May 21, 2012 · 5:31 am
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
- 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.
May 18, 2011 · 9:22 am
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?
- 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!
Filed under Anxiety, biblical counseling, christian counseling, christian psychology, counseling science, counseling skills, Mindfulness
Tagged as Anxiety, christian counseling, counseling, Fear, mental health, Obsessive–compulsive disorder, Posttraumatic stress disorder
October 18, 2010 · 11:11 am
As you fall asleep, do you have a common thought or feeling pattern? As you wake up? In the shower? We are creatures of habit in this regard–we maintain our perceptions (of self, of the world) even in the light of contradictory information or experiences. This is why a pessimist always expects the worst and a narcissist always expects to be right. If you could categorize all your thoughts and feelings, what would your perception pattern look like? Hypervigilant? Discouraged? Embittered? Hopeful?
Now, can you change this pattern? For example, if you are not inclined to be hopeful, can you practice hopeful responses–even when things really do go south? And if you can change the pattern, what does that change look like?
Here are some of my thoughts…I would love to hear from you about what you do to practice something other than your usual way of looking at the world.
1. It is possible to re-write our narratives. How we talk to ourselves about an event either will solidify a feeling or begin to change it. For example, my wife recently had a sleepless night. She was able to use that time to talk to the Lord even while she was feeling out of sorts. In the morning, she had a positive, if also tired, way of feeling about the night.
2. Change does not look like zero experiences of an old narrative running through our head. Change looks like being able to recognize the old but also a new pattern as well. This change is not merely talking yourself out of one schema and into another. Rather, mindful awareness of threads of your experience that have been there all along get more play and so therefore become more salient over time.
3. Change isn’t permanent. Just as a professional athlete cannot go without practice, we cannot expect effortless maintenance of a new way of feeling.
October 13, 2009 · 5:21 am
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?
Filed under Abuse, Anxiety, biblical counseling, Biblical Reflection, christian psychology, Christianity, counseling, Post-Traumatic Stress Disorder
Tagged as Anxiety, counseling, Fear, PTSD, trauma
September 3, 2009 · 10:24 am
[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?
Filed under Anxiety
Tagged as Anxiety, Fear
January 4, 2008 · 5:09 am
Anxiety, as I wrote about yesterday, drives us to try to control our future, conceal our flaws, perfect ourselves, just plain worry about tomorrow, and ignore the poor while we hoard good things from God. These are ideas that flow from Luke 12.
And the answer? Is it just don’t do it? What does the passage suggest in place of anxiety–or better yet: in response to anxiety since our God knows we are like sheep and need to be comforted when we are afraid.
1. Consider. Look around and consider the many good things God has and is giving us. When we are in fear mode, all we see are the potential, nay probable, dangers. We are Peter looking down at the waves and all we can see is that the water is deep. Instead, be mindful of God’s handiwork all around you.
2. Fear God. Be awed by his power and might over creation and that in his good pleasure, he created YOU.
3. Hold your goods loosely. Be generous knowing that God will outgive you (however, do not treat this as the health/wealth false prophets who suggest that God will give you what you want). Anyway, you won’t need stuff in heaven so live on the cheap and give to the poor.
4. Be watchful of the better things. Look for evidence of God’s mighty hand rather than the potential for disaster. When you see his power, rejoice.
This is not all the bible has to say about anxiety but merely some thoughts from Luke 12. Consider which response to anxiety you most need to concentrate.
November 16, 2007 · 9:50 am
No, I’m not talking about the decade of the 90s. I’m talking about that habit we have of living as if the 10% of life that irritates us is really 100% of our life. This week I was doing a live counseling demonstration with another teacher in front of Biblical students. She was struggling with some negative comments made by others. Even though she is confident in her opinion about what is right, a few negative comments about her position have thrown her for a loop.
Haven’t we all been there? I can get 24 fabulous reviews of my class and only one negative. But what do I think about for the next two days? I can get two great reviews of a submitted article but if I also get one pan, I find myself fantasizing the discussion with that reviewer where I dismember their argument, limb from limb. Or, even more insidious, we can get wind of the fact that someone MIGHT be upset with us or unhappy with something we have done. We don’t know for sure, but it might be true. So, do we assume the best or live in the worst?
So, in the counseling demonstration, I asked how confident she was with her opinion. She said 90%. In elections, that’s a landslide victory. In sports, your team creams the other team. But in life, we tend to live in the 10%. What if I’m wrong…what if I screwed up…what if they are mad at me…what if I’m not a good teacher…what if… We don’t do well with the unknown parts of life. We demand 100% approval and security.
So, do you tend to live in the 90% or the 10%? Neurotic folks like myself tend to replay the 10% until it might has well be 100%. In talking to my wife about this, she admitted this was why she stopped being a counselor. She didn’t like the chance that she might be screwing people up. Interestingly, egocentric folks who can’t admit ever being wrong often are but live in the 10% of the time when they were right. And fatalists assume they will screw up but just keep going and compartmentalize the 10% as something that they can’t change.
Where do you live? How do you respond? Are you a neurotic, narcissist, or fatalist?
Filed under Anxiety
Tagged as Fear, Worry
November 6, 2007 · 1:17 pm
As a final comment on this past weekend’s CCEF conference, I want to briefly mention Ed Welch’s new book, Running Scared: Fear, worry, and the God of Rest (Greensboro, NC: New Growth Press, 2007). All conference attendees got a free copy. Here are a couple of my observations about the book:
1. It is 30 chapters. You don’t have to read them in a linear fashion although they do build on each other. They have a meditative/reflective nature to them.
2. The book is really about worry. If you struggle with panic attacks, you won’t find helpful solutions. In fact, he does a brief put down of the cognitive-behavioral techniques. On the one hand, he is right that these don’t ultimately give us peace, on the other hand–sometimes they help us get through a moment.
3. He does a nice job surveying the kinds of worries that overtake us and the common responses (control, perfectionism, anger, stress, depression, overprotection, etc.)
4. What does your fear say? Ed considers a few of the common messages (e.g., I am in danger, I am vulnerable, I need and might not get…). He also points to the overemphasis of the future in all worry. Worriers, he says, live in the future (and see it in minute gory detail). Seldom does our worry come true as we thought and so much of our worry is that of false prophets–proclaiming something as nearly already happened that only is a possibility.
5. The book is pastoral. I hear Ed’s voice in this as soft and knowing. I think this book reads like his voice more than any other of his works. He reminds us that Jesus speaks tenderly when he calls us to not fear. He talks to us like a shepherd would talk to a little lamb.
6. Yes, God tests our faith and yet he is also very generous. In order for us to be rescued from danger, there has to be danger. He is near. He hears. He tests us. He gives us grace for today. He delivers (ch. 9).
7. The rest of the book details how we deal with fears about money, what people think of us, about death, pain, and punishment, and ends with a focus on “peace be with you.”
All in all, a good read for those wanting to meditate on something other than their own fears. This is especially a good read on those feeling guilty and judged because of their fear and lack of faith. You get a picture of a very generous God who knows your fear and is near. If you are looking for very practical steps (what do I do this afternoon about…) you probably won’t get ready answers, though I think you could do the work to apply some of the principles to your daily life.
Good book Ed.
November 2, 2007 · 12:02 pm
Ed Welch suggests that we live with so much fear that we may ignore how omnipresent fear actually is throughout our life. Books, media and friends don’t invoke our fear but express the fears we already have. Fear is universal, whether it is the fear of the bogeyman in the closet or the fear of rejection when we get older. Fear is universal.
The most prominent command in Scripture? Do not worry. We should expect that the Bible would have something to say about worry.
Is this command not to fear a holy version of, “Stop it!” No, Welch says it is a pastoral encouragement and comfort and God reserves his most precious and penetrating word to our universal struggle. When you see Jesus repeatedly saying, Do not be afraid (Luke 12) don’t hear it as a nagging or threatening command but a soft and parental reminder of the truth. God is pleased to repeat himself. He, like us, takes deep joy in being trusted.
Is fear sinful? Welch says, “maybe” but that we should rather focus the question on to whom will we turn when we are afraid. We are going to be afraid. That is a fact. But, focus rather on the relationship with God. God has constructed a world based on trust and relationship.
Fear is a relational matter. Many of the treatments ignore this fact and focus solely on the cognitive side. What if we think more relationally about the healthy response to anxiety? Of course, this means the focus is on our relationship with the Sovereign God.
October 31, 2007 · 9:55 am
Starting Friday, CCEF is running its annual conference in Valley Forge, PA. You can click this linkto register or view speakers and breakouts. Several look pretty good. The keynote is by Ed Welch who is releasing his new book on the topic (free to conference registrants). By the way, his picture is on the page link above. Do you think it looks likes he’s trying to scare little children with that attack position? I’ll be there manning the Biblical Seminary booth and possibly live-blogging if the Wi-Fi is free as it was last year. If you are going to be there, come by and say hello.