I think it is beneficial to journal.
A journal can become a sort of relational experience, in which the journal becomes your confidant; in this way the journal experience becomes something similar to a psychotherapy experience (e.g. the journal may become a non-judgmental, accepting, well-framed safe place for exploring ideas, feelings, joys, and problems).
As with all other relational experiences, some tactics can work better than others:
A psychotherapy experience is likely to be quite limited if the only things spoken are descriptions or repetitions of problems, with no response from the therapist.
Likewise, I believe that a journaling experience will be very limited if it involves only the documentation of problems or sorrows.
I think the experience of journaling can be much more powerful and therapeutic if "the journal" can offer empathy, support, or advice. Here, the "point of view" of "the journal" would need to be composed by you, the author.
A cognitive-behavioural model of journaling can include this idea more clearly: here, every problem or issue related in the journal would be written in one column, with the adjacent column devoted to "talking back" to the problem or issue, either through reassurance, empathy, advice, analysis, problem-solving approaches, etc. It may seem not to be very genuine to "force" such a "talking back" when you may not feel in any mood to write down a supportive comment about your journal entry. But as an exercise, frequently repeated, it can start to train your mind always to "talk back" to various symptoms, recurring negative thought patterns, or "negative self-talk".
So I encourage such a style of journaling, in which every sorrow or symptom is always "talked back to" in the next column.
Another role of journaling can be as a creative outlet, which I think is independently therapeutic. Here, the journal could include descriptions of your day, but also other creative forms such as poetry, drawings, photographs, video, audio recordings, other media, etc.
It can be satisfying to have an experience of your journal as a place to do work and have a sense of accomplishment. The beginning of the accomplishment can be simply to maintain the frame of keeping your journal regularly. Further accomplishment comes from your journal becoming a place in which problems are addressed, examined, worked through, and solved. Or a place where the joys of your life can be celebrated.
Tuesday, October 7, 2008
Wednesday, October 1, 2008
Politics & Economy in the Mind
Different political styles, views, and beliefs could be considered different strategies or algorithms to solve problems.
So-called "right-wing" beliefs may include the following features:
1) strict rules
2) a clearly polarized distinction between "right" and "wrong"
3) perhaps an emphasis on facilitating the progress of the most "elite" members of the group (whether this be in an economic sense, or in terms of other types of accomplishment). The thinking could be that if the "elite" are flourishing, then the entire society will ultimately flourish, either through a "trickle-down" effect, or through a type of "natural selection" process.
Disadvantages of the right-wing strategy include the following:
a) the "elite" groups may be "elite" for unfair reasons (e.g. luck; born into a rich family, despite a lack of earned merit). Or the "elitism" may be founded upon a skill which benefits merely the individual but which may have a detrimental effect on the community as a whole (e.g. an unscrupulous businessperson who may maximize profits through narcissistic and bullying disregard towards others, towards the environment, towards the law, etc.)
b) the "trickle-down" effect may not actually work in all cases. The rich may simply get richer, and the poor get poorer.
c) The strict rules may cause a rigidity to the culture which leaves various groups feeling excluded, marginalized, or persecuted.
d) The so-called "natural selection" may either occur at the cost of great suffering for many individuals, and therefore be morally intolerable--or the "natural selection" may not occur at all, paradoxically (here, the literal example would be that birth rates in highly advantaged groups are usually lower than birth rates in disadvantaged groups).
So-called "left-wing" beliefs may include the following features:
1) more flexible rules
2) an emphasis on investing society's energy in all members of the group, so as to directly support those who are struggling most. The thinking here is that if everyone is supported equally, then the entire society will flourish.
Disadvantages of the "left-wing" strategy include the following:
a) the strategy may be inefficient, and in some cases may discourage excellence. For example--by analogy but perhaps also literally--if there is a group of athletes wanting to train for the Olympics, but there are only a few trainers or facilities, the "left-wing" model might give every athlete equal training time. The star athletes would get only a mediocre ability to train, and therefore would never excel as they could have. Or, entire areas of human excellence might never be developed: space travel to the moon, heart or brain surgery, organ transplantation, etc. might never happen because they are expensive, might not be seen as efficient ways to invest energy, time, and money, and they would require the formation of a type of "elite" group (e.g. astronauts, heart surgeons, etc.). This inefficiency may certainly happen in some forms of "left-wing" economic management.
Most groups, be they nations, cities, clubs, or families, have some mixture of strategies, between the extreme "right wing" and "left wing". Perhaps part of the choice of style is determined by the cultural history of the group, though part of it could be determined by the active choice of the group.
Mind you, it seems to me that many people's positions on these matters are highly influenced by factors such as what their parents or peers think, or even by inherited predisposition--see the following twin study :
Alford, John R., Carolyn L. Funk, and John R. Hibbing "Are Political Orientations Genetically Transmitted?." American Political Science Review, 99 (2005, May): 153-167.
The study shows a significant contribution of inherited factors which influence a person's ideological stance. There are some subtleties to the findings which make the article worth a look.
An advantage to a "democratic" system is that the style could be more changeable, and that individuals don't have to be stuck permanently in a style that they don't like. A disadvantage of democratic systems is that most groups and most individuals vacillate a lot, and are often almost equally divided between "left" and "right" (e.g. look at the U.S. electorate). This can result in leadership which is itself ambivalent and unstable.
The above comments are a prelude to a metaphor I've been considering, about how the mind, or how strategizing about life, works.
A "right-wing" approach in the mind or in one's life might be to develop one's strengths, and to pay little attention to one's weaknesses, with the belief that optimizing one's strengths will optimize success in life. So if you are a talented musician but have weaker math skills and social skills, the strategy would be to practice music 12 hours per day, to skip out on math, and not to bother socializing.
A "left-wing" approach might be to divide one's day up into 30 minute blocks, and devote equal attention to music, math, socializing, knitting, soccer, cooking, etc.
Both the above approaches, in their extremes, would probably not work out very well, or whatever successes would result would come at a high cost. In the first case, we might have a brilliant but isolated, depressed, and autistic musician. In the second case, we might have a pretty well-rounded person, who however would never be able to make a career out of music, and who might carry a lifelong frustration about never having had the chance to fully develop gifts or potential.
I think most of us would agree that a moderate position between those two extremes would be most beneficial in the above example. The theoretical musician described above probably ought to practice a lot -- much more than most others -- but probably ought to spend some time struggling through some math, and trying to get involved in social activities. In the long term, such a mixed model would probably lead to even more excellence, since a well-rounded person with good morale and multiple strengths is likely to have more energy to share with society, and is less likely to be sidelined by depression. Furthermore, there can be unexpected synergistic benefits from having a broad range of experiences.
So, in my opinion, from a psychological point of view, I believe that a "moderate" position in the "political spectrum" of the mind is healthiest and most beneficial, perhaps a position which is able to flexibly assimilate ideas from both sides of an ideological spectrum.
Another phenomenon that occurs in political debate is intense polarization: opposing groups merely fight and argue with each other. The fighting and arguing rarely seem to resolve anything, but may in fact further entrench the polarization of the opposing points of view. I think it is healthy -- in the politics of the world, and the politics of the mind -- to always be on the watch for polarization, and to take active steps to diminish it. Groups of individuals tend to separate, polarize, and compete -- sports fans or athletes are one example. In can be fun to playfully feel polarized into "us" and "them" at a sports event. But it isn't fun when the polarizing occurs automatically, and interferes with problem solving, whether it be in political debate, in an argument with a loved one, or within one's own mind.
In the internal "politics" of the mind, I think it is healthy to have a clear sense of identity, to develop your positions, ideas, beliefs, values, etc. But I think it is important to watch for polarization. This may require an openness to sometimes respectfully consider ideas that seem opposed to your position.
Likewise, in world politics, I think it is important for opposing parties to work at affirming or considering the validity of their opponents' positions, to find common ground, to even find some wisdom or inspiration -- once in a while -- in the opponents' ideas.
So-called "right-wing" beliefs may include the following features:
1) strict rules
2) a clearly polarized distinction between "right" and "wrong"
3) perhaps an emphasis on facilitating the progress of the most "elite" members of the group (whether this be in an economic sense, or in terms of other types of accomplishment). The thinking could be that if the "elite" are flourishing, then the entire society will ultimately flourish, either through a "trickle-down" effect, or through a type of "natural selection" process.
Disadvantages of the right-wing strategy include the following:
a) the "elite" groups may be "elite" for unfair reasons (e.g. luck; born into a rich family, despite a lack of earned merit). Or the "elitism" may be founded upon a skill which benefits merely the individual but which may have a detrimental effect on the community as a whole (e.g. an unscrupulous businessperson who may maximize profits through narcissistic and bullying disregard towards others, towards the environment, towards the law, etc.)
b) the "trickle-down" effect may not actually work in all cases. The rich may simply get richer, and the poor get poorer.
c) The strict rules may cause a rigidity to the culture which leaves various groups feeling excluded, marginalized, or persecuted.
d) The so-called "natural selection" may either occur at the cost of great suffering for many individuals, and therefore be morally intolerable--or the "natural selection" may not occur at all, paradoxically (here, the literal example would be that birth rates in highly advantaged groups are usually lower than birth rates in disadvantaged groups).
So-called "left-wing" beliefs may include the following features:
1) more flexible rules
2) an emphasis on investing society's energy in all members of the group, so as to directly support those who are struggling most. The thinking here is that if everyone is supported equally, then the entire society will flourish.
Disadvantages of the "left-wing" strategy include the following:
a) the strategy may be inefficient, and in some cases may discourage excellence. For example--by analogy but perhaps also literally--if there is a group of athletes wanting to train for the Olympics, but there are only a few trainers or facilities, the "left-wing" model might give every athlete equal training time. The star athletes would get only a mediocre ability to train, and therefore would never excel as they could have. Or, entire areas of human excellence might never be developed: space travel to the moon, heart or brain surgery, organ transplantation, etc. might never happen because they are expensive, might not be seen as efficient ways to invest energy, time, and money, and they would require the formation of a type of "elite" group (e.g. astronauts, heart surgeons, etc.). This inefficiency may certainly happen in some forms of "left-wing" economic management.
Most groups, be they nations, cities, clubs, or families, have some mixture of strategies, between the extreme "right wing" and "left wing". Perhaps part of the choice of style is determined by the cultural history of the group, though part of it could be determined by the active choice of the group.
Mind you, it seems to me that many people's positions on these matters are highly influenced by factors such as what their parents or peers think, or even by inherited predisposition--see the following twin study :
Alford, John R., Carolyn L. Funk, and John R. Hibbing "Are Political Orientations Genetically Transmitted?." American Political Science Review, 99 (2005, May): 153-167.
The study shows a significant contribution of inherited factors which influence a person's ideological stance. There are some subtleties to the findings which make the article worth a look.
An advantage to a "democratic" system is that the style could be more changeable, and that individuals don't have to be stuck permanently in a style that they don't like. A disadvantage of democratic systems is that most groups and most individuals vacillate a lot, and are often almost equally divided between "left" and "right" (e.g. look at the U.S. electorate). This can result in leadership which is itself ambivalent and unstable.
The above comments are a prelude to a metaphor I've been considering, about how the mind, or how strategizing about life, works.
A "right-wing" approach in the mind or in one's life might be to develop one's strengths, and to pay little attention to one's weaknesses, with the belief that optimizing one's strengths will optimize success in life. So if you are a talented musician but have weaker math skills and social skills, the strategy would be to practice music 12 hours per day, to skip out on math, and not to bother socializing.
A "left-wing" approach might be to divide one's day up into 30 minute blocks, and devote equal attention to music, math, socializing, knitting, soccer, cooking, etc.
Both the above approaches, in their extremes, would probably not work out very well, or whatever successes would result would come at a high cost. In the first case, we might have a brilliant but isolated, depressed, and autistic musician. In the second case, we might have a pretty well-rounded person, who however would never be able to make a career out of music, and who might carry a lifelong frustration about never having had the chance to fully develop gifts or potential.
I think most of us would agree that a moderate position between those two extremes would be most beneficial in the above example. The theoretical musician described above probably ought to practice a lot -- much more than most others -- but probably ought to spend some time struggling through some math, and trying to get involved in social activities. In the long term, such a mixed model would probably lead to even more excellence, since a well-rounded person with good morale and multiple strengths is likely to have more energy to share with society, and is less likely to be sidelined by depression. Furthermore, there can be unexpected synergistic benefits from having a broad range of experiences.
So, in my opinion, from a psychological point of view, I believe that a "moderate" position in the "political spectrum" of the mind is healthiest and most beneficial, perhaps a position which is able to flexibly assimilate ideas from both sides of an ideological spectrum.
Another phenomenon that occurs in political debate is intense polarization: opposing groups merely fight and argue with each other. The fighting and arguing rarely seem to resolve anything, but may in fact further entrench the polarization of the opposing points of view. I think it is healthy -- in the politics of the world, and the politics of the mind -- to always be on the watch for polarization, and to take active steps to diminish it. Groups of individuals tend to separate, polarize, and compete -- sports fans or athletes are one example. In can be fun to playfully feel polarized into "us" and "them" at a sports event. But it isn't fun when the polarizing occurs automatically, and interferes with problem solving, whether it be in political debate, in an argument with a loved one, or within one's own mind.
In the internal "politics" of the mind, I think it is healthy to have a clear sense of identity, to develop your positions, ideas, beliefs, values, etc. But I think it is important to watch for polarization. This may require an openness to sometimes respectfully consider ideas that seem opposed to your position.
Likewise, in world politics, I think it is important for opposing parties to work at affirming or considering the validity of their opponents' positions, to find common ground, to even find some wisdom or inspiration -- once in a while -- in the opponents' ideas.
Tuesday, September 30, 2008
Evidence-based support for long-term psychotherapy
I invite the interested reader to have a look at an article in the Journal of the American Medical Association, 300(13), pp. 1551-1565 (as of today, it is the current issue).
http://jama.ama-assn.org/cgi/content/short/300/13/1551
It presents some compelling evidence that long-term psychotherapy is significantly effective in treating a wide variety of psychiatric illnesses, including those illnesses that are more complicated, perhaps not neatly fitting into a single diagnostic category. It specifically shows a superior benefit for "psychodynamic" psychotherapy. Psychodynamic therapies are more intensive, philosophically and intellectually challenging styles of psychotherapy, which also emphasize the importance of examining closely the patient-therapist relationship during the therapy sessions. Most psychotherapy research has looked at short-term therapy (typically lasting a few months), and the evidence base formed from this research has caused a standard of practice to evolve which supports short-term but not long-term therapy. This is very problematic, because such a standard of practice is literally "short-sighted": Many patients require, and benefit greatly from, longer courses of psychotherapy. I do understand that it is difficult to do long-term research studies for any type of treatment (it is much, much easier to do an 8-week study than a 5-year study!), so this paper is very important.
Interestingly, the study did not show a specific benefit from the therapist having more years of experience. But this is not a surprise to me. In my experience with teaching medical students & residents, and also encountering many different supervisors during my training (which is now a decade ago), I found that differences in each individual's style, personality, attitude, and comfort with patients, were far more significant factors which influenced their helpfulness as clinicians or therapists, rather than years of experience. I can think of examples on both sides: the passage of years may magnify authoritarian or arrogant tendencies, and reduce open-mindedness, in some psychiatrists, particularly if they are ascending some sort of professional hierarchy, if they are trying to earn the most possible money, or if they are not enjoying their work. Clearly, this is not beneficial to patients or students. On the other hand, I have encountered many psychiatrists whose talent and wisdom have grown and deepened over time; in these cases I think years of experience have allowed a gentle, compassionate, understanding calm with patients, with a continuing open-mindedness to learn and continue growing, personally and professionally, as therapists and teachers.
The study did not show evidence that a "manual" helped the therapy be more effective. Again, this is absolutely not a surprise. Imagine trying to have a conversation with someone who was basing their responses to you on what a "manual" advised! While the use of manuals has been a well-meaning device for helping therapists-in-training to learn, and for measuring the effectiveness of therapy techniques in research, such devices in many cases can obtund the type of creative, spontaneous, friendly, wise, and sometimes playful interactions that I believe are the foundations for good therapy. These qualities I think are harder for therapists to learn or to teach, though I think that a sort of apprenticeship model is most likely to work best. It is not a surprise to me that the best such apprenticeship models are themselves long-term ones (over years), as opposed to having a therapist-in-training constantly migrating every few months, to some new or different therapy style or supervisor. Mind you, I do think it is important for any therapist to learn every major type of therapy, from a variety of different mentors, and in my opinion it is then necessary for the budding therapist to form an individual style that suits them best. In this way they will be truest to themselves, and therefore be best able to help their patients.
http://jama.ama-assn.org/cgi/content/short/300/13/1551
It presents some compelling evidence that long-term psychotherapy is significantly effective in treating a wide variety of psychiatric illnesses, including those illnesses that are more complicated, perhaps not neatly fitting into a single diagnostic category. It specifically shows a superior benefit for "psychodynamic" psychotherapy. Psychodynamic therapies are more intensive, philosophically and intellectually challenging styles of psychotherapy, which also emphasize the importance of examining closely the patient-therapist relationship during the therapy sessions. Most psychotherapy research has looked at short-term therapy (typically lasting a few months), and the evidence base formed from this research has caused a standard of practice to evolve which supports short-term but not long-term therapy. This is very problematic, because such a standard of practice is literally "short-sighted": Many patients require, and benefit greatly from, longer courses of psychotherapy. I do understand that it is difficult to do long-term research studies for any type of treatment (it is much, much easier to do an 8-week study than a 5-year study!), so this paper is very important.
Interestingly, the study did not show a specific benefit from the therapist having more years of experience. But this is not a surprise to me. In my experience with teaching medical students & residents, and also encountering many different supervisors during my training (which is now a decade ago), I found that differences in each individual's style, personality, attitude, and comfort with patients, were far more significant factors which influenced their helpfulness as clinicians or therapists, rather than years of experience. I can think of examples on both sides: the passage of years may magnify authoritarian or arrogant tendencies, and reduce open-mindedness, in some psychiatrists, particularly if they are ascending some sort of professional hierarchy, if they are trying to earn the most possible money, or if they are not enjoying their work. Clearly, this is not beneficial to patients or students. On the other hand, I have encountered many psychiatrists whose talent and wisdom have grown and deepened over time; in these cases I think years of experience have allowed a gentle, compassionate, understanding calm with patients, with a continuing open-mindedness to learn and continue growing, personally and professionally, as therapists and teachers.
The study did not show evidence that a "manual" helped the therapy be more effective. Again, this is absolutely not a surprise. Imagine trying to have a conversation with someone who was basing their responses to you on what a "manual" advised! While the use of manuals has been a well-meaning device for helping therapists-in-training to learn, and for measuring the effectiveness of therapy techniques in research, such devices in many cases can obtund the type of creative, spontaneous, friendly, wise, and sometimes playful interactions that I believe are the foundations for good therapy. These qualities I think are harder for therapists to learn or to teach, though I think that a sort of apprenticeship model is most likely to work best. It is not a surprise to me that the best such apprenticeship models are themselves long-term ones (over years), as opposed to having a therapist-in-training constantly migrating every few months, to some new or different therapy style or supervisor. Mind you, I do think it is important for any therapist to learn every major type of therapy, from a variety of different mentors, and in my opinion it is then necessary for the budding therapist to form an individual style that suits them best. In this way they will be truest to themselves, and therefore be best able to help their patients.
Tuesday, September 9, 2008
Rates of Change - filling a milk jug
Some symptoms or problems can improve within a day.
Others could take a week or more.
In mood and anxiety disorders, and in other struggles towards life improvement, many significant changes or improvements can take several months.
With this kind of time scale, it can be hard to perceive any change happening in the present moment.
So, consider this analogy:
Let your symptoms or problems be represented by an empty 4-litre milk jug.
Let your efforts to improve your symptoms or problems be represented by a dropper, which will add individual drops of milk to the jug. Each major step towards substantive change is represented by a full jug. In many ongoing processes of life change--such as dealing with chronic depression--you may need to take repeated such steps, but I think each single step can be very important and significant.
A single drop is about 1/20th of one millilitre in volume. So, in order to fill the jug, you will need to add 80 000 drops.
In order to add 80 000 drops in about 2-3 months' time, you will need to add about 1200 drops per day, or 50 drops per hour, or about 1 drop per minute.
This is the rate to keep in mind with regards to substantive life change -- it is like adding 1 drop per minute in order to fill up a 4-litre milk jug. The moment-to-moment pace may seem slow, but it is not imperceptible, as long as you have a way to visualize it. Keep using your dropper. Be patient.
(To extend this analogy a bit further, I guess we should say that it is important to make sure your jug doesn't have any leaks -- many therapeutic efforts cannot catch up with what is lost from a leaky jug! Leaks may be caused by chronic stresses, addictions, unaddressed physical health problems, unhealthy relationships, etc. )
Others could take a week or more.
In mood and anxiety disorders, and in other struggles towards life improvement, many significant changes or improvements can take several months.
With this kind of time scale, it can be hard to perceive any change happening in the present moment.
So, consider this analogy:
Let your symptoms or problems be represented by an empty 4-litre milk jug.
Let your efforts to improve your symptoms or problems be represented by a dropper, which will add individual drops of milk to the jug. Each major step towards substantive change is represented by a full jug. In many ongoing processes of life change--such as dealing with chronic depression--you may need to take repeated such steps, but I think each single step can be very important and significant.
A single drop is about 1/20th of one millilitre in volume. So, in order to fill the jug, you will need to add 80 000 drops.
In order to add 80 000 drops in about 2-3 months' time, you will need to add about 1200 drops per day, or 50 drops per hour, or about 1 drop per minute.
This is the rate to keep in mind with regards to substantive life change -- it is like adding 1 drop per minute in order to fill up a 4-litre milk jug. The moment-to-moment pace may seem slow, but it is not imperceptible, as long as you have a way to visualize it. Keep using your dropper. Be patient.
(To extend this analogy a bit further, I guess we should say that it is important to make sure your jug doesn't have any leaks -- many therapeutic efforts cannot catch up with what is lost from a leaky jug! Leaks may be caused by chronic stresses, addictions, unaddressed physical health problems, unhealthy relationships, etc. )
Thursday, September 4, 2008
Managing Relationship Conflict
This is no easy subject. So much depends on the specifics of the situation and of the relationship. And perhaps different people deal with conflicts best in their own different ways.
But I think a few generalizations can be made:
1) Once anger has risen beyond a certain point -- and this point may vary, for different individuals, or for different situations -- there is no benefit to continued conversation. Anger is often a state of "outward flow", a state of action; an angry person may not be able or willing to listen or receive an "inward flow" of information or feedback. There needs to be a break, to cool down, after which if there are issues to discuss, both people will be able to hear each other better. Most issues of conflict are more fruitfully discussed when both parties are in a calm state.
2) If you are feeling unsafe, bullied, or subject to physical aggression, it is necessary to find a safe place as soon as possible. This may mean leaving physically. Or it may mean leaving the relationship. From the safe place, it will be necessary to carefully assess what to do next. It can be hard to think or plan clearly when you are in a dangerous position. You may need to seek external help, for shelter or safety.
2) Practicing empathy. While the capacity to empathize is to some degree an inborn, heritable trait, it is also a skill that can be practiced and improved. The simplest exercise is, in an argument, to simply state how you believe the other person is feeling, and why. We all have a powerful resistance to actually do this, even though most of us acknowledge that it's a good idea.
3) Apologizing. But only if you truly believe that you have been out of line.
4) Accepting apology. Which doesn't necessarily mean accepting a repetition of the status quo.
5) Be wary of the same old conflictual pattern happening over and over again.
6) If there is some positive territory, allowing some time and space for that. This could be shared interests, pleasures, activities, or mutual friends.
7) There are workbooks and other reading material which deal with relationships, managing or resolving conflict in marriages, etc. If this is a theme in your life, I strongly encourage you to acquaint yourself with this literature, and to work through a workbook or two (best if both you and your partner do it, of course). As with all self-help literature, you may find some of it preachy, trite, biased by the individual views of the author, etc. but I do think it is important to acquaint yourself with what is out there, some of it can be very helpful or at least an introduction to ideas that can help.
8) An external mediator, such as a therapist, can be helpful. It can often be important to find a mediator who does not have a specific individual alliance with either person in the conflict (i.e. the mediator should be neutral). And it can be important to find a mediator who is experienced working with relationship conflict. I believe it is important to consider that a mediator may help a relationship improve, but may also help an unhealthy or unsustainable relationship end more peacefully.
9) Maybe I should have "ranked" this item higher than (9) since it is very important: if there are untreated psychiatric symptoms in either individual member of a conflicted pair, then it can be very helpful to address and treat those symptoms. High levels of irritability can be treated with various types of psychotherapy, lifestyle change, and/or medication--with a reduction in an individual's irritability, that person may be able to negotiate conflict more peacefully and productively. In some depressive or anxious states, feedback which sounds critical in any way can lead to feelings which are so badly hurt that the conversation cannot continue. This emotional lability or hypersensitivity can also be treated through psychotherapy, lifestyle change, and/or medications.
But I think a few generalizations can be made:
1) Once anger has risen beyond a certain point -- and this point may vary, for different individuals, or for different situations -- there is no benefit to continued conversation. Anger is often a state of "outward flow", a state of action; an angry person may not be able or willing to listen or receive an "inward flow" of information or feedback. There needs to be a break, to cool down, after which if there are issues to discuss, both people will be able to hear each other better. Most issues of conflict are more fruitfully discussed when both parties are in a calm state.
2) If you are feeling unsafe, bullied, or subject to physical aggression, it is necessary to find a safe place as soon as possible. This may mean leaving physically. Or it may mean leaving the relationship. From the safe place, it will be necessary to carefully assess what to do next. It can be hard to think or plan clearly when you are in a dangerous position. You may need to seek external help, for shelter or safety.
2) Practicing empathy. While the capacity to empathize is to some degree an inborn, heritable trait, it is also a skill that can be practiced and improved. The simplest exercise is, in an argument, to simply state how you believe the other person is feeling, and why. We all have a powerful resistance to actually do this, even though most of us acknowledge that it's a good idea.
3) Apologizing. But only if you truly believe that you have been out of line.
4) Accepting apology. Which doesn't necessarily mean accepting a repetition of the status quo.
5) Be wary of the same old conflictual pattern happening over and over again.
6) If there is some positive territory, allowing some time and space for that. This could be shared interests, pleasures, activities, or mutual friends.
7) There are workbooks and other reading material which deal with relationships, managing or resolving conflict in marriages, etc. If this is a theme in your life, I strongly encourage you to acquaint yourself with this literature, and to work through a workbook or two (best if both you and your partner do it, of course). As with all self-help literature, you may find some of it preachy, trite, biased by the individual views of the author, etc. but I do think it is important to acquaint yourself with what is out there, some of it can be very helpful or at least an introduction to ideas that can help.
8) An external mediator, such as a therapist, can be helpful. It can often be important to find a mediator who does not have a specific individual alliance with either person in the conflict (i.e. the mediator should be neutral). And it can be important to find a mediator who is experienced working with relationship conflict. I believe it is important to consider that a mediator may help a relationship improve, but may also help an unhealthy or unsustainable relationship end more peacefully.
9) Maybe I should have "ranked" this item higher than (9) since it is very important: if there are untreated psychiatric symptoms in either individual member of a conflicted pair, then it can be very helpful to address and treat those symptoms. High levels of irritability can be treated with various types of psychotherapy, lifestyle change, and/or medication--with a reduction in an individual's irritability, that person may be able to negotiate conflict more peacefully and productively. In some depressive or anxious states, feedback which sounds critical in any way can lead to feelings which are so badly hurt that the conversation cannot continue. This emotional lability or hypersensitivity can also be treated through psychotherapy, lifestyle change, and/or medications.
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