An orthodox perspective on overcoming anxiety: Christ, the Church Fathers, and Cognitive Scientific Psychology
Anxiety in a man's heart weighs him down. (Prv
12:25)
Understanding anxiety
In psychology research, anxiety disturbances
represent a variety of mental disorders (American Psychiatric Association,
2000). The maladies associated with anxiety include: panic disorder,
agoraphobia, social phobia, obsessive-compulsive disorder, posttraumatic stress
disorder, acute stress disorder, anxiety associated with medical conditions,
anxiety induced by substance intake and generalized anxiety disorder.
A detailed discussion of specific disorders is
beyond the scope of this presentation. As anxiety is the common feature of all
anxiety disturbances, I examine the biological, cognitive, and behavioral
factors associated with anxiety. I also present reflections of a few early
Church Fathers who recognized anxiety as malady and, like modern behavioral
scientists sought a cure.
Features of anxiety
Those experiencing anxiety commonly describe
having feelings that are very unpleasant, such as fear and apprehension, as
well as perspectives that are vague and diffuse, that is to say, not concentrated
in one place. Bodily features can include motor reactions such as the inability
to relax, jumpiness, tightness of muscles, trembling, hyperactivity, heart
palpitation, perspiration, and vertigo. These symptoms can be accompanied by
apprehensive thoughts and expectations.
Etiology of Anxiety
Biological factors
The biological source of anxiety is the
sympathetic nervous system, which includes the nerve cells and fibers that lie
outside of the brain and spinal cord. The sympathetic and parasympathetic
nervous systems together comprise the autonomic nervous system, and in turn,
the autonomic nervous system and somatic nervous system (controlling sensation
and bodily movement) form the peripheral nervous system.i
Biologists (Selye, 1982) consider anxiety to be
related to the fight or flight survival system. When confronted with a
life-threatening stressor, the sympathetic nervous system secretes hormones
that aid in survival.ii Collectively, these hormones, called the
catecholamines,iii increase cardiovascular response, respiration, perspiration,
blood flow to muscles (increasing muscle strength) and mental activity. In
response to a stressor, individuals can either confront the stimulus or run
from it. In response to a stressful stimulus, the region of the brain called
the locus coeruleusiv reacts by increasing levels of norepinephrine, resulting
in an increase of cognitive function in the prefrontal cortex and motivation
via the brain nucleus accumbensv region. An activation of the
hypothalamic-pituitary-adrenal axisvi ensues, producing the stress response
(Thase & Howland, 1995).
Anxiety without a stressor
In addition to stressor-induced anxiety, recent
research has demonstrated that anxiety frequently occurs in the absence of an
identifiable stressor, as well as in response to ordinary stimuli encountered
in life (Barlow, 1988). Moreover, the treatment of anxiety has included the use
of prescription drugs, particularly selective serotonin reuptake inhibitors
(SSRI), which target serotonin rather than norepinephrine. The effectiveness of
this treatment, in biological terms, suggests that brain networks or
neuroanatomical pathways other than the locus coeruleus can mediate anxiety
(Kent, Coplan & Gorman, 1998).
Barlow (1988) suggests that arousalvii rather
than anxiety may be at the basis of non-stressor anxiety. Another research
program proposes that brain systems and structures, such as the hippocampus and
amygdala, might transform arousal into anxiety (Coplan & Lydiard, 1998).
These brain structures regulate both verbal and memory processes with potent emotional
meaning, and are part of the limbic system. The limbic system is responsible
for activating the hypothalamic-pituitary-adrenocortical (HPA) axis underlying
emotions.viii
The HPA pathway projects to the cerebral cortex
of the brain, which is responsible for higher brain functions, including
sensation, voluntary muscle movement, thought, reasoning and memory. The
cortical, memory and verbal brain processes explain why the anxiety is linked
to cognitive interpretations of events, whether stressful or non-stressful. The
cognitive interpretations that accompany or heighten anxiety are labeled,
distorted and irrational (cf. Barlow, Chorpita, & Turovsky, 1996a; Barlow,
& Lehman, 1996b; Beck, 1991; Burns, 1980; Ellis, 1962; Morelli, 2006c,d,e).
Cognitive Factors in Anxiety
Appraisal
According to the cognitive model, anxiety is
related to a series of appraisals that the anxious individual makes of the
events in the world they encounter (Lazarus, 1966, 1993a,b). The general theme
of these appraisals is the perception of threat. Threat is described by Beck
(1971): “… the main problem in the anxiety disorders is not the generation of
anxiety but in the overactive cognitive patterns (schemas) relevant to danger
that are continually structuring external and/or internal experience as a sign
of danger.”
Appraisal is conceptualized by Lazarus as the
individual’s interpretation of events they confront as challenging, harmful or
threatening and his assessment of whether he has the coping skills to respond
efficaciously to these events.
Types of appraisal
Primary appraisal is an interpretation about
whether an event in life involves harm, regardless of whether the harm or loss
has already occurred or is a potential or threat in the future. Primary
appraisal can be further classified into three types: an irrelevant appraisal,
which is of little significance; a benign-favorable appraisal, which has
pleasing or beneficial consequences; and a stressful appraisal. Stressful
appraisals are further delineated into three sub-types, damaging-loss, threat
and challenge-stimulating. Challenge-stimulating appraisals do not have the
same unfavorable implications as a damaging-loss or threat appraisal. Rather,
challenge-stimulating appraisals can be perceived as enhancing-profitable or
exciting. For example, if you missed an important meeting because you wrote
down the wrong time on your calendar, the harm has already been done. A threat
appraisal would assess the potential damaging consequences of having missed the
meeting. A challenge-stimulating appraisal, on the other hand, would focus on
the objective to turn around the potential dire consequences and find an
enhancing outcome. Taking responsibility for the mistake and the willingness to
pursue and re-schedule the meeting can demonstrate honesty and leadership.
Secondary appraisal is an evaluation of
resources and determination of their efficacy in coping with stressful events.
Coping involves metacognitive processes such as regulating problem solving
strategies and putting the strategies to use. Of course, coping also
presupposes that an individual has learned the skills to employ the problem
solving strategies and has the ability to employ them. In the example of the
missed meeting, you may first pose a question to yourself: “Do I know any way
of making a favorable outcome? How would I look at this from the point of the
other person scheduled to be at the meeting?” You might answer these questions
as follows: “I appreciate honesty and initiative, and the other person might
value these qualities too. The best defense being proactive; I will call
immediately and take responsibility for the scheduling error and communicate
the desire to pursue the agenda.” Coping also involves developing emotional
control, which is discussed below.
Cognitive constellations
In the cognitive model, following appraisal
subsequent information processing is organized by constellations or assemblies
of neural structural components called cognitive schemas (Beck & Emery,
1985). These neural constellations are often referred to by cognitive researchers
and clinicians by their original name, cognitive sets, with the proviso that
the concept of cognitive sets be extended to include the biological “relatively
enduring” neurological structural element. Once activated, cognitive sets
determine the construction of an individual’s associations, interpretations,
memories and perceptions of the activating events, which in turn allow for
classification, evaluation, explanation, labeling and assigning meaning to
situations and objects. These sets can either be in verbal-semantic modality or
visual-imagery modality.
Cognitive sets can be quite specific, such as
labeling objects: automobile, cup, or glass. Sets also can include principles
and or rules to discriminate between objects: compact car, midsize car, and
SUV. Cognitive sets can also encompass abstractions such as freedom, liberty,
and love. Complex sets can further identify an object or event that may be
dangerous. For example a snake with a rattle would be perceived as dangerous
versus a common black snake as non-threatening. A particular political party or
ideology could be perceived as a danger to freedom.
When an activating event construed as a threat
occurs, specific cognitive schemas relevant to the particular “characteristics
and context” of the event are triggered. Beck and Emery (1985) point out the
characteristics and context are a series of adjustments to fit the appropriate
schema to the particular threat. The adjustments in turn provide the range of
affective, that is to say emotional responses and behavioral patterns related
to the threatening stimulus. The cognitive constellations allow for a rapid
appraisal of objects and events previously appraised, in effect by-passing any
re-analysis of previously encountered events, objects and situations. This
rapid appraisal, also called automatic thoughts, has two consequences: first, a
beneficial consequence of facilitating a rapid response to a real threat, and
second, a deleterious consequence of perceiving non-threatening stimuli as
dangerous, thus producing cognitive-emotional ‘false alarms.’ Continuous
activation of a danger set in response to objects or events that are genuinely
non-threatening is considered an expression of psychopathology.
Cognitive modes
In normal cognitive processing cognitive
constellations are factually related to the object or events being processed.
In this case the cognitive constellation is activated by the situation one
encounters, or in other words, the constellation coincides with the reality of
the situation. A woman going to church, for example, might be expected to have
a cognitive set activated that includes adoration, love, trust and worship of
God. However, a cognitive set that is not relevant to the situation might be
pre-activated, becoming hypervalentix and thus likely to be used in
interpreting or cognitively processing the objects or events encountered. A
semantic or imagery associative neural network can be pre-activated. In the
case of anxiety the neural network associated with threat or danger would be
activated, and the woman could interpret her church attendance as a sign of
weakness, thinking that others view her as weak, this threatening her view of
herself as strong and self reliant. Alternatively, she may associate church
with death and sense an impending doom. In the case of depression, a
depressogenic mode or pre-activated associations would be readily available,
and a cognitive set for going to church might include such impressions as:
“What is the use of going to church?—God won’t listen to me anyhow—Things will
still be the same—Whatever I do there won’t make a difference.” A significant
intrusion mode (anger) might include associations of wanting to strike back at
God or an authority figure for a perceived injustice. Some unjust tribulation
may have occurred in the woman’s life, and church might be interpreted as a way
of striking back at God for having allowed the injustice.
Cognitive distortions
Cognitive appraisals, cognitive constellations
and their modes are also subject to the following eight distortions related to
anxiety:
Selective Abstraction: Focusing on one event
while excluding others. In one of my recent cases, Jack (all names are
changed), an employed young man, selectively focused on an accident he
witnessed: a truck filled with molten tar overturning on a car while making a
turn at an intersection. Jack’s focusing on this event triggered anxiety and
fear of travel.
Arbitrary Inference: Drawing a conclusion
unwarranted by the facts in an ambiguous situation. For example, Jill was stuck
in an elevator for about five minutes. She concluded that she would get stuck
again if she entered an elevator. This fear seriously impacted her ability to
do her work, which required elevator usage.
Personalization: Interpreting a general event in
exclusively personal terms. Jill became anxious after a business meeting
(attended by about 25 managers) when her supervisor mentioned that one manager
was about to be laid off. Linda immediately personalized the statement by
assuming the supervisor directed the comment at her, even though no evidence
supported that conclusion.
Polarization: Perceiving or interpreting events
in all or nothing terms. Jill became anxious after receiving an “average” in
her annual employment evaluation as a teacher. She polarized events into two
categories: good teacher versus bad teacher. Her Average rating fell into the
bad-teacher category. She failed to see that all events can be graded on a
continuum between two poles. On such a scale, an average evaluation is actually
as the term implies: average. Furthermore, she had tenure and was one of the
senior educators in her district and the only teacher in her school district in
a state-mandated specialty that could not be eliminated.
Generalization: The tendency to see things in
always or never categories. Jill was anxious she would loose her job and never
get a good evaluation to be employed again. Her anxiety led to a self-defeating
pattern of behavior that distracted her from her work, thereby negatively
impacting her performance.
Demanding Expectations: Beliefs that there are
laws or rules that must always be obeyed. This distortion is sometimes referred
to as the “tyranny of the shoulds.” Jack came into treatment because he was
anxious about his ability to be an effective father. His son consistently
talked back to him and would not follow his instructions. Jack irrationally
believed that there is a universal law that children should always do what
their parents ask. If his child didn't obey, he had the right to get upset and
see himself as a poor parent. Jack failed to apply the Christian principle that
God asks and never coerces obedience. A program of rewards for appropriate
behavior and punishment for inappropriate behavior administered without anxiety
or depression would be the constructive response to apply here (Morelli,
2006a,b).
Catastrophizing: The perception that something
is worse than it actually is. Jill erroneously reacted to her average job
evaluation as if it represented a grave and catastrophic event and thus reacted
with even more anxiety.
Emotional Reasoning: The judgment that one's
feelings are facts. Jill had a feeling that her new supervisor did not like
her. When asked how she knew this, she responded that her "feelings were
always right.” She was afraid her next evaluation would be “needs improvement.”
She failed to discern the fact that although real, feelings cannot prove
whether something is true or false. I tell my patients that no matter how
strongly some people "felt" the world was flat when Christopher
Columbus set sail, Columbus proved the world was round. Feelings are not facts.
Disputing and restructuring distorted cognitions
In previous presentations on cognitive
intervention of dysfunctional emotions, I have emphasized that effective
clinical intervention first involves helping the patient to recognize and label
the cognitive distortions and themes, followed by helping the patient to
restructure the distortions. Three questions are helpful in challenging the
patient's thinking so that restructuring can occur:
Where is the evidence?
Is there any other way of looking at the
situation?
Is the situation as bad as it seems?
In treating anxiety additional questions have
been shown to be useful (Beck and Emery, 1985):
Where is the logic? In an example given by Beck
and Emery 1985, a patient was anxious about his health condition and concluded
that his physician was holding back important information. Examination the
logic of the conclusion found it was unlikely his doctor was lying to him.
Is a causal relationship being oversimplified? A
priest thought that a mistake in a homily meant that the congregation would
loose trust in him. He observed other priests making mistakes in their homilies
without loosing the credibility of their parishioners.
Are habits being confused with facts? The
cognitive distortion of arbitrary inference can be developed into a
mind-reading habit. One woman who was anxious when she came into church had
developed the habit of thinking what others are thinking about her, and
concluded that parishioners were judging her appearance and personal life. Her
habitual internal message went something like this: “She does not know how to
dress and she is not a true ‘Christian.’” This woman had to learn to apply a
reality test to overcome her mind-reading habit.
Are interpretations of a situation far enough
removed from reality to be accurate? As a guideline, stay only with behavioral
pinpointing (Morelli, 2006a), focusing on what was said and or done and when
and where the behavior occurred. Avoid any interpretation. For example, Mary
ignored me when I said hello [behavioral fact]. She must think I am a bad
person [interpretation].
Is the version of the facts being confused with
the facts as they are? The rule is that facts are facts. Interpretations or
opinions vary, and can trigger dysfunctional emotions such as anxiety.
Is the thinking in all or nothing terms? Anxious
individuals often conclude that others will categorize them in one of two
diametrically opposite groups. A parishioner thought others would think of him
either as a total saint or a depraved sinner. Rather than impose the two-pole
opposites, this man can learn to view himself somewhere in the middle. We all
sin, but can repent, yearn and trust God for Him to indwell in us.
Are extreme or exaggerated words or phrases
being used? Making exaggerated statements is related to the cognitive
distortions of generalization, demanding expectations and catastrophizing.
Words that signify these distortions such as always, can’t, must, ought, need,
and should can be replaced by a more accurate, realistic descriptions: “I am
feeling anxious.”
Are examples being taken out of context? A
patient who is afraid of sliding off the freeway in a car may fail to consider
that sliding accidents are most likely to happen at high speeds or in slick or
icy road conditions.
Are cognitive defense mechanisms being used?
Sometimes anxiety is avoided by rationalizing, denying or projecting. A person
may deny they are afraid to speak out by claiming others do not want to hear
their viewpoint. Alternatively, a fearful person may claim that others would be
uncomfortable if he were to communicate how he really feels.
Is the source of information reliable? Patients
who are afraid of a particular outcome, such as bankruptcy, might be
hyper-sensitive and inclined to believe the financial information that fits
their fear without evaluating the validity or reliability of the information.
Is the focus on certainties rather than
probabilities? Some anxious patients want a 100% certainty they will not
experience fear before they engage in a task previously fearful. In clinical
and pastoral settings I have told those struggling with anxiety that no one who
appears brave in the face of danger (for example, a soldiers exiting a foxhole,
a fireman entering a blazing building) is without fear. One has to learn to
carry fear around like a suit case. Paradoxically, the more it is carried, the
lighter it gets. Some fear will probably always be with each of us, but it need
not be disabling.
Is a low probability being confused with a high
probability? One can come to embrace the idea that just because something could
happen does not mean it will happen.
Is the focus on irrelevant factors? A patient
heard about several people who died in an accident and felt that he would also
be in an accident and die. Such an anxious person has to be helped to perceive
the independence of certain events. This of often called the “gamblers
fallacy.” For example, when tossing coins, each coin toss is an independent
event. If someone tosses ten heads in row, the eleventh toss is still a 50-50
chance of being a head or a tail. This is true with all life events. This
explains why casinos make money and most gamblers loose.
Behavioral Factors in Anxiety
In the behavioral model, anxiety can be
influenced and attenuated by the same factors that influence learning. In the
Classical Conditioning paradigm developed by Ivan Pavlov (1927), associations
that evoke anxiety are formed between two types of stimuli (events):
Conditioned Stimuli (CS) and Unconditioned Stimuli (UCS). These stimuli are
paired once to several times and occur to the individual himself or can even be
observed to occur to someone else. A CS-UCS pairing viewed as occurring to
someone else (a model), as discovered by Bandura (1986), is labeled or called
vicarious or observational learning. In either case the previous neutral stimulus,
the CS comes to elicit the anxiety response previously evoked by the UCS.
Responses to the UCS are called Unconditioned Responses (UCR), while responses
to the CS are Conditioned Responses (CR). A simple example: a dog (CS) bites
(UCS) a child, evoking a pain response (UCR). Later, the sight of a dog (CS)
elicits an anxiety (pain) response (CR). The child becomes afraid of dogs.
The Operant Conditioning paradigm, first
uncovered by B. F. Skinner in the 1930s (Skinner, 1968), often interacts with
responses that may have first been classically conditioned, although some fear
and anxiety responses may spontaneously occur and then be shaped by the laws of
learning. A summary of the Operant Conditioning paradigm follows: Behavior is
shaped (made stronger or weaker) by its consequences. Consequences that make
behavior stronger or more likely to occur again:
Positive reinforcement: After behavior occurs it
is followed by a pleasant event.
Negative reinforcement: After behavior occurs an
unpleasant event is taken away.
Consequences that make behavior weaker or less
likely to occur again:
Positive punishment: After behavior occurs it is
followed by an unpleasant event.
Negative punishment: After behavior occurs a
pleasant event is taken away.
A child who emits fearful behavior in response
to a dog (as in the example above) may be positively reinforced for their fear
behavior. A parent or guardian may shower the child with consequences found
very pleasant such as hugging, kissing, or giving the child a much desired toy.
Fear or anxiety behavior is thereby strengthened. Here is an example of
negative reinforcement using the same example: after the child emits the
fearful response, the child is rewarded by a particularly odious task being
removed; he does not have to mow the lawn or help in garden chores for the
coming week. Once again, the anxiety response is strengthened. Behavioral
management techniques as applied in parenting situations are reviewed more
thoroughly in a recent article (Morelli, 2009).x
Clinical application
Behavior therapy is based on the principles of
learning that have been successfully employed in treating a variety of
behavioral and emotional problems, including the anxiety disorders (Martin
& Pear, 2006).
Contingency management: Programs consist of
pinpointing behavior, that is what is said and done and when and where the
behavior occurred, and determining if the behavior is appropriate or
inappropriate. Appropriate behavior is increased by application of the
reinforcement procedures outlined above. Inappropriate behavior is decreased by
the use of the punishment procedures outlined above.
Social skills training: Teaches patients to
perform behaviors that facilitate interaction and communication with others.
Socially appropriate rules and standards of pro-social relational behavior are
targeted, communicated, and modified by verbal and nonverbal interaction. Learning
such skills increases access to naturally occurring reinforcers that take place
in life, and decrease life punishments and can be applied to social
interaction, parenting and other relevant life skills.
Modeling: The patient learns a new behavior
through observation of a model (Bandura, 1977). Four conditions have to take
place before the new behavior can be learned (Bandura, 1984):
Attention to the model. Paying attention to the
characteristics of the model such as salience; affective valence, that is to
say strong or weak emotions; functional value and prevalence; as well as paying
attention to the characteristics of the observer such as perceptual cognitive
capability, cognitive set and arousal level.
Retention processes. The encoding processes of
the observer: verbal or imagery, cognitive organization, rehearsal skills and
memory skills.
Motor reproduction processes. The ability to
replicate the model’s behavior: physical capability and component sub-skills
and observation of feedback.
Motivational processes. The external, internal,
hedonistic, social, moral, or religious incentives that motivate the observer
to perform the model’s behavior.
Exposure methods and systematic desensitization:
Exposes the patient to the feared stimulus. Indirect methods use imagery of the
feared stimulus. Direct methods involve exposure to the actual feared stimulus.
In systematic desensitization patients are gradually exposed to a situation
they fear, either in a role-playing situation or in reality. Models are often
used in conjunction with the procedure. Research suggests (Meichenbaum, 1971)
that peer or coping models are more effective than mastery or expert models.
Behavioral homework assignments: Homework is
assigned to the patient between therapy sessions. For example, have a
claustrophobic patient enter and then immediately exit an elevator while a
companion keeps the elevator door open.
Contingency contracting: The therapist and
patient develop a written or verbal contract of appropriate behaviors to be
increased and inappropriate behaviors to be decreased. Contingent reinforcement
and punishment are frequently incorporated in the contract.
Role playing: The therapist and patient engage
in role-playing scenarios that are related to the patient’s anxiety (Kelly,
1955). Various responses are attempted by trial and error and the patient is
then given a response to try out as a homework assignment. Subsequent sessions
monitor and refine the process. Specific pragmatics or paralinguistic areas to
focus on include: response speed, volume, inflection (tone of voice) and
dysfluency (such as stammering). Eye contact, facial expression, gestures, and
posture (direction of leaning: forward, backward, relaxed or stiff, etc.) are
elements that can be practiced as well.
Flooding: Direct exposure to the
anxiety-provoking situation that the patient fears the most (either through
mental visualization or real life contact) in an effort to extinguish the fear
response.
Progressive relaxation: Systematic relaxation of
the muscles and breathing until the patient reports an absence of bodily
tension.
Self efficacy and psychological intervention
Psychologists understand the necessity for
determination and resolve as an element of healing anxiety and other emotional
disorders. Bandura calls the process self efficacy and defines it as "the
ability to develop a program or plan for action to reach a goal" (Bandura,
1986).
Generally people with higher self-efficacy are
better able to attain goals. Consequently, psychological interventions that
employ self-efficacy are incorporated into the cognitive and behavioral
treatment of anxiety disorders. The major variables bringing about self
efficacy are:
Mastery experience: Practicing appropriate
concrete graduated actions in respond to fear-stimulus cues. In the case of the
claustrophobic patient in the systematic desensitization example above, therapy
might focus on the success of entering the elevator rather than exiting.
Accomplishing a single step may be viewed as mastering the first of a series of
sub-goals that lead to a final goal: riding the elevator alone to the top floor
of the building.
Vicarious experience: Observing a peer model
struggling with the same problem of performing an appropriate behavior in
response to a fear-stimulus cue. For example, have as a child who is afraid of
dogs watch another fearful child approach and pet a dog.
Prompting: Using key words or phrases as cues to
appropriate action, followed by verbal approval as reinforcement (Morelli,
2005). For example, if a child verbalizes, "Ok! Just let me take one step
toward the dog," say "Good job!" The child might continue with,
“Ok! I did that step, now let me try another one.”
Perceptions of arousal: Having an accurate
understanding of the physiological nature of bodily arousal and knowing that it
can be managed. The child attempting to overcome the fear of dogs might monitor
his or her arousal at each step and see that it is “endurable.”
In my clinical experience I have discovered that
many of the people treated for emotional disorders, including anxiety, have a
pattern of unsuccess. Successive failures result in low self esteem and in some
cases serious depression that leads to low self-efficacy (Morelli, 2005).
Efficacy training, therefore, is an important component in any healing process.
The more success an individual experiences, the greater his self-efficacy.
Efficacy for the Christian
The Church Fathers taught that healing takes
determination and resolve. St. Gregory of Sinai, for example, noted: “We
energize [virtues] according to our resolve ...” Some of the Fathers taught
that determination arises from the incensive power of the soul. St. Nikitas
Stithatos wrote: “Our incensive power ... serves as a weapon” that provokes
determination and resolve and thus is in accord with the will of God. He
continued: “When our desire and our intelligence, in a way that accords with nature,
aspire to what is divine, then our intensiveness is for both of them a weapon
of righteousness ...” (Philokalia IV). For the Christian efficacy is not only
“self efficacy” but ‘God-empowered efficacy.’ The words of the psalmist come to
mind: “He who dwells in the shelter of the Most High, who abides in the shadow
of the Almighty, will say to the Lord, ‘My refuge and my fortress; my God, in
whom I trust.’ For he will deliver you from the snare of the fowler and from
the deadly pestilence …” (Ps 90:1–3). The Christian can follow the spiritual
wheat that was gleaned from our holy western Church Father, the Blessed
Augustine: “Pray as if everything depends on God, and work as if everything
depends on us.”xi
The efficacy of the therapeutic synergy of clinical
science and the healing mysteries of Christ is our trust and dependency on the
living God who sustains and governs all that occurs in the universe.
Jesus on anxiety
Anxiety challenges the very core of our
relationship with God: allegiance confidence, loyalty, and trust. Recall the
words of Jesus as recorded by St. Matthew: “O men of little faith? Therefore do
not be anxious, saying, 'What shall we eat?' or 'What shall we drink?' or 'What
shall we wear?' For the Gentiles seek all these things; and your heavenly
Father knows that you need them all. But seek first his kingdom and his
righteousness, and all these things shall be yours as well. Therefore do not be
anxious about tomorrow, for tomorrow will be anxious for itself. Let the day's
own trouble be sufficient for the day.” (Mt 6:30–34) Understanding that anxiety
is a separation from God was not lost on the prophets of the Old Testament. Job
tells us: “All the life of an ungodly man is spent in anxiety.” (The Orthodox
Study Bible-LXX).
St. John of the Ladder on fear (anxiety)
Before the advent of modern scientific
psychological research, it appears St. John of the Ladder (579–649 AD) (1982),
well understood what we today call anxiety. In his Ladder of Divine Ascent, St.
John writes: “Fear is danger tasted in advance, a quiver as the heat takes
fright before unnamed calamity. Fear is a loss of assurance.”
St. Maximus the Confessor on fear (anxiety)
St. Maximus the Confessor (580–662 AD) likewise
had an astute understanding of fear or anxiety. He tells us: “… an evil which
is expected in the future is called fear, and one experienced in the present is
called distress … [a] contemplative [one striving to be a holy Christian], on
the other hand remains dispassionate in the face of such evils, since he has
united himself with God and is detached from all that happens in this present
life.” (Philokalia IV)
Faith: A four- (five-) letter word
In today’s secular world faith is a four letter
word. The height and measure of intelligence is to be skeptical. Skeptics
believe that they believe in nothing, they are skeptical of all. The secular
skeptic is really a believer in the religion of secularism. This religion has
its own websites.xii Skeptics are the self-proclaimed intellectual elite of
those who are not credulous or gullible, and proud of their claim to be able to
see things ‘veridically,’ or the way they think they really are.
Tongue-in-cheek we can consider the following quote: "A skeptic is a
person who, when he sees the handwriting on the wall, claims it is a
forgery." (Morris Bender, on www.answers.com/topic/ske...). This is the
only reality.
Is it possible to exist without faith?
Faith is a term filled with surplus meaning. One
reason I seldom use the word ‘faith’ or ‘belief’ in my articles (or homilies)
is because of the pejorative meaning of the word in popular usage. For
secularists and skeptics, faith is imbued with anti-intellectualism, if not
downright stupidity. However, I find the core meaning of faith found in the
dictionary to be much more helpful. Most individuals do not have a strong
intellectual dispute with the dictionary synonyms for faith: allegiance,
confidence, loyalty, and trust (American Heritage Dictionary, 1994). In
everyday life, for example, can we get along without confidence and trust?
Faith: A practical example
How many individuals who go to work are
skeptical that their car will not start up each day? Alternatively, many other
examples can be imagined: the airport near our home will not be there, the
light in our home will not turn on when we flick the light-switch. It would be
almost impossible to live daily life without some sense of trust and confidence
(faith) in the events we encounter. Psychologist George Kelly (1955) said that
meaning in life is centered on ‘how we anticipate events.’ That is to say, a
person’s conceptualization of the world is directed by a web of expectations if
he acts in specific behavioral patterns. Mentally ruminating and being
skeptical about such events or the possible outcome of each action we make
would in fact be a potential red flag for a mental disorder. Over thinking is
not incompatible with obsession type disorders, which gravely attenuate social
and occupational functioning. Effective functioning in life almost demands
being able to anticipate events, while simultaneously engaging in continual
cognitive information processing. Using the previous example, if a person had
trouble starting his car the evening before work, then this information should
be considered in anticipating (faith: trust and confidence) whether the car
will start the next day. If the car has had a near perfect history of instant
startup, anticipating a startup would be quite normative.
The Understanding of the Church Fathers
Detachment
The Church Fathers see anxiety as a problem of
attachment to the world and what we really treasure. St. Neilos the Ascetic
(Philokalia I) tells us: “Detachment is the mark of the perfect soul, whereas
it is characteristic of an imperfect soul to be worn down with anxiety about
material things.” The good saint cites the words of Jesus Himself: “And why are
you anxious about clothing? Consider the lilies of the field, how they grow;
they neither toil nor spin; yet I tell you, even Solomon in all his glory was
not arrayed like one of these.” (Mt 6:28–29) Overcoming anxiety by detachment
is echoed by St. Simeon the New Theologian: “… acquire … freedom from anxiety
with respect to everything whether reasonable for senseless – in other words,
you should be dead to everything.” (Philokalia IV) St. Gregory Palamas
continues the same theme: “When a person bids farewell to all things, to both
money and possessions, either casting them away or distributing them to the
poor according to the commandment (cf. Lk 14:33), and weans his soul from
anxiety about such things … his intellect withdraws untroubled into its true
treasure-house and prays to the Father ‘in secret’ (Mt 6:6). And the Father
first bestows upon it peace of thoughts … then he makes it perfect in
humility.” (Philokalia IV) As Jesus Himself counseled: “Let not your hearts be
troubled; believe in God, believe also in me.” (Jn 14:1)
St. John of the Ladder (1982) links anxiety with
attachment and, conversely, its spiritual cure: detachment. Consider his words:
“I have observed many men in the world assailed by anxiety, by worry, by the
need to talk, by all night watching, and I have seen them run away from the
madness of their bodies.” The cognitive psychologists that linked anxiety with
the ‘tyranny of the shoulds’ stand in the tradition of St. John who points out
the way of psycho-spiritual healing: “No one can enter crowned into the
heavenly bridechamber without first making three renunciations. He has to turn
away from worldly concerns, from men … he must cut selfishness away; and
thirdly, he must rebuff the vanity that follows obedience.” The saint goes on
to say “Detachment is good … [the one] withdrawing from the world for the sake
of the Lord is no longer attached to possessions.”
The words of St. John of he Ladder share the
spirit of St. Paul’s council to the Hebrews (13:5–6): “Keep your life free from
love of money, and be content with what you have; for he has said, ‘I will
never fail you nor forsake you.’ Hence we can confidently say, ‘The Lord is my
helper, I will not be afraid; what can man do to me?’” The individual who works
at being reliant on God also works at trusting in Him.
Trust
The Prophet Isaiah (26:3) tells of the
relationship between the absence of mental stress and serenity when we rely on
God: “Thou dost keep him in perfect peace, whose mind is stayed on thee,
because he trusts in thee.” St. John of Karpathos specifically links
eradication of anxiety with trust in God: “We should on no account wear
ourselves out with anxiety over our bodily needs. With our whole soul let us
trust in God: as one of the Fathers said, ‘Entrust yourself to the Lord, and
all will be entrusted to you.’ ‘Show restraint and moderation,’ writes the
Apostle Peter, ‘and be watchful in prayer … casting all your care upon God,
since He cares for you.” (1 Pt. 4:7; 5:7; Philokalia I) The anxiety-challenging
questions, developed by Beck and Emery (1995), as noted above, can be compared
to the Spirit-inspired wisdom of St. John, for those who are still coping with
anxiety because they are doubtful God really cares for them. St. John counsels:
“… think of the spider and compare it with a human being. Nothing is more weak
and powerless than a spider. It has no possessions, makes no journeys overseas
… amasses no savings … does not meddle in the life of others … living in this
quiet fashion … always hard at work—nothing could be more lowly than the
spider. Nevertheless the Lord, ‘who dwells on high but sees what is lowly’ (Ps
113:5–6, LXX) extends His providence even to the spider, sending it food every
day, and causing tiny insects to fall into its web.” (p. 309)
St. Paul counseled having trust in God as the
way to overcome anxiety. He tells the Philippians (4:6–7): “Have no anxiety
about anything, but in everything by prayer and supplication with thanksgiving
let your requests be made known to God. And the peace of God, which passes all
understanding, will keep your hearts and your minds in Christ Jesus.
"Blessed are the poor in spirit, for theirs
is the kingdom of heaven.” (Mt 5:3)
St. Ephraim the Syrian (1997) puts this
Beatitude of Jesus into his own words, reflecting the connection between
attachment to the wants and needs we think are the essential to our living in
this world and fear and anxiety resulting from the threat of their loss. He
states: “Blessed is he who has in the Lord become completely free of all
earthly things in this troublesome life, and who has loved the good and
merciful God.” In discussing this, the good saint reflects, “Blessed is he who
in the Lord has become free of all the affairs of this vain life.” His counsel
makes us think that the things evoking anxiety the most are those things we are
most attached to in our own lives. Solomon, the son of King David and writer of
the book of Ecclesiastes, in the wisdom of his old age and under the
inspiration of the Holy Spirit states:
“… vanity of vanities! All is vanity. What does
man gain by all the toil at which he toils under the sun? A generation goes,
and a generation comes, but the earth remains for ever. The sun rises and the
sun goes down, and hastens to the place where it rises. The wind blows to the
south, and goes round to the north; round and round goes the wind, and on its
circuits the wind returns. All streams run to the sea, but the sea is not full;
to the place where the streams flow, there they flow again. All things are full
of weariness; a man cannot utter it; the eye is not satisfied with seeing, nor
the ear filled with hearing. What has been is what will be, and what has been
done is what will be done; and there is nothing new under the sun.” (Eccl
1:2–9)
If I may be permitted a personal reflection,
most of the major threats (events) in my life that I handled somewhat well
(admittedly a subjective and possibly biased self observation) are not the
major thornsxiii that I have had to deal with. Rather, I get “nervous” about
the little things. When traveling to the airport, I arrive at least three or
four hours before my flight. On Sunday, I get to the parish two or three hours
before the start of Orthros and Divine Liturgy. During Holy Week, for evening
services, I make sure to arrive at the church before 3:00 p.m. My homilies are
completed by Monday or Tuesday of the prior week. I constantly tell myself the
popular mantra: ‘Let go and let God.’ In other words, I have to constantly
remind myself to “have trust in God.” For me, humanly speaking, this is not
easy. But all of us are called to this challenge of placing all our trust in
God. The specifics may be different but the overall process is the same.
The holy apostle Peter as ‘psychologist’
In his epistle of encouragement to the churches
in Asia Minor, Peter wrote: “Humble yourselves therefore under the mighty hand
of God, that in due time he may exalt you. Cast all your anxieties on him, for
he cares about you.” (1 Pt 5:6–7) This is exactly our task in overcoming the
anxieties we have in our lives. To be humble before God is to acknowledge our
dependency on Him and on His Church and its Holy Mysteries which He has given
to us for the healing of our diseases and infirmities. This was told to us by
Jesus Himself, who St. Matthew records: “And he called to him his twelve disciples
and gave them authority over unclean spirits, to cast them out, and to heal
every disease and every infirmity.” Thus with the use of our intelligence, we
work at disputing and restructuring the distorted cognitions that accompany
anxiety; we use practice pro-social behaviors that compete with anxiety related
behaviors, but in addition, by God’s grace, we attend Divine Liturgy, partake
of the Eucharist—the very Body, Blood, Soul and Divinity of Our Lord—, go to
Holy Confession, and receive the anointing of Holy Unction for the healing of
our body, mind, and soul. (Morelli, 2006f)
St. John of the Ladder (1982) points out: “Fear
starts sometimes in the soul, sometimes in the body, and the one communicates
the weaknesses to the other. But if your soul is unafraid even when the body is
terrified, you are close to being healed.”
We end again reflecting on the words of St. John
of the Ladder: “The servant of the Lord will be afraid only of his Master,
while the man who does not yet fear Him is often scared by his own shadow.” As
Jesus said: "With men this is impossible, but with God all things are
possible." (Mt 19:26)
An article by Fr. George Morelli
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