Ministering to those with anxiety
Dr. Gregory Popcak Comments Off on Unworried
We live in anxious times. According to the National Institute for Mental Health, 20% of Americans are diagnosed with some type of anxiety disorder every year. Of course, this number only represents those people who receive treatment. Research by the Anxiety and Depression Association of America estimates that fully 63% of people who experience anxiety disorders never seek help. What makes this truly unfortunate is that modern approaches to treating anxiety are terrifically effective. More than 85% of people who seek therapy for anxiety are able to get the skills they need to lead healthy, anxiety-free lives.
You, as priests and pastors, have the opportunity to help the anxious souls in your care both by serving as a spiritual first responder, providing both appropriate interventions to ease a person’s suffering and the encouragement people need to seek more professional mental health counseling when it is indicated.
The experience of stress, worry and anxiety are so common, people often assume it is an unavoidable part of the human condition. That said, there is an important difference between the so-called normal anxiety that comes from living in a broken world and anxiety disorders that require professional treatment. The difference comes down to the way the person’s brain makes them respond to the challenges in their life.
In my book “Unworried: A Life Without Anxiety” (OSV, $16.95), I make the distinction between “concern” and “anxiety.” When we are concerned about something, we might feel stressed in the presence of a particular problem, but that stress motivates us to seek resources, gather support and make a plan to address the problem. Concern represents a healthy, proactive response to problems. When a parishioner brings concerns about marriage and family life, financial struggles, health issues, etc., to you, it can be tremendously helpful to ask questions that can help them seek resources, gather support and make a plan to address their problems.
By contrast, anxiety is experienced as stress that is unhealthy and unproductive. Anxiety prevents a person from identifying resources, gathering support or making a plan. In some cases, anxiety can be so great they can’t identify the problem in the first place.
When a person is experiencing anxiety — as opposed to concern — their bloodstream floods with stress chemicals such as adrenaline and cortisol. These chemicals literally turn off the cortex, the logical, problem-solving part of the brain, and ramp up the limbic system, the emotional, fight-flight-freeze part of the brain that’s in charge of our survival instincts. When this occurs, we become unable to respond effectively to our problems or even use good advice when it is offered. The cortex appreciates advice and knows how to make good use of it. But the limbic system causes the brain to lock down and ignore or dismiss even the best advice. When the limbic system is engaged, it forces the brain to treat even the smallest problem as a life-or-death struggle that cannot be solved, only survived.
As a result, a clinically anxious person can only respond to their problems in one of three ways: 1) by “tantrumming” about them (the fight response); 2) withdrawing and ruminating about how awful everything is OR running around distracting themselves (the flight response); or 3) talking incessantly about how awful the problem is without ever doing anything about it (the freeze response).
In these cases, the real problem isn’t the stressor but rather the internal, lock-down response the person keeps experiencing in the face of the stressor. This lock-down response represents the limbic system’s overthrow of the cortex. When this happens, a person becomes virtually incapable of responding to problems in an effective, solution-focused way.
This brain-based coup staged by the limbic system is what constitutes an anxiety disorder. In most cases, people with anxiety disorders cannot take advice. They may listen to it and even agree with it, but they won’t be able to use it. In fact, the more advice you try to give them, the more anxious they may get.
In short, people who come to you with concerns can be helped by pastoral and spiritual interventions alone. By contrast, people experiencing an anxiety disorder will require additional mental health treatment to learn how to get their brains “unstuck” so that the limbic system can calm down and the cortex can come back online giving them the capacity for engaging their problems in a reasonable, proactive manner.
In light of the above, it would stand to reason that the most effective treatment for anxiety would be medication. In fact, a significant body of research shows that this is not the case. In particular, a 2016 study by researchers at the University of Manchester found that medication can be a hindrance to recovery from anxiety disorders. The researchers found that anxious patients who received therapy alone (especially cognitive-behavior therapy) experienced more and longer-lasting relief from anxiety than either patients who received medication alone or a combination of both medication and therapy.
Modern psychotherapeutic techniques are actually more like physical therapy for the brain. Cognitive-behavioral therapists use different techniques that help strengthen the dominance of the cortex over the limbic system and facilitate better communication between the different hemispheres of the brain. These changes in a patient’s brain-state before and after psychotherapy can actually be observed using functional imaging technology such as fMRI and fPET.
But if psychotherapy is like physical therapy for the brain, it can be useful to think of psychiatric drugs like pain medication for a physical injury. For a person with a physical injury, pain medication alone will most likely not facilitate a return of the patient’s range of motion. Even if the person is getting both physical therapy and pain medication, the patient may be disinclined to do his physical therapy exercises, choosing to lean too heavily on the drugs to make him feel better.
The study by the University of Manchester found that this is exactly what happens when using medications to treat anxiety disorders. If patients are only given anti-anxiety medications, their anxiety usually returns immediately after they stop taking the drugs. When anti-anxiety medications are used in conjunction with psychotherapy, patients tend to make slower progress in treatment because they aren’t as consistent with their therapeutic exercises. In general, research suggests that if medication is going to be used at all in the treatment of anxiety disorders, it should only be used in a supportive manner once the patient has made a serious and consistent attempt to do the exercises prescribed by his or her therapist. Therapy is the primary and most effective treatment for anxiety disorders.
But whether a person is coming to you with concerns or what you suspect to be an anxiety disorder, there are several things you can do.
Check Your Reactions
Talking to anxious people can make us anxious. Structures called “mirror neurons” in our brain give us a taste of what other people are feeling so that we can empathize with them. But if we aren’t careful, we can allow their anxiety to wind us up, which then fuels their anxiety. Check your reactions. Pay attention to how quickly you are speaking. Slow down. Even a little. Pause for a breath before responding to their comments. Watch your posture and be sure to relax in their presence. Simple behaviors like this can allow you to trigger your parishioner’s mirror neurons and help them calm down by being calm.
Second, be careful about giving advice or trying to fix the other person’s anxiety. Remember, people who are stressed and anxious aren’t in a position to use advice. The best thing you can do is help them pray — and to pray over them. If you suspect an anxiety disorder, the anointing of the sick may be appropriate. Regardless, help them to pray more proactively — that is, instead of just saying, “God help me. God help me. God help me!” ask them to pray something like, “Lord, help me to respond to my struggles in a manner that will glorify you, work for my greater good, and work for the greater good of all those affected by this problem.” Then teach them how to listen to the ways God might be answering their prayer every day.
People who are prone to anxiety often tend toward hyper-responsibility, blaming themselves even when there is nothing to blame themselves for. Many anxious Christians are afraid that they are “letting God down” by being anxious. Remind them of the saints who struggled with anxiety, such as St. Alphonsus Liguori or St. Ignatius, who suffered from scruples, or St. Thérèse of Lisieux, who experienced separation anxiety following the death of her mother.
Ask them to spend some time challenging their thoughts of condemnation by writing down even the tiny ways God is showing his love for them. Ask them to make a “sacrifice of praise” by thanking God for each of these things even when they don’t feel like it. Remind them to do this, not because God needs our praise, but because connecting with his love and providence is good for us.
In addition to praying with them and over them, asking questions is another powerful way to address both concerns and anxiety. Ask the person what resources, support or plans they might need to respond more effectively to their challenges. Ask them when they feel most effective. Ask what little differences make a positive difference in their mood: Do they get more rest? Eat better? Ask for help more often? Look for the differences that make the difference, and help the person build those differences into their day.
If you suspect an anxiety disorder could be at play, recommend counseling. Explain what I shared above about how counseling works. If you have a counselor to recommend the person to, try to get them to make an appointment before they leave your office. They will be much more likely to follow up if they do. Early intervention is key to successful outcomes and people are much more likely to seek help if they are aided in doing so by people they trust. Be the bridge that connects people to the support they need.
As spiritual first responders, you can make a huge difference in the lives of the souls in your care. Let God use you as an instrument of conveying his peace to the hurting hearts that call upon you for support and guidance.
New habits explored to address worries
Dr. Gregory Popcak’s book “Unworried: A Life Without Anxiety” (OSV, $16.95) explores building new habits of thinking, communicating and acting that will help free us from worry. He integrates insights from our Catholic faith with cutting-edge psychological research to help those with anxiety for a comprehensive plan for conquering anxiety and living a life of true peace. Go to https://www.osvcatholicbookstore.com/product/unworried-a-life-without-anxiety for more information and to order.