Category Archives: Anxiety

October 13, 2009 · 5:21 am

Fear and trust hand in hand?


This week I’ll be speaking to a group of counselors about complex PTSD. One of the hallmarks of C-PTSD is the combination of chronic relational fear AND chronic shame/guilt over having said fear. It manifests itself as, “I’m afraid of you but I know it’s my fault for being afraid.” (NOTE: the reverse is not necessarily true: that those who have chronic fears, trust problems, and self-condemnation have PTSD or C-PTSD.) My focus at that training will be on this question: How do you lead someone (in therapy) in the repetitive work of “Do not give in to fear”?

On Sunday, Tim Lane of CCEF preached a sermon about fear and disappointment. In that sermon he mentioned our propensity to “flail ourselves”–assuming that we must be doing something wrong–if we experience fear. Instead of focusing on the experience, we ought to examine our responses to fear. Do we shut down? Do we believe that we are alone and isolated? Do we turn inward and act only in self-interest?

He gave us this quote from CS Lewis (Screwtape Letters): “The act of cowardice is all that matters, the emotion of fear is, in itself, no sin.”

Here’s my question: Is it possible to be afraid and to trust nonetheless without much reduction in the level of fear? Don’t we assume that if we act in a trusting way that our fears should abate? Especially in light of trusting God? Is it possible to trust God fully and yet fear? What might such fear and trust together look like? If we could do both at the same time, would it reduce inappropriate self-condemnation?

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September 3, 2009 · 10:24 am

How fear works


[For those looking for a serious discussion of anxiety on this site, you can check out this post or use the search engine on the top right for more posts. This post isn’t one of them.]

You know you have fears that make no sense–that you rarely share with another. They show up in your dreams (like being at work without your pants) and they cross your mind from time to time. Where do they start? I’m not sure but this story is one of mine. On a recent flight across the the Atlantic some woman had temporary psychosis and tried to call the president from the bathroom of the plane to tell him she had been hijacked. Apparently, she drank too much after taking a sleep aid.

See, I was told I should consider taking a sleep aid on my trip to Africa in June. I can’t sleep on planes. But I worried that I would end up doing something like this woman did or like the man who recently took off his clothes in order to be comfortable.

How does fear work? Your mind imagines the possible and turns it into the probable. No matter that thousands of people take sleep aids every day and do not do crazy stuff. Since it is possible, I assume it is likely for me. That is how fear works–the possible becomes probable.

By the way, do you think the doctor who helped this poor woman should have been compensated for his work for 4 hours?

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August 31, 2009 · 5:44 am

Disorders of Extreme Stress Not Otherwise Specified (DESNOS)


I recently scanned a book, Healing Trauma(published by Norton in 2003), and ran across a new name (for me) for the problem of complex PTSD–Disorders of Extreme Stress NOS or DESNOS.  Because many christian counselors are only marginally aware of the research on complex PTSD I’ve decided to give a brief summary here.

The following symptom presentation may be found in those with prolonged and severe personal abuse (and often starting at an early age): 

  1. alterations in the regulation of affective impulses, including difficulty with modulation of anger and being self-destructive,
  2. alterations in attention and consciousness, leading to amnesias and dissociative and depersonalization episodes,
  3. alterations in self perception, such as a chronic sense of guilt and responsibility, and chronically feeling ashamed,
  4. alterations in relationships with others, such as not being able to trust and not being able to feel intimate with people,
  5. somatizating the problem: feeling symptoms on a somatic level when medical explanations can’t be found, and
  6. alterations in systems of meaning (loss of meaning or distorted beliefs)

Some folks include a 7th characteristic: (alterations of perceptions of perpetrator(s).

Check out the this paper(44 pages long) written on the assessment and treatment of DESNOS.  Though written for psychiatrists, I found the language easy to understand. The authors do a nice job of helping counselors differentiate between Borderline Personality Disorder and DESNOS. While they recognize significant overlap between the two constellation of symptoms, DESNOS folks tend to experience less relational push/pull (less manipulative behavior) and more push behaviors coupled with more intense sadness and grief.

Counseling work falls (per this paper) into 3 categories: stabilization, trauma processing, and re-integration into their world.

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August 28, 2009 · 5:18 am

The danger of “why” questions


Most thoughtful counselees want to ask “why” questions. Why do I do what I do? Why did she do what she did? Why am I the way I am? Why am I so depressed? Why isn’t my life going the way it should or seems to go for others? Counselors too ask “why” questions. Why did you blow up at her? Why is this child afraid of going to school? And closer to home, why did my client drop out of therapy?

On the surface why questions seem to want to get to the bottom of things. We assume that if we understand the nature of the problem, we’ll know how best to respond. And there is much truth in this assumption. 

But consider their danger. Some answers to the “why” are so complex that the answer to the “why” doesn’t really point to any one answer. Further, we frequently prejudge the question with implicit answers (e.g., it is because something is wrong with me…I’m a loser…God doesn’t want me to be happy…I can’t help it that I’m this way…).

Why questions also make us passive. We look for answers; we mull over the “facts.” We are less likely to become active to do something about our situation when we are in a “why…” mode.

Let me suggest a better kind of question: What questions

What is happening? What am I feeling/thinking/doing? What is it that I want? What do others want? What am I doing about my situation? What goals do my behaviors emphasize? (this is a why question that forces us to look at our behaviors and see if they match up with our stated desires) What options are before me? Be descriptive rather than interpretive. Notice that why questions jump to interpretation but seldom activate a person to do what is in their power to do.

Frequently, by asking descriptive “what” questions, we find it easier to activate the will and begin doing something about our situation. In addition, we often come to posthoc understanding of the “why” when we have some distance from the situation.

So, the next time you find yourself stuck in the “why” set of questions, stop and try to ask yourself some what questions instead. Observe the impact of distancing from the passive whys? Does it help?

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August 20, 2009 · 5:23 am

Be Anxious for Nothing???


Posted slides on my “Articles, Slides…” page (#13 on the list) from the talk I gave last night at Macedonia Baptist Church. Talk entitled: Be Anxious for Nothing??? Dealing with Anxiety in a Frightening World.

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August 10, 2009 · 9:54 am

Happenings


I’m passing on a couple of items from my schedule…

1. Speaking. I’ll be speaking at Macedonia Baptist Church (Norristown, PA) on the next two Wednesdays (8/12 and 8/19) for their Summer Bible Conference (theme: Mental Health Awareness). This week will be on Sexual Addiction and the 19th will be on the topic of Anxiety.

2. School. We start late this year on 9/14. For those interested in our course offerings, check out Biblical’s site for course listings. Note that we have entry level, advanced, and post-MA courses on Monday nights. I’m teaching an on-line course (Social & Cultural Foundations of Counseling) and two face to face classes (Counseling & Physiology, Psychological Assessment). Should be fun!

3. Conference 1. The AACCis hosting it’s World Conference in Nashville Sept. 16-19. My colleague, Bryan Maier, and myself will be speaking there. On the 16th, Diane Langberg and myself will be presenting a 3 hour preconference workshop about addressing the problem of pastoral sexual abuse. Later in the week, I’ll be lecturing on the use of the Bible with trauma clients.  If you like zooy places, then come as that is the best description I have for the Opryland Hotel.

4. Conference 2. November 13-15 is the annual CCEF conference, entitled, Sex Matters. I’ll be presenting on the 14th, “When Sex in Marriage Doesn’t Work.”

5. Newly published. The latest issue of the Journal of Psychology & Christianity(v. 28:2) is just out on the topic of Theophostic Prayer Ministry and related issues. I and my George Schwab have an article in that edition: “God as healer: A Closer Look at Biblical Images of Inner Healing.” Plus, a number of the other articles site previous work that Bryan Maier and I did a few years ago where we critiqued TPM’s theological bases. 

6. In the works. I’ve just completed work on a booklet, “Sexual Addiction: When is Residential Treatment an Option?” It is intended to be an ebooklet published by a local ministry. We are researching the best way to publish such a booklet for those caught in the trap of an addiction. If any of you have any great ideas for the best way to get that out on the Internet (including issues around document delivery, sales, and pricing), I’d love to hear about it.

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April 17, 2009 · 5:28 am

Physiology Phriday: Will I be on meds for the rest of my life?


During the course of discussing a person’s anxiety or depression, the conversation turns to the possibility of using antidepressants. Inevitably, I am asked, will I have to take them forever? Clearly, the questioner does not want to and sees the possibility of taking medication for the rest of their life to be unacceptable. So much so that many resist starting or even going to see a psychiatrist in order to consider whether they might take a medication. Rarely do they ever ask if the medications will help.

Consider for a minute why a person might ask this question. Here’s some of the reasons I think I’m asked this question:

1. Everybody is on them and they never get off (from the viewpoint that too many people take them for every little hangnail and then allow themselves to stay on the crutch forever, never solving their problem)

2. Medicines are for weak people, I’m not weak. (Not sure if the person would have the same response if their medical doctor said their thyroid wasn’t working and so they would need synthroid for the rest of their life)

3. It is only a spiritual problem. Taking the medication will solve the problem but not the spiritual problem. I’ll be avoiding the real issues.

4. I hate medicines of all kind. I hate remembering to take them and I hate their side effects.

5. I don’t think they will really work.

Can you think of other reasons? Now, antidepressants do work from a research vantage point. They are not the silver bullet. They will not make a bitter, angry, depressed person, less bitter. They may help them sleep better, improve their mood, and thus more clearly come to terms with their bitterness. Medications never block the heart from spiritual matters. Only the person who does not want to deal with spiritual matters will use them to avoid looking more deeply inside. God can be found in both suffering and comfort. Whether we will look for him is a bigger question.

So, what if you need them for the rest of your life? What if they really do make it possible to function well? Is our distaste for medicines due to their side effects or due to the fact that we have to accept that we are weak and broken people?

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March 20, 2009 · 5:43 am

Physiology Phriday: Repetitive thoughts?


Have you ever been tortured by a repetitive word, sound, phrase, song, or the like run through your head? Does it happen only during the day? At night when you wake up?

In psychological studies, there are a number of ways people talk about these experiences. Sometimes folks talk about intrusive thoughts/imagery, but this is usually in the context of PTSD or OCD studies. Others talk about rumination or repetitive thoughts, usually in the context of worry, depression, or anger. Finally, another batch talk about hallucinations in regards to psychotic disorders.

But what is going on in the more mundane repetitive thoughts? Diagnostically, they probably fit a bit more in the OCD genre than anything else (like counting, ordering, etc.).

1. Stress is usually a factor. They happen more frequently the more distressed a person is. It means the person is on higher alert than normal. The repetitions may be directly related to the stressor or may not. What is not know is whether the repetitions are a consequence of stress or a mediator of stress. What is known is that when a person, under stress, experiences repetitive thoughts salient to the stress, feels responsible to fix the problem, and attempts to suppress repetitive thoughts, their ruminations are MORE likely to increase.

2. Neuroticism is probably a factor as well. Sorry folks: those with anxious and depressive tendencies have more repetitive thoughts than others.

3. Emotional intensity as a native trait of the person may also be a factor. There is some evidence that individuals with strong emotions have a greater predisposition to PTSD (and therefore intrusive thoughts) if exposed to traumatic events.

But what to do about repetitive thoughts? Have you found anything helpful? There are certain things that are NOT helpful

1. Ruminating over the thoughts (Ugh, I can’t believe I’m still having that thought)

2. Trying to solve the problem they may be attached to

3. Trying not to think about pink elephants

Okay, so maybe those things don’t work. What does? Sad answer? We don’t know. Distractions do for a short time. Some actually give in to them and repeat them outloud to try to quell them. The more it is possible to pay them little notice, the easier it is to let them slide on out of the mind.

Maybe try to consider them an interesting mental quirk–like the lovable Monk (TV detective) 🙂

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January 19, 2009 · 5:32 am

Things that scare counselors…


There are certain things that scare counselors. Some things are real, others are mere fantasies. Some are big scares others are smaller ones. When I teach ethics and we talk about liability, the tension in the room increases. When I teach about suicidal clients and the need for a proper response, the tension increases.

What do I fear? Not remembering a client’s name when I run into them in the public. I don’t think that has ever happened but I fear it nonetheless. More real is the fear of doublebooking, of walking into the waiting room and seeing two clients there for the same time. Now, that has happened to me and sometimes it has been my own fault. Even when it isn’t my fault, my stomach does a flipflop.

But now I have a new experience…being approached by a US gov’t official who flashes a badge and requests to speak to me in private about a matter. I had the feeling that one gets when the police car behind you starts flashing their lights. What did I do? Am I in trouble?

It turned out well however. After verifying his credentials and the release of information in hand, I learned a friend of mine was seeking national security clearances for his job. A couple of questions and the officer was on his way. Pheww…I’m not in trouble.

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October 10, 2008 · 10:57 am

Mindfulness and meditation


In my own reading I’ve been exploring the concept of mindfulness and its similarity to meditation, being present, etc. There are biblical corollaries that make this an important topic as so frequently we react to life rather than observe it without giving in to impulsive reactions. Mindfulness and meditation are different but may share some commonalities. For example, healthy biblical meditation includes focusing on the character of God, his word, his creation, etc. It includes being aware of these things rather than judging experience or anxiously running after a feeling. Mindfulness also includes this focus and being present. Consider the opening words in Erica Tan’s recent essay,

According to Germer (2005, p. 7) in Mindfulness and psychotherapy, mindfulness is “the awareness of present experience with acceptance.” Mindfulness is a skill that enables an individual to be aware of the present–feelings, thoughts, situation, other people., and so on–without being reactive.

She goes on to quote Germer again about the opposite of mindfulness,

To be mindful is to wake up, to recognize what is happening in the moment. We are rarely mindful. We are usually caught up in the distracting thoughts or in opinions about what is happening in the moment. (p. 4-5).

In this way, mindfulness is similar to meditation in that both are focused on “noticing” things with our reactivity. Meditation does assume or judge things from God’s point of view in such a way that frees us from worry or fighting the situation. Both include an acceptance but meditation includes acceptance of God’s point of view.

I think mindfulness research in psychology has exploded because of the propensity for us to be constantly and anxiously judging our worlds. We confirm our own fears about what is right, wrong, good, bad. It recognizes that there can be wise thinking about these things but much of our lives are reactive and anxiety based. So, we benefit from the reminder that acceptance of feelings, and experiences helps us to be aware of that there is a “bigger picture” as Tan reminds us. While some may think this acceptance makes us passive or allows us to become unwilling to do something about sinfulness, that is not the point of mindfulness or meditation and would be a mis-use of these tools.

Tan, E. (2008). Mindfulness in Sexual Identity Therapy. Journal of Psychology and Christianity, 27, 274-278.

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