Recently, I was interviewed for a podcast on the topic of anxiety by Walt Mueller and the good folks at the Center for Parent/Youth Understandings. You can listen here: https://cpyu.org/resource/episode-39-anxiety-with-dr-phil-monroe/
Tag Archives: Anxiety
Over the years of doing therapy with Christians I have noticed how many feel guilty for their anxieties. “If only I could trust God more…I say I believe he is good but clearly I don’t trust him because I can’t stop being anxious.” Still others express distress that their faith in God does not change their feelings of hurt over past relational wounds and fears it will never get better.
It seems we believe this maxim: If I really trust in God, I will be at peace. I will not struggle with the brokenness around me or with the unknown future.
Is this true? Is it possible to trust God fully and experience chronic negative emotion?
Let me suggest a better maxim and then illustrate it with a couple of Psalms.
Because I trust God completely, I bring him my angst again and again.
At the recent #CCEF16 conference on emotions, David Powlison referred to Psalm 62:8a, Trust in him at all times, O people; He noted that this assertion is strong. But what does it look like in action? David pointed us to the next line (8b) Pour out your hearts to him, for God is our refuge. Trusting God looks a lot like venting, crying out in our confusion, sharing our fears and despairs.
Take a closer look at this Psalm. The writer is under assault by others. He likens himself to being a tottering fence, something easily knocked over. He is asking his enemies, “how long are you going to harm me?” He knows their intent. But their evil is the worst sort, one that pretends to be good but is really evil. They take delight in lies. With their mouths they bless, but in their hearts they curse. It is likely the psalmist could say, “with friends like this, who needs enemies?”
So, how does he talk to himself? Look at the cyclical pattern: reminder-pain-reminder-warning-reminder
- He starts with some truth. My only rest (or silence/peace) is in you God. You alone are my fortress. I will never [ultimately] be shaken.
- He laments. But you enemies are trying your best to destroy me, a weak, tottering fence.
- He reminds himself. Remember, look for rest and peace in God alone, it is only there you can find it, even when the ground is shaking
- He warns self and others. Don’t trust in your position, don’t trust in ill-gotten gain. And if God blesses you, don’t trust in the blessing
- He cycles back to truth. Remember this one thing: God you are strong AND loving. You will remain righteous in your dealings with us.
While the Psalm ends, I suspect the writer could easily have kept the pattern going, as in starting again with the first verse or adding more to the pattern.
This pattern of truth, honest admission of pain, reminder of truth is a far better picture of the reality of life hidden in Christ than the false stoic (or Zen) image of being unperturbed by the chaos in and around us. God does not remove us from the storm. Instead, we express our trust (as much to remind ourselves as in bold assertion), we lament, we groan, we pour out our troubles and we circle back to the one truth we can hang our hope on.
You can see this pattern also in Psalm 42 and 43 with slight variations: Remember when I used to be out in front leading the worship but now my tears are my only food. Why am I like this? I hope in God. But I am downcast. Day and night God is loving…but it seems you have forgotten me in my oppression? Vindicate me. You are my stronghold so why is this not getting better? Free me so I can worship you…yet I am still in despair even as I hope in you.
If you feel guilty much of the time when thinking about your level of trusting God, consider this alternative narrative: it is the greatest act of trust to keep bringing God your troubles, even when things or your response to them do not get easier.
So, does trust in God remove our anxieties? Not as much as we might think. But, if you could no longer feel guilty about your angst, might you in fact feel more peace as you trust God through the storm?
For those of you who love or are helping PTSD or complex trauma victims, you may find this video link helpful. Dr. Diane Langberg (after an introduction by me) explores the experience and process of dissociation, or “leaving” the present. She discusses why it happens and what is going on when a person dissociates. At the end of the video, she explores a few helpful ideas for helping to ground the individual in the present.
Over at the Biblical faculty blog, I have a post previously posted here. You can read it here. The trick to this antidote? It starts every 5 minutes.
I’m an anxious person by trait. It is a common trait, especially in graduate school (in combination with narcissism. I say this also in self-disclosure; both features support successful completion of doctoral studies). Anxious people tend to spend considerable time ruminating through “What if…” questions along with should, coulda, woulda thinking. We worry about our past failures coming to light and whether we’ll be up to the challenge the future presents.
Sound pretty negative way to live? It is. The only way we differ from depressed people is that we still have some thought that our worry might save us from disaster. As you can imagine, such worry robs us of joy. It keeps us from enjoying the present or seeing God’s gracious hand on our lives. And we compound our problems by then shaming ourselves for failing to follow God’s command, “Do not be afraid.”
The Five Minute Antidote
Part of the problem with anxiety is that we are trying to control/manage every possible outcome in order to avoid future disaster(s). Fearful people know that the answer to their anxiety will not include,
- Just not caring anymore. We’ve tried that…it doesn’t work.
- Making sure we get it RIGHT. Tried that too. Didn’t work.
So, what might work? Try this on for size,
What is God’s plan for me for the next five minutes?
Most of us have no clue what God is planning for us next year or even next week. But, I suspect most of us can discern what we need to do right now…for the next five minutes,
- I need to make dinner
- I need to read this assignment for school
- I need to attend to my child’s homework
- I can call a friend who is grieving
We usually know the one thing we can do for the next five minutes. Do that with as much focus as you can. Here’s what you are likely to discover: your anxiety decreases, or at least does not increase. When we stop the ruminations or internal conversations, our anxieties decrease and our ability to be present increases. So, when you find yourself in an anxious stew, try to ask yourself, What is one thing I can do for the next five minutes or What does God want me to do for the next five minutes? Consider this your method of living out Psalm 131, where you are are stilled and quieted like a weaned child, content with what He has for you for the next five minutes.
Oh, did you think this will solve all your anxiety problems? No, of course not. But where God does give you something to focus your attention, call that a success. Part of the Christian life is repetition–repeated worship, repeated repentance, repeated obedience, repeated trust. So, do pray for God to remove your “thorn” but look for five minute relief. Notice when it works and then ask God for another five minute focus on the thing he has for you RIGHT NOW.
Ever wonder why? Check out this quote by Richard McNally¹ about the role of the amygdala,
LeDoux discovered two pathways for activating the amygdala, a subcortical structure integral to the experiences and expression of conditioned fear. One pathway rapidly transmits sensory input about fear stimuli to the amygdala via a subcortical route, whereas the second pathway passes through the cortex, taking twice as long to reach the amygdala. Subcortical activation of the amygdala makes it possible for a fight-or-flight reaction to begin even before information about fear-evoking stimulus has reached conscious awareness via the cortical route.” (p. 178, emphases mine)
If this is true, then in anxiety and intense emotion-producing events our brains begin the reaction phase prior to any thought processes. If true, then we might consider
- The goal of trauma treatment or anger management is NOT to avoid having reactions but to more quickly reach cognitions and alternative emotions that help moderate a negative reaction
- the empirical evidence for the clinical process whereby a client adopts a neutral reaction as opposed to a negative reaction is quite lacking. There are a number of models that process to “cool down” the amygdala, but these treatments often lack serious empirical support.
So, the next time you instantly react in a way that bothers you, don’t be so hard on yourself. Instead stop yourself, take a deep breath, work to analyze the situation and to lean into a post hoc truth. We have our hands full enough with what we know we need to do, we don’t need to worry so much about our first reaction.
¹McNally, R.J. (2003). Remembering Trauma. Cambridge, MA: Harvard University Press.
For most people, anxiety is a looped internal conversation. It just keeps starting over even when we don’t want to listen to it anymore.
The Christmas season we’re in can make anyone quite anxious. (Don’t think so, watch this fun video to remind you why.) Those of us naturally anxious and ruminative find the added responsibilities, family stresses, and disappointments just adding fuel to the fire. You try to take a moment to rest but all you can do is think about what is yet to be done or what you tried to do but failed. You pray but before you finish you are back to your worries. You distract yourself but the looped fears keep running in the background.
What helps you decrease your anxieties and repetitive worries? Can you really suppress them? Or should you have another goal in mind than just trying to shut them down? Are there any practical strategies that work?
Daniel Wegner gave a short award address on this topic at the 2011 APA convention (now found in v. 66:8 of the American Psychologist, pp 671-680). In the address he tells us what we already know. It is hard to suppress thoughts in a direct manner (e.g., I won’t think about how much work I have to do). So, Wegner focuses on indirect strategies. Here is a sample of strategies with empirical support:
- focused distraction
- pre-planned alternative topic to think about when the rumination starts. Benefit? Avoids mind wandering which will more quickly return to the anxiety. Example: Every time I think about the conflict at work I will focus on a comforting favorite verse or an upcoming happy occasion.
- Stress and load avoidance
- Overall reduction of stress helps reduce unwanted/anxious thoughts. Focused distraction helps only to a point. Overwork which may provide some distraction will increase anxious thoughts over time.
- Thought postponement
- Choosing to postpone anxiety to a set time can work to reduce the amount of rumination experienced. Example: I’ll spend time worrying about my visiting in-laws at 4:30 pm.
- Instead of fighting and arguing with fears some find it helpful to observe fears without taking action. There is some evidence that those who accept the occurrence of unwanted thoughts have less distress than those who fight the thoughts.
Wegner goes on to mention other strategies (i.e., planned exposure, mindfulness, focused breathing, self-affirmation, hypnosis, and journaling) for reducing unwanted thoughts.
A Different Goal?
What if the goal isn’t to remove or end unwanted thoughts and anxieties but to cope with them and not to be dragged along by them? Does this sound like failure to trust God? Failure to be at peace? if the goal is to trust God in the midst of uncertainty and anxiety, what would that look like? How would you know that you were doing well? To do this we would need to give up on the goal of having an absence of anxiety and to reimagine peace as something one can have in the midst of angst. After all, we are not seeking to be absent from this world but to live in the world that is full of chaos and uncertainty.
Here are two goals you might consider:
- Being okay with things not done to perfection and with the disappointment of others who have come to expect perfection from you
- Experiencing anxious thoughts as normal and yet savoring moments of rest when they present themselves
- Using one strategy for anxiety reduction each day
So, how do you measure your seasonal high anxieties and what goal do you seek to reach during this Christmas season?
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?
- 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.
- 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.
- 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.
- 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?
- 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.
- 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.
- 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.”
- 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!
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!
Ed Welch has a good post at www.ccef.org on the “unpardonable sin” passage found in Matthew 12. This is a worrisome passage for many–especially those with scrupulosity (aka Obsessive Compulsive Disorder). He hits the nail on the head that the flip answer, “if you are worried about this, you haven’t committed it” is both likely true but also insufficient for the true worriers among us. So, his post goes in great detail about the passage, its context and good conclusions to draw from it. Well worth your read!