And you know, maybe it means if you're in a household where you just can't get a moment's peace, maybe it means going to the bathroom.  When you're in your timeout place, period, can you distract with activities? You know, sometimes during that timeout, you don't want to just sit there and stew on it. You need to push it out of your head so the adrenaline can go down and you can get into your wise mind and think more logically about what's going on. You can block the situation from your mind temporarily using thought-stopping. Thought-stopping, if you haven't used it before, is exactly what it sounds like. You tell yourself, I am not going to think about that right now. No. And you intentionally start thinking about something different. Encourage people to identify three or four thought-stopping statements they can use and three or four things that they can switch their attention to. Practice mindfulness in threes, three things you see, three things you hear, three things you smell, three things you feel, and maybe three things you taste, depending on kind of where you're at in the day. But mindfulness in threes just helps somebody start focusing on the here and now and where they are instead of focusing on whatever cognitive stuff they've got going on. Helps them get out of their mind. And during that timeout, encourage them to breathe. Some people call it relaxation breathing. Some people call it combat breathing. But you breathe in for three, hold for three, out for three. Some people do four. It doesn't matter.  So your brain starts slowing down and secreting GABA and serotonin and all kinds of the other good happy chemicals. Other immediate strategies. Talk to a friend or journal. Extroverts will want to talk it out. Introverts may want to write it down, but getting it out of your head so it's not just bouncing around in there can help you kind of get some perspective on it. When you're doing this, try to create meaning from it. Why is this happening? What can I get out of this? Exercise. When you're stressed out, when you're angry, you've got those adrenaline going through your system and your heart's beating and it's going, we got to do something. Let's go. It's kind of like that little chihuahua that's been cooped up all day long. Take that energy and use it for something positive, like exercise. Draw it back down through those big muscles. Get rid of that adrenaline and then you can think a little more clearly. And finally, radical acceptance. It is what it is. So you get a pink slip, you get yelled at by your boss. You get in a fight with your significant other, whatever it is. And instead of just blowing up, just taking a minute and thinking, all right, it is what it is. What next? How can I improve the next moment? So those are your immediate strategies. And clients will have other immediate strategies that they use that, let's start making a list. That's great. Then move on to preventative strategies. What general things can you do to prevent or minimize vulnerabilities emotionally? So you're not already starting out, stressed out, overwhelmed or exhausted. Well, exhausted comes down physically. But emotionally, that means putting happy things in your life. It's not just the absence of anger. It's the presence of happiness. So encourage happy things in your life. Do things that make life more pleasant. Mentally, look at your cognitions. Try to cognitively restructure and, you know, look at the bright side of things. And I tell clients, you know, take a quarter, flip it. If it lands on heads, you're going to be put on your rose colored glasses and be as Pollyanna positive as you can for the entire day. You're just going to look at the optimistic side of everything. And if it lands on tails, you know, no change. Don't worry about it. And then I want you at the end of the day to describe how your day went and see if things went a little bit better on the days that you were looking at the bright side or not. And if they don't, okay, you know, that's fine. But encouraging them to do an entire day of looking at nothing but the positive and seeing how people interact with them differently, et cetera. Physically, how can you minimize vulnerabilities?  Deal with any chronic pain. And socially, what can you do to minimize or prevent vulnerabilities? Maybe it means avoiding certain people. And ideally, that's not going to be the end strategy. That's a stop gap until you develop better communication skills or whatever it is. But sometimes, you know, what can you do right now to prevent vulnerabilities socially? Or, you know, if you're going to a meeting that might be really, really stressful, I always went and I sat right next to my boss because my boss was great. And so I always felt a certain element of safety there when I would sit next to him. When you are vulnerable for some reason, what can you do to reduce the chances that you're going to get angry?  So it is what it is. How can you prevent lashing out at somebody or getting unnecessarily angry the rest of the day? What can you do to help yourself? Because you know you're already kind of at your brink. Mentally, if you're feeling negative, what can you do to reduce the chances that you're going to get angry? Physically, you're sick. You're in pain. It's just not a good day. What can you do? Sometimes it means shutting the door and telling people, you know what? Not a good day today. Other times it may mean, you know, stretching. It may mean taking your lunch hour and actually going to lunch instead of sitting at your desk and working on your case notes or whatever. And then socially, what can you do to reduce the chances that you're going to get angry? And again, I encourage people to do more than just eliminate. Put positive things in there. Surround yourself with positive people. Do things, even if you're in a bad mood, do things that are going to help you get in a better mood. Like watch those silly cat videos or dog videos or listen to a comedian. You know, I have a little over 400 different skits on my Amazon playlist of different comedians. So I always have something I can listen to. And sometimes you just got to go out into the car, put on the Amazon playlist and it's good for a few minutes. So at the end of session four, review the anger log from last week, identify what the biggest anger trigger was. What immediate strategies could you have used to diffuse that situation? And what preventative strategies might have made a difference. So you're going back over the stuff and looking at the vulnerabilities, identifying what immediate and preventative strategies you could have used. And then develop a plan to start reducing one or two vulnerabilities each month. Because we have vulnerabilities. We have negative cognitions. We have all that stuff. So, you know, somebody may decide, you know what, I am going to start being more positive. Or I am going to start doing something every day that makes me laugh and brings joy into my life. One or two a month is plenty. If they try to do more than that, they're probably not going to be super successful. Session five, the aggression cycle. An episode of anger can be viewed as consisting of three phases. Escalation, there's the event and the responses, cues, thoughts, feelings, everything that's going on. So encourage people to identify during this escalation phase. So you notice you're angry and then it starts to build. What can you do when you start noticing these cues? What are your immediate strategies? Explosion is when somebody reacts to those urges. You know, they just, they scream at somebody. They put their fists through the wall. They do whatever. So what can you do when you have the urge to be aggressive? And you may need to make small baby steps instead of screaming at somebody, going into their room, putting their face in a pillow and screaming really loud for a second. Yes, it's not the best solution. But as an interim, as a stop gap, instead of screaming at somebody else, it's definitely a better step. And then they can take a breath and go, all right, now let's talk about this. And then post explosion is the third phase, the negative consequences, the short-term and negative, short-term and long-term negative consequences, both emotionally, cognitively, legally, socially and physically. So have them review their anger log from last week and identify the event that got the most angry or had the most negative consequences and identify what they could have done to reduce the escalation, what immediate strategies could they have used, and what could they have done to have prevented the explosion. So this is immediate strategies as well as vulnerability prevention. So I'm wanting them to see how they do have some control over their environment and they do have some control over these situations. Yes, they can't control other people, but they can control how well fortified they are to deal with any crap that comes their way. Cognitive distortions are unhelpful ways of perceiving things. Think about a time something happened and you thought it was one way, but it turned out to be wrong. So these often are cognitive distortions. Personalization is one that people use. Is all my fault that this happened or is all your fault that this happened or it's all about me.   Because I've never been anything but nice to you. You see where we can go from feeling bad to aggression really fast. So if somebody starts personalizing something and feeling like there was an air of ingratitude or whatever it was, look for three other explanations besides you that this situation might have happened. If they minimize the positive, they say, you know what? A trained monkey could have done this. I don't know why I wasn't able to do it. I get angry at myself because I'm failing at something. Asking yourself what good happened or is happening or what could come out of this that could be positive. Encourage people to look at what did you do well? What things are going well? Maybe this is an unfortunate situation. Is there any positive that could come out of it? Selective abstraction, only seeing what you want to see, mental filter. If somebody's angry, they're going to tend to see the negative side of stuff. So encouraging them to back up and look at all the facts. What are all the actual facts in the situation for and against my anger? Sounds like that worksheet, which is on the website now, by the way, the challenging questions worksheet. Try taking the other person's point of view. So get in their shoes and go, can I see it their way? Initially, people may not want to do that because then they might have to admit that they're wrong and then that gives up control and that's a whole other anger issue. But encourage them to look at some options. Exaggerating the negative or catastrophizing. You did this, so now I'm going to lose my job or the world's going to come to an end or whatever the case may be. Encourage them how likely is this to happen? Whoops. All or nothing, if they're talking in all or nothing terms, she never does this. All right, let's find the exceptions. If they have that control fallacy that they should be able to control everything, they should be able to control their spouse, their co-workers, their this and their that, that ain't going to happen. I'm just going to break it down to them like that. That ain't going to happen. What parts do you have control over? And let's focus on what you can control. So they do feel, so they don't feel like they're a fish flapping out of water. If they're overgeneralizing something, you know, whenever you grow up in a house that has a lot of violence, maybe they overgeneralize when people get loud that this is going to be violent, this is going to be dangerous, encourage them to ask how is this situation different? So maybe it's not dangerous. Arbitrary inference, you know, people use this a lot when they talk about fear of flying. They draw conclusions without having enough information. So encourage them again to look at the evidence and emotional reasoning. I feel angry about this. Therefore, there must be a threat. So look at the facts. A lot of times it comes back to looking at the facts and the big picture. So again, reviewing the anger log and identifying cognitive distortions that were in play and then talking about what cognitive distortions were or are common in your family. So you notice we didn't talk about mitigating or not mitigating but immediate and preventative strategies this time. You know, you may have already gone through all that. You may choose to go through it again. But now when we're processing the anger issue, we're going to add on to it what cognitive distortions were in play. And, you know, is this something you learn from your family? Session 6, we talk about the ABCDEs. A stands for activating event or the red flag event. B represents the beliefs about the event because it's not the event themselves that generally produce feelings of anger. It's our interpretations about beliefs and events. So if something happens, you know, you may have two different people who see the exact same thing.  The same situation. So it wasn't the situation itself. It was how each person interpreted it. C stands for the emotional consequences, which in this case is going to be some sort of anger. So D stands for dispute. This part of the model identifies unhelpful beliefs and encourages people to reframe them in alternate ways. Identify the facts for and against the belief. Make sure you're not confusing high and low probability events. You get cut off in traffic. How likely is it that you really were about to die? You know, you were going 25 miles an hour on a city street. There was a curb there or a shoulder there you could have pulled off on. How likely is it? Identify and address thinking errors and cognitive distortions. So in that D you're disputing those beliefs. E stands for evaluating your response options and choose the one that gets closer to the people and things that are important in your life. So is this worth my energy? Or what is the best way to handle this? And I encourage you somewhere in the process to have people identify what does it look like to have a happy or rich and meaningful life however they want to define it. And then every time they start to get angry they can say, alright based on my choices, what choice is going to help me get closer to a rich and meaningful life. Reveal the anger log again and identify the most intense anger episodes from the past week and apply the ABCDE model. So again going through that you're identifying the cognitive distortions. What strategy are you currently using to be more aware of cues reduce vulnerabilities and deal with anger to prevent it from escalating. So we're pulling back stuff in from the last few sessions to make sure that they're not forgetting about these things. And then we can talk about ways to integrate that into the anger control plan if they're having difficulty figuring out how to make this transition happen. Session 7 is assertiveness. The basic message of aggression is that my feelings thoughts and beliefs are very important and yours are not. The basic message of passivity is that your feelings thoughts and beliefs are important but mine are not. The basic message of assertiveness is that both of our feelings thoughts and beliefs are important. So that's awesome. So when we're being assertive we're creating a win-win. We're not saying that you're wrong and I'm right or your needs don't matter and mine do. We're saying how can we get both of our needs met and compromise. Encourage clients to talk about some of the advantages of acting assertively when trying to resolve conflicts. But also go over the drawbacks to assertiveness. Don't forget the whole motivational interviewing thing. We need to learn to look at both the benefits and the drawbacks. So whatever the drawbacks they identify are we need to help them figure out how to mitigate those drawbacks. So they're willing and somewhat motivated to be more assertive. Session 7 you go over conflict resolution. Identify the problem, the cues, the specific impact, decide whether to resolve the conflict and then address and resolve the conflict if you think it's worth resolving. So talking about that we're getting less away from learning new skills more into solidifying how to put this all together. So encourage people to review the anger log, apply the conflict resolution model to one episode and identify strategies that they're using to control their anger and to prevent vulnerabilities that seem to be helping. Session 8, we talk about anger in the family because we learn a lot about how to interpret events and cope with distress by observing our family. We watched Mom and Dad from the time we were knee-high to a grasshopper. So how was anger expressed in your family while you were growing up and how do you express it now? What did you think when it was expressed that way? What do you think when you express it that way now? How did your father express anger? How did your mother express anger? Were you ever threatened with or exposed to violence? How were other emotions such as happiness and sadness expressed in your family? Some families are only comfortable with anger so those other feelings were not okay. And likely they may have been or on the other hand they may have been okay with those other feelings and not okay with anger. And what role did you take in your family and you know were you the hero, were you the one that was always getting the varsity letters and straight people? Were you the victim? Did you just try to blend in? Were you the wallflower or were you the scapegoat for everybody's problems? We learn a lot about how to interpret events through our family. Also what messages did you receive about your father and men in general? What messages did you receive about your mother and women in general from your family of origin? Did you feel accepted and loved or did you feel like you couldn't do anything right? How did your family deal with failure? What feelings, thoughts and behaviors carry over into your relationships today? And what purpose did these behaviors serve? You know if you're acting like your dad used to act what purpose does that serve? Encourage them to review their anger management plan from the past seven weeks and identify things that have changed. Hopefully they're having a decrease in intensity and or duration. Identify what progress they've made. What still needs to change? What strategies are working well? So this is a time when you start really tuning up that anger management plan and talking about you know if somebody says well I haven't made much progress in preventing vulnerabilities or I'm still getting angry at work all the time. Then they can get feedback from the group which is pretty well established now about some techniques that might work. And then anger myths. I encourage clients to tell me you know why these are not real. Anger is inherited. Anger automatically leads to aggression. You must be aggressive to get what you want. Venting anger is always desirable. Anger is a negative emotion. It's all in your head.  Men are angrier than women. The older you get the more angry you are and anger results from human conflict.  And that's not ideal but did they cause the anger or were you irritable because you were uncomfortable? So it's important to be aware that anger is always human conflict that causes anger. Older people are not necessarily always angry. And that thing sometimes you were told in order to feel better you just need to vent your anger. No, research actually shows that that's not true. So I encourage them to tell me why these are myths and then if they can't come up with something then I'll throw some suggestions for themselves why these are myths and this helps me figure out if I've taught everything I needed to teach. Anger is a natural emotion it's designed to alert people that there might be a problem. When people are vulnerable or have learned maladaptive ways of dealing with anger or simply never learned healthy coping skills they can experience anger management problems. Excessive anger negatively impacts people emotionally, mentally, physically, socially, passionately, legally and spiritually. So the whole shebang anger just kind of permeates everything. Effective anger management involves preventing vulnerabilities being aware of and working on those sensitive areas or threat areas such as rejection failure, loss of control and death. Preventing anger whenever possible and developing immediate coping responses to deal with it when it occurs. Are there any questions? Right everybody, have a great day and I will see you tomorrow. If you enjoy this podcast please like and subscribe either in your podcast player or on YouTube. You can attend and participate in our live webinars with Dr. Snipes by subscribing at allceus.com slash counselor toolbox. This episode has been brought to you in part by allceus.com providing 24-7 multimedia continuing education and pre-certification training to counselors, and nurses since 2006.


The next item of business is members' business debate on motion 13860 in the name of Clare Adamson on pancreatic cancer awareness. The debate will be concluded without any questions being put. Would those members who wish to speak in the debate please press the request to speak buttons and can I remind those in the public gallery that we would appreciate no clapping or jeering or other rise? I would ask Clare Adamson to open the debate please for around seven minutes. I thank my colleagues from across the chamber for supporting the motion and allowing this member's debate to take place. It is the second debate raising the issue of pancreatic cancer in the chamber. It is a way of recognising the tireless work of those involved in pancreatic cancer UK and pancreatic cancer Scotland who support people who have been touched by those diseases in our country. I was very honoured to host the event last night jointly from both charities and meeting many of the people who have been affected by pancreatic cancer, those who are dedicated to fundraising, those who are raising awareness, those who are doing research and, of course, supporting those who have been affected by their families and friends suffering from this disease and also to meet some of the survivors. We attend many such events in this place but what was quite noticeable last night is how few survivors are in attendance. Only one person in the room had survived pancreatic cancer by more than 10 years and they are known as the 1 per cent club in the pancreatic community. Those are stark figures that have hardly changed in the last 50 years and that is why we all have to work together in Scotland to make breakthroughs and lead in this area. It was delighted that it was also in attendance last night when the young leaders from the Precision Panc research team at the Beatson research centre were funded by Cancer Research UK and the Scottish Government that seeks those vital breakthroughs in pancreatic cancer. Why is that so important and so unique? The five-year survival rate for Scotland is 5.6 per cent and that has only increased by 2.1 per cent in the last 20 years. There were 784 people diagnosed with pancreatic cancer in 2016, 719 people died of this illness the same year. 9.2 per cent of patients diagnosed with pancreatic cancer distal bile or retract or duodenal cancer in Scotland have potentially curative surgery in 2016, only 9.2 per cent. 63 per cent of people with pancreatic cancer are diagnosed at stage 3 or stage 4, the advanced stages of the disease. 80 per cent of the people with pancreatic cancer are not diagnosed until the cancer is at the advanced stages. Surgery is the only treatment that can save lives, yet only 8 per cent of the people with pancreatic cancer reach the surgery stage. Pancreatic cancer UK has stressed and the many members and the families that I have met, especially the Begley family and Mr Begley's daughter Linda Bunny, have stressed that pancreatic cancer must be treated as an emergency and oncological emergency.  So many days and hours in this disease are as weeks and months and years in other cancers, and it is why it is so unique and why we need a very specific approach to it in Scotland. We are lucky in Scotland in that a 15 per cent target already exists as part of the quality improvement indicators in trying to get people through surgery and through treatment, and that is being achieved in some of our health boards, and it would be very, very welcome if that target could be achieved across the board when it comes to pancreatic cancer. It is a very tough disease to diagnose. The presentation of the symptoms can be seen as something else. It involves stomach pain, back pain. You cannot touch a pancreatic cancer, you cannot feel a lump or a change in your body apart from the symptoms the way other people have had this change in the bowel movements, change in bowel smell, change in those areas. People have been working really, really hard to alert people to the symptoms of pancreatic cancer. I know that there is a pancan van—we have all got that right—that has been going around.  It is being going into our town centres—they were on the high street today—taking the message about being wary of the symptoms, people knowing what to look for and for seeking advice and treatment as quickly as possible for this. I would also like to thank the many, many organisations and councils that have supported the light up purple for this month of pancreatic cancer awareness. We had the Kelpies lit up, we have had major buildings across Scotland including the Scottish Parliament support, the light up purple challenge. This is a really unique and devastating cancer. One of the asks from the cancer charities is that a review of the pathways in Scotland is undertaken and that a review of treatment pathways will be considered by the Government. I know that the Government is doing a cancer review in general at the moment but it would be interesting to see what features of pancreatic cancer that are unique to that disease will be considered in looking at the pathways forward. I will be really interested to know the benchmarking that the Government will use to note that we have progress in that area. We now move to the open debate. Speeches of around four minutes, please. Miles Briggs, followed by Bill Kidd. Thank you, Deputy Presiding Officer. I am pleased to take part in today's debate. I would like to start by welcoming all those who have joined us this evening in the public gallery. To start by congratulating Clare Adamson on securing today's debate and recognising her consistent interest in campaigning and involvement in the issue, I think that it is important in those debates that we recognise members who are using their time in this Parliament to really progress issues. Clare is certainly one of those people. I would also like to thank Pancreatic Scotland, Pancreatic Cancer UK for providing useful briefings for today's debate, as well as those constituents who have contacted me here in Lothian, who have lost members of their family, who have dedicated their life now to making sure that we focus on trying to take forward any actions that we can. I want to begin today by agreeing with the motion's content, praising those for the excellent pancreatic cancer charities that we have and their supporters and the need to progress early detection and diagnosis. As Clare Adamson rightly stated, only 17 per cent of people with pancreatic cancer are diagnosed at stage 1 and 2, with 63 per cent of people diagnosed at stage 3 or 4 advanced stage. We must work to make progress to change that.  As well as improving early detection, we need to see far swifter treatment after diagnosis, something that Pancreatic Cancer UK is right to be campaigning so strongly on. Only 9 per cent of patients diagnosed with pancreatic cancer or diodino cancer in Scotland had potentially curative surgery in 2016, and only 2 in 10 received chemotherapy. A model of fast-track surgery in Birmingham has demonstrated that an additional 20 per cent of people can have surgery if treated within the 20-day period. That means that, for Scotland, more than 200 extra people could survive every year for beyond a year. I have talked about this and the need for ministers to look towards developing a fast-track model in the chamber before. I hope that we will see ministers, when they respond to this debate, look to how we can change this and how plans are being taken forward in this area. Similarly, for those with late stage cancer, the model at the Clatterbridge Cancer Centre in Merseyside demonstrated that, if individuals are treated quicker, 25 per cent more can receive chemotherapy, and we need to see if we can replicate this best-practice model here in Scotland. I recently had the pleasure of visiting Pancreatic Cancer UK's Future Leaders Academy, a training programme based at the Beatson Institute in Glasgow. I was delighted to be joined on that visit by Kim Rowan, who I know is in the public gallery with us this evening, and who really is an inspirational, dedicated pancreatic cancer campaigner and is well known to many MSPs in the chamber for her significant contributions to our cross-party group on cancer. On that visit, I was incredibly impressed by the work being undertaken by Professor Owen Sampson, director of the Cancer Research UK Beatson Institute and the Pancreatic Cancer Future Leaders Academy, and his highly talented team of researchers. Their truly groundbreaking research, I do believe, offers real hope for the future. The young researchers working there may well become world-leading scientists, bringing the breakthroughs of the future to fruition. We are expecting great things from them, and I hope that they will deliver on that. One issue that was raised with me on that visit was that of protected research time and research work. I wonder if the minister has any comments on that when she is closing the debate. If the minister would be willing to look into those concerns that have been raised, I am happy to write to her about them. I am whether or not they are aware of cancer research UK have said in terms of welcomed increase capacity in this area. I think that the research work that clinicians could do to complement the future leader programme is something that we should all be working for. More broadly, it must be a concern for all of us that pancreatic cancer is historically underfunded in the UK, receiving only 1 per cent of cancer research budget over the past decade. To conclude, Deputy Presiding Officer, I again very much welcome to today's debate. I am willing to be part of playing my role and I hope that the whole Parliament's role in raising awareness of pancreatic cancer and the need to improve diagnosis and treatment. Charities such as pancreatic cancer UK have set out positive and specific measures that we could now do to take forward a real difference in life expectancy. I hope that ministers will take a decisive lead to look at how we can take those forward to provide and extend lives. Last night, as Clare Adamson mentioned, I was filled with hope to meet so many people. At long last, we can hopefully see an opportunity to make a real breakthrough. I hope that we can all work towards achieving that in the future. Bill Kidd, followed by Monica Lennon. Thank you very much, Presiding Officer. A big thank you to Clare Adamson for bringing this debate to Parliament. This debate, as it is in the middle of pancreatic cancer awareness month, is timely and very important. I am going to say a few things that have been said already, unfortunately, but it cannot be done with being as much emphasis on it as possible, is the fifth most common cancer in Scotland. Of the 20 most common cancers in Scotland and the UK, it has sadly the lowest survival rate. Survival of this disease has hardly improved since the 1970s, and very sadly one in four will pass away one month after diagnosis. Out of all research into the different types of cancer, pancreatic cancer only receives 1.9 per cent of the annual UK cancer research budget, and pancreatic cancer UK emphasises that that has resulted in a lack of breakthroughs in understanding the disease better and developing new breakthroughs. That is an extremely serious and fast-killing disease, and we need to do everything in our power to tackle that. Charities are a critical player in that fight. One example that I would like to mention has been mentioned already comes from the Future Leaders Academy at the Cancer Research UK Beaks and Institute, which is based on my constituent, Glasgow Anisland and also in Bersden, Mogai. A substantial grant of £625,000 is funding four years of research focused specifically on pancreatic cancer. To this end, the charity Pancreatic Cancer UK recruited five PhD students to conduct that research. It provides a basis for hope that there will be vital breakthroughs in understanding and treating the disease. By deepening the scientific understanding of how cancer grows and how it resists current treatments, there is the potential for the research to show ways of targeting those two processes. That could enable the development of treatments that slow down or even halt the disease. Alongside the line of research, the team is always looking into ways to wake up the body's immune systems to help it to fight the disease. Aside from that boost to research, public awareness of the disease and of prevention is also vital. Cancer Research UK reports that 31 per cent of pancreatic cancer cases are preventable, which emphasises to me how important public awareness is. Ash Scotland highlights that smoking causes 22 per cent of cases of pancreatic cancer and that the risk doubles among people who smoke. However, after someone stops smoking, that risk decreases over time. Research shows a correlation of higher rates of cancer amongst poorer communities. As smoking is more prevalent in poorer areas, it is particularly important that health professionals inform people living in those areas about those risks. That message needs to reach everyone. It is so important that Scotland changes the way that we respond to cancer by adopting healthier lifestyles. That is something that we all should take on board. We must hold on to the knowledge that investment into research will provide medical breakthroughs, and the boost to research happening in Glasgow provides hope that the devastating statistics that we have heard about will be turned around. Beyond that, the work done daily by charities to provide emotional, practical and financial support to people affected by cancer gives people dignity and a lifeline amidst what must be one of the most difficult things that they and their loved ones have had to face. I will close by asking those listening to consider giving to pancreatic cancer charities, whether it is a one-off donation or a monthly giving basis. Every pound donated will go towards saving lives and giving hope. I thank Clare Adamson for not only bringing the debate forward and securing cross-party support, but for being a champion and for speaking so movingly about the issue. I welcome people in the gallery. It is nice to see a splash of purple across the Parliament. I thank Clare for the ribbon badge that was handed to me just a few minutes before we started. Reading the briefings that have come in from pancreatic cancer UK, McMillan Cancer, Cancer Research UK and Pancreatic Cancer Scotland, when you stop to read the briefings and read the statistics, is terrifying. That could be a very, very bleak and negative debate.  We know that it is tough to diagnose, it is tough to treat and it is tough to survive. It must be simply terrifying to receive that diagnosis or to be a loved one of a person who has had that diagnosis. In reading the national picture, I was quite troubled to learn that in Lanarkshire, where I represent constituency central Scotland, there is a higher incidence of pancreatic cancer in Lanarkshire. I know that that is something that Clare Adamson will also be concerned about, and I would like to try to understand that a bit better. In all those situations, we have to try to look at the human story behind these statistics. Just today, I picked up one of my local newspapers, the East Kilbride News, and there was a story about Kenny Forbes, a local man who was diagnosed with pancreatic cancer. His story is a hopeful story. He has described himself as one of the lucky ones, which is not what you expect people with pancreatic cancer to say, but he has been able to be treated for his cancer and, according to his story, he has made a full recovery and is back at work as an electrician. That has to give his hope. I am also mindful that it is round about the anniversary of my neighbour, who sadly died of pancreatic cancer this time last year. A neighbour whom I would often meet in the driveway when he was coming home from work talking about his family and for him to be diagnosed within a couple of months to have lost his life is very sad. We know that cancer is preventable. We have a big job to do across the Parliament working together, but when you hear Kenny's story, it gives hope. I was not aware of the Begley family story, but I thank you to Claire Adamson for shining a light on that. Although, sadly, Mr William Begley passed away, Linda and the family have been absolutely tenacious in their campaigning and it keeps us and the Parliament completely focused. There are some positives that are clear. I have not talked about the quality performance indicator. Again, there is some success there, but I was quite concerned that there has been a bit of a rollback in some of that progress. The latest figures that we have show that the target was only met in Lanarkshire and perhaps the minister in her closing remarks will touch on that issue around the QPI and why we have had that dip in performance and what we can do to bring that back up again. I do not think that we can repeat enough that with pancreatic cancer we are facing a cancer emergency. Faster treatment is vital to increase people's chances of survival. A lot of good suggestions have come forward from campaigners. Miles Briggs has touched on that, and I think that focusing on the beats and the opportunity that we have with that centre of excellence. No pressure on these young researchers, we have high expectations, so we have to make sure that they are properly resourced. Bill Kidd rightly mentioned the wonderful funders that goes on in communities and from families. People with that lived experience, but we cannot leave that burden just to charities and to people who have that generosity of spirit. We have to make sure that we do all we can to prevent ill health, to help people to live healthier lives. However, when people get those diagnoses, they can have hope that they can survive and live well after cancer. Maureen Watt followed by Annie Wells. Thank you very much, Presiding Officer. I thank Clare Adamson for bringing this motion to Parliament for debate this evening. I apologise for not being able to attend the pancreatic cancer awareness event last evening. I was, however, able to visit the pancan van, which I think was generously provided by the Arnold Clark organisation when it visited Aberdeen St Nicholas Street on Monday 12 November. I really have to pay tribute to the three brave souls who endured a particularly cold day to hand out leaflets to raise awareness of the symptoms and the risks associated with pancreatic cancer. They were telling me that there was genuine interest among the members of the public who came and spoke to them. Of course, they were able to answer questions around pancreatic cancer. It is great that, during this month, the pancan van has been out around the country to raise awareness. I also recommend the pancreatic cancer Scotland's website for the wonderful information that they have on the disease. The little leaflet that they were giving out during their visits to the cities around Scotland was very informative. I do not think that I myself had made the connection between the pancreas, which I normally think of producing the juices, which help to digest food. It is also, of course, the organ that produces insulin, which we all know is really important in terms of blood sugar levels. We get a lot of information about obesity and diabetes, but I have not really understood the significance of it in relation to pancreatic cancer. It is disappointing that still the causes of the majority of pancreatic cancer cases remain unknown, although we do know that, as with other cancers, being overweight, smoking, diabetes and the family history of the cancer may all be contributing factors, as is having experienced pancreatitis. As others have said, the cancer, unfortunately, has the lowest survival rates, and those numbers have barely changed over the last five decades. That is not just in Scotland but elsewhere, because I am sure that, if progress was made anywhere else in the world, it would be adopted in Scotland and elsewhere as quickly as possible in order to have better outcomes. It is really essential that people know the signs of possible pancreatic cancer and that they are widely recognised, so that the earliest possible diagnosis and treatment can begin. I agree with others who have said that treatment should begin as quickly as possible for that particular cancer, because we know that it can have a good outcome, especially if it has not spread to other organs and that people can have a particular procedure. The pancreatic cancer Scotland's website says that, and I quote NHS treatment in Scotland, it is as good as anywhere in the world, and patients can rest assured that they will be looked after properly. As someone else said, it is absolutely vital that people have the support of family and friends and that they know what to do. Of course, that is where other organisations come into being, such as McMillan, Marie Curie and Maggie's cancer centres, all of which are active in Aberdeen and elsewhere. There is a Facebook group that people who have had the operation can join, which is called the Whipple Warriors, and they can share their experiences and advice. I found out that that is apparently called after the name of the procedure, which is called the Whipple Procedure. I wonder whether that is what Miles Briggs has visited, because there is research being carried out in Scotland and elsewhere and a lot in the Wilson Institute and funded by the Institute, which is called Precision Panc. That is to improve the diagnosis and treatment, and increasingly it is using the understanding of genome sequencing, again where Scotland is world-leading in diagnosing it. I am sure that everyone here wishes that there is a breakthrough in early diagnosis and treatment of this terrible disease. The last of the open debate contributions is from Annie Wells. I, too, want to thank Clare Adamson for bringing this debate to the chamber today and for her continued passion and commitment to the cause. Unfortunately, I could not be there last night, but I was there last year, and we spoke last year at the event as well. My sincere thanks to Clare. Last Thursday marked the world pancreatic day in this month, pancreatic awareness month. More than 50 per cent of patients have never heard of pancreatic cancer before their own diagnosis, and half the population cannot name a single symptom of pancreatic cancer, which makes raising awareness all the more important. That is a great opportunity to thank the pancreatic cancer charities, who work extremely hard to do this and to further support their work. Often during members' debates, when I actually learn about health conditions that I have not had the personal experience of, this one is no exception. Prior to this debate, I was not aware that pancreatic cancer is one of the least survivable cancers, and the fifth most common cause of cancer death in Scotland. Nor was I aware that pancreatic cancer has an extremely low survival rate, between 3 and 6 per cent. Often, that is due to late diagnosis, as we have heard, and there are currently no screening or early detection tests, and as many as one in four people can die within a month of diagnosis, many not receiving any active treatment at all. Early detection is vital to improving a person's chance of survival, and currently, symptoms are not known well enough. It is estimated that 70 per cent of patients with pancreatic cancer will go to the doctor initially due to pain, often described as being in the stomach carrier and radiating around the upper back as the tumour presses against the abdomen and spine. Many people I imagine will not have anticipated their diagnosis, making raising awareness even more important. Through engaging with local communities to help people to identify key signs and symptoms of pancreatic cancer and to raise the money needed to research early diagnosis, pancreatic cancer charities need our support. During pancreatic awareness month, charities have campaigned for people to wear purple to help to raise awareness and to help to create a discussion, which is why I have dug out the only purple top that I own—probably not the most suitable for the chamber, but yes. In Glasgow, the Queen Elizabeth hospital, the Silverburn shopping centre and Mosshight flats have all been lit up this month to show support. All year-round charities such as Pancreatic Cancer Action offer awareness talks at workplaces and the resources for individuals to set up awareness stands in supermarkets, community centres and in GP surgeries. Now that I am aware of such initiatives, I will do my best as an MSP to spread the word through social media and encourage others to do the same. Faster treatment is of course key to more people surviving pancreatic cancer. Pancreatic Cancer UK has described it as a cancer emergency, as we have heard from Monica Lennon. Calling for people with pancreatic cancer to be treated within 20 days from diagnosis is something that I would wholeheartedly support. Research into pancreatic cancer is also vital. As an MSP for Glasgow, I too want to highlight cancer research UK's £10 million investment into the pioneering project, PrecisionPanc, which is led by a clinical trials unit at Glasgow's Beaks in West of Scotland Cancer Care Centre and aims to transform pancreatic cancer trials in the UK. To finish today, I thank Clare Adamson for highlighting an extremely important topic, as well as the pancreatic cancer charities that work tirelessly to raise awareness of the condition and raise the funds needed to find early detection tests that are so desperately needed. With one person dying every hour in the UK due to pancreatic cancer, the need for us all to raise awareness of this disease has now been more pertinent. I thank Clare Adamson for bringing this important debate to Mark pancreatic cancer awareness month. I would also like to welcome the visitors to the gallery, as Monica Lennon said. It is a lovely splash of purple in the chamber. I thank members for their very measured and considered contributions from right across the chamber this evening. They have highlighted the importance of the charities' work and how vital research is in finding cures and treatments for this disease. There have been many mentions of the Beats in Glasgow this evening in the research that they do. My family, too, have been affected by this terrible disease. I would also like to thank Pancreatic Cancer UK and Pancreatic Cancer Scotland for the vitally important work that they do supporting those affected by pancreatic cancer, their families and their loved ones. I am particularly proud of the work done by my constituent Fiona Brown of Pancreatic Cancer Scotland, who is incredibly passionate about raising awareness. As we all know, November marks pancreatic cancer awareness month and I know that both organisations have been working hard. The parliamentary reception yesterday, attended by my colleague Jo Fitzpatrick, was a great success and I know that he was impressed with what he heard. Another such event is the tour of the pancan van, which has been driving the length and breadth of Scotland to raise awareness of the risks and symptoms of pancreatic cancer. Today, the purple van was on the royal mile, bringing awareness right to our doorstep. As we have heard from other members, across Scotland, public buildings have been bathed in purple light and tribute to those affected by this disease. I am happy to say that the Scottish Government contributed to this awareness by lighting up St Andrew's house and Victoria Key Purple last Thursday. The Scottish Government recognises the devastating impact of all cancers, including pancreatic cancer, on individuals, their family and friends. However, it is also right that we should recognise where progress has been made. Over the past 10 years, the overall age-adjusted cancer mortality rate in Scotland has reduced by 10 per cent. That is a great improvement and is testament to the amazing efforts of all those working across the NHS and the third sector. Patients and their families lie at the heart of all our efforts to tackle cancer because it is the human story behind the statistics that matter most. It is for this reason that I also want to mention Linda Murray, whose father, William Begley, passed away from pancreatic cancer. I believe that she is here today in the gallery, along with my constituent Fiona and others who have been affected by this terrible disease. Linda kindly developed a comprehensive and detailed report outlining her pancreatic cancer journey and has continued to engage with Scottish Government ministers and officials to improve care for those affected by pancreatic cancer. There are certainly many lessons to be learned for all of us delivering cancer services in Scotland, not least around putting the patient voice, their wishes and those family members and loved ones to the forefront. In March 2016, the Scottish Government unveiled its ambitious and wide-ranging cancer strategy, beating cancer ambition and action, which serves as a blueprint for the future of cancer services in Scotland. Over the coming years, the cancer strategy will deliver £100 million of investment to improve the prevention, detection, diagnosis, treatment and aftercare for all those affected by cancer. After two full years of the strategy, a total of £39 million of investment has been made and nearly one-third of the actions outlined in the strategy have been completed. The Scottish Government has also undertaken a range of actions to tackle known cancer risk factors, some of them highlighted this evening in the areas of diet and obesity, excessive alcohol consumption and smoking. Supporting our ambitions to improve cancer services for all those affected is the £41 million detect cancer early programme. Over the past six years, the programme has increased diagnostic capacity across Scotland and worked to raise awareness of the signs and symptoms of cancers. However, while we always seek to encourage early diagnosis wherever possible, we recognise that that is particularly challenging in the case of pancreatic cancer, where symptoms can often be difficult to diagnose. In addition to the detect cancer early programme, we are also updating the Scottish referral guidelines for suspected cancer, which are issued to GPs to help them to recognise cancer symptoms. Those guidelines, including the specific section on pancreatic cancer, are currently being revised with a view to publishing next year. We are also working to address waiting times, and the Ministerial Cancer Performance Delivery Group published its report in May this year with recommendations to improve waiting times for the diagnosis and treatment of those people with cancer in Scotland. Those recommendations will be taken forward with advice from an implementation group, and I am happy to record that, through their membership of the Scottish Cancer Coalition, third sector organisations such as Pancreatic Cancer UK and Pancreatic Cancer Scotland will have the opportunity to feed into the work of that group. We know that there is increasing pressures on the imaging services that are so critical to diagnosis and treatment and monitoring of cancers, particularly pancreatic cancer. That is why we are investing in more radiology training places, more radiology consultants and encouraging more recruitment into radiology vacancies across Scotland. The Scottish Government also recognises that further research is required on pancreatic cancer, and we have invested £650,000 to support the precision Panc study. That study aims to match patients to the most appropriate clinical trials through genetic analysis of their tumors. Along with an additional £10 million investment from cancer research UK, that study will help to improve our understanding of pancreatic cancer and will hopefully lead to more effective treatments. On the point that Miles Briggs raised, I welcome a letter to the Cabinet Secretary for Health and Sport on the issue that he raised about protected time for research. As we have heard, Pancreatic Cancer UK has issued a call to action through their faster treatment campaign, and Scottish Government officials will be meeting with Pancreatic Cancer UK in the coming months to discuss what actions can be taken to support that. The Scottish Government has written to the three regional cancer networks in Scotland in relation to publication of their clinical management guidelines and pathways for pancreatic cancer in order to provide patients and carers with greater understanding of the clinical decision-making processes. As I noted earlier, we have seen significant progress in relation to cancer. However, despite everything that we have achieved, we know that we must keep looking at what we can do better, how we should transform care, how we can equip ourselves to deliver even better health and social care services in the future. The actions outlined in the cancer strategy will assist with that, but it will also require us to move forward together. That was why it was so encouraging to hear such a collaborative and cohesive debate this evening, and we must work with our dedicated NHS professionals and researchers. However, just as importantly, we need to work with and listen to those people living with cancer, their carers, and the voluntary groups such as Pancreatic Cancer UK and Pancreatic Cancer Scotland. Once again, I thank them for the work that they do.


The 22nd Marine Expeditionary Unit and the Finnish Navy conducted a 10-day exercise in Finland from August 8th to 18th. The Finnish Navy provided the Jihu-class landing craft during the exercise to facilitate the expedited movement of U.S. and Finnish troops to maintain a minimal footprint in the area. During the bilateral exercise, the U-700 was able to conduct well-deck operations aboard the Whitby Island-class dock landing ship USS Gunston Hall. This showcases that the vessel is capable of ship-to-shore operations and its ability to integrate with U.S. naval vessels. The U-700 became assets during the exercise due to its capabilities providing a strategic advantage while also providing extra tactical benefits.


What they gonna do with me now? I'm still a twerk of the town Got me the sisters, I'm hooking them down Reaching the smiles and the frowns Hey, what's up y'all, we're on a new episode of Talk of the Town Today we got a special guest Bloody, how you feeling? I'm chillin', I'm chillin', how you feeling? I'm good. So they gotta say Bloody from the O or just Bloody? How would you like it? Okay, so I'm actually a couple questions to just say first and then come to your mind What's your favorite song right now? My favorite song right now Yeah I don't even do it too, but my son Kwoni I like that song right now Oh, you were in tune? Okay, okay, okay Yeah, I'm in tune Celebrity Crush Sexy Red Yeah, you keep saying that That's what I'm good for What you like about Sexy Red?  I know I can handle that, I'm handling that That would be okay So last thing you spend money on? Last thing I spend money on Some food, I just bought some food today Some weed, some food Okay, if you could put together a collab Three people, who would it be? A collab three people? Like not myself? Including yourself Like me and two other people? I don't know Anybody in the world? Anybody in the world?  Or name the worst song ever? Big D.O.A, that's a bad turn What's your dream car? Dream car And I need the Maybach Maybach driver's soul for me Me that one Which rapper would you not let their daughter If you have one?   No, they desperate like that That means they ready for the project They ready for that project Okay, what's the conspiracy theory you think is real? Conspiracy theory, I think it's real I don't know I don't know Maybe aliens is real Okay And give us, you got a picture Give us a caption for like That's a bar of yours A caption, that's a bar of yours Yeah, give us one of your bars that can be used as a caption Denim on bar when I'm coming outside Yeah, I like that one, Denim on bar Okay Okay, okay Favorite thing about Sugar Hill?  Most underrated artist I don't even know That's cool That's cool Alright, so give us the backstory of your name Makaju I got the same name as my pops Okay So he used to do music too or no? No He just, um, you still, you buck with your pops, right? Yeah, cool, okay He supports the music? Yeah Yeah, he's jacking it So how you got into music? How I got into music My son died, my son died rapping I just went to the studio, we're mad With everybody from my buck, my son died Doody, Keen, everybody All the guys that I was rapping I just went all the way to the studio Chilling, then I just started rapping Like now How long ago, like a year? Not like January Oh, almost a year Yeah, once I get this January It'll be a year, great So, um, so Of course you say your dad's supportive Is everybody in your family supportive? Or your music?   Yeah, so like, you kinda already been in the spotlight I feel like So did it only make sense to do music Or was you into something else? Did you see yourself doing something else? I was into something else But everybody kept saying rap, rap, rap Then I just did a song We dropped it on the freestyle And they liked it, so I dropped another one What you was into before? Before, I was just outside I used to play football when I was like 10 and 10 and stuff like that Okay, okay, okay Alright, so, you know, being from Sugar Hill Y'all grew up together What makes someone like your bro Like your man? It's like, what, like You have to have My bros is people I knew since I was a little kid And then the people from my neighborhood My bros too But anybody else, like You gotta have genuine love for me to Jack you nowadays bro Because niggas gonna be genuine And then niggas always end up falling out Especially if you from New York I'm gonna end up falling out with you Because that's how it goes I mean, okay, I feel like I feel like y'all could, I don't know I feel like, y'all feel like Y'all be having disagreements That could be talked about on the back end Or does everybody just take it to the internet so fast?   Like, they have to be dissing Or just like, if you wasn't giving energy before Or like, how do you know? Look, if somebody dissing my block I already know all my options Yeah, don't mind if they're dissing Every day it's a new character No, every day it's a new person dissing I don't mean that they per se Come from a block that we already had beef with And it's blocks that don't diss us That we got more beef with Than blocks that people that do diss us Type shit, type shit, okay, okay So, like, on the um How do you feel about that? Like, people that's kind of like dissing Trying to get attention and stuff like that People that are dissing, trying to get attention I mean, go up, how you go up But you dissing nothing, you don't know us That's how you can hear a big boy On the music tip, what's some of your plans Though moving forward? Gotta go up, I just gotta go up What's some goals you have for yourself right now? My goals I got for myself I need a drop, drop again I need a new deal right next year I need to keep going up You just signed a deal I'm trying to be next year A month is not long I'm talking about like in the next six months So you want to go major, you want to go major texture Got it, got it, got it Moving forward to the project Right? Do you have a date yet? Well yeah, I'm dropping on the 8th, we all saw it September 8th So tell me if I'm on a post, I don't want to sign a deal Oh yeah, it's my birthday, September 8th So you're dropping on the 8th, any features on the project? Got man features Any to share? Yeah, I got features with the guys Me and Tudi, me and Theta Me and BBG Couple of guys, you going up How is duty low? Free my son duty I just did a free duty low song That's about to come out on the freestyle My son KJ, about to drop that So for me Do you feel like cops be like harassing y'all Being at y'all artists Or they just be a lot longer Cops that do be harassing I don't know I might even, I don't play with the police Type shit So you titled your project From the trap to rap From the trap to the rap From the trap to the rap man So what inspired that name? I'm really outside Up and outside Like okay That's not me When we hear this project What do you want us to get from it Like what do you want your fans Supporters to get from this project From the trap To rapping out That's what I really wanted to get I don't know Are you opening up more Because I feel like in some of your songs You really open up about like pain Or what you've been through and things like that Are we going to know more bloody on this one? It's a couple like Four or five old songs The rest of them is going to be new songs The rest of them new How you been doing Feeling like about traveling so far Miami everything I've been to Miami before I'm going more Places now You went viral in Miami Miami, you crazy right? Yeah, so like What happened with that? Crazy day Running late Should have been on time right? Oh so you missed your flight? I mean we missed it but we was on time We was like almost there So how did it get to the internet though?    I was been working with Crate since I was dropping my singles That's how I was distributing my music Through Crate Music Where I get paid off my YouTube Faster Than other distributions For me So moving forward Like what are you looking for I'm looking for Trying to do more shows Trying to just go more places I'm really trying to perform the O.D. That's what I'm looking for Being that A lot of people from Sugar Hill is doing music A lot of y'all are I feel like when y'all all get together Y'all go viral But like you know sometimes on the doly tip It don't seem like everybody be supportive Or some people be more supportive of other artists Than others Do you do numbers like discourage you Like if we a song don't get a certain amount of views Does that bother you or do you feel like You just gotta keep working No I mean Me personally Numbers don't discourage me But I done been around my friends They don't do it They be getting a little tight too But me like I just started doing 100 in a day So if my joint don't do 100 a day It don't matter to me because For me I'm just starting As long as I'm getting more than 50K 100K A day or something like that Or like on the video As long as I get 100K on the video I'm good I don't care about that Do you often do other stuff besides Drill music? I mean I guess I want to just rap Like I want to rap I started just drill like I guess I want to rap like no dissing No dance Just straight rapping So are you working on that next year? Are you working on that on a project Or is a couple diss tracks in there? No that's diss tracks in there That's a couple diss tracks in there That's a couple drinks Okay, okay, okay So being that You around a lot of people in the industry now What's something that you learned so far Like traveling, meeting different people What's something that you learned so far on your journey?   Yeah I got old So that's like Before I was dropping Before I was rapping how I rap now It was like funny tracks Funny tracks Do you feel like you ever dropped him or not? I probably gotta change my verse Or I gotta change my verse I was gonna say cause I don't think since he passed Everybody really dropped music with him I think everybody hold the name on release You know what I'm saying?  Nah I guess we all gonna put it out one day You got some Okay Do you feel like they should release a little bit more of his music Or do you feel like I think they definitely I don't know if he is gonna drop another tape soon I don't know He got enough music for sure I hope so He definitely got enough music So Yeah I think that's kind of everything Anything else you wanna touch on? Did you see the drama On the thing About D.D. Lincoln The new upcoming boy What's his name? Baby G or something like that? Baby G Baby G He just started coming out He young I don't know I think about Oh God said they didn't pick a song So we should release it Yeah and then like in Chicago They was like the whole thing One of them said some shit You see all of that?  In New York Yeah in New York Why do you feel like you've done Anybody I wanna do music with Probably from my block Other than that people that's neutral I got a couple songs that's coming out I gotta do these songs Or I keep forgetting to get them shit done Are you gonna do a song with a girl Yeah Like who would you do a track with From New York or elsewhere But We no sexy right Yeah but like what do you do a song with a girl Yeah someone that's not op I don't know gotta be someone that's not op Okay I get it What if she a singer though They don't gotta be like Definitely gotta get a track Any girl that wanna get a track With me just let me know Are you sketchy about the girls that are op Like you ain't trying to know music with them type shit Or just like it don't make sense It'll be tough What you would do like a Like a clout thing Like you about to go up Do a song together A marketing thing whatever right Right yeah no You're not with that So tell people where to find you How could they tune in with you Alright y'all go find me My instagram blight from the old My youtube blight from the old About a drop of album September 8th Everybody be on point Pre-save that right now Alright And that's the talk of the town Make sure you like comment and subscribe And make sure you check out our website at www.talkofthetownshow.com