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This post is intended for Christians looking to deepen their faith and mental health.  The Bible has a lot to say about fear and anxiety. In fact, some variation of “do not be afraid” is the most common directive in Scripture, occurring in some fashion more than ‘do not steal,’ ‘do not kill,’ and even ‘love your neighbor.’ How do anxiety and fear work? When we study these constructs in research, we are understanding mechanisms through which the body/brain is informed to face a threat or danger. We can argue these responses are inherently good, with their purpose being survival, protection, and preparedness. Its activation results in the sympathetic nervous system being primed: adrenalin and noradrenalin are produced, cortisol increases, heart rate increases, blood flow moves to muscles and away from extremities, speed and depth of breathing increases, and many other physiological changes occur.[1] I’m grateful to have these responses- when they are in context. Out of context, they suck, to put it bluntly. Problems like panic attacks, worry, phobias, obsessiveness, skin/hair picking/pulling, preoccupation, social fears, avoidance, and more can be quite terrible. One of the things I love most in my walk with Christ is context. Direction. “The Lord is at hand; do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God” (Philippians 4:5b-6, ESV). What is being said here? Partly, “Do not be anxious about anything.” Since anxiety is a feeling of imminent threat- or in other words, it’s at hand- it’s very interesting that immediately before this phrase in Scripture we have another observation revealing a different type of imminence: “The Lord is at hand.” In the context of the Lord being near we are told, “Do not be anxious.” This Greek word for ‘be anxious,’ μεριμνᾶτε (transliterated as “merimnate”), means to be divided and distracted, fearful, and caring for things that are out of context.[2] Sounds a lot like anxiety disorders, right? Yep. Or even just day to day worry/anxiety? Yep. When a person feels anxiety and fear and misinterprets this as significant, a person’s entire life and values can shift to focus on whatever is the subject of their fear, whether classified medically as a disorder or not. This can lead to a preoccupation with avoiding something or someone (spiders, relationships, sex, social situations) to obsessively checking to make sure everything is okay (car, stove, locks, bodily sensations, health, perfectionistic behavior), or pursuing something (money, security, approval of others)- and MUCH more.[3] To help work through these things and avoid pathological responses, I believe we need supports like therapy, help from friends, breathing techniques, mindfulness, exposure techniques, etc. This only underscores our complexity (we are “fearfully and wonderfully made”[4] yet simultaneously all messed up[5]) and highlights what we are told in Scripture about our limits.[6] We can rightly use these tools to help us, just as we do nutrition, medicine, community, and so forth. But there is one thing these tools can’t do on their own: attach us to the very God of the universe and give us a lasting hope and focus- with meaning and purpose at the highest level. So God gives us a jewel of a passage in Philippians 4 where we are kindly reminded what our attention is to be on (context), and a little bit of how we can live it out (practice).[7] It is well known within the anxiety treatment world that even the most effective therapies (here’s looking at you, classic CBT, which I love and specialize in) often need supports to connect to larger beliefs, values, and commitments (ACT, DBT, and MI are some of the most common modalities). If we don’t connect a person to larger motivations and goals than “I just want to feel better,” it is often near impossible for a person to grow with sustainable change for the long term because they don’t have a sufficient reason and value to keep them invested. God gives us this.
Want more? Well, there’s two tips in the next two verses, Philippians 4:8-9
“Anxious for nothing” will take a lifetime to put into practice. I’m grateful to have the opportunity. ~Justin [1] Continued misinterpretation and repetitive experience of these symptoms worsens disorder, like in Panic Disorder, GAD, Phobias, OCD, PTSD, and more.
[2] Bible Hub. (n.d.). 3309. merimnaó. Retrieved July 13, 2019, from https://biblehub.com/greek/3309.htm [3] I think it’s very important to note that we have to be very careful with saying anxiety/fear is sin- and what we mean by this. A lot of Christians get tripped up on this, and many, ironically, become more anxious. The extent of this point would likely require an entire book, so I will not take the space here to elaborate. [4] Psalm 139:14; Genesis 1:26-27 [5] Jeremiah 17:9; Romans 3:23 [6] Psalm 73:26; 2 Corinthians 12:9-10 [7] Oh yes, there’s a whole lot more in Scripture on this topic. Let's not reduce a couple sentences into a "how-to-manual." Addiction is confusing. It is confusing to seasoned professionals. Let’s just admit it.
It is not a specified diagnosis under the DSM or ICD; it’s only broadly referential to a sometimes amorphous categorization.
Take a look at a broad array of definitions (some even from reputable research organizations), which emphasize sometimes different things:
Clarity through the confusion While still in the middle of a ‘call to arms’ in clarifying Addiction is, we ultimately have a very stable understanding of the symptoms/criteria of problematic behaviors, and most of the time, how to treat them.
Substance Use and Addictive behaviors do exhibit many consistencies despite the actual substance or reward behavior pursued, and they respond to similar treatments. Regardless of the organization, the following are usually consistent details across definitions:
"Types" of Addicts There is an extensive history of attempts to categorize addiction, through “typologies.” Prior to scientific research, which began with E.M. “Bunky” Jellinek, there were many attempts to understand the mystery of addiction, but mostly from an observational or anecdotal standpoint.
We don’t have any consensus yet, but why is it important to know what type or level or continuum a person is on? At a minimum, we need to understand where a person falls on a continuum if we are to treat effectively. Here is one continuum of use problems (Adapted from Earleywine, M. (2016). Substance use problems (pg. 2). Göttingen: Hogrefe.):
Effective Treatment As I like to say, "Don’t drive your lawnmower on the freeway." Just like you wouldn’t do this (I hope), don’t assume that therapy alone, or a doctor alone, or worse, doing nothing- alone- will be enough “horsepower” to get you where you need to go. Effective treatment requires applying the factors necessary to get the job done. The person who abuses a substance occasionally on weekends will need to be treated different than the person who is “hooked” on something. Two categories of professional treatment exist, with incorporation of several additional supportive factors:
Besides treatment, supportive factors often include, but are not limited to:
My plea: Take addiction seriously. Don't know whether your are addicted or not? Find out. Addiction is a complex- bio-psycho-social-spiritual- issue. Problems with drugs, alcohol, or behaviors on a spectrum of addiction cause substantial disability, even death. And here's the kicker- people who have problems with these often experience lapses in judgement and poor insight into having a problem. Start with a strong assessment by a competent professional who is trained and experienced. Look for evidence based treatments (think CBT or Motivational Interviewing). Advocate for truth and be assertive. Ask hard questions of your provider. When providers get shifty or start to recommend some unusual treatment when you need a first line treatment, exercise caution. I'm Justin K. Hughes, MA, LPC, and I specialize in the treatment of Addiction through CBT and Motivational Interviewing (MI). As always, please like or follow me, using whatever platform you prefer. Also, subscribe for meaningful content regularly! In Vivo Exposure
Directly facing feared objects or situations, examples include: Getting on a flight, touching a doorknob that feels “contaminated,” not going back to check a lock, or going to a social gathering. Good exposure attempts to match the content and detail of a person's fear as close as possible. So, for example, if a person fears “going crazy” in a social setting, the best exercise will be working up to facing that, not just exposing to the thought or word. On the other hand, if the fear is that a person will have inappropriate impulses (to harm, sexually, etc.), sitting with the intrusive thought and being present will serve best. Imaginal Exposure Imaginal exposure involves accessing the content of fears and anxieties through cognitive means. For example, a fear that someone will fail, make the wrong decision, harm someone, die, or choose the wrong relationship are not accessed by activating these life occurrences. They are addressed imaginally. There are many ways to practice Exposure imaginally, but the most common are writing scripts, stories, listening to recordings, watching videos, or using visualization. To be clear, Imaginal exposure often is the most confusing and hardest to grasp of exposure practices, as it seems to be creating negative thoughts or “bringing” unrealistic and negative thoughts on- the seeming antithesis of most of psychology and cognitive therapy. But what is really done here is only facing what a person is already experiencing, thinking and feeling. Interoceptive Exposure Intentionally bringing up physical sensations that are feared, such as: Heart racing, shortness of breath, sweaty palms. Ways to do this when a person's health allows are breathing through a cocktail straw, breathing rapidly, or sitting up quickly. Virtual Reality (VR) Exposure With the advent of new technology, we have a recently emerging type of exposure. Some may class Virtual Reality into imaginal exposure, but it can be seen as a cross between in vivo (situational) and imaginal. This is especially helpful with treating disorders such as Flying Phobia, where the access to an actual plane and flight to practice can be cost-prohibitive and difficult. What is Exposure Therapy?
Exposure therapy is a psychological treatment that is practiced in Behavioral and Cognitive Behavioral Therapy (CBT). It is indicated as a first line treatment for a number of disorders such as
Exposure therapy helps clients to systematically confront fearful stimuli along with changing fearful responses. This relearning increases confidence and decreases disruption in life. Over time, discomfort and fear typically decreases through active engagement rather than avoidance, suppression, neutralization, or ritualization. The evidence base is very strong for its use and effectiveness, though it is currently only applied a minority of the time in clinical settings. How Do You Do Exposure Therapy? The principles of exposure may be simple, but the specifics- personalized to any one individual- involve many working parts. Assessment
According to Dictionary.com, their word of the year is "Misinformation." Defined as "false information that is spread," misinformation occurs "regardless of whether there is intent to mislead." Misinformation, and its brother, disinformation, can be harmful. Clearly. Though much of the current state of discussion around this concerns external affairs. Much of what we are responsible for at least begins internally (how we respond and engage). Aligning our thoughts, beliefs, and behavior with reality- what's true and realistic- is a crucial "mechanism of action" that helps facilitate positive outcomes. This is particularly true in the method of therapy I use- CBT (Cognitive Behavioral Therapy), We know that cognitive distortions [click for pdf list] only prevent us from succeeding and growing. These errors are harmful especially when they are consistent approaches to thought, such as All-Or-Nothing Thinking (I missed my workout today; I might as well skip this week), Mental Filtering (I know they said they enjoyed meeting me, but they must not like me because they talked more to other people), and jumping to conclusions (I just know that she got off the phone quickly because she thinks I'm an idiot!). The deeper these go, the more impactful they are and harder to break. So in a world of misinformation, make sure you first tell yourself the truth, whether it's difficult or comforting. In this time of the year that is special, wonderful, challenging, or downright awful for some, what can you do? Be realistic. Tell yourself the truth, and to others. Align your thoughts, beliefs, and actions with commitment, purpose, and meaning (and if you're not sure what yours is, find it with help!), and try to get as close to what's honest and accurate. Be a good researcher (humble). Don't get snowed by misinformation. Give the gift of realistic, truthful thinking. Your brain will thank you (and probably everyone else will, too). Merry Christmas, and Happy Holidays! Yours truly, ~Justin  Photo by Toa Heftiba on Unsplash Want a surefire way to experience more gratitude? Be grateful. I'm not trying to sound trite; those who practice gratitude are more grateful. I struggle to apply this discipline myself. But when I do, I see the world differently. Enjoy the following video (thanks to my brother for passing along). Happy Thanksgiving. Do I want this, or do I not? Is this my actual desire, or what I don't want? Does this thought or desire define me? What if it's terrible or horrible? Sometimes the things I think about are because I value them or desire them. Sometimes the things I think about are because I don't value them or desire them. What the heck? Egosyntonic and Egodystonic are two psychological terms to describe phenomena of thoughts/urges that are synonymous and antonymous to what a person desires or wants. Sometimes our thoughts reflect very much what we desire or want, but around 90% of people endorse having "intrusive thoughts," or unwanted thoughts. It is crucial to do a good functional analysis on a thought/behavior to determine whether someone is doing something in order to pursue- or to avoid- the very same thing.  Photo by Joel Fulgencio on Unsplash  Photo by Dhiva Krishna on Unsplash Yesterday and today both I witnessed bad car wrecks. I haven’t seen a car wreck in over two years. Not only have I been more cautious driving since, today I caught myself telling my wife possible reasons for seeing two crashes in a row.
“Hey babe, maybe people are absent-minded with summer and vacations. Be careful.” Possible. However, I inferred meaning that may have nothing to do with what actually happened. Do you ever do that? Read into what your significant other is saying? What your clients are thinking? Make an assumption? We all do that. Decisions. Determinations. Judgments. I work with thoughts and thinking day-in and day-out. A big part of my job is to help folks live in reality. Correcting distortions and errors in their thinking is a large part of this. Of course, as a human being, I experience this just as much as the next person. It is a discipline to not only look to logic and reason, but also to connect with emotions and experience- and attempt to be grounded. I hope I always continue to work on this. So the reasons why a nice Mercedes got its hood completely crumpled may not really be in my purview. Nothing wrong for me to guess. However, it is significant for me to stay aware that my thoughts stick close to reality, because the further they diverge from it in day-to-day life, the more likely I am to make determinations that are wrong. The more I do this, the more firmly rooted my beliefs become. My emotions will follow my beliefs. And my beliefs determine my course. My course affects others. Others affect history. See where this is headed?  Photo by Owen CL on Unsplash Did your anxiety increase over flying after news of the engine failure on Southwest Flight 1380? Even a little? I have booked plane tickets twice since the incident in mid-April 2018, and when choosing seats, I hovered precariously as I decided whether to select my favored window seat, or if I go for the "safer" aisle. My wife mentioned slight concern over the window seat because of the tragedy that occurred. Working closely with the CBT treatment of Anxiety Disorders and OCD, I knew the moment I read the news- first about engine failure and the sad death of a wife and mom, Jennifer Riordan, and more recently the loss of cabin pressure and a window crack on a separate flight- there would be increased fear and anxiety about flying. Why? Flying commercially is statistically more safe in the U.S. than it’s ever been. Even with these incidents. Even with 100 of these incidents. The fear is natural, and even normative, to some extent. It makes sense that we’d instinctually be a bit curious about our well-being in a metal tube soaring at 500 mph with tons of jet fuel propelling it. Even the possibility of flight has been denied in most of human history. But what about when fear starts to cause problems ? Affect choices? Leads to avoidance of life pursuits and goals? Or becomes one more in a cumulative list of anxieties and worries? One way to be 100% certain that you will increase your fear load is by giving the aforementioned flight(s) unrealistic credit. By associating personalized, catastrophic meaning to a situation that is one of the safest things you can do (safer than riding a bike), a distortion has taken place. Some disorders, such as Specific Phobias, PTSD or OCD, make it pathologically difficult (i.e., neurobiologically) to change how one feels and thinks, regurgitating fear quicker than your vertigo-experiencing seatmate with their airline-branded “barf” bag. With Flight 1380 being the first fatality on a U.S. passenger airline since February 2009 (over 9 years), flying on a plane is a remarkably secure form of travel. Unconvinced? Check out Forbes’ mining of some reputable stats. Here’s the thing; education and stats are helpful, but only go so far. Fear is more than a reasoning thing- or in neuro terms, more than a prefrontal cortex (PFC) thing. Fear is an emotional thing. An amygdala thing. A learned response and genetic thing, along with a pervasive attitude and decision thing. It’s something that can destroy, harm, and erode, or it’s something that can be used in its rightful context, and set aside when not useful (e.g., PTSD treatment where a person can balance both safe and smart decisions, while facing disordered fear, so they can live life more fully). So if you’re like most people who need a bit more than statistical education to counter anxiety and become stress resilient, remember this: What you think and believe (cognitively) is vitally important. What you do (behaviorally) is vitally important. Your health and well-being are intricately tied to these. Small decisions today can lead to a long-term impact. For many of us, the greatest threat we face today is fear. So I chose the window seat. ~Justin “I am an old man and have known a great many troubles, but most of them never happened.”  Photo by Leio McLaren on Unsplash “Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing.” – Helen Keller
I don’t want to live my life being overly cautious, but rather appropriately cautious. We are discovering in the research of anxiety disorders, OCD, and now depressive disorders, that possessing an Intolerance of Uncertainty (IU) is a common construct linked with higher anxiety and life disruption. What is IU? My favorite definition: “Belief that uncertainty, newness, and change are intolerable because they are potentially dangerous” (Steketee et. al 2005, p. 125). IU links threat with uncertainty. But is uncertainty a threat? Take a moment and ponder one of your favorite memories. What did it involve? Was there any risk? Any vulnerability? Any chance of failure? Most of the best life stories I hear are of those that involve, well, all of these things. A person who cannot tolerate not knowing actually misses out. How? Isn’t knowledge power? What happens is this: the more control a person must have, the less control a person has. The more certainty that is sought, the more narrowly circumscribed life becomes. Quick examples:
Want to know how you handle uncertainty? Take the free IUS-12 assessment here. [Go to "Read More" below to find out how to score the assessment.] Let’s be clear: everyone is uncomfortable with some uncertainty. And reasonable protection from risks is part of being wise- which can also be subjective. But the more you necessitate that certainty must exist, the following is more likely to happen:
In the research on IU, there are also two subset strategies identified: Prospective anxiety (desire for predictability) and Inhibitory anxiety (uncertainty paralysis) (Fourtounas et. al 2016).
If you struggle with any of these, the next questions is this: How do I live with uncertainty and anxiety, while also taking suitable precautions? The solution is fairly straightforward, but not easy. Once a problem area has been identified (along with what is reasonable, normative, or within your values), gradually and consistently gain ground by pressing into your fear without using a false reassurance strategy that reinforces the false threat of uncertainty. In therapy, one of the most powerful tools that exists to deal with uncertainty is what we call Exposure and Response Prevention (ERP). This is the single most effective tool in treating OCD, and it is very valuable in other disorders. The reasons it usually has to be done in therapy are several:
I personally love Exposure because it helps me face life with a “bring-it-on” attitude rather than a “stumble-through-best-I-can.” ERP in therapy is very specific, very structured, and very powerful. However, even the person who is not in therapy can benefit from its principles:
“Some men storm imaginary Alps all their lives, and die in the foothills cursing difficulties which do not exist.” ~Edgar Watson Howe So what uncertainty are you not letting yourself live with? When is ‘not knowing’ unacceptable to you? Uncertainty is not the problem. It is unrealistic to be 100% certain about most everything in life. Life has few certificates of guarantee, and those are only as good as what is backing them. Ready to face your uncertainty? ~Justin |
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Justin K. Hughes, MA, LPC
Owner, Dallas Counseling, PLLC
justin@dallascounseling.com
P: 469-490-2002
17330 Preston Road, Suite 102D
Dallas, TX 75252
Owner, Dallas Counseling, PLLC
justin@dallascounseling.com
P: 469-490-2002
17330 Preston Road, Suite 102D
Dallas, TX 75252
©2019 Dallas Counseling, PLLC
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