Category Archives: counseling science

May 18, 2011 · 9:22 am

Physiology of fear


Regions of the brain affected by PTSD and stress.

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Had a conversation regarding fear and anxiety with someone yesterday. In light of that I am resurrecting a post I wrote from 2007 (with a few edits) regarding the physiology of fear. We often view fear as only a spiritual or faith problem. But for those who want to know what is going on in their bodies when they experience fear, consider the following:

(Those interested in other posts on anxiety can search that and related terms in the search box at the upper right hand of this blog)

…

Am teaching on anxiety, panic, and OCD tonight. Definition of anxiety: Responding to ambiguous stimuli (life situations) by reading them in the worst or most dangerous possible light. The Scriptures teach us that fear and worry are not good things. Time and time again God tells his people not to be afraid. We see that God wants us to see life through a different set of eyes, much as Elisha wanted his servant to see the army of angels instead of their enemies (2 Kings 6). But given the numerous encouragements to not give in to fear, we must admit it is a common struggle for every human being. Some struggle more than others.

What is going on with those whose lives are filled with worry and fear? Are they less spiritual? More sinful? It is easy to say, “buck up” to folks who are anxious–and entirely unhelpful to most. Logical challenges to fear (e.g., really, what is the chance you will die in a plane crash today?) may help some in the moment, but usually don’t get to the root of the matter. Jesus encourages fearful people by pointing them to see life from 40,000 feet. He doesn’t deny risk and suffering but encourages folks to keep their eyes on him. And with Peter, he reaches out to grab him even when he does start looking at the waves.

But what of the physiology of anxiety? What do we know and how does the christian counselor make use of the data?

  1. Fear responses are quickly learned and seemingly etched into the amygdala. One bad experience of food poisoning from a turkey sandwich at Applebees means my stomach tenses a little when I see deli turkey, even without remembering the food poisoning. Imagine what happens if you suffer repeated assaults or worse! The earlier the person is exposed to deep fears, the more likely they suffer from hyperarousal and startle responses.
  2. Neurotransmitters are involved which means you act first and think later. There’s little conscious cognitive processes involved until after anxiety is under way. Fear inducing stimuli lead to immediate neurotransmitter changes that then divert blood from organs to muscles. Tension builds, shallower, less effective breathing begins. Carbon Dioxide levels decrease in the blood stream which in turns creates pain, numbness, and a sense of danger. And so the cycle continues. During and after, we make attributions and so enhance the connections of the feared stimuli and our flight response. The higher the perception of pain, the greater fear/flight response. Despite medical advances, most of our medications either shut down the feed-back loop (beta blockers, anti-anxiety meds like xanax) or attempt to increase the available neurotransmitter serotonin associated with positive outlook.
  3. OCD, in particular, has some probable links to early exposure to viruses such as Strep and Flu. There is a higher incidence of OCD in people born during winter months and who live in colder climates. The link is not clear.
  4. PTSD patients have higher right hemisphere brain activity (than do non-PTSD individuals) when exposed to anxiety provoking stimuli. Further, it appears that trauma patients have greater difficulty coming back to “center” after a trigger. Likely the hypothalamus and other brain structures are overactive in the stress response and do not “cool” down quickly.

That’s just a few things we think we know about the physiology of fear. Now, what do we do with fear from a spiritual standpoint?

  1. Worship. Worship/meditation on other things takes our attention away from the fear stimulus. It forms habits and relationships as we repeat what we want to believe until we actually own it and believe it on its own merits.
  2. Fight. We do challenge our thinking as soon as we can. Yes, the fight/flight chemicals are coursing through our veins but we challenge just the same so we can break some of the connections and the ways we reinforce our fears. One other way we fight may seem a bit odd. We admit there are real things that are scary and overwhelming out there. We do not try to deny the reality of suffering (past or future) but admit it over and over. It is scary to die. I was assaulted in that alley. I am in pain and more may be coming. But, God is with me and it is good to call on him and ask him tough questions about his protection of me.
  3. Stay Present. Being present in the moment is essential to avoiding living in the fear of the past or the future. Some fear is indeed in the present but most are not. When I am able to focus or describe the now, I am less likely to be imagining a future feared event. “Right now I am sitting at my desk and looking at a picture of my children and enjoying the smiles on their faces. Right now I am getting ready for bed and working on a sudoku puzzle and noticing that I am getting tired.”
  4. Work. Building habits where I do not allow myself to run from the feared situations (where appropriate!). Moving myself closer to some of the feared scenarios in a slow and consistent manner. No, this is not flooding (where you are dumped in the pit of snakes because you have a phobia of snakes…). Allow the work to take the time to reorient the deep recesses of the brain. Don’t expect or look for immediate change!

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May 11, 2011 · 12:32 pm

Thinking about Licensure in PA?


If so, come to Biblical to meet with other interested parties on June 11, 2011. If you are working on your masters degree or already have one and want to talk through the process for becoming a LPC in PA you might benefit from talking with those who have recently gone through the process. The following link will give you more information on the lunchtime seminar and contact information to RSVP should be interested in attending.

bib-0511-F2

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April 13, 2011 · 8:24 pm

Webinar on Complex Trauma: April 19, 2011


Diane Langberg and I are scheduled to do a three hour webinar for the American Association of Christian Counselors (AACC) on the topic of complex trauma and sexual abuse. It will run live April 19, 2011 from 6p to 9p. You can learn more about the content of the webinar by visiting this link.

Use the above link to register. Cost is $59 to “attend” via your computer or $69 if you want CEUs. AACC is able to give 3 CEUs for those needing APA and NBCC approved continuing ed.

Our presentation will be broken into 4 segments with Q & A. Topics include: overview, differential diagnoses, 3 phase treatment approach, educating the church about trauma, connecting victims to God, counselor self-care, and next steps for church leaders.

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April 7, 2011 · 5:46 pm

Relationship’s role in therapy?


How important is it to get the right kind of counseling/therapy modality? How important is it to get the right person?

These questions plague both researchers and the people looking to get better. Why do some clients get better and others do not? Why do some therapists have a better success rate and others do not? Does the kind of therapy matter?

Well, as you can imagine, the answer is, “it depends.”

Yes, diagnosis and assessment do matter. If your child begins to struggle with bed-wetting after having been continent, you need to know what the problem is and what to do about it.

But, consider this: various studies make overlapping comments as to what really is going on when people get better

  • One researcher suggests that some 85+% of the reason for change are factors pertaining to the client and what is called “extratherapy” factors (social support, physical health, etc. )
  • Another places the portion the therapist plays in the 13% or so

Confusing? Consider this stark fact presented at a recent conference I attended

Patients receiving placebos from the top (best?) 1/3 psychiatrists fared better than patients who received actual medications from the bottom 1/3 psychiatrists. This was cited from the following study: Kim, D., Wampold, B. E., & Bolt, D. M. (2006). Therapist effects in psychotherapy: A random-effects modeling of the National Institute of Mental Health Treatment of Depression Collaborative Research Program data. Psychotherapy Research, 16(2), 161-172.

So, when you are looking for a therapist or psychiatrist, you may want to know if he/she studied at Harvard or a degree mill. But, you may be better served to by one who listens to you, doesn’t fall asleep, and is able to collaborate with you to find a solution that works for you.

The moral of the story? Better to have a good psychiatrist with no meds than a poor one with a gunnysack full of pills.

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February 25, 2011 · 11:09 am

Strengths profile


I’m advising one of our DMin students on his dissertation. He is researching how the use of Gallup’s Strengthfinders assessments and some training materials from World Harvest Mission might help build better functioning ministry teams.

This is my first time getting to see how the Strengthfinders works. So, Drew, the student, gave me the assessment. This tool returns the top five strengths themes (out of 34) based on my answers to the questions on the test. Here is my Gallup profile (in order of strength) with a few descriptive sentences:

Relator

Relator describes your attitude toward your relationships. In simple terms, the Relator theme pulls you toward people you already know. You do not necessarily shy away from meeting new people—in fact, you may have other themes that cause you to enjoy the thrill of turning strangers into friends—but you do derive a great deal of pleasure and strength from being around your close friends. You are comfortable with intimacy. Once the initial connection has been made, you deliberately encourage a deepening of the relationship. You want to understand their feelings, their goals, their fears, and their dreams; and you want them to understand yours. For you a relationship has value only if it is genuine.

Individualization

Your Individualization theme leads you to be intrigued by the unique qualities of each person. You are impatient with generalizations or “types” because you don’t want to obscure what is special and distinct about each person. Instead, you focus on the differences between individuals. You instinctively observe each person’s style, each person’s motivation, how each thinks, and how each builds relationships. You hear the one-of-a-kind stories in each person’s life. Because you are such a keen observer of other people’s strengths, you can draw out the best in each person. This Individualization theme also helps you build productive teams. While some search around for the perfect team “structure” or “process,” you know instinctively that the secret to great teams is casting by individual strengths so that everyone can do a lot of what they do well.

Strategic

The Strategic theme enables you to sort through the clutter and find the best route. It is not a skill that can be taught. It is a distinct way of thinking, a special perspective on the world at large. This perspective allows you to see patterns where others simply see complexity. Mindful of these patterns, you play out alternative scenarios, always asking, “What if this happened? Okay, well what if this happened?” This recurring question helps you see around the next corner. There you can evaluate accurately the potential obstacles. Guided by where you see each path leading, you start to make selections. You discard the paths that lead nowhere. You discard the paths that lead straight into resistance. You discard the paths that lead into a fog of confusion. You cull and make selections until you arrive at the chosen path—your strategy. Armed with your strategy, you strike forward. This is your Strategic theme at work: “What if?” Select. Strike.

Intellection

You like to think. You like mental activity. You like exercising the “muscles” of your brain, stretching them in multiple directions. This need for mental activity may be focused; for example, you may be trying to solve a problem or develop an idea or understand another person’s feelings. The exact focus will depend on your other strengths. On the other hand, this mental activity may very well lack focus. The theme of Intellection does not dictate what you are thinking about; it simply describes that you like to think. You are the kind of person who enjoys your time alone because it is your time for musing and reflection. You are introspective. In a sense you are your own best companion, as you pose yourself questions and try out answers on yourself to see how they sound. This introspection may lead you to a slight sense of discontent as you compare what you are actually doing with all the thoughts and ideas that your mind conceives. Or this introspection may tend toward more pragmatic matters such as the events of the day or a conversation that you plan to have later. Wherever it leads you, this mental hum is one of the constants of your life.

Learner

You love to learn. The subject matter that interests you most will be determined by your other themes and experiences, but whatever the subject, you will always be drawn to the process of learning. The process, more than the content or the result, is especially exciting for you. You are energized by the steady and deliberate journey from ignorance to competence. The thrill of the first few facts, the early efforts to recite or practice what you have learned, the growing confidence of a skill mastered—this is the process that entices you. Your excitement leads you to engage in adult learning experiences—yoga or piano lessons or graduate classes. It enables you to thrive in dynamic work environments where you are asked to take on short project assignments and are expected to learn a lot about the new subject matter in a short period of time and then move on to the next one. This Learner theme does not necessarily mean that you seek to become the subject matter expert, or that you are striving for the respect that accompanies a professional or academic credential. The outcome of the learning is less significant than the “getting there.”

Pretty good description I think…I like to relate to a small group of people. I like getting deep with a few. I enjoy the work of seeing the individual differences of friends, staff, clients, etc. I’m pretty good at getting a plan of action going right away. I’m not so good at carrying it out because I love to think and learn and so new information is always available and since I like to think about a wide diversity of things, it can be hard to stay focused on any one thing for too long. 

What I like about this particular tool is that it looks at a variety of strengths rather than personality traits.

Anybody have experience with this tool?

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February 22, 2011 · 11:47 am

One treatment protocol for many DSM diagnoses?


Could we devise one mental health treatment for many counseling problems? Given that so many problems have similar symptoms (anxiety, mood dysregulation, vigilance, intrusive and unwanted thoughts, etc.) and appear to involve common neurobiological processes (limbic systems), might we be able to find a single treatment for multiple expressions of problems?

David Barlow and others say yes.

The Renfrew Center (an eating disorder clinic) publishes Perspectives: A Professional Journal of the Renfrew Center Foundation, a free journal. In their Winter 2011 issue they have a brief article by David Barlow and Christina Boisseau about a new “transdiagnostic unified treatment protocol” (UP) that can be applied to all anxiety and depressive (and eating) disorders. Let me summarize a few points from the article:

  • 70 to 80% of clients with eating disorders also have anxiety disorders, 50% meet criteria for depression
  • A number of anxiety and depressive disorders have emotional dysregulation as a central theme
  • Etiology of these diagnoses may be best accounted for by “triple vulnerability theory”: biological vulnerability to negative mood…early negative childhood experiences due to attachment issues or unpredictable environment leading to an elevated sympathetic nervous system…and psychological learning from an event focusing on a particular issue (anxiety, panic, observation of parent’s panic, etc.)
  • The Unified Protocol (UP) focuses on “the way that individuals with emotional disorders experience and respond to their emotions” (p. 3). UP consists of 5 core modules
    • emotional awareness training (focus on “nonjudgmental present-focused awareness”)
    • cognitive reappraisal (“identifying and subsequently challenging core cognitive themes”)
    • emotion driven behaviors (EDB) and emotional avoidance (identifying maladaptive EDBs, learn new responses and avoid avoiding emotions)
    • awareness and tolerance of physical sensations (self-explanatory…as they relate to emotions)
    • emotion exposure (“…goal is to help patients experience emotions fully and reduce the avoidance that has served to maintain their disorders(s)”)
  • These modules are flexible and shaped to the individual needs of the client

Obviously, there is much work to be done to validate this protocol but it makes sense. You can see the CBT foundation but also a greater focus on emotion rather than cognition.

Those interested in the full text and references can find it here!

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February 17, 2011 · 5:34 am

Report on sexual violence in the DRC


I’m coming late to this but just finished reading an April 2010 report on the problem of rape in the Eastern Democratic Republic of Congo. The report is supported by Oxfam and is written by the Harvard Humanitarian Initiative. You can read the 66 page report or quick overview by clicking here.

What they document (between years of ’04 and ’08) is a retrospective study of 4,311 rape victims at post-rape interview at Panzi Hospital in South Kivu area (well-known for their pelvic surgeries to repair fistulae caused by rape). The results indicate that while war-related rape may be decreasing, there is an over 1700% increase in civilian rape. Evidence of a culture change as a result of a war?

Very difficult read. Most victims were gang raped at night, in their homes, in front of their families. Necessary for those who want to understand the experiences of these women. Most of the efforts to help are about either (a) surgical repair or (b) economic recovery. This makes total sense since these are the top two issues victims face (often victims are abandoned by their families or lost their families during the rapes). But what to do about psychological trauma? What works for these women who do not have the time nor the money to go to therapy?

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February 16, 2011 · 9:57 am

More on Narcissism


Hadn’t read my Monitor on Psychology (Feb 2011 edition) til this morning and saw that the cover story is on the possible rise of narcissism in young folk these days. Now, this magazine is popular and doesn’t go too deep into reporting on research…and I haven’t followed up on the studies to read them for myself, but…

  • one study has 80% of middle school students scoring higher on self-esteem in ’06 than ’88
  • Another shows an increase in the lifetime prevalence of NPD
  • However, no nationally representative samples comparisons have been done to really shed light on whether a rise is truly taking place
  • One meta study of 85 studies (between ’82 and ’06) suggests an increase of narcissism among college students

The article goes on to muse about whether materialism and social networking lead the way toward narcissism but also wonders whether the decrease in availability to easy credit will lower the self-promoting trend a bit.

In an ironic twist, it appears that the DSM 5 may not include NPD as a diagnosis. Rather. It will include a more general diagnosis (see below taken from the DSM5.0rg site). Strangely, one of the “types” is NOT narcissism.

The essential features of a personality disorder are impairments in identity and sense of self and in the capacity for effective interpersonal functioning. To diagnose a personality disorder, the impairments must meet all of the following criteria:

A.    A rating of mild impairment or greater in self and interpersonal functioning on the Levels of Personality Functioning.

B.    Associated with a “good match” or “very good match” to a personality disorder type or with a rating of “quite a bit like the trait” or “extremely like the trait” on one or more personality trait domains.

C.    Relatively stable across time and consistent across situations.

D.    Not better understood as a norm within an individual’s dominant culture.

E.    Not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

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February 14, 2011 · 5:59 am

Resources about narcissism?


Cover of "The Drama of the Gifted Child"

Cover of The Drama of the Gifted Child

A few weeks ago I was asked about resources on the topic of narcissism, things a person struggling with some of the features might read to better understand their inner world. I didn’t have any really great “lay” materials on the topic so I’m going to poll the audience. A perfect entry for Valentine’s Day when we celebrate those people who make us feel special!

Narcissism is an ugly word if it is used about you, as in, “you’re so narcissistic!” This usually means someone sees us as being self-centered.

The truth is…most of us have a touch of it at times. We desire affirmation, we fantasize about being recognized for our achievements, we want to be special (or at least seen that way), we have times of feeling entitled and may even manipulate the feelings of others to get what we want. Our focus on self may limit our empathy towards others. We may be haughty. All of have some of these features some of the time. Some of us have these features most of the time.

Having these feelings doesn’t mean we are personality disordered. But, our willingness to acknowledge and work on being more other centered MAY reveal whether we meet diagnostic criteria. Meaning, if you can admit to the problem and improve your capacity for empathy then you probably aren’t meeting criteria for a personality disorder.

What causes narcissism?

The simple Christian answer is sinful self-focus. But since ALL of us are sinners and flawed…can we be more specific why some people seem to struggle more with the problem, why some have an enduring bent  or a fixed pattern of relating to the world? One theory suggests that narcissistic features arise out of a lack of mirroring which results in a deep fear that we aren’t special…or worse, are worthless. There is likely some truth to this. However, it seems that some narcissism is encouraged in a me-first culture.

Resources?

So, what resources do you know that get at some of these experiences, desires, feelings of narcissism that could help a person be more aware of their impact on others.

Here’s a few reads I know about:

1. Drama of the Gifted Child, by Alice Miller. A classic psychodynamic read about our emotions. She does a nice job illustrating the fears/cravings of narcissism and borderline features and how we all have a touch of these. Not necessarily helpful in what to do about the experience but good to delve into the experiences of depression, grandiosity, denial, and self-contempt and what these do for us.

2. Re-inventing Your Life, by Jeffrey Young. In particular, look at chapter 16. In fact, if you follow the link, you can search “entitlement” in the “search inside” box on the left and once you get results, scroll down to the one on p. 314. You can read a bit of the chapter to see how the authors do a good job describing the common symptoms of narcissism.

3. Anatomy of Secret Sins, by Obadiah Sedgwick. Well, not exactly about narcissism but definitely about uncovering our true self-centeredness. Sedgwick lived between 1600 and 1658! Excellent read on the problem of self-deception.

If you try to search for books on this topic, you will discover (not surprisingly) most are written to those who either have to live with the person or are trying to get free of them. Few are written to the person with the problem.

Any resources you might add to the list?

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February 10, 2011 · 5:26 am

When theory, technique and person combine…


Am trying to write an academic journal article on clinical applications of Christian Psychology. Heady…I know. Too heady for me I think. However, in my study I ran across these quotes from

Leitner, L.M. (2007). Theory, Technique, and Person: Technical Integration in Experiential Constructivist Psychotherapy. Journal of Psychotherapy Integration, 17, 33-49.

From his abstract:

From an experiential constructivist position, the distinction between the therapist as a person, the therapist’s theory of psychotherapy, and techniques used within the therapy room is, in some ways, forced and arbitrary.

He starts out this article, after the abstract with,

“Becoming a psychotherapist is not about assembling a bag of tricks and learning the formula for matching tricks (i.e., techniques) with problems. What you do as a therapist emerges from who you are in the therapy room. And, when an intervention comes from who you are, it is no longer a technique.”

SO, it stands to reason that we ought to view therapists in their sessions in order to see what kind of people they are. We therapists often think in terms of theory to practice. But practice probably reveals a truer picture of our theory.

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