Managing Anxiety - Pastors and Counselors - CSU Shiley Haynes Institute for Palliative Care (2023)

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Guest editorial by Kyle D Johnson
Discipleship Minister and Visiting Professor at Jarvis Christian College in Hawkins, TX

Debbie tells the chaplain about a problem. She is constantly scared and fears that something terrible is waiting for her in her future. The chaplain asks about Debbie's fears. She fears for her marriage, her family, her job, her home, her church, her community, her bills, her car, her clothes, her friends and how the chaplain will answer.

Debbie looks around nervously as she speaks. The chaplain almost gets lost on Debbie's list. A missing point in the story is "Where are Debbie and the chaplain?" The answer is almost irrelevant because people with anxiety problems are everywhere. Of course, Debbie is an exaggerated example, although some ministers may think, "Yeah, I've met someone like that."

Counselors encounter people with anxiety wherever they work. The setting may be medical, psychiatric, military, correctional, or industrial. Anxiety can happen anytime, anywhere. I have served as a chaplain or student chaplain in a variety of fields: medical, psychiatric, military, and correctional. I found someone with an anxiety problem in every setting. Sometimes I felt like meeting someone who suffered from anxiety every day.

How can a minister advise a person who almost seems to be gripped by fear? How does one minister to someone who has fears and anxieties throughout her life? And how can you do pastoral work in a situation where time is pressing?

Time is of the essence, whether you are a patient hospitalized for a few days or one of 800 soldiers under the care of a chaplain. Pastors are consulted for pastoral care, but rarely for long-term counseling or psychotherapy. So where do you start and how can you make a difference in a short amount of time?

A starting point is the difference between fear and anxiety. EITHERDiagnostic and statistical manual of mental disorders (5ºed.)(2013) gives useful definitions of fear and anxiety and points out their differences:

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"Fear is the emotional response to a real or perceived imminent threat, while anxiety is the anticipation of a future threat" (p. 189).

In short, fear is a reaction to what the person is actually facing, while anxiety is the fear of what could happen and often won't. A person with anxiety will obsessively think about what could happen, even when the chances are slim. This obsessive and disturbing contemplation can last for hours. What are the reasons why people with anxiety seem to hold on to their worries? Cognitive neuroscience may provide some clues.

search withfunctional magnetic resonance imaging (fMRI).) found that people with anxiety problems have brain changes (Coombs III, Loggia, Greve, & Holt, 2014; Cha, Carlson, DeDora, Greenberg, Proudfit, & Mujica-Parodi, 2014; Coombs III, Loggia, Greve, & Holt, 2014). These changes help to perpetuate the anxiety problems that these people suffer from.

This research can help a minister understand that these people do not worry about worrying. Your brain circuits help maintain your behavior. What can a minister do for someone suffering from anxiety perpetuated by changes in brain circuitry?

Brain imaging research has also found that counseling interventions can help to alter anxiety-driven circuitry in useful ways (Beauregard, 2006; Månsson, Carlbring, Frick, Engman, Olsson, Bodlund, Furmark, & Andersson, 2013). ; Phelps, 2006). Counseling interventions in relation to psychotropic drugs can be very helpful.

However, counseling interventions alone can be very helpful in inducing changes in the person's brain. Since counseling interventions can be helpful, where does the chaplain begin to engage them in a chaplaincy intervention? One factor that drives a person's anxiety is a lack of self-efficacy. self-efficacy:

"It refers to the belief in one's ability to organize and carry out the sequences of actions necessary to achieve particular achievements" (Bandura, 1997, p. 3).

In other words, does anyone think they can successfully complete a challenge? A person generally does not attempt to perform a task that he believes he cannot perform. I wouldn't try to run a marathon because my marathon self-efficacy is close to zero.

However, my self-efficacy in making my wife laugh at the idea was high. However, due to the high level of self-efficacy, I would not hesitate to drive to the local store to purchase an item. In general, perceived self-efficacy influences what one tries and doesn't try to do. The perception of one's own self-efficacy determines how much effort one puts into completing a task. What role does fear play in self-efficacy?

A person with anxiety doubts their ability to successfully cope with a feared outcome. Anxiety occurs when a person is faced with a task for which he does not have the self-efficacy. Another word for this fear response is fear.

The person with anxiety is afraid to take on a challenge that they doubt they can meet successfully. An example might be a hospital worker who is afraid of losing his job. The employee believes that losing the job will lead to overwhelming problems such as: For example, losing a spouse, not being able to continue paying the bills or not being able to support the children.

The employee's workplace must not be endangered. The employee's supervisor may be very satisfied with the employee's performance. The employee only fears that the position may be at risk. The fear of this employee is a form of fear. Another employee who sees a potential job change as a challenge that could create new and better opportunities wouldn't be concerned. This employee would have strong self-efficacy to deal with a potential job loss.

Lack of self-efficacy is at the heart of anxiety. Knowing that self-efficacy plays a key role in anxiety can help the counselor formulate a counseling response.

pastoral interventions

A minister has several options for pastoral intervention. The counselor must decide which intervention is best suited for the person with anxiety. There is no one size fits all. The objective is to offer an individualized and personalized intervention that best suits the person who needs it.

One intervention is to encourage the person to relax into self-imposed, often perfectly constructed patterns (Bandura, 1997).

A person can be hard on themselves and expect an undue level of perfection. This person may believe that perfection is the only way to keep a job, not realizing that all employees make some mistakes.

The constant search for perfection can wear everyone down. The counselor can help the person realize that what they expect of themselves is unrealistic and help them move toward more realistic expectations. The person may not be aware that they have irrational patterns.

The counselor can help increase the person's self-efficacy by pointing out that it is possible to make mistakes and still keep their job. The minister can remind a person of a theistic belief such as Judaism or Christianity that Gd did not create us perfect human beings but imperfect ones, more than capable of making mistakes but capable of doing a good job. Suppose that talking to the person is not enough. How does a minister help someone relax her standards?

Another useful intervention is A-B-C-D-E by Albert Ellis (Ellis & Dryden, 1997).

Most people can remember the first five letters of the English alphabet. A stands for trigger event. B stands for belief (ie irrational). C stands for consistency. argues D. Furthermore, E is an event (ie, new). How is this intervention used?

Ellis says that a person experiences an event and concludes that the emotional response is caused by the event (Ellis & Dryden, 1997). In other words, it's not what you see, it's what you think you see. An example might be a nursing student receiving a clinical lesson from an instructor.

Suppose the nursing student made a mistake, such as not introducing herself to a patient in front of an instructor. The instructor corrects the student in the correct way to make contact with a patient. A student who sees the correction as a reprimand might conclude that her disappointment in her performance is due to the teacher's correction. Her feelings of disappointment may affect her self-efficacy as a nurse and therefore diminish her ability as a student.

Another student might see the instruction as a useful lesson and think differently.

The second student feels validated by the instructor who is helping him learn how to properly approach a patient. The second student has high self-efficacy in her ability to learn and become a good nurse. What led to the different reactions?

The first student sees her feelings of hurt and disappointment (C for Consequence) due to the teacher's correction (A for Activation Event). Ellis (Ellis & Dryden, 1997) would say that the first learner is likely to have perfectionist tendencies and see the instructions (A for the trigger event) as an indication of failure (B for the irrational belief). The student's C (emotional consequence) is due not to the A but to the student's B (an irrational belief in the possibility of perfection as a student). The student assumes that A causes C, but C is actually caused by B or the student's irrational belief in perfection. Her problem is not what the student saw, but what the student thought she saw. He recalls that the other student saw instruction (A) as helpful and had a very different C (consequence). The other student thought very differently about what she saw. Ellis would recommend pointing out to the first student the irrational qualities of her belief in artificial perfection or D (Disputing Belief). Then the student can develop a more useful B (rational belief) and a new response to the teacher's correction or E (new effect).

A more rational belief in one's own expectations would have a positive impact on the freshman's sense of self-efficacy as a student and on the potential to be a good caregiver. Higher self-efficacy can lead to lower anxiety in the first learner. The minister might remind the student with a theistic belief that humanity is imperfect and that perfection is not really possible. And constructive learning is possible.

A third possible pastoral intervention is Guided Imagery (GI) or systematic desensitization (Wolpe, 1986).

I find the first term easier to spell. The counselor uses a person's imagination to help them overcome anxiety-provoking situations. The counselor guides the person through a relaxation exercise in which the counselor helps the person relax one area of ​​the body at a time.

I routinely start a person on their feet and work my way down with comments like, "Relax the muscles in your feet. Allow your foot muscles to relax. Feel the stress move away from your feet." people can follow a slow and progressive relaxation using only one part of the body at a time.The relaxation exercise does not require a lot of time.

Next, the minister has the person briefly imagine a situation that causes some anxiety, such as the first nursing student being corrected by the instructor. The counselor can guide the student to change her feelings and respond to the teacher. The counselor begins with mildly anxiety-provoking situations and gradually moves to increasingly anxiety-provoking situations.

The last intervention to mention is one that I use. This invention is called meditation.The counselor guides the person through the progressive relaxation mentioned in the GI example. The counselor then instructs the person to focus on her breathing instead of using the GI. The minister assures the person that it is normal for the mind to wander while he is breathing. The counselor instructs the person to gently refocus on the breath.

The counselor then encourages the person to allow the thoughts to pass through their awareness instead of fighting the thoughts. A suggested goal is to have the person do this exercise on her own twice a day for 20 minutes. I have found it helpful to suggest a meditation practice before bed. Newberg found changes in the brain that help a person to be more relaxed and less anxious when practicing meditation (Newberg & Waldman, 2009).

A benefit of any intervention is the opportunity for the counselor to teach the person and for the person to practice. These interventions do not require prolonged contact between the counselor and the person with anxiety problems. Each intervention can be taught in a few sessions, and the person continues to practice the intervention without having to consult the minister.

There is always the possibility that the counselor will advise a referral. Not all people with anxiety problems will respond to these interventions. Stronger intervention by a trained psychiatrist, such as B. a chaplain may be required. The chaplain must confirm to the person the availability of the chaplain once the referral is made.

Kyle D. Johnson, M.Div. Kyle is a visiting professor at Jarvis Christian College in Hawkins, TX, where he explores the lessons of cognitive neuroscience for counseling and counseling. He is an associate faculty member at St. Stephens College in Edmonton, Alberta, Canada. And he is a part-time minister at First Christian Church in Athens, TX, where he helps provide the county's only free mental health care service for people who can't afford counseling.


Bandura, A. (1997).Self-efficacy: the exercise of control. Nueva York: WH Freeman and Company.

Coombs III, G., Loggia, ML., Greve, DN. and Holt, D.J. (2014). Amygdala perfusion is predicted by its functional connectivity with the ventromedial prefrontal cortex and negative more, 9(5), 1-10.

Ellis, A & Dryden, W (1997). The practice of rational emotional behavioral therapy (2ndNorth DakotaHrsg.). Nueva York: Springer Publishing Co.

Månsson, K.N., Carlbring, P., Frick, A., Engman, J., Olsson, C.J., Bodlund, O., Furmark, T. and Andersson, G. (2013). Cambióneural correlatesVonAffective processing after Internet-based cognitive behavioral therapyforSocial anxiety disorder.psychiatry research,214(3), 229-37.

Newberg, AB and Waldman, MR (2009). HowGod Changes Your Brain: Groundbreaking Discoveries From a Leading Neuroscientist. New York: Ballentine.

Wolpe , J. ( 1985 ). Systematic desensitization. In AS Bellack & Hersen, M (eds.), Dictionary of Behavior Therapy Techniques (pp. 215-219). New York: Pergamon Press.

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