Tag Archives: Anxiety

May 21, 2012 · 5:31 am

Why we react and then think


Human brain parts during a fear amygdala hijac...

Human brain parts during a fear amygdala hijack from optical stimulus. (Photo credit: Wikipedia)

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

  1. 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
  2. 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.

2 Comments

Filed under anger, Anxiety, counseling, counseling science, trauma

Tagged as , , , , ,

December 19, 2011 · 1:45 pm

Stopping seasonal high anxieties: Some strategies and a better goal


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?

Practical Strategies?

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.
  • Acceptance
    • 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?

4 Comments

Filed under Anxiety, Psychology, Uncategorized

Tagged as , , , ,

May 18, 2011 · 9:22 am

Physiology of fear


Regions of the brain affected by PTSD and stress.

Image via Wikipedia

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!

16 Comments

Filed under Anxiety, biblical counseling, christian counseling, christian psychology, counseling science, counseling skills, Mindfulness

Tagged as , , , , , ,

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!

3 Comments

Filed under Anxiety, counseling, counseling science, cultural apologetics, Doctrine/Theology, Psychology

Tagged as , , , , ,

February 2, 2010 · 2:27 pm

The unpardonable sin


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!

Leave a comment

Filed under Anxiety, biblical counseling, Biblical Reflection, christian counseling, Ed Welch

Tagged as , , ,

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?

22 Comments

Filed under Abuse, Anxiety, biblical counseling, Biblical Reflection, christian psychology, Christianity, counseling, Post-Traumatic Stress Disorder

Tagged as , , , ,

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?

2 Comments

Filed under Anxiety

Tagged as ,

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.

4 Comments

Filed under Abuse, Anxiety, counseling, counseling science, counseling skills, Post-Traumatic Stress Disorder, Psychology

Tagged as , , , ,

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.

1 Comment

Filed under Anxiety, biblical counseling, Biblical Reflection, christian counseling, christian psychology, counseling

Tagged as ,

May 8, 2009 · 5:17 am

Physiology Phriday: Abuse alters genes?


Check out the following link for some very interesting research on how abuse alters the NR3C1 gene in the hippocampus which functions to limit our stress responses. It appears that when the gene is altered, it inhibits natural control of stress responses thereby leaving the abuse victim on high levels of alert.

This may give new meaning to “the sins of the fathers passed on to the third generation” comment in Scripture.

4 Comments

Filed under Abuse, counseling science, Psychology

Tagged as , ,