ANXIETY: A RELIGIOUS PRESPECTIVE FOR
UNDERSTANDING AND TREATMENT
Baruch Shulem and Moshe Berliner
We are all familiar with the feeling of anxiety. Under normal circumstances it is a personal response to a specific problem. One feels anxious and either acts to solve the problem, or remains passive hoping that the difficulty will resolve itself. Generally one way or another, change occurs and the anxiety subsides.
The anxiety that many feel today is not related to a specific act or focused problem. Rather, the situation itself is the problem. We are continually affected by fast-breaking potentially life-threatening change. The usual ways with which we deal with the emotional vicissitudes of everyday life are no longer adequate. Events appear to be out of control or at least out of our control. This leads to a feeling of helplessness, which adds to the enormity of the threat.
We as professionals have become aware of this change through the significant variation in the referrals coming to our office. Family functioning has been affected; couples are arguing more and are having more difficulty working smoothly together; people in communal settings are having difficulty containing aggression; children are exhibiting fears, sleep problems are more prevalent. We have been contacted by educational facilities, Yishuvim, and kibbutzim with requests to advise them about how to deal with the growing tensions and sense of helplessness on both group and community functioning.
The universality of the phenomenon we are describing indicates that it is a social problem expressing itself in individual, family, and community functioning.
Our traditional models of working with individual - or family - created problems have been inadequate to deal with these referrals. We have therefore developed a model to treat these new manifestations of anxiety. After a period of implementation and revision we decided to put some of our thoughts about our work into writing. Our goal is to share with the broader helping community a number of key ideas that we find helpful in aiding individuals, families and communities to deal with unusually high levels of anxiety.
The ideas we are presenting emerge from the integration of our religious perspective and our professional knowledge. We believe this combination of two perspectives greatly enhances our work. These ideas serve as the basis of the interventions we devised, which have been effective as well as efficient when working with religious and non-religious individuals alike.
Our thinking about anxiety begins with a central question -- What is an emotion? Modern psychological theory offers a variety of answers, none of which has been accepted as definitive. In its most popular conception, psychology portrays emotions as a kind of independent force, emerging from the depths of man's inner world, over which he has little or no control. Some theories posit that controlling one's emotions is itself the basis of emotional problems. According to these theories, psychological health is marked by an individual's ability to express every emotion he has, to hold nothing back, to "do his thing", and be ready "free".
Chazal view emotions from a fundamentally different perspective. They understood emotions to be a byproduct of thoughts and actions. "After the deeds the heart follows." Emotions do not have an independent life of their own. They emerge as understandable and logical consequences of various elements of a person's life. When a person thinks in a certain way or entertains a particular thought, a concomitant emotion emerges. When a person takes a specific action, he causes an emotion to be felt. There is an understandable lawfulness to a person's emotional life.
From this perspective Chazal posit a central truth: emotions can and should be controlled. Emotions are derived from a specific context over which an individual has a significant degree of control. For example, Chazal mandate that a person feel simcha at specific times of the year. Only if one posits that one has the ability to create a feeling can the halacha mandate "simcha on demand". Certainly a person can be held responsible only for elements of life over which one has control.
We would like to explicate two additional aspects of emotions. The first relates to the naming of the emotions, and the second to the purpose of emotions. That name of an emotion does not tell us anything about the emotion; it does not even hint at the components or complexity of the emotion. The name is simply a tag. As a result, a person may fail to understand and appretiate the vast richness and profundity of the inner experience that is the emotion. For example, when a person hears the latest news report and says he is anxious, he is using that word to describe his reaction not to the report but possibly to one or more of the following internal responses engendered by the external report:
1. Memories; a series of painful memories of related matters; 2. Images: a set of threatening projected images of the future;
3. Physical responses; body sensations such as tension in his chest and change in the breathing pattern;
4. Interpretations; thinking about the news and putting a value judgment on it;
5.Environmental responses; the immediate response or conditions in the environment.
All this he summarizes in three words, "I am anxious." To call an emotion by its name is to aggregate a complex configuration of disparate thoughts, memories, body responses and mental images, all interacting within a very specific context.
A second point is that emotions exist in order to motivate us to take an action. An emotion is a signal from the individual to himself. For example, the feeling of love signals one to give to another. Fear signals one to protect oneself. Pain signals one to care for oneself, and boredom signals oneself to bring about change.
Responses to these signals can be characterized by two central elements: They happen "out of consciousness" i.e. they do not emerge from conscious, rational decision making; and they appear with great rapidity.
The first element refers to the fact that few of us decide which emotions we will feel or how strongly we will feel them. They seem to just happen. This is not in fact what occurs. Emotional responses follow an internal lawfulness that expresses itself as personal patterns and styles. Each individual has a set of internal rules that determine how, when, and with what strength he will respond to any stimulus. What may appear to an outsider as an "emotional" style, i.e., Danny is a optimist or Yosi is a fearful person, may simply be the name we give to that individual's most prevalent set of responses to that particular situation. It is this regularity that indicates a lawfulness and not just a "once in while" response. As many people say, "if you press a certain button, you're going to get a certain type of emotional response."
The second element is the rapidity with which emotional responses occur. No conscious decision-making process could operate so quickly. The immediate nature of the emotional response is based on it's being an unconscious, automatic reaction.
Lawfulness and rapidity have positive elements: they allow us to react immediately in a situation and to mobilize emotions in service of action. They free us from the constant decision making that would overwhelm us. Thus, significant elements of our lives goes on automatically, allowing us to become involved in other activities beyond the immediate issue of "how should I respond now." They also allow us to develop consistant styles of living and contribute greatly to creating an environment in which we are able to predict ourselves and others. Without this lawfulness, living in this world would to be a random unpredictable experience.
These two elements, lawfulness and rapidity, also have negative aspects to them. Lawfulness can turn into rigidity and stereotypic responses. Rapidity can lead to preset rules of action which preclude subtle choices and the more exact calibration of specific emotion to a particular event or interaction. In addition, rapidity works against the basic tenet of all psychological models - that an individual's freedom of choice is a critical element without which there is no true mental health.
An emotion can thus be seen simply as a particular type of information which is intended to help us adapt. While some information may cause discomfort and other information may cause a sense of well being, the actual response to any emotion should not be confused with it's function - to signal to act. Since every emotion, pleasant or not, helps us become aware of our needs in order to act upon them, we can view all emotions as inherently adaptive. Without such a function, rapid self- protective behavior would not be possible.
Emotions and "The Situation"
Using this model of emotions we postulate the following rules:
This method begins by having an individual ask three fundamental questions:
By asking these questions of oneself, an individual takes the first steps in demystifying one's emotional style. From vague, automatic responses a person can identify sources of information, methods of interpretation, and choices of response.
In order to detail how this method works, let us apply it to a specific case of radio report describing a terrorist incident.
This report will be filtered, like all external information, through one or more of the five sources mentioned above. The individual's emotional response is not generated by that external information but rather this selective use of internal sources. Those who filter this report through one or more of the five sources which produces anxiety will not surprisingly feel anxiety. Those who hear the same radio report but focus on other sources of internal information will respond with different "emotions".
A simple formula is created: external event - internal interpration - emotional response. The task is to slow down this information processing procedure in order to gain control of emotional response.
In our example of the radio report, gaining control would start with the following question. "What automatic responses lead me to feel anxious?" We would then survey our responses in the five different sources which might contribute to engendering this emotion. We would examine the relative contribution of each of the five sources.
Our anxiety doesn't just emerge. It is caused by our focusing on certain of these sources of indirect information. It is a product of a rapid unconscious lawful choice concerning which information will be used. This unique coming together of subtle elements of information generates anxiety. Since it is precisely this focusing that generates the anxiety, the key to lessening anxiety is the ability to change the focus. We need either to lessen the specific use of one of the sources of information or to identify additional information which was not previously used. In other words, controlling anxiety and tension is at it's base a process of refocusing.
PRACTICAL STEPS TO REDUCE ANXIETY
Phase One: Treatment of anxiety when it occurs
Reducing anxiety is dependent on learning how to refocus on alternative sources of information. A number of steps can be taken to reduce anxiety at the time it actually occurs. Other steps can be taken to prevent anxiety in future situations. These two processes supplement each other and can be used together.
We have found that when individuals refocused on two of the five sources of information, they felt an immediate lessening of anxiety. The two adjustments are controlling breathing patterns and preventiing the focusing on negative information. T his we call 'first level intervention'. Its goal is the immediate alleviation of overwhelming anxiety.
The first step in controlling anxiety attacks is to monitor one's breathing. When a person is anxious his breathing is usually rapid and shallow, a pattern that enhances both anxiety and tension. People report that when they focus on their breathing and slow it down, they experience an immediate sense of relaxation and an enhanced sense self control. By using this procedure before, during, or after a critical incident, a person can more freely choose which information to attend to.
The next step is to identify types of information that were not focused upon during the incident and which could contribute significantly to lessening the anxiety. For example, remembering successful responses to these frightening incidents from the past; not thinking about angry useless arguments for or against certain ideas but rather planning positive acts to correct the situation; taking precautionary concrete steps for self protection, etc. This search for more positive information can best happen in conjunction with the breathing technique described above. The resulting relaxation permits a person a wider range of mental activity and positive use of additional information.
The greater control of breathing and the selective use of positive information significantly lessen overwhelming anxiety. They do not, however, prevent the basic pattern from reoccurring. The long term treatment of basic anxiety is best handled in the following fashion.
Phase Two: Steps to prevent the reoccurrence of anxiety
Phase two consists of two different procedures. The first procedure requires the individual to review and assess the information he finds significant in any event and to identify what characterizes his response to that particular information. The second procedure is to connect these particular responses to ones world view which shapes and gives meaning to the events we experience.
The first procedure should be undertaken in a period of relative calm. One should review the sources of information used in order to ascertain which source most contributed to the anxiety. One should literally outline which sources were used. If one can't do this the first time, one should watch for another appearance of anxiety, carefully observing oneself. In addition to self observation one can ask a friend to describe one's responses One should try to remember dialogues (internal or external) from the past concerning similar issues or incidents. This process of identification, as with any process of self-knowledge or education,may take time.
Once the sources of information which contributed to the anxiety have been identified, one should imagine a more positive outcome or response in place of the automatic threatening response that was experienced. One can do this by identifying or even creating positive images which will block the negative images, thoughts, or memories that generate the anxiety. By continually reviewing this information, a person creates a new set of automatic responses. These new responses based on more successful imagery of an appropriate response will engender less anxiety when the person confronts the same situation. This retraining has two goals: to interrupt negative automatic thinking and to prepare for more adaptive responses.
Once the sources of negative information have been identified and replaced with more positive sources, we can turn our attention to the overall ideas and meanings we attribute to any given situation. This area of concern is commonly called "world view." Specifically, we are concerned with how one focuses on time. One of the most profound misfocusing occurs when a person relates only to his immediate experience, ignoring the past and the future. This tunnel vision greatly enhances the impact and significance of the negative information. This misfocusing denies an individual the ability to draw on the past for support or to search in the future for alternative sources of information that might serve as a guide in taking appropriate action. He remains focused on this one highly negative moment in time. He is essentially left alone with this critical incident.
From a religious perspective this misfocus on the immediate time frame need not happen. The religious Jew has a spiritual outlook, a unique way of understanding time on a dual track built into his world view. On the one level, he lives in what we call "history" - the time frame defined by day to day occurrences and the meaning assigned to them. Within this context a Jew is commanded to act - to endeavor to influence the outcome of events. To influence and not to control. Nowhere is a Jew commanded to succeed, but rather to act according to the eternal dictates of the Torah. Once a person understands deeply that the ultimate outcome of his efforts are totally dependent on factors beyond the rational definition of "a causes b," then the third party - God's will - enters into the formula. The person acts and God decides which path history will take.
On another level, the Jew understands that time can only be measured in terms of eternity. Thus he has at his disposal a powerful tool against unproductive anxiety. The ability to place events on a continuum from the beginning of time to its ultimate end places any current historical event into a perspective of eternity, greatly diminishing the emotional impact of that one event.
We have proposed that external incidents do not, in and of themselves, cause anxiety. Rather, it is our own interpretations of those events that engender that emotion. The present situation in Israel is likely continue to provide negative information and specific incidents that can be the raw material for excessive anxiety.
It is our understanding that misfocusing on certain types of information engenders anxiety. Each individual has his own style of focusing and reacting to information. By becoming aware of that style and refocusing on information that is more positive, an individual can gain added control over his emotional life. Refocusing empowers one to make decisions that are more conducive to self-protection and enhance our social interaction and our sense of personal well being.
We identified two successful techniques that can be used as means to lessen anxiety: slow, deep breathing, and focusing on positive information. The third element entails understanding the events of history within the framework of Jewish belief -- eternity ameliorates moments of stress.
This perspective of eternity is a reminder that a Torah outlook greatly enhances the quality of life and empowers the individual who is called to confront and overcome the vicissitude of everyday life.Please send us your comments to TorahPsychology@shemayisrael.co.il