Psychology and Christianity: Understanding Mental Health and Faith

1. Jennifer Konzen, PsyD, LMFT, CCDC, CST

2. 02/24 – Psychology and Christianity: The Historical Battleground and a Disciples Faithful Approach • 03/17 – Understanding Mental Health Throughout the Lifespan: Definitions, Diagnoses, and Neurological Concerns • 03/24 – Treatment for Individuals, Couples, and Families: Anxiety, Depression, and Suicidality • 03/31 – Special Challenges: Sexuality and Drugs • 04/07 – What Every Christian Should Know: Modes of Therapy; Choosing a Therapist; Goals and Process; Maintaining Change; Ethics and Laws of Mental Health

3. Social Anxiety • Panic Disorder (panic attacks) • Generalized Anxiety Disorders • Obsessive Compulsive Disorder

4. A. Marked fear or anxiety about one or more social situations about possible scrutinyby others (having a conversation, meeting unfamiliar people, being observed (e.g., eating or drinking), and performingin front of others (e.g., giving a speech). B. Fear of acting in a way or showing anxiety symptoms that will be negatively evaluated (humiliating or embarrassing; lead to rejection or offending others). C. The social situations almost always provoke fear or anxiety. D. The social situations are avoided or endured with intense fear or anxiety.

5. Recurrent unexpected panic attacks. • Panic Attack: an abrupt surge of intense fear or discomfort with four or more symptoms: Note: The abrupt surge can occur from a calm state or an anxious state. • Palpitations, pounding heart, or accelerated heart rate. • Sweating. • Trembling or shaking. • Sensations of shortness of breath or smothering. • Feelings of choking. • Chest pain or discomfort. • Nausea or abdominal distress. • Feeling dizzy, unsteady, light-headed, or faint. • Chills or heat sensations. • Paresthesias (numbness or tingling sensations). • Derealization (detached from surroundings) or depersonalization (from self). • Fear of losing control or “going crazy.” • Fear of dying.

6. A. Excessive anxiety and worry about a number of events or activities B. The individual finds it difficult to control the worry. C. Three (or more) of the following six symptoms : 1. Restlessness or feeling keyed up or on edge. 2. Being easily fatigued. 3. Difficulty concentrating or mind going blank. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).

7. A. Presence of obsessions, compulsions, or both: 1. Obsessions: a. Recurrent and persistent thoughts, urges, or images that are intrusive and unwanted. b. Trying ignore or suppress thoughts, urges, or images, or to neutralize them a compulsion. 2. Compulsions: a. Repetitive or excessive behaviors with rigidly applied rules b. Behaviors or mental acts not connected realistically with what they are neutralizing or preventing B. Time-consuming; cause distress; causes challenges with functioning.

8. School, job performance and circumstances, homework and tests, responsibilities in the home, future career • Relational: Friends, family, parents, children, death of loved one, lack of stability at home, conflict in family • Lifestyle: Home, travel, projects, sports, busy, money • Physical: Lack of sleep, health problems • Intimacy: Lack of love life or strong marriage • Body: Looks, appearance, body image • Spiritual: Sin, expectations of others, leadership position

11. Asthma • Ulcers • Insomnia • Chronic headaches • Hypertension • Coronary heart disease

12. Coronary heart disease • Caused by a blocking of the coronary arteries • Includes angina pectoris (chest pain); coronary occlusion (complete blockage of a coronary artery); and myocardial infarction (heart attack) • Leading cause of death in men older than 35 years and women older than 40 years in the U.S. • Causal psychosocial factors: • Job stress, high levels of anger or depression • Causal physiological factors: • High cholesterol, obesity, hypertension, smoking, lack of exercise

13. Major Depressive Disorder requires ONE Major Depressive Episode which is: • Five (or more) of the following symptoms in a 2 week period: • Depressed mood most of the day, nearly every day (e.g., feels sad, empty, hopeless). In children and adolescents, can be irritable mood. • Markedly diminished interest or pleasure • Significant weight loss when not dieting or weight or decrease or increase in appetite nearly every day • Insomnia or hypersomnia nearly every day. • Psychomotor agitation or retardation • Fatigue or loss of energy nearly every day. • Feelings of worthlessness or excessive or inappropriate guilt nearly every day (not merely self-reproach or guilt about being sick). • Indecisiveness or difficulty concentrating/thinking • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

14. Bummed, blue, down • Can’t just “snap out of it” • Not always a “cause” • About 7% of population (F>M) • Leading cause of disability worldwide! • ALWAYS consider medical conditions (many can cause depression) • Baby Blues vs. peripartum onset MDD • Anxiety, substance use

16. Poor appetite • Difficulty sleeping • Crying more than normal; sadness • Racing thoughts • Defensive responses: anger, taking things personally, taking criticism badly • Lack of motivation • Lack of enjoyment • Feeling hopeless, helpless • Suicidal thoughts

18. A. Depressed mood for most of the day, for more days than not for at least 2 years. Note: In children and adolescents, mood can be irritable and duration 1 year. B. Two or more of the following: • Poor appetite or overeating. • Insomnia or hypersomnia. • Low energy or fatigue. • Low self-esteem. • Poor concentration or difficulty making decisions. • Feelings of hopelessness. • No Major Depressive Episode • If a major depressive episode has occurred, diagnosis is MDD not PDD

20. A. During most menses, five symptoms in the final week before onset of menses, improvement within a days after onset of menses, and minimal or absent in the week postmenses. B. One (or more) of the following symptoms must be present: • Marked labile mood: mood swings; sad/tearful, or increased sensitivity to rejection. • Marked irritability or anger or increased conflict. • Marked depressed mood, hopelessness, or negative self-thoughts. • Marked anxiety, tension, and/or feelings of being keyed up or on edge. C. One (or more) of the following symptoms • Decreased interest in usual activities (e.g., work, school, friends, hobbies). • Difficulty concentrating. • Lethargic, easily tired, or marked lack of energy. • Marked change in appetite; overeating; or specific food cravings. • Hypersomnia or insomnia. • A sense of being overwhelmed or out of control. • Breast tenderness or swelling, joint or muscle pain, feeling bloated, or weight gain.

23. Must meet the following criteria for a Manic or Hypomanic Episode: A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood AND abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week, daily, most of the day. B. Three (or more) of the following symptoms (four if the mood is only irritable) • Inflated self-esteem or grandiosity. • Decreased need for sleep • More talkative than usual or pressure to keep talking. • Flight of ideas or thoughts are racing. • Distractibility • Increase in goal-directed activity (socially, at work or school, or sexually) or agitation • Excessive involvement in activities that could have painful consequences (buying sprees, sexual indiscretions, or foolish business investments). Manic Episode: The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features. Hypomanic Episode: The episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic.

24. A. Hypomanic and depressive symptoms (but no hypomanic, manic, or major depressive episodes) B. Symptoms present for half the time over 2 years.

25. Eating Disorders • Drug and Alcohol • Sexual Disorders • Trauma

26. Emotional Regulation: Emotional Eating, Substance Use, or Behavioral Addiction in response to emotional states • Eating/use in response to emotional distress or negative emotions • Turning toward food/use instead of: seeking human connection; going to God for comfort; finding better ways to self-soothe for comfort • Automatic reaction to unrecognized negative feelings • Conscious behavior to ease emotional distress • Efforts people undertake to influence the experience and expression of their emotions

27. Eating gets me through hard times • When experts tell me to avoid specific foods, I want to eat a lot of them • I do not always follow a food plan, because I have a right to eat what I want • Food calms me down when I am angry • When friends or family advise me not to eat something, I often eat it • When I am sad, eating comforts me • I resent it when experts tell me how and what to eat • Food relaxes me when I am nervous • When there is trouble, food is my best friend Chesler, Harris, & Ostreicher, 2009.

28. Dopamine • Associated with positive emotions; use increases dopamine • Hypothalamic-pituitary-adrenal axis (activated during stress) • Release of stress hormones cortisol, adrenaline, glucocorticoids • People who have increased food intake due to emotional eating have higher cortisol secretions • Drug use (incl. alcohol and nicotine) influences the HPA axis • Trauma causes dysregulation in HPA axis • Opiods • Released during social interactions; associated with reward system; linked to emotions, food choice, or drug use; causing a visible reduction in stress (calming effect of sweet food or alcohol) • Oxytocin • Releases opiods naturally during relational bonding; also drug use, behavioral addictions, binge eating

30. 15-20% of those with depression attempt suicide • 90% of those who commit suicide were dealing with depression • Hopeless, meaningless, worthless • Are suicidal attempts just trying to get attention • Shame and Stigma – lack of understanding about depression keeps people from talking about it

31. Effective mental health care; easy access to a variety of clinical interventions • Strong connections to individuals, family, community and social institutions • Problem-solving and conflict resolution skills • Contacts with caregivers and providers (e.g., follow-up phone call from health care professional) • Meaning and Purpose • Positive Therapeutic Relationship

32. Acknowledge Care Tell • Listen like Jesus: John 2 (Hold the moment) • Ask the question! • How, when, where? • Level of emotional pain • Previous attempts • Drug/alcohol abuse • Police/5150 hold/PERT

33. Are you thinking about suicide? • Be direct, and let them know you are comfortable talking about suicide. There is nothing to be ashamed of. Let them know you want to help them to choose life. • Do you have a plan? • Finding out if someone has thought about how they would attempt suicide can let you know how close to an attempt they may be. Having this information is necessary to help you remove lethal means. • Ask about the pain • Suicide often isn’t about wanting to die, it’s about not wanting to live. By trying to understand someone’s pain, we can help offer hope by reducing the pain and reminding them of their reasons to live.

34. Non-judgmental listening • make them feel safe • Be genuine • Ask open ended questions: Prov 20:5 – draw out the deep waters • Looking for what is underneath the behavior • Remember you are a messenger of reconciliation (2Cor 5) • Learn about their illness and help them stick to treatment • Pray with them • Don’t be afraid to say I don’t know

35. Warning signs/Triggers • Internal coping strategies • Social supports • Family & friends • Professional agencies/contacts (#s in phone) • Make environment safe • Follow up

37. Theory of Change: How do people change • Romans 5:3 – suffering, perseverance, character vs. avoidance of pain • Humanism and Psychology • Enhance self-esteem and nurturing growth • Accessing your resources: people have within themselves resources to change including reaching out and asking for help • Making mistakes provides opportunities for growth • Positive coping • Spiritual integration • God-esteem • Understanding your strengths and weaknesses • Seeing the sinful nature, repentance and ownership • Seeking spiritual guidance • Motivation, shame and guilt, vulnerability, connection, empathy, and meaning

38. God Esteem • Really understanding how God feels about you • God has given each person unique strengths • “Each one should use whatever gift he has received to serve others” (1 Pet 4:10). • “Each man has his own gift from God; one has this gift, another has that” (1 Cor 7:7). • Each of us has the opportunity to use those gifts • “For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do” (Eph 2:10).

39. Responsibility and Choice • “Choose life” Deut 30 • Sin and repentance: Example - Pride and Selfishness • Selfishness • “An unfriendly man pursues selfish ends; he defies all sound judgment” (Prov 18:1) • “For where you have envy and selfish ambition, there you find disorder and every evil practice” (James 3:16) • Pride • “The proud and arrogant man – ‘Mocker’ is his name; he behaves with overweening pride” (Prov 21:24) • “Pride only breeds quarrels” (Prov 13:10)

40. Motivation – purpose and meaning • “He has committed to us the message of reconciliation… We are Christ’s ambassadors, as though God were making his appeal through us” (2 Cor 5:18-19) • Vital importance of openness and seeking input • “Whoever heeds life-giving correction will be at home among the wise” (Prov 15:31) • “Many advisors make victory sure.”

41. Coping Skills • Depression • Anxiety • Bipolar • Medication • Therapy • Trauma Treatment • Support Network • Family Therapy (incl. Couples Therapy) • Group Therapy

42. Sensitive • 2 Kings 20 • “You are going to die” – Hezekiah prays • “I have heard your prayer and seen your tears; I will heal you.” – guaranteed 15 more years • How would we respond? • “Prepare a poultice of figs.” – Why? • Medication as a tool

43. Sympathy, empathy, concern, genuine, curiosity • Just ask! Open ended questions

44. Cognitive Behavior Therapies (CBT, DBT, ACT) • Cognitive restructuring • Automatic Thought Record • Thoughts, Beliefs, Emotions • Core Beliefs • Attachment Theory • Other therapies – psychoanalysis, solution focused, family therapy, narrative therapy

45. Medication (antidepressants, benzodiazepines, etc.) • Anxiety management therapy • Healthy lifestyle • Relaxation training

46. Relaxation techniques • Breathing • Grounding • Biofeedback • Meditation and Yoga • Art and expression (incl. Art Therapy) • Walking, journaling, singing

47. OCD: Externalizing, Acceptance, Guided Imagery, Worry Time, Exposure Exercises (Imagined Exposure) • Assertiveness, Body Awareness, Positive Coping Skills • Family/Couple Therapy – impact of symptoms on marriage, children and family • Attachment Theory • Secure Attachment • Management of Emotion • Emotional Connection

48. Dialectical Behavior Therapy (DBT) • Mindfulness Based Therapies • Acceptance Commitment Therapy (ACT) • Values Clarification • Mindfulness • Ride out the waves of emotionally-provocative thoughts • Commit to actions that align with what really matters most in your life • Where traditional CBT seeks to change the content of internal experiences (thoughts and feelings), ACT seeks to change the relationship to them

49. Mindfulness (Wise Mind) • Emotion Regulation • Distress Tolerance • Interpersonal Effectiveness

50. Drumming group therapy • Music • Art • Dance