Starting July1 I will be teaching an on-line course, Healing Trauma in International Settings. Here’s the introductory video for students to watch during week one that tells what I plan to have them do during the course. Don’t worry, most of the course ISN’T watching me talk. You can see the full syllabus here.
Tag Archives: counseling
Physiology of fear
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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?
- 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!
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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.
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Filed under christian counseling, counseling, counseling science, Uncategorized
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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Filed under counseling, counseling science, counseling skills, Uncategorized
Single session therapy?
Anybody ever found just one session of counseling productive (meaning you only went once but it was extremely helpful)?
Counseling takes time…usually. You want to get to know your client, hear their history, learn how they think and feel, what they have already tried, and walk with them into some new ways of thinking or responding to their life situations. This kind of work takes time, a lot of time in some cases. And the solutions take even more time.
But I suspect there are some folk who could benefit from just 1 hour of troubleshooting. If you have had one of those experiences, what happened? What was helpful?
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Filed under counseling, counseling science, counseling skills, Uncategorized
Additional information on the March 2011 sex trafficking and abuse conference at Biblical Seminary
I’ve mentioned the conference before here on this site. But here is additional information for those considering the conference in order to acquire either graduate academic or continuing education credit.
NOTE:
- Conference dates: March 17-19
- The conference is free for all attendees, only those who want CEs or grad credit will have to pay a fee
- A PDF of the information below is available here: Please pass on to anyone who might be interested.
Continuing Education at Biblical Seminary
March 17-19, 2011
The Biblical Call: A Christian Response to Human Trafficking and Sexual Abuse[i]
Mental health professionals and clergy interested in attending this seminar may be able to acquire 10 contact hours of continuing education by attending this conference. Biblical Seminary is an accredited graduate institution and thus is qualified as a pre-approved provider of continuing education in the form of graduate coursework by Pennsylvania’s State Board of Social Workers, Marriage and Family Therapists, and Professional Counselors (§47-49.36) and Pennsylvania’s State Board Of Psychology (§41.59). (Attendees who wish to receive academic credit should follow directions in the footnote below.)
While Biblical Seminary provides verification of attendance and a transcript showing completion of the CE course, attendees are responsible to verify acceptance of these hours by their particular licensing boards prior to registering and paying for CEU credits.
The following information may be used to apply for approval to your licensing body.
Speakers:
Diane Langberg, PhD; Bethany Hoang, MDiv; Pearl Kim, JD; Robert Morrison, MBA; Philip G. Monroe, PsyD
Seminar Overview:
This conference continues the “Conversations on Christianity and Culture” series focusing on sexual violence and injustices in a variety of contexts: domestic and international settings and sexual abuse in Christian communities. Attendees will explore these issues from biblical, psychological, legal, and sociological perspectives. The conference will conclude with a focus on practical intervention and prevention strategies.
COST:
The conference is free for all attendees. Register here. Those who wish to receive CE credits will be charged $20.00 per CE unit (0-9 credits) or $180.00 for all 10 CE units. Attendees will be billed following the conference and certificate of attendance will be held until payment is received.
Educational Objectives:
- Become familiar with the psychological and sociological data regarding domestic and international trafficking phenomena and also sexual violence within Christian settings
- Describe common community and individual consequences resulting from these sexual traumas
- Consider biblical and theological factors relating to sexual violence
- Identify effective and practical interventions as well as preventative actions to treat and stop sexual slavery and sexual violence
Tentative Schedule:
Thursday, March 17
| Speaker | Title | Time length |
| B. Hoang | Biblical Call: Response to Violence (obj. 3) | 1:15 |
| D. Langberg | Biblical Call: Global Violence against Women and Children (obj. 1-3) | 1:15 |
Friday, March 18
| Speaker | Title | Time length |
| B. Hoang | International Human Trafficking (obj. 1) | 1:15 |
| D. Langberg | Domestic Human Trafficking (obj. 1) | 1:15 |
| Breakout Sessions (choose two as each session is repeated; total length: 2:30) | ||
| B. Hoang | Follow up from morning session (obj. 3) | 1:15 |
| D. Langberg | Follow up from morning session (obj. 1-3) | 1:15 |
| P. Kim | Spiritual Warfare and Criminal Prosecution (obj. 3) | 1:15 |
| R. Morrison | Mobilizing all Christians in Effective Action Against Human Trafficking (obj. 4) | 1:15 |
Saturday March 19
| Speaker | Title | Time length |
| D. Langberg | Sexual Abuse in Christian Organizations (obj. 1-4) | 1:00 |
| Panel (all speakers) | Panel Discussion (obj. 1-4) | 1:30 |
[i] This course is also available for one (1) academic credit. Credit students will be required to complete additional readings and coursework after the seminar. Those interested should view the course syllabus on our school’s website and complete a brief, online non-degree application. Cost for a one credit course is $447.
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Psychological mystery recommendation: White Lies
Just finished Anna Salter’s novel, White Lies. The book was published 10 years ago, so you may have already come across this great read. If not, Dr. Salter is a forensic psychologist with expertise in the area of sex offending. I highly recommend the book if you want to see how a psychologist goes about gathering data on a perpetrator so as to recommend treatment or predict future re-offending.
What I found most interesting was her use of sentence analysis (written and spoken) to highlight how we tend to deceive self and others. Lying comes in what we say and don’t say. At one point, the offender (a doctor) states that he started his residency at such-and-such a place but never mentions where he finishes it. She evaluates the sentence and tells the reader that the offender has told more of the truth than he planned. No one would say they started it somewhere unless they didn’t finish it there. Instead, you would say, “I did my residence at…”
Her work reminds me of some training I got from Eric Ostrov as an intern at a juvenile jail facility. Dr. Ostrov told us that people generally want to confess their sins–or at least a more acceptable version of them. They make themselves passive in an event, they confess a sin they wished they committed (e.g., crossing sexual lines with a client who seduced them) rather than the sin they did commit (inviting and manipulating a client into a sexual situation).
Long ago I had aspirations of becoming a forensic psychologist. In fact, I did some training and practice in my pre and post doc and had a job offer lined up. I ended up choosing to come to Biblical Seminary. While I don’t regret that choice, the work of exploring self and other deception still interests me.
Anybody out there read her other two novels: Fault Lines or Shiny Water?
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Filed under Abuse, counseling and the law, counseling science, Good Books, self-deception
Can you change your nightmares?
Blogging has been much harder this fall with a busy teaching and traveling schedule. I’ve been doing a lot of reading and thinking about best practices to deal with trauma in international settings–specifically in the Great Lakes region of Africa. Diane Langberg and I have been consulting with a Christian organization to help develop those practices with a local, sustainable mindset.
One of the recent items I read had to do with attempts to address repetitive “posttraumatic nightmares.” Bret Moore and Barry Krakow published, “Imagery Rehearsal Therapy: An Emerging Treatment for Posttraumatic Nightmares in Veterans” in the September 2010 issue of Psychological Trauma: Theory, Research, Practice, and Policy (v. 2, 232-238).
Imagery Rehearsal Therapy (IRT) attempts to alter nightmares by changing the storyline of the nightmare. The authors view nightmares as learned behavior such as insomnia. The CBT style treatment entails
- education about the relationship between nightmares and insomnia.
- education about cognitive restructuring via imagery
- client selects a particularly disturbing nightmare (maybe not the most disturbing one first)
- Client then instructed to “change the nightmare anyway you wish” (notice they are not asked to make it positive or even less distressing)
- Client then rehearses (over sessions) the new dream through imagery techniques
Previous controlled studies indicate a reduction in nightmare frequency and intensity. This particular summary article reports that the evidence is there that veterans find it helpful even at 12 months post treatment with 4 sessions.
A couple of things to note. There may be some effect of desensitization from rehearsal of the initial dream (exposure therapy) though the exposure is brief. Also, the client does not spend time rehearsing the actual traumatic events in this therapy–only the nightmares.
Some thoughts:
- This treatment makes sense. Ever have a dream that seems to go on and on, or one that you go back to upon waking up in the middle of the night. Often we may find ourselves trying to make the dream turn out okay. This treatment uses our fully awake brains to rehearse something we want to think about.
- If nightmares are the result of a collection of anxieties then it stands to reason that repeating new thoughts and images will begin to make associations in the brain that might compete with the anxieties.
- Christian living emphasizes re-telling the truth to ourselves. Consider how OT authors remind readers of the Exodus or Paul reminds the Ephesian readers of their prior state (chapters 1-3). What we rehearse does have an impact on our brains.
- Finally, some of our nightmares seem written in indelible ink. Do you still have test anxiety nightmares 20 years after your last class? I do. But I feel differently about them now than I might have back when I was still worried about school. It may be that we begin to feel differently about the nightmares. The less we are bothered by them the more infrequent they will be.
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Filed under counseling, counseling science, counseling skills, Psychology
Considering Marriage at Virginia Beach
In a couple of days I’ll be going to Virginia Beach to attend the CCEF conference on marriage. If you are in the area or going to the conference yourself do stop by the Biblical Seminary booth and say hello. We have info to show you on
- new on-line courses next summer and fall
- a summer class on forgiveness
- an exciting (FREE) conference next March 17-19 dealing with sex trafficking and abuse and showcasing Diane Langberg and Bethany Hoang (IJM) that can be taken for credit (not free) or CEU.
- information and even a discount for moving your completed CCEF DE courses into graduate accredited credits.
At the conference I’m especially interested in seeing what will be said on the topic of damaged relationships. Often we Christians paint the beautiful image of sacrificial, Christ-centered marriage. And we should–because too often we lose sight of the vision of what marriage is intended to be. But we ought also to address the issue of brokenness and how to live in the now when marriage does not seem to be working. We of all people ought to be the best at describing marital life when change isn’t forthcoming.
So, here’s a couple of conference session titles I’m most interested in
Thriving in a failure-t0-thrive marriage (Julie Lowe)
Adultery: Can there be a day after the worst day ever (Tim Lane)
Too broken to fix (Mike Emlet)
When will the new day dawn? Loving a spouse who was victimized in the past (Julie Lowe & David Powlison)
Also looking forward to the view of the ocean. Missed seeing much of it this summer. Anyone up for a quick dip?
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Filed under biblical counseling, Biblical Seminary, christian counseling, marriage
Coming to Peace with Psychology 6
After a long hiatus I return to my summary/review of Everett Worthington’s Coming to Peace with Psychology (IVP, 2010). If you are new here just search his last name in the search bar on my blog and you can quickly catch up.
Chapter 10 is the second chapter in the last section of the book (“What Psychological Science has to Offer Theology”). This chapter covers the limitations of psychological science. Up to this point he has been lauding the value of psychological science as a marriage partner with theology. In fact, the purpose of the book is to argue for such a relationship over those who he sees as being overly critical of psychological science (due mostly, in his mind, to the anecdotal nature of psychological theory).
What does he point to as the limits of his science?
- Despite amazing advances in psychological science, counseling hasn’t changed much (hmmm, does he consider this a limit of science or is this a complaint about practitioners?)
- Psychological science must focus on general truths and so may not be as applicable to any one person
- Scientists are not without bias (but then he goes on to say that given the review process, truth is a lot more likely than not)
- Science can’t reveal the eternal (but it can reveal things of eternal value)
- Inability to precisely predict behavior
- No ultimate “proof” (but, probability is possible)
- Scientist biases include “heuristics” (picking answers from an “available” list), confirmation biases, etc. which reveal our human self-serving nature.
- Emotional experiences tend to make us more certain of our perceptions and beliefs.
- human limitations on what we can remember, understand, perceive, do.
Notice from his list that he focuses on common human limits of knowing. This is a good start but insufficient. It treats science biases in an individualistic manner. I find this ironic given that I believe he has much awareness of family systems. In fact, systems add an additional bias–group think as example number one. Funny too that he gave very few illustrations from science of these various biases. For the most part, he illustrated them from everyday life or from theology. So, we are left with a chapter that admits to some general limits on how far psychological science can take us but no clear acknowledgment of systematic biases in the world of psychological science.
Now, let me be clear. I am not one who believes that psychological science is always biased all the time. And even when it is, there can be much to be learned from it. Nor do I believe that those within biblical studies or theology are unbiased either. But, I do think we need to recognize how specifically these biases send psychological science in some wrong directions.
Musings on Faith and Psychology 