What do you worry about? What keeps you up at night, tossing and turning? What triggers anxiety for you? Chances are whatever it is is not actually happening in the present moment. Whatever it is is something you anticipate or something that has already happened that continues to echo in your mind. Whatever it is is not happening right now, in this present moment.

One of the most insidious aspects of anxiety centers on a pattern of thinking that takes us out of the present and focuses us on the future. We worry about what lies ahead and create narratives for ourselves, often based on past experiences, about what might happen. Or we ruminate about past traumas, reliving them in our minds and asking ourselves what might have been different, if only… When we do this, we separate ourselves from the present moment. We take ourselves out of present time. And the further we project ourselves out of the present, the more anxious we become. Indeed, we lose ourselves because we are no longer grounded in the here-and-now. And when we do this, feelings of anxiety and dread take hold and grow. We are lost and anxious because we are no longer present to ourselves.

One of the techniques I offer to clients with anxiety is aimed at bringing the client into the room, into the here-and-now. It’s a simple technique: I ask the client to bring their attention to the weight of his/her body in the chair and to look directly at me (or if eye contact is too intimate, to focus on a spot just above my head). As they do this, I ask them to attend to their breathing and ask them to answer several questions: what is going at this moment that is creating anxiety for you? What, if anything, in this room is making you feel anxious? What am I doing that is creating anxiety for you? The answers to these questions are typically “nothing is happening right now, but…” I stop the client, and draw attention back to the breathing and observe that right now nothing is happening to create anxiety. I’ll observe that whatever follows the word “but” is something that is not actually present in the room—something that lies either in the past or the future. We’ll continue to do this until the client is grounded in the present moment. (Often, the client visibly relaxes.)

(If something is actually happening to create anxiety in the here-and-now, the focus shifts and we will attend to whatever is presently happening. Sometimes, this means creating a more open physical space and changing the milieu; other times, it means attending to some aspect of the therapeutic relationship. In any event, it is critical to discern the here-and-now dynamic that triggers anxious responses; it is critical to differentiate between the present and past/future orientation.)

This technique is not meant to eliminate anxiety, but rather to put it in perspective and ground it in the appropriate tense (present, past or future). The exercise reorients us to the present moment. Grounding in the present changes our relationship to our experience and ourselves; it helps us perceive and think about what is actually happening in the present moment. And then, from the perspective of the present moment, we can then explore the roots and paths of the thinking pattern and the origins of the anxiety itself. We can also plan for the future. (Planning for the future and actually living in the future are two very different experiences. Effective planning is predicated on the ability to be grounded in the present, having put into perspective the lessons from the past.) However, we can only effectively do the deeper work by staying firmly grounded in the present moment.

Whatever worries you, whatever keeps you up at night need not control your life. Being oriented in time—being grounded in the present moment—is an important first step to managing those worries. While you may have been exposed to danger in the past (which undoubtedly offer lessons for the present) and while danger may indeed lie ahead (which you can plan for, if you stay grounded in the present), you can only live in the present moment.

Something happened to trigger the client's rage just before group was to begin, and the client came into the group in a fury. He had enormous difficulty reporting the incident. But once the details emerged, it became clear that his angry response was out of proportion to the actual event: loudly explosive, with an energy that signaled an imminent loss of control, mere steps from actual violence. Over the years, I’ve had a lot of experience with helping angry clients, but I felt a bit anxious in the presence of such volatility, concerned about being able to insure safety while helping the client and the group manage and work through it. Nonetheless, the group helped the client regain enough control so that he was able to recognize what had happened. He spoke of feeling that “my brain is like scrambled eggs right now”—a vivid image that illustrated the level of his activation as well as his confusion and his experience of being out of control. He described his rage as “like being suddenly trapped in a space that gets smaller and smaller. I’m determined to get out and will do whatever it takes to get myself out of it.” Another client commented that “When I get angry I hurt people. I know how to hurt people; getting mad and getting violent is how I survive. I hurt them so they wouldn't hurt me, or so that they would stop hurting me. I don’t want to hurt people, but it’s what I do when I’m in that space." Yet another client said "I don’t get angry; I go right to rage. And when I’m in that place, I lose sight of all the consequences that can occur. When I think about it, it really scares me because I realize that I’m capable of anything. And then when the anger is over, I regret what I did.”

These men have all experienced rage; they have all experienced the consequences of out-of-control anger. They are slowly, painfully learning about their anger’s triggers, patterns, and nuances; and they are learning specific techniques for better managing it, without violence or negative consequences. They are learning about and trying to change their own thinking. Indeed, the group’s members are encouraged to look at their beliefs about anger while also developing new skills for managing it. And they are admitting that they are actually frightened of their anger.

But the most challenging aspect of the work centers on perceiving the connections between anger and the pain that anger can mask. The hurt underneath the anger is acute, and getting at that hurt is a slow, delicate process. The hurt underneath is a vulnerability. For most of us, acknowledging the pain, fear and vulnerability that arises in tandem with anger/rage is very difficult.

It’s all too easy to see only the anger. It’s dramatic and gets attention. The trouble is, anger is an effective means for hiding pain. Anger can be defensive. It can push people away, preventing anyone from touching what is most painful. Quite frankly, anger and rage can be scary. (The men I've quoted know just how scary they can be; they know just how frightening they appear to others, and they know how close they can come to outright violence—and most of them are afraid of themselves when they feel themselves veering toward rage; they are afraid because they often feel powerless to control their anger.) Paradoxically, what many people—the men in the group included—really want is to feel connected with others so that they can safely connect with and heal their pain. However, it’s hard to be around angry people, and most of us keep angry people at arm’s length whenever we can. And so the deeper pain remains raw and unhealed.

Anger that is out-of-proportion to its immediate cause almost always has roots in deeper conflict and pain. So too with displaced anger. Psychotherapy—both individual and group therapies--reaches for that pain and tries to help each person understand it; psychotherapy helps clients understand how pain manifests as anger, and learn how to manage anger and pain’s impact in the present. The pain can be rooted in traumatic events, unresolved conflicts, profound losses, abandonment. Identifying the hurt beneath the anger is an important step toward healing and being able to manage anger in a healthy manner. Many of the men in the group have difficulty acknowledging, much less being in touch with, the pain underneath and instead have learned to enact it—usually with terrible consequences to themselves and others. But until the hurt beneath the anger is identified and worked through, explosive, destructive anger will continue to manifest.

The group helped the client understand that the anger he was expressing was largely rooted in his past, and that the immediate trigger merely tapped into all that repressed anger. The group helped him separate the past from the present and helped him develop strategies for managing the here-and-now anger, and encouraged him to work through the older anger in individual psychotherapy. At the group’s end, he thanked his peers for helping him and expressed hope that he could continue the work that would help him “be a better man.” The group had done its job.

*Note: In order to respect and protect the confidentiality of the clients, I've omitted identifying information. I've drawn upon and condensed material that had developed over a long period of several group processes. I received permission to quote the men. As one of them said, "if my experience helps someone else, it's important to share it."