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 17, 2011 · 5:56 am

What is the difference between a trial and a stressor?


Words matter. The words you use to describe an event really do shape how you will view it and how you will respond to it. For counselors, the words they use to conceptualize a client/case will shape how they see clients and how they will attempt to intervene. This is why I take considerable time in my Practicum class to practice case conceptualization.

Most beginning counselors are good at collecting information. But, for most, that data might well be a hopelessly knotted  ball of twine.  Where to start pulling? How do we make sense of the various pieces of data? And since data never comes to us uninterpreted, which “data” do we tend to gravitate to? Behaviors? Family history? Motivations? Biology? Environment? Client beliefs? But even more confusing are the words we use to describe these sectors of life–and the meaning they convey!

Stressor v. Trial?

Here’s how language influences case conceptualization. Your client experiences long-term family discord due to an adult child with schizophrenia. The family member routinely goes off medications and the police have to be called in order to transport him or her to the hospital after threatening self-harm. Your client comes to counseling to seek support for handling this difficult situation. As you can imagine, the client feels alone, worn down, and wondering how to keep going despite no sense that the situation will get better any time soon.

What do you imagine might be the impact of calling this family situation a trial? And how might you view it differently if you called it a stressor. Notice any differences? Benefits of each? Drawbacks of either? In your mind, are they equivalent? (See Eric Johnson’s brief discussion of these two words and their similarities/differences in regard to Christian psychology in his Foundations for Soul Care, p. 240)

Here is my thinking. Within Christian tradition, a “trial” signifies a difficult time or season but from a spiritual or divine perspective. It conveys a purpose–a testing or proofing of one’s faith. We tend to view trials (or desire to at least) from an eternal point of view, “testing of your faith produces perseverance…”  (Jas 1:3). Notice that while “trial” does signify difficulty, the focus is largely on the purpose it serves.

On the other hand, a “stressor” is something that causes stress or distress in a person’s life. Notice that this word carries no sense of eternity, divine value or purpose. It merely describes a facet of life that is troubling a person’s life.

Imagine with me a counselor who uses “trial” to describe the distress in the life of the client mentioned above. How do you expect that might shape the counselor’s view of the situation and thus response sets to that client? Would our counselor be more likely to view the trial as something to endure, more likely to engage in spiritual conversations so as to find comfort and peace in the middle of the storm? Would their conversations tend toward the hope of heaven? Is it possible that using the language of trials might cause a counselor to ignore the real-time experience of distress?

Now imagine the counselor who uses “stressor” to describe the same distress. Would this counselor be more likely to discuss in detail the physical, psychological impact of living with a mentally ill and unstable family member? Would this counselor then be more focused on finding ways to decrease the moment-by-moment stress levels? Is it possible that using the language of stressor might cause a counselor to ignore an eternal perspective?

Hopefully, you can see the value of both word meanings and the interventions described. It is possible to use the language of trials and focus in on the details of how that trial impacts the client. And it is possible to use the language of stressors and keep in mind an eternal perspective. Whatever language, the interventions off stress education and reduction and hope building are necessary interventions.

If you are a counselor or counseling student, observe the language you use to describe your clients and their lives. How does that language influence your view of them and the interventions you might use with them?

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May 16, 2011 · 10:43 am

God Behaving Badly – InterVarsity Press


David Lamb, a colleague, as just published a book with InterVarsity Press entitled, God Behaving Badly: Is the God of the Old Testament Angry, Sexist, and Racist? If you have found yourself asking or being asked this question, you might find this book a help. Dave doesn’t shirk from the questions that most find difficult to answer. Plus, the book is VERY easy to read. He interjects personal stories and funny media depictions of God in such a way as to illustrate his points (What do Bruce Almighty and Elijah have in common?) and does not use highly esoteric language found in some OT oriented books.

I believe you will be hooked right from his first question on page 1: “How does one reconcile the loving God of the Old Testament with the harsh God of the New Testament.”  Don’t we usually ask this the other way around? You’ll see David has been thinking about these topics for some time.

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May 14, 2011 · 11:53 am

Lithium in your water? Might it be beneficial?


Here’s an interesting finding. A research team compared the top ten lithium-enriched regions of Austria (areas with naturally occurring lithium in the water) to the top ten lithium depleted regions of the same country. Those regions with greater naturally occurring lithium levels had statistically fewer suicides than those regions that had low naturally occurring lithium. The research does not prove a causal link between suicide levels and lithium levels in the water. It could be that there are better treatments or facilities in those regions. But, it does give you pause.

Lithium is, you may recall, a salt which is used to treat affective disorders like bipolar disorder. For many years doctors considered it the gold standard treatment. Many still do even though compounds like Wellbutrin and some anti-psychotics are also used to treat bipolar disorder.

While NO ONE is considering prophylactic use of Lithium (like we do now with fluoride in the water), this research does beg the question: at what point would preventative Lithium be appropriate? In other words, how many lives would need to be saved to make it something that we would want to give to everyone? Or, should we only give it to those who are deemed at-risk?

Assume for a moment that the cause for the lower suicide rate is the presence of Lithium in the water. Further assume that the research data is accurate in finding that the suicide rate in the Lithium enriched areas is 11:100,000 while the suicide rate in the depleted area is 16:100,000. I doubt that anyone would promote public distribution in order to save 5:100,000 but I do wonder what the number would need to be before anyone would recommend blanket addition to the water supply.

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May 13, 2011 · 10:54 am

Ascertaining adult victim culpability


In a recent training on the topic of pastoral sexual misconduct, I was asked a question about the culpability of an adult victim. The question went something like this:

I know that a pastor who engages in sexual activity with a parishioner carries the bulk of responsibility for the immoral conduct. But doesn’t the woman that he had an affair with have some responsibility as well? Isn’t she culpable for something?

It is a question I have been asked many times–and a very good one. It is good because it causes us to think through how to respond to such individuals caught in a tragic situation. It is also good because it causes us to examine our own beliefs and impressions about justice.

Now, let me give you all some context on that question I received. This kind of question usually arises when discussing how we think about sex between a pastor and an adult parishioner that appears to be consensual. It usually is asked after I have made the case that the ONLY proper term for sex between someone with authority (legal, spiritual, work, etc.) and someone who is under authority is…sexual abuse. In this case, it is pastoral sexual abuse. Consequently, we ought NOT use the word affair to describe the relationship. The reaction behind the question about culpability has to do, I think, with the perception of choice, freedom to say no, signs of pursuit of a sexual relationship, etc. It doesn’t seem fair or just to let the person (woman in this example) off the hook.

The world recognizes that sex between teacher and student, pastor and parishioner, prison guard and prisoner, adult and child are wrong. Sex in these “forbidden zones” is abuse. But of course some power differentials don’t seem so large as others. We get that a prisoner has little choice to say no to a prison guard. But what about a friendly pastor and a lonely woman who enjoy each other’s personalities and then end up engaging in an affair? Is it really abuse? Is it abuse if she sought the relationship or sought to continue it after the first line crossing?

Here’s how I tend to try to respond. Stick with me as the matter is complex.

1. No matter what efforts the woman makes, the pastor is ultimately responsible to protect the integrity of the relationship. Thus, the pastor bears all the culpability for crossing the line.

2. The woman may bear some culpability for decisions and choices that set her up for this relationship. Maybe she fantasized about being loved, maybe she have desired power and found that sex is the ultimate power move. But just as likely she may have VERY LITTLE culpability. I’ll explain why next. But even if she does bear some…here’s a question I want you to pause on:

Why do we jump to this question right away? What drives us to want to settle questions of responsibility? What do we fear will happen if we treat her as a victim right now and leave culpability questions for a later time?

3. Not only does the pastor bear the blame for the sexual relationship, the pastor is likely to have used any number of techniques (in a knowing way or a self-deceived way). What are most pastors good at? Words. Words with emotion. Setting a tone. A pastor is usually quite gifted in convincing others that what they think, say, feel is right. Thus, their words shape, manipulate, coerce, groom the other into being open to a sexual relationship.

4. How do most cases of pastoral sex with adult parishioners begin? In the pastoral counseling office. A needy person feels desirous of pastoral care, seeks out the pastor and within that context, the pastor begins shaping the relationship which leads to sex. Now, it is possible that the parishioner is also a leader in the church, either paid or volunteer. Would such a person have greater culpability. Likely. But again, I could not answer this question until after evaluating the techniques of deception used by the pastor.

Conclusion? Culpability lies so heavily with the  person in power–the pastor–that victim culpability cannot be ascertained until (a) the pastor’s techniques of deception are better understood, (b) the victim has received help for the damage done to him/her by the pastor, and (c) opportunity for spiritual healing is present. Finally, this set of values I have laid out here do not require that we treat the pastor harshly. We also want to help the pastor understand what brought him/her to this point in life. And yet, we do not need to spend much time, at first, trying to determine guilt.

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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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May 6, 2011 · 12:45 pm

Guest post/article on www.christianpsych.org


For those interested in Christian psychology and its future, you can read a short essay I wrote on the topic here

Check out the site for other interesting blog entries. It shows the diversity of ideas and interests in the field.

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May 4, 2011 · 5:50 am

Some thoughts and emotions on justice


What is justice? How do you go about determining what is just and what is unjust?

If you are like me, you’ve had a number of conversations and thoughts about justice in the last 48 hours. I can only believe that such conversations about justice are good, especially if we apply our philosophies to ourselves as well as others.

So, how do you answer my first questions? Do you lead with your intellect or your emotions? Let’s consider each (even though we can’t really separate these two parts of our being)

The intellectual approach to determine what is just

1. What is legal? Lawful = just. This works if you assume that those who create the laws are just lawmakers. But, we all can point to some draconian laws that we would not consider just.

2. What is deserved? Justice = penalty fits the crime. If you get what you deserve, an eye for an eye, then you have been served justice. Of course, if we follow this thinking, it could be just to walk up to a pedophile and castrate him. This would be illegal whether he was tried and convicted or not.

3. What is adjudicated fairly? Justice = blind adjudication. If you are accused of a crime, then justice is served if you receive a fair trial. However, justice does not hold exactly the same meaning as fair. It more accurately means righteous. One could have a fair trial and still get away with murder.

The emotional approach to determining justice

If we are truthful, our emotions tell us what is just. We hear of someone getting their due and we feel relief. Or, we hear someone who got his due but we hear that the one measuring out justice did so in a vicious or destructive way…and we feel conflicted if not downright sickened. Some of our thoughts on justice reveal certain values that we have yet to articulate. Consider the following options from an emotion perspective:

  • Law enforcement attempts to capture a killer but uses deadly force because they thought they saw him reach for a gun
  • A soldier kills an opposing soldier on the battlefield
  • A soldier kills an opposing soldier who was unarmed and running away
  • A soldier kills an opposing soldier who had dropped his weapon and raised his hands in surrender
  • A mass murderer who was not given a final time to give self up before being shot to death
  • A mass murderer killing another murderer who had only killed once

I suspect we could argue that in each case, the killing was legal, even deserved. But does it pass the emotional smell test?

Think this is a new issue? Then check out Habakkuk in the Old Testament. He raises a complaint to God about the sinfulness of his own people, Israel. God answers him and tells him that a heathen group of terrible sinners will bring just punishment on Israel. Habakkuk, as you might expect, struggles with this. “You are going to you THEM? Why they are the WORST!” God answers and tells him that he, God, is going to act in righteous and mind-blowing ways. And Habakkuk responds in only the faithful way he can: I see your fame, I see your Glory and I stand in awe. You are just in all you do. And even if there is no food to eat, I will yet praise you.”

Justice, it turns out, doesn’t always make sense to us. It may be easier to tell what is not justice than what is. For example, we ought not promote pragmatism (e.g., killing someone because jailing him will cost too much) or vengeance (e.g., eye for an eye…since bin Laden didn’t warn 9/11 victims, we ought not warn him).

We cannot go on human laws alone, intellect (as good as it is), or feelings. God’s view of it surpasses all of these ideas. And even when we come to terms with justice, we recognize that justice, without mercy also, is something none of us want to see. We will treat others better than they deserve. We will rejoice when evil men may no longer harm. We will be thankful when governments deliver justice and yet hold them to higher standards than those they judge. We will not return evil for evil. And we will mete out justice yet knowing that we too will face our day of justice as well. And so we will ask God for the grace to live justly, love mercy, and to walk humbly!

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May 3, 2011 · 5:54 am

Sign up now for 3 great summer courses!


Biblical is now taking registrations for summer elective courses in counseling. We have 3 offerings (each 1 credit) you won’t want to miss!

  1. MAC712 A Healing in International Settings (ONLINE), July 1-31 2011 Summer Class Syllabus
  2. MAC713 A Christian Counseling in the Postmodern Context (ONLINE), August 1-31 CC in PM Context 2010 Syllabus
  3. MAC701 Forgiveness (IN PERSON), August 12-13

I teach the first course, I co-teach the second course with Dr. Richard Smith, and my colleague, Dr. Bryan Maier teaches the course on Forgiveness. The two on-line courses are designed to be done over 4 weeks with NO pre and post work. The “bite” of work is small since it is spread out. Dr. Maier’s course is one weekend and will require some pre and post work. Each of these courses can be audited (but later cannot be turned into credit)

Where to register?

  • First time students (or grads of other programs looking for some additional training: pbyrd@biblical.edu
  • Returning students/alumni: kmehlbaum@biblical.edu

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May 2, 2011 · 8:57 am

What is the proper response to Bin Laden’s death?


Last night as the news media began telling of Bin Laden’s demise I began contemplating this question: What is a proper response to his death or, for that matter, the death of any oppressor, abuser or grossly unjust person? What is the right response?

Celebration? I heard one person say they were not celebrating death but were celebrating the end of a mass murderer. Glee? Wishing him well in hell? Praising justice or vengeance? Confidence? (immediately, news outlets were noting futures for markets and the US dollar were on the rise and oil futures were on the decline)

Or, should we merely mark it with somber reflection on all those who died at his hand or in the attempt to bring him to justice over the past ten years?

Is there a best response? Here are some words that come to mind:

  • Relief. Something undone has been completed. At least one era has come to an end. One person seeking harm to another can do no more.
  • Joy. Now this is a complex emotion. You will see at the bottom I do not think we ought to gloat. But joy is a proper emotion when right is defended and wrong is put away. Now, this emotion needs tempering because in this world, we can easily defend righteousness with wrong actions and motives. You damage me so I, in turn, take out my wrath on your family. So, our joy must be tempered by the knowledge that “they” are not always evil and “we” are not always good.
  • Satisfaction. Any time justice is served, there is a level of satisfaction or vindication. Never fully experienced in this life, but in bits and pieces. (Of course there will be ongoing conversation about whether this was carried out in a just manner)
  • Remembrance. Of those who died as victims to a tyrant (and their families), of those who died trying to bring a tyrant to justice.
  • Reflection. Several kinds of reflections are quite appropriate. First, it is good and right to reflect on justice as a key character of God. Such reflection ought to cause us also to reflect on our own need for mercy in light of our own failings. We can reflect on how we want to handle future tyrants and how we speak about those who are quite different from us.
  • Pray. We can pray for peace. We can pray for protection of those who still serve in harm’s way. Pray for an end to the training of malleable children into practices of war, whether a child suicide bomber in the Middle East or a child soldier in the Congo.  We can pray that we will not turn a blind eye to injustices within our own communities. It is deadly to think that injustice is only in other countries. Remember, turning a blind eye to injustice in our midst is being complicit with the actual act of injustice.

While joy is a proper response to justice (Prov 21:15), I would think we ought not celebrate or gloat. Proverbs 24:17 tells us not to gloat when our enemy stumbles. But later in the same chapter it does tell us that there will be blessing for those who convict the guilty. Let God be the author of that and let us not attempt to bless ourselves.

If we rejoice, we ought to rejoice that God is in heaven and that our names are written in the book of life (Luke 10:20). Rejoice that all things here will pass away and one day there will be no more need for armies and warfare.

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