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You are here: Home > Marital Conflicts > AnxiousSpouse

Anxiety and Mistrust in Marriage

Watch here to see the anxious, emotionally distant spouse webinar presented by Dr. Fitzgibbons.

The Nature of Anxiety

Anxiety is a complex and powerful emotion that arises many sources,including the loss of one's ability to trust or feel safe, intense worries, an excessive sense of responsibility, weaknesses in confidence, guilt, modeling after an insecure or anxious parent and biological factors. As trust and confidence decrease, anxiety and fear regularly intensify. 

Later, these conflicts can lead to the development of an anxiety disorder which can have a seriously damaging impact upon one’s physical  and mental health and thinking, as well as upon importantrelationships. Anxiety disorders are serious illnesses that can be asincapacitating as severe arthritis or other medical illnesses.

Not infrequently, family of origin mistrust, particulary from hurts in the father relationship,  can unconsciously emerge after being buried for years or even decades and be directed at a completely trustworthy spouse with severely damaging consequences.  The spouse with such a father wound experiences the loss of a feeling of love for his/her spouse and anger that is really meant for the father but is misdirected.

A New Epidemic of Anxiety

The level of anxiety within spouses, marriages, families andcommunities has increased significantly over the past year because ofworldwide economic problems resulting in a 50% loss of value in thestock market, an epidemic of defaults on mortgages and bankruptcies,massive layoffs, severe banking difficulties, pay reductions andfurloughs, major losses in retirement accounts and great difficulty inkeeping up with the bills.

Such financial and job worries regularly lead to a serious difficultyin sleeping and then to more intense fears, irritability, and, inmany,an intense sadness.  The insomnia needs to be addressedpromptly because a stable sleep pattern is essential in dealing withlife's pressures.  Those who struggle with insomnia should considerstarting on one of the numerous safe sleep medications that can reduceanxiety and result in a good night's sleep.

In view of the many psychiatric research studies which havedemonstrated the benefits of faith in addressing emotional conflicts, werecommend regularly to people of faith that they consider employing afaith meditation to deal with their financial and work anxieties severaltimes a day and, particularly, before going to bed.  Suchmeditations focus on trusting God with all of one's fears. Scripturalprayer that can found both in the psalms and in the New Testament can bevery helpful because it can be effective in building trust, one of themost important virtues that can assist in reducing anxiety.

The present economic crisis may also result in the experience ofstrong anger toward many in the government, financial markets, bankingand other institutions because in many instances where theirselfishness, greed, high risk taking, desire to control or poor judgmenthave contributed to the present hard times.  This anger can alsocontribute to insomnia and blocks the ability to resolveanxiety. The anger must be addressed and the most effective way isthrough the practice of the virtue of forgiveness through reflectionseveral times each day and at bedtime.  If a person of faith findsit difficult to forgive, he or she can give the anger to God, acceptpersonal powerlessness and in an act of trust, surrender all to God.

Sue

Sue is a thirty three year old attractive, married mother of threewho struggled with anxiety symptoms that seriously interfered with herlife. She attributed her anxiety to feeling overwhelmed by herresponsibilities and lack of support from her husband.Sue's husband's demanding career resulted in his frequent absence fromdinners and travel that kept him away from home several nights eachmonth. She missed his comforting presence, particularly at night, anddid not feel enough support in the care of the children and the home.Attempts were made to help Sue seek more balance in her life, let go ofher excessive sense of responsibility and to determine if her husbandcould make changes in his work schedule in order to be more present toher and the children.

When Sue explored other sources of anxiety from the past, she came torealize that her family background contributed to her anxiety. Herparents divorced when she was 11 years old. It seriously wounded hersafe feeling and unconsciously led her to overreact in anxiety. Shediscovered a strong fear that her marriage might also end. In therapyshe was surprised to discover significant amounts of unresolved angerwith her father whom she viewed as being responsible for the parentaldivorce because of his selfish behaviors. She decided to work atforgiving him in order to resolve the pain from her past that wasleading her to overreact emotionally. Sue experienced emotional reliefand growth in her ability to trust as she worked at forgiving herfather.

Addressing Sue’s emotional pain from her parent’s divorce and herhusband’s travel greatly diminished her anxiety, Also, she discoveredthat her faith was beneficial as she began to meditate more upon theLord’s loving presence with her and upon trusting him with her burdens andfears. As described later in this chapter, a number of research studieshave proven empirically the benefits of faith in the treatment of anxietydisorders.

The Journey of Anxiety

As with anger, anxiety or mistrust can develop at one stage oflife,be denied and then can be misdirected decades later at one'sspouse.  When one does not feel safe in childhood, overreactions in mistrust, fear and irritability are common in adultlife.  Anxiety is strongly associated with both the sadness andanger of life hurts and unjust treatment which explains the highprevalence of these emotions when one is anxious and in anxietydisorders. 

The diagram below demonstrates the relationship between lifehurts,anxiety, sadness, anger and insecurity.

Anxiety as a Warning Signal

This unique emotion can be at times beneficial to us in that it can bean important warning signal that something is occurring in our lives whichneeds to be understood and addressed.   For example, anxiousfeelings may develop because one’s confidence is shaken by marital,family, or professional relationships or stresses. Then, the spousecanreflect upon and be thankful for his/her special gifts and take othersteps to address the stresses, such as recognizing the need to have morebalance in one's life, to set aside more time for the maritalfriendship, to have proper sleep hygience, to correct selfishorcontrolling individuals or to learn to surrender more oftenone'sworries..

Anxiety and irritability often arise when a spouse is not beingtreated with proper respect in the marriage.  When this conflict isidentified, a request should be made to be treated with appropriaterespect.

The good news is that most marital conflicts can be resolved,particularly, if the spouses are open to self-knowledge and to growthinvirtues.

Prevalence of Anxiety

Anxiety is the most common psychiatric disorder. The nationalco-morbidity study of 2005 revealed that 28.8 % of Americans will havean anxiety disorder in their lifetime with the median age of onsetbeing11 years of age (Kessler, R., et al, 2005.)

The recent downturn in the American and world economy is damaging thebasic ability of many people to feel safe resulting in higher levels ofanxiety, sadness and irritability.  

An increase in anxiety disorders is occurring in children, in ouropinion, because of many factors that are damaging a child’s basicability to feel safe and protected. This basic trust is establishedfirst and foremost in a child’s early life bonding with the mother.Unfortunately, in the present narcissistic culture the material andemotional needs of parents too often are placed before the most basicneed of children to have a securely attached mother relationship andto have the benefits of a mother and a father.

Children’s basic ability of feel safe and trust is being damaged by:

• excessive time in day care
• out of wedlock birth, which is experienced by one third of American children and almost half of all European children
• the absence of a parent in the home after school
• excessive parental anger
• parental emotional conflicts
• the excessive anger in other children in the neighborhood and schools
• parental separation or divorce
• lack of a moral code
• severe financial stresses .

The rising use of SSRIs in young adults is a clear indicator of theserious problem they have with excessive anxiety. Major factorscontributing to this problem in young adults in addition to thoselisted above are:

• difficulty in trusting in friendships because of the severe narcissism in their peers
• friendships based upon others using them for their own pleasure and not upon wanting the best for them, that is, not based on virtue
• failure to experience the comfort and safety of a home in which the father and mother love and respect each other
• trauma from being used as a sexual object
• parental separation or divorce
• severe peer rejection.

Fortunately, severe trust wounds from early in life can be healed sothat anxiety and mistrust do not dominate person’s life. A clear andpowerful example of this fact and reason for hope is the life ofJohn Paul II whose mother died when he was a child, whose only olderbrother died when he was 9 and whose father died when he was 19 . If thenineteen year old Karol Wotyla had been evaluated during the war inPoland by a team of mental health professionals who were then asked tooffer an opinion of his future emotional and mental health based on thenumerous losses in his family life, most would have said that this youngman would probably experience ongoing problems with serious anxiety inhis life. They would have probably suggested that he might laterstruggle with various types of anxiety symptoms of the followingisorders – generalized anxiety disorder, panic disorder (due tocatastrophic thinking), social anxiety disorder and posttraumaticstress disorder.

Childhood trust wounds in children, young adults and adults take timeto heal. Again, growing in virtues, establishing healthy trustworthyrelationships and utilizing faith, when appropriate, can create withinan individual as sense of safety, trust and hope which are essential toself-giving and to maintaining a healthy personality.

Damage from Anxiety

Excessive anxiety is a major source of tension and stress inmarriages and families. The ability to feel safe is essential to givinglove and to receiving love. St. Teresa of Avila referred to this when shewrote, "Trust and only trust should lead to love."

It significantly interferes with marital happiness because a spousebecomes preoccupied and turns in on himself/herself that can markedlylimit the ability to give oneself, to receive love and to cope with thedemands of daily life. Many spouses respond to anxiety or the loss of asafe feeling in life by developing a need to control,irritability,sadness, weaknesses in confidence and social isolation. Allthese conflicts then damage romantic feelings, the marital friendshipand betrothed love. Unless addressed properly, the loss of trust leadsto the loss of the feelings of love and can tempt some spouses toconsider separation or worse divorce.

Again, one of the major ways in which anxiety damages marriagesand children is being interfering with the safe feeling that is essentialto self-giving. Consider now rating your own self-giving and that ofyour spouse on the self-giving checklist in the evaluate your marriagechapter. After completing that checklist, ask yourself ifanxiety/mistrust could be a factor limiting your cheerful giving.

Symptoms of Anxiety

The Diagnostic and Statistical Manual of the APA (DSM IV-R) lists thefollowing symptoms which constitute a (generalized) anxiety disorderwhich is the most common anxiety disorder:

• excessive anxiety and worry occurring more days than not for at least six months
• the person finds it difficult to control the anxiety
• three or more of the following symptoms present for more days than not for at least 6 months
• restlessness or feeling keyed up or on edge
• being easily fatigued
• difficulty in concentrating or mind going blank
• irritability
• muscle tension
• sleep disturbance (difficulty falling asleep or staying asleep, or restless unsatisfying sleep)

Who has more of these symptoms, you or your spouse?

Also we have developed the checklist below which evaluates additionalsymptoms of mistrust or anxiety as they effect our emotions, thinking,behaviors, physical health and spiritual life. Now please rateyourself and your spouse on this checklist that is meant to give aqualitative esense of the intensity of anxiety symptoms.

Thinking

• Catastrophic thinking (something bad is going to happen)
• Rigid thinking-a lack of openness
• Excessive criticism of others (as a unconscious way to distance people)
• Negative thinking
• Suspiciousness
• Hypochondriacal thinking (fear of serious illness)
• Paranoid thinking
• Excessive fantasy life
• Obsessional thoughts of controlling others
• View reasonable expectations of spouse as control pressure
• Excessive worrying
• Difficulty concentrating

Behaviors

• Numerous controlling behaviors
• Doesn’t listen to spouse
• Inability to show affection (fearful of being vulnerable)
• Difficulty praising others (fearful of allowing anyone to be close)
• Difficulty initiating lovemaking in marriage
• Doesn’t support spouse with children
• Inability to include others in making important decisions
• Overly controlling with money
• Flight from committed relationships by excessive work, hobbies, or other interests - including too many religious activities outside of the home
• Inability to trust spouse with care of the children
• Few close friends
• Compulsive eating
• Excessive drinking or drug usage
• Addiction to pornography (escape to fantasy world)
• Difficulty pursuing intimate relationships
• Fear of flying, elevators or bridges
• Tendency to isolate oneself
• Difficulty in receiving help or advice from others
• Refusal to allow spouse to discipline children
• A need to have things his/her own way
• Withdrawal from others in front of TV, books, computer, etc.
• Overly strong dealing with others (caused by fear of being hurt)
• Infidelity
• Compulsive masturbation
• Attempt to isolate family from relatives
• Excessive financial fears
• Restlessness and hyperactivity (an absence of feeling safe)
• Aggressive behaviors
• Criticizes spouse in front of children
• Tries to cut spouse off from friends
• Lack of responsibility for spouse

Emotions

• Regularly irritable or hostile (anger keeps others at distance)
• Overly anxious
• Panic attacks
• Overreaction emotionally to minor life events
• Rarely relaxed or peaceful
• Bad temper
• Overly upset if things don’t go as planned
• Very lonely (fearful of being vulnerable and of receiving love)
• Fear of the future
• Emotional rigidity
• Lack of gentleness
• Easily fatigued
• Sleep disturbance
• Social anxiety
• Chronic fatigue (drained by worry)

Physical Health

• Irritable bowel syndrome
• Muscle spasms in different parts of the body
• Colitis
• Coronary artery disease
• Vulnerability to all major diseases if mistrust persists for years
• Severe headaches
• Muscle tension
• Light headedness
• Dizziness
• Nausea
• Rapid heart beat

Spiritual Life

• Weak spiritual life
• Difficulty in listening
• Limited ability to pray
• Excessive restlessness in meditation
• Difficulty in meditating
• Withdrawal into religion (excess religiosity)
• Limited ability to receive God’s love

A score below 10 indicates mild mistrust, a score between 10 and 20shows moderate mistrust and above 20, severe mistrust.

What are the most common symptoms of anxiety in your spouse and inyou?

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Origins of Anxiety/Mistrust

The most common cause of anxiety in our clinical experience is theresult of the loss of trust or a safe feeling at different life stages.One develops trust or a safe feeling in life through the establishmentof secure attachment relationships first in the home with one’smother,th en one’s father, siblings and then outside the home withfriends, peers, teachers, coaches and dating relationships. Many youngadult shave their trust badly damaged by relying excessively uponromantic feelings and giving themselves to others who turn out not to betrustworthy.  In adult life trust or ones safe feeling can bedamaged innumerous ways including by hurts in friendships, datingrelationships, work, and by one’s spouse.

Cultural factors also are contributing to the damage of trustand growth in anxiety. These include the collapse of the nuclearfamily through divorce, day care, the sexual utilitarian philosophyresulting in people being treated as objects, the growth of narcissism inthe culture, single pa renthood, the growing hostilityagainst Judeo-Christian morality and marriage in the media, schoolsystems and the judicial and legislative branches of government.

In evaluating the origins of anxiety it is essential, as with Sue, totry to determine how secure the spouse felt in important lovingrelationships, as well as in peer and in work relationships at eachlife stage. For numerous reasons most of us enter our adult lives andthen our marriages with trust "wounds."

Please rate yourself and your spouse on the origins ofmistrust/anxiety below.

Origins of Mistrust at Different Life Stages

Childhood

• Emotionally distant, unaffectionate parents
• Excessive time in day care
• Modeling after fearful, mistrustful or overly controlling parent
• Serious illness in a parent, sibling, or oneself
• Parental separation or divorce
• Alcoholic or narcissistic parent
• Loss of a parent, brother, sister, or close friend
• Legacy of mistrust and fear in the family
• Lack of confidence
• Rejection by peers
• Victimization by the excessive anger of others
• Poverty

Adolescence

• Same causes as in childhood
• Poor body image
• Difficulty in playing sports
• Parental separation or divorce
• Post abortion trauma
• Treatment as a sexual object

Adult Life

• Same as in childhood and adolescence
• Repetition of the weakness of a mistrustful parent
• Lack of secure feeling with one's spouse
• Insensitive treatment by a spouse or children
• Controlling, angry or selfish behaviors in one's spouse
• Weak confidence
• Betrayal by loved ones
• Divorce
• Unjust treatment by bosses or co-workers
• Financial pressures
• Treatment as a sexual object
• Loss of job
• Loss of health
• Rejection by significant others
• Sense of responsibility for one or both parents

Where there any surprises here in regard to trust wounds fromchildhood, adolescence and adult life in you and in your spouse? In our clinical work we find that hurts in the father relationship arethe most common sources of trust weaknesses prior to marriage, but thathurts in the mother relationship are the most difficult to heal sincethe relationship with the mother is the basic foundation to trustpeople.

What are your major sources of anxiety and worry?

What are your spouse’s major sources of anxiety and worry?

In our experience social anxiety disorder, some cases of generalizedanxiety disorder and OCD, as well as performance anxiety are often theresult primarily of weaknesses in confidence.

Pope Benedict in June 2008described another source of anxiety.  He stated, "But thereis also -- and today above all -- a more profound form of fear of anexistential type that sometimes overflows into anxiety. It is born froma sense of emptiness that is linked to a culture that is permeated by awidespread theoretical and practical nihilism (6/22/2008)."

The Dangerous Journey of Anxiety/Mistrust

As with excessive anger and sadness, trust conflicts can develop atone life stage, be denied and then emerge powerfully years or decadelater. This dynamic is seen frequently in spouses whose parents werecontrolling, angry or emotionally distant, all of which can damagea child's trust. Later, under various types of stress in married life,this mistrust and anxiety with associated irritability can be misdirectedunconsciously at one’s spouse.

In reviewing the origins of mistrust, do you think you may haveoverreacted to your spouse because of trust weaknesses you brought intoyour marriage or acquired due to hurts outside your marriage?

Anxiety and other disorders

Anxiety is strongly associated with sadness, weaknesses in confidenceand excessive anger. The diagram below attempts to demonstrategraphically the relationship between life hurts and these powerfulemotions.

The presence of other mood disorders (co-morbidity) is being shown tobe a fundamental characteristic of the course and nature of anxietydisorders. The National Co-morbidity Study demonstrated that 8 of10subjects with lifetime generalized anxiety disorder also had aco-morbid mood disorder during their lifetime. Also, when co-morbid mooddisorders are present in generalized anxiety disorder, a significantincrease in associated disability and dysfunction is also found.

Generalized anxiety disorder (GAD) has a high rate of co morbidity (association) with major depressive disorder (MDD), bipolar disorder, other anxiety disorders, and substance use disorders. The presence of anxiety results in longer depressive episodes , a more chronic course of major depressive disorder, worse psychosocial impairment, reduced chance of recovery from the initial episode of major depressive disorder, and increased risk of suicide, Simon, NM (2009). Also, anxiety disorders negatively impact the course of bipolar disorders, (Lee, J.H., 2009).

The clinical use of forgiveness by decreasing the anger associated with anxiety/mistrust can play an important role in the treatment of both generalized anxiety disorder and associated mood disorders. John Paul II has written that unless we forgive we become prisoners of our past. Our unresolved anger can encapsulate and lock in deep within us anxiety, sadness and insecurity.

Anger in Anxiety Disorders

Although DSM - IV lists irritability as one of the six symptomsassociated with the diagnosis of generalized anxiety disorder, theevaluation of anger and hostility in anxiety disorders does not receivedenough attention even though many studies demonstrate high levels ofanger and anger attacks in anxious patients. Many anxious spouses simplydon’t realize how angry they are with those who have damaged theirability to trust. Also, the presence of anger attacks contributes to apoorer treatment outcome for anxious patients.

High levels of anger have been reported in posttraumatic stressdisorder and recommendations have been made that clinicians incorporateanger management strategies into treatment plans for PTSD.

Clinical experience has shown that many clients with anxietydisorders have significant levels of anger. While anger attacks are anextreme manifestation of anger, many clients with anxiety disorderstruggle with lesser degrees of active and passive-aggressive anger.Such anger is often a result of betrayals in childhood, adolescence,or adult life.

Anger appears to encapsulate both anxiety and sadness andsubsequently can interfere with recovery from both anxiety anddepressive disorders. Forgiveness removes the anger from this emotionalcomplex, thereby helping with the reduction of anxiety and sadnessoften while marital or family of origin conflicts are also beingaddressed.

The Treatment of the Anger Associated with Anxiety Disorders

We will describe now the uncovering and the treatment of the stronganger which is found in anxiety disorders, review the four phases offorgiveness therapy and describe how to use forgiveness in the healingof anxiety disorders.  Forgiveness is a powerful virtue which candecrease both anger and the anxiety associated with it.   Ourapproach is one aspect of the newer field of positive psychology withits focus on growth in virtues.  Too often the anger associated withanxiety disorders is not identified and subsequently not treated. In ourprofessional opinion failure to do so interferes with recovery fromthese disorders.

The uses of forgiveness can make a significant contribution to thetreatment of anxiety disorders. My colleague and coauthor, Dr.Bob Enright at the University of Wisconsin, Madison, has demonstrated inmany research studies that forgiveness can significantly symptoms ofanxiety as well as symptoms of depression, anger and insecurity. It’ seffectiveness is accomplished by removing the anger associated withhurts from different life stages which have damaged a person’s basicability to trust or to feel safe. Forgiveness will decrease anxietydirectly as a result of the resolution of anger especially in clientswhose anxieties are caused by fears of their unconscious anger, as occursin many spouses with obsessive-compulsive disorders.

As anger from past hurts decreases, past fears and mistrust seem tohave less influence over the present. In fact, the healing of angerappears to facilitate a growth in trust or a safe feeling, as well asinability to be assertive. At the same, it frees individuals from thenegative influence of others who have hurt them, for example, acontrolling, critical, selfish, distant or angry parent or spouse.

This process will now be described.

The Uncovering Phase

In the first phase of therapy, spouses with anxiety often have someinitial difficulty in identifying specific hurts or stresses in theirlives that have predisposed them to anxiety. Because anger locks intothe unconscious at different developmental stages, especially childhoodand adolescence, the resentment only emerges when traumatic life eventsare examined.  The initial uncovering of anger rarely is the finalword on the true cause of the anger; additional causes will be discoveredat a later point in the work phase.

Based on the spouse’s history of their anxiety, forgivenessexercises a re often used to uncover anger during this period. The spouseis asked to focus on the desire to understand and forgive an insensitiveparent,spouse or employer who hurt them. As in the treatment ofdepressive illness, this exercise can lead to the emergence intoconsciousness of significant emotional pain from past hurts.

The Decision Phase

As a person begins to understand the connection between anxiety andfear on the one hand, and being treated unjustly on the other, aperson’s motivation to forgive increases. With greater insight into the possible benefits of forgiveness, that motivation can further increase.

The Work Phase

As a matter of routine during the work phase, spouses are regularlygiven written assignments that describe who they should try to understandand forgive and how they should approach the task cognitively oremotionally. Those with obsessive-compulsive disorders often demonstratethe greatest resistance during this phase. The defenses surroundingtheir anger and betrayal pain are powerful and they dissolve slowly asthey face the reality of their hurts. In addition, perfectionistictendencies can make the work quite difficult because it involvesadmitting the depth of the anger that has been denied.

Individuals with posttraumatic stress disorders tend to be the mostaware of both their anger and who their offenders are.  However,they often have the strongest impulse to seek revenge and to strike backat those who have hurt them. In this phase, many of these individualswant to approach the offender and express their anger, while they areworking at forgiveness. They need to be cautious of the possibility oflosing control of their intense anger and of the limitations ofexpression in the resolution of anger. Although healthy assertiveness isimportant, it can have limited value because mere words or behaviorsoften cannot compensate for the depth of pain and anger from asignificant hurt. Also, the expression of anger rarely results in a truesense of justice or in freedom from the desire for revenge.

In contrast to revenge, healthy assertiveness in association withforgiveness is an important aspect of the treatment of those withexcessive anxiety. Many of the spouses develop an excessive sense ofresponsibility which makes it difficult for them to relax, sleep, andlead healthy lives. In addition to forgiving an offender who has causedtension in their lives, they benefit from taking steps to protectthemselves from the unreasonable and damaging demands of others.Assertiveness may be needed with an employer who has unreasonableexpectations concerning work hours or children who demand participationin numerous sports activities to the detriment of a balanced familylife. It may also be of benefit with an insensitive or emotionallyunsupportive spouse who has damaged one’s ability to feel safe, aswell as demanding people who attempt to make the spouse feel overlyresponsible for them or others. Assertiveness is employed withforgiveness in these cases so that one will learn to express anger in ahealthy way, minimizing the possibility of overreacting. Here the spouseworks at first forgiving and then, as the anger diminishes, gives acorrection to a spouse in a gentle manner if he or she has beeninsensitive, controlling, critical, angry, selfish oremotionally distant.

A number of men with generalized anxiety disorder related to theirwork identify a lack of confidence as a major factor in theirvulnerability to excessive anxiety. They discover that a major factor inthis conflict is also their relationship with their fathers who failedto affirm that adequately so that good male confidence could develop,who were overly critical of them or who were selfish and ignored them.In this phase of treatment, these men find that forgiving their fathersis quite difficult, but they feel guilty and conflicted about beingangry with them. Fortunately, as their understanding of their fathers childhood experiences grow, they are usually able to recognize that theirfathers modeled their behavior after their own fathers (the spouse’sgrandfather) and they realize that the hurts were rarely inflicteddeliberately.

An exception to this father whose selfishness turned him in onhimself and completely blocked his self-giving and sense ofresponsibility. In these cases spiritual forgiveness can be effectiveduring which the person thinks either "God forgive my father" or "I ampowerless over my anger and want to turn it over to God."

At this point, the benefits of forgiveness begin to be experienced.Such benefits include a diminished level of anxiety and fear, a decreasein an excessive sense of responsibility, increased self-esteem, animproved ability to trust one’s spouse, an enhanced ability to lead amore balanced life, and an improved ability to be assertive in a gentleway with insensitive and controlling people.

The Deepening Phase

After resolving significant amounts of anger through forgiveness,most clients with anxiety disorders are able to find meaning in theirsuffering. Often they become much wiser and more assertive, take bettercare of themselves in relationships and they usually become more carefulabout whom they trust. The role of forgiveness within the context ofspecific anxiety disorders will be presented now through case studies.

Married Life, Trust and Anxiety

John Paul II wrote in his encyclical, Faith and Reason,n.33,"Menand women are on a journey of discovery which is humanly unstoppablesearch for the truth and a search for a person to whom they might entrustthemselves."

Most spouses believe they have completed their journey of discoveryand found someone whom they can trust and give themselves to completely.Unfortunately, for numerous reasons this ability to trust often isweakened either by the emergence of mistrust wounds from family painor hurts in previous relationships, from marital hurts or from both. Astrust decreases, so too does the feeling of love with a subsequentdecreased ability to give and to receive love and to view the spouse aa special gift.

Marital Hurts and Anxiety

Also, in our clinical experience a number of spouses experienceanxiety in their marriages because their ability to trust their spousesis damaged by his/her

• failure to act in a responsible manner
• treatment of the other as an object rather than as a special gift
• failure to communicate in a predominantly positive, cheerful manner
• controlling behaviors
• selfish behaviors
• emotionally distant behaviors
• angry behaviors
• substance abuse
• not giving himself/herself fully to the marital friendship
• disordered priorities with placement of children, work or outside activities ahead of the marriage

These behaviors can result in numerous symptoms of anxiety in theother spouse. Approaches to spouses with the conflicts above areaddressed in other chapters on this site. The offended spouse should tryto understand why a spouse is acting in these ways, work on trying toforgive this spouse and ask the spouse to grow in various virtues todiminish these conflicts. In addition to forgiving those who havedamaged one's trust, it can be helpful to consider forgiving those whohave damaged the trust of one's spouse because their trust wounds maywell have created stress in one's marriage.

John Paul II wrote of the challenges to marital love in Loveand Responsibility, n. 135,"The strength of such a (mature) loveemerges most clearly when the beloved stumbles, when his or herweaknesses or sins come into the open.  One who truly loves doesnot then withdraw love, but loves all the more, loves in fullconsciousness of the other’s shortcomings and faults, and without in theleast approving of them. For the person as such never loses his/heressential value. The emotion which attaches to the value of the personis loyal."

Diminishing anxiety and building trust

Some of the following actions can beneficial in decreasing anxiety:

• try to recognize the need for more trust
• discuss major worries and concerns with one’s spouse
• daily try to let go of excessive worries
• focus daily on the positive qualities of one’s spouse as a special person
• make a commitment to try to let go of a need to control
• try to seek balance in one’s life
• try to build the marital friendship by being positive in one’s communication style with five positive comments for each negative (see John Gottman)
• medications can be helpful
• forgive spouse for hurts of the past
• discuss conflicts honestly in relationships
• admit powerlessness over mistrust and turn it over to God
• give to romantic aspect of marriage
• try to let go and let God with all burdens and responsibilities
• pursue balance in one’s life
• try to relax in the PM and not work
• set aside date night regularly
• keep angry, controlling, critical people at a distance
• consider an employment change if employer is extremely insensitive
• correct insensitive people
• be careful whom one trusts
• try not to be obsessed with material possessions
• pursue the virtue of temperance

Cognitive distortions and cognitive therapy with anxiety

Emotional trauma and pain can have a powerful influence upon the mindwith the resultant development of unhealthy and distorted thinkingpatterns. For example, damage to trust can lead to a distorted thoughtsthat "no one call be fully trusted" or that "I need to control people and my life so that I won’t be hurt in a similar way the future." Also,damage to confidence from hurts can lead to the cognitive distortionssuch as, "I am a loser", "I am unlovable" and "I’m not a gift to others."These cognitive distortions need to be and can be uncovered andaddressed so that they no longer keep one as a prisoner of one’s past.

Here are some of the common cognitive distortions seen in anxietydisorders:

• My worst fears will come true.
• Others will hurt or control me.
• I could not trust my parents to be sensitive and I cannot trust my spouse.
• Something terrible is going to happen.
• My spouse is not trustworthy.
• Committed relationships will not work for me.
• I will be betrayed and mistreated as my mother or father was.
• If I don’t show love, I won’t be hurt.
• Those of the opposite sex are not trustworthy.
• Our marital friendship will be as unhappy as was my pa rents’.
• My spouse’s love should heal all the anxiety and insecurities from my childhood.

These cognitive distortions can be regularly addressed and corrected,particularly when one is also incorporating growth in the virtue oftrust. Responses to these distortions can include:

• My spouse is trustworthy and I will not be betrayed as I was in my childhood.
• My childhood pain is not going to control my adult life, especially my ability to trust.
• I will be happier by respecting and not trying to control.
• My spouse wishes the best for me.
• I will let go of my control tendency and trust more.
• I will work diligently not to repeat the mistrustful/anxious thinking and behaviors of a parent.
• I trust we can work through our marital stresses because we are completely committed to each other.
• A faith meditation can be "God help me to feel safe and protected."

Anxiety Disorders

The following cases will illustrate the value of employingforgiveness in the healing of anxiety disorders.

Generalized Anxiety Disorder Related to a Lack of Balance inMarital and Family Life

Inge was a thirty-four year old mother of two children who soughttreatment for extreme anxiety, insomnia, and fatigue. She feltoverwhelmed by the responsibilities involved in caring for her familyand actually feared insanity. The family rarely ate together and she andher husband had little quality time with each other because of numerouspressures and demands.

Initially, Inge was unable to recognize the cause of her anxiety.Slowly, she identified a number of significant stresses and then feltquite angry about them. She was particularly upset by her children’s paparticipation in numerous sports, including traveling sports teams and theexcessive importance her husband placed upon such involvement by thechildren. She became overwhelmed with the demands of practices and gamesas well as long weekend tournaments. Family dinners, relaxing weekendsat home, and time with her husband had become a thing of the past.

She recognized that she had been denying how angry she was in hereffort to please her husband and her children. She even felt somewhatguilty about her anger, but eventually came to accept it asbeing appropriate. As her true feelings emerged, she was able tocommunicate to her husband, Mike, that she thought compulsiveparticipation in sports was more important to him than to their children.She insisted that changes had to be made in the family schedule becauseshe was being emotionally harmed by the pressures she felt from him andtheir children.

Her decision to forgive her husband and her children for beingself-absorbed and insensitive was motivated by a desire to be healthyand by a desire for a better relationship with her family. The work offorgiveness was facilitated by her husband’s apology and immediate decision to limit each child to playing only one sport per season and toexclude all participation in traveling sports teams. Regular attempts to ward understanding Mike’s needs and insecurities that arose from his ownlack of success in sports helped her to feel more compassion for him andenabled her to truly feel like forgiving him.

As balance was established in her family life and as she continuedtofo r give, Inge’s anxiety symptoms abated. Later, she was able to helpseveral other friends who felt overwhelmed by similar pressures in theirfamilies and was pleased to find meaning in her suffering.

Joy, a thirty year old single parent, suffered symptoms of excessiveanxiety, irritability, and muscle tension. She was also troubled by periodic episodes of excessive anger which she did not fully understandand which met the criteria for anger attacks.

Joy had grown up with a father who was defensive and critical and anolder sister who directed anger against her when she was young. Finally,she felt betrayed in a number of valued relationships with men in herlife. She recognized that the hurts in the relationships with her fathermade it difficult to trust men and led her to overreact in relationships.

Joy was motivated to forgive in order to break the unhealthy patternin relationships with men and to sever the control of past emotionalpain.

In re framing, she came to understand that her sister brother harboreda great deal of resentment toward their father and misdirected it ather. She came to see her father as someone who was unable to control hifears of being betrayed, who employed sarcasm and anger to keep othersat a distance and who feared giving himself to anyone.

Joy employed past forgiveness exercises during which she picturedherself as a girl and teenager and thought that she wanted to forgiveher father and her sister for ways in which they had hurt her. Theseforgiveness exercises were initially cognitive in nature. Asher understanding of her father’s difficult childhood and adolescencewith each of his parents grew, she began to feel sorry for him. Eventually, her feelings of empathy helped her to truly feel likeforgiving him.

The forgiveness exercises with her sister were more difficult becausehe continued to direct anger at her that she did not deserve. She wantedto honestly discuss with her the disappointments in theirrelationship but was so mistrustful of her that she decided tocommunicate through writing. Unfortunately, she was unable toacknowledge her misdirected anger. In spite of her denial, Laura workedat forgiving her sister on a cognitive level, but did not progress tofeel like forgiving her, because she was unable to develop empathy forher.

In the sessions Joy regularly expressed her anger toward her father,sister, and other males who had hurt her and followed this release bystating that she wanted to understand and to forgive them.  Sherecognized that at various times she had misdirected this resentmenttoward other men she had dated, her mother, her daughter, andcoworkers.  She came to admit that the betrayal experiences fromher family background and from dating relationships had resulted in aneed to be in control. These insights enabled her to go to others and askfor their forgiveness.

As her resentment diminished over the next eight months, sheexperienced a greater ability to trust in relationships and she alsofelt much calmer. She overreacted less in anger and grew in her abilityto let go of the need to control others.

The Parental Legacy of Anxiety and Catastrophic Thinking

Many spouses struggle with strong anxiety in their lives as a result of unconsciously modeling after a highly fearful or anxious parent.  Current neuroscience might atribute this common difficulty to the mirror neuron system in the brain.  Under various types of marital stresses a modeled anxious parental reponse can emerge and create significant stress. 

This particular conflict can be difficult to uncover it can be associaed with a significant degree of anger with the parent that an anxious and often perfectionistic spouse wishes to deny.  This denial can diminish by growing in understanding the stresses in the parent's childhood that damaged confidence or trust which then facilitates the work of forgiving that parent.  Past forgiveness exercises are essential in this process during which a spouse imagines himself/herself as a child and thinks of forgiving the anxious parent. Also, correcting the acquired fearful and insecure thinking pattern of the anxious parent is important.

In our clinical experience it is difficult to overcome a parental legacy of social anxiety with weaknesses in confidence or intense catastrophic, negative thinking without a spiritual component in the healing process.  Here the anxious spouse can meditate several times daily on being powerless over anxiety and insecurity and turn them over to God.  The empirically proven value role of the faith in recovery from anxiety disorders is presented later in this chapter.

Generalized Anxiety Disorder Related to Work Stress

A major factor influencing the development of anxiety disorderstoday is the marked changes in the workplace with subsequent mistrustand fears. Some people believe that their employer no longer makes a commitment to them regardless of the quality of their work or theiryears of loyalty to the employer. Large numbers of people live dailywith the fear of losing their jobs and of not being able to find anothergood position. Others suffer under unreasonable work demands coupledwith a significant insensitivity on the part of their employer to theeffects that this pressure has upon them and their families.

Andrew, a single thirty-five year old man, was a successfulprofessional who experienced insomnia, lightheadedness, and musculartension as well as periodic severe anxiety before going to work. As thenumber two man in his office, Andrew had a demanding career in which hefelt overly responsible and he worried constantly about various workprojects. His boss was a critical person who never affirmedor complimented him. There were days he was so overwhelmed by workpressures that he felt like running out of the office. Under these stresses, he was having great difficulty motivating himself to go towork and he feared for the future if he quit his job.

Initially, Andrew had no conscious awareness of angry feelings. Ashis insight grew, he soon came to recognize that he had been denyinga great deal of anger with his boss, Fred, who expected Andrew to dothe work of 2 or 3 people and to work sixty to seventy hours over a sixday week. In the uncovering phase Andrew manifested significantresistance to admitting anger with his boss for the unreasonable demandshe had placed upon him. It was suggested to him that he was denying hisanger because he rarely honestly faced his emotional pain and because hefeared exploding at his boss and subsequently losing his job. Hereluctantly agreed to try thinking of forgiving Fred because of histrust in the therapists advice that this would help his treatment.

The approach used to deal with Andrew’s reluctance was to assign acognitive forgiveness exercise in which he was asked to try to forgivehis boss daily for being so critical, demanding, and perfectionistic.When Andrew realized that he had an option for dealing with his angerwith Fred other than expressing it, he slowly began to admit he wasdenying strong resentment towards his boss. He was motivated to resolvethis newly discovered anger and as he continued to forgive, his anxietydiminished.

The work phase of forgiveness was quite difficult for Andrewbecause he continued to deal with the same problems daily and he doubtedthat his boss would change. He did, however, experience symptomaticrelief by daily thinking that he wanted to forgive his boss because herecognized that his unconscious anger and resentment had been a constantsource o tension. There were days when Andrew found himself so upsetwith Fred and so drained from his work pressures that he was completelyunable to forgive. Andrew related in session, "I am so furious with Fredthat I cannot forgive him." My response was, "Try to think of Fred as avery troubled man and then think I want to try to forgive him so thathed oesn’t control me." This suggestion helped with the work offorgiveness which was proceeding basically on a cognitive level. However, on somedays when he was feeling stronger, he was surprised thathe actuallyf et sorry for his boss because he knew that Fred’s personallife was miserable.

Andrew’s anger diminished gradually over the course of eight monthsas he worked to let go of his excessive sense of responsibility and tocommit himself to have more balance in his life. Fortunately forAndrew,a change transpired at the office. His boss’ health could nolongertolerate a seventy hour work week and Fred had to take a leave ofabsence. When he returned he could only work part time. Andrew, then,was appointed director of the office and he took steps to establishbalance in his life and career. In that role he finally felt secureenough to be assertive with Fred that was of great benefit to him. His determination to provide his associates with a healthier workenvironment helped him discover some meaning in the suffering hehadendured.

Generalized Anxiety Disorder and Motherhood

The vocation to motherhood is one of the greatest blessingsand sources of happiness in life.  While most women are very happyintheir pregnancy, after the birth of a first child some motherscanbecome overly anxious which is often the result of the pressuresof taking care of the baby, morning, noon and night.  Thesestressesand associated anxiety can diminish their happiness, result insadnessand even lead them to experience the baby. at times, as a burden,rather than as a gift. 

The anxiety caused by feeling overly responsible for a babycan diminish by seeking balace in life.  Time should be set asidefor supportive relationships with other young mothers and for themarital friendship.  In those with faith these anxieties can alsodiminish by trusting the Lord several times daily with all theresponsibilites for the baby and by meditating that the Lord and Our Ladyare also responsible for the baby.  Surrending the burdensandresponsibities for children regularly helps parents to enjoychildren more and to appreciate them more as special gifts fromGod. Another effective meditation which can be helpful in copingwith the stresses of caring for children is, "Lord fill me with loveso that I can give."

The other common source of anxiety in young mothers is the resultof an inner conflict with selfishness.  The completeself-giving required in mothering a baby can lead to the emergence ofthis inner character weakness because selfishness turns one in upononeself and subsequenlty can make the self-giving to a babydifficult.  Growthin a number of virtues can decrease selfishnessand, subsequently,anxiety.  These virtues include generosity,self-denial, humility, kindness and temperance.  The chapter on theselfish spouse on this website can be helpful in resolving this characterweakness.

Social Anxiety Disorder

Social anxiety disorder is the most common subtype of anxiety witha has a lifetime prevalence of 7 to 13.3%. It has an early onset (80%ofcases occur before age 18 years, Otto, M.W., et al,2001.) and usually precedes other anxiety, mood/depressive andsubstance abuse disorders. Only major depression and alcohol dependenceare more prevalent in the United States (Kessler, R., et al.,1994.)  In one study thirty-seven percent of people with lifetimesocial anxiety had comorbid major depression, 39% had substance abusedisorder, and 81% had at least one other lifetime disorder. In anotherstudy more than 50% of young adults with anorexia nervosa or bulimianervosa had comorbid social anxiety disorder (Flament & Godard,1995.)  Social anxiety is associated with significant distress andfunctional impairment in work and social domains and usually persists ifnottreated.

The DSM- IV states that the onset also may abruptly follow a stressfulor humiliating experience, or it may be insidious. Some peopledevelop social anxiety due to emotional trauma within the family or inother important relationships leading to low self-esteem, patterns ofisolation, and difficulties in trusting in relationships. Althoughanger associated with these traumas is often unconscious, it shoulduncovered with those who have hurt them.  Also, many adolescents andyoung adults with social anxiety drink excessively priorto socializing.

Those with social anxiety benefit greatly from workingat understanding and resolving their hostile feelings toward those whohave hurt them.  Forgiveness can diminish resentment but it is oftena difficult process, especially for those ridiculed or badlybetrayed because such individuals may have powerful fantasies ofrevenge. Continued denial of these fantasies can lead to violentimpulses andlater to aggressive behaviors in those who once appeared tobe quiet and withdrawn.

The treatment of the anger associated with anxiety disordersis essential.  We caution individuals that the failure to forgivewill essentially lead them to be prisoners of their past and blockthe healing of their anxiety.  The case study below describesthe healing process.

Rocco came from a stable family and enjoyed good relationshipswith his parents and his sister.  As a twenty-six year oldsingle professional, he sought treatment for extreme anxiety andfears associated with socializing with his peers.  His fears wereso intense that he began to avoid his friends and to isolatehimself. Also, fear began to invade his work and he obsessed aboutthe people he would meet in new work assignments.  Finally, he foundthat he needed to allay his anxieties by drinking before he could goout socially.

Rocco’s symptoms developed shortly after ending a fiveyear relationship with a girlfriend whom he had hoped to marry. Prior to the ending of their relationship, he was outgoing and sociallya tease but now he harbored an intense fear of being hurt or betrayedbyothers.  He began to blame his ex-girlfriend, Marina, for hisfears and started to feel powerful resentment towards her.  Roccohad been affectionate and devoted to Marina, but he ended therelationship because of her unwillingness to be warm and giving. 

When he began to uncover the depths of his anger, he made the decisionto forgive Marina as a way to overcome his fears.  In the work ofunderstanding and reframing Rocco was able to recognizethat Marina’s father manifested narcissistic behavior toward hermother and sister which resulted in extreme fears of being hurt in asimilarmanner.  “He used Marina’s Mom,” hesaid,“and then abandoned her when Marina was young. No wonder shegrew up feeling afraid that the same thing would happen to her,”he pondered.  Rocco began to feel compassion for her and he wasable to work at forgiving Marina.  It took many months of hard workfor him to experience a decrease in his social anxieties and resentment,but the personal commitment to the process produced concreteresults. During that time he was able to be honest with Marinaabout his social phobia, his resentment towards her, his desire toforgive, and his beliefs about the origin of her emotional pain. 

Panic Attacks due to Work Stress and Father Conflicts

Justin was a thirty-three year old married father of threewho awakened with a racing heart, trembling, and shortness of breath. Hewas evaluated in an emergency room and informed that he wasphysically healthy but was experiencing a panic attack. Over the previousyear ,Justin was under a great deal of stress as a result of beginning anew business which had not yet been successful. He became obsessedwith fears of failing financially and had great difficulty insleeping. Although he knew that he was overreacting, he could not controlhisfears.

Justin was raised in a stressful home as a result of hisfather’sinability to maintain a stable job due to his alcoholism andexplosive temper. The severe financial stress on the family resulted infrequent moves and other hardships. Initially, he denied being angry withhisfather, but later stated, "I’m just extremely disappointed with myDad’s irresponsible behavior and, yeah, I guess it does make me angrywhen I think about all the pain he caused our family. I know you’retelling methat the reason I have this uncontrollable fear comes from thestresses of my childhood and adolescence; I am angry."

Later he experienced some guilt with his newly discoveredanger because he believed that his father had had a terriblechildhood himself. Justin’s love for his father in spite of his weaknessbecame one of the major motivations for entering into the work offorgiveness. Over a period of four to six months, as he persistentlythought about forgiving his father for all the fears of his childhood atthe advice of the therapist, he began to experience significantimprovement. In this process Justin tried to view his father as someonewho had never felt safe with his own mother and who had subsequentdifficulty trusting in relationships. This awareness of the wounded boyinside his father enabled Justin to truly feel like forgiving his father.The understanding of the origin of his fears, the resolution ofhis resentment with his father for his role in the development ofthose fears, medication, and cognitive behavior therapy resulted inthe resolution of his catastrophic thinking and fears. Finally,Justin believed that good could come from his pain. He planned in thefuture to suggest to his father, who was still an episodic binge drinker,that ifhe would work on letting go of his own strong resentment towardhis deceased mother, it might help him to maintain his sobriety.

Panic Disorders related to Spousal Substance Abuse andExcessiveAnger

Clinical experience and research studies indicate that the majority ofclients with a panic disorder have significant amounts ofunresolved anger and have great difficulty in honestly dealing with thisemotion. This anger regularly originates from betrayal experiences atdifferent life stages and often interferes with the resolution of panicattacks. With the use of forgiveness in treating panic disorders, it ispossible to resolve the betrayal anger and facilitate the healingprocess.

The most common events for adults which damage the ability totrust and which predispose individuals to panic disorders include:maritalinfidelity, substance abuse, physical or emotional abuse,job insecurity, severe financial pressure, or a extremely excessive senseof responsibility. Childhood factors leading to panic disordersincludedeath or loss of a parent, serious illness, abuse by peers, orpoverty. Forgiveness is employed in such life events throughchildhood,adolescence, and adulthood to resolve anger with theoffenders.

The anger in panic attacks seen in spouses of substance abusersis difficult to treat when there is a lack of motivation for theoffending individuals to commit themselves to a recovery program. Thesespouses are regularly told that their drinking damages the ability oftheir spouse to trust and to feel safe, thereby predisposing them toanxiety and to panic attacks.  Forgiving someone who continues to offendin the same manner on a regular basis is extremely challenging. However,if the offended one does not try to resolve the justifiable anger, itwill cause additional personal harm.  Spouses can be helped by thinkingthat they are powerless over their anger and want to turn it over to Godorby meditating, "God forgive my spouse." At times the anger inpanic attacks only abates after alcoholic offender goes into atreatmen program.

The ability to trust in the spouse of a substance abuser can alsobe helped by regular participation in Alanon groups.

Equally difficult to resolve is the resentment associated withpanic attacks in those who are married to extremely angry and abusivespouses. When spouses are subjected on a regular basis to excessiveanger, critical comments and controlling behaviors, they can lose theirbasicability to trust without their even being aware that this isoccurring. Then, suddenly, in a supermarket, movie theater, or departmentstore, they can experience a panic attack.

Also, the hostile feelings and rage in those with panic disorders as aresult of sexual abuse in childhood and adolescence can beextremely intense. The feelings of revenge can be overwhelming and attimes only respond over time to a cognitive decision to let go of thisresentment so that one is not controlled by the past and by spiritualforgiveness.

Adult Children of Divorce and Anxiety

Numerous studies have reported difficulty in trusting and anxietyaslong term conflicts in the children, adolescents and adult childrenofdivorce. These anxieties are viewed by psychologist, Dr.JudithWallerstein (1991) perhaps the leading researcher on the longterm impact of divorce, as the universal legacy of divorce, affectingnotonly the especially vulnerable.  Difficulties in trusting and fearsof abandonment can interfere with the safe feeling which is essentialto marital friendship and betrothed love.

Many married adult children of divorce are aware that theinstability of their family background resulted in a great deal ofanxiety which makes it difficult for them at times to trust theirspouses consistently.  Under stress they can easily overreact with angerand anxiety toward their spouse.  Their mistrust regularly limitstheir self-giving to the marital friendship and they often give much moreto their children emotionally than to their spouses becauseunconsciously they feel safer in those relationships. Also, they areoften aware of strong unresolved anger with one or both parents but theycan come to realize that their fears are associated with this innerresentment.

Their decision to work on forgiveness is often based on the hopethat it will help their marriage and help them to feel better bydecreasing their inner anger and fears.  They often begin the work offorgiveness by thinking daily, "I want to understand the most offendingparent more and his/her life struggles and hurts so that they can let goof their resentment with this parent."

This work of forgiveness can result in the emergence of a deep sadnessfrom feeling profoundly cheated. At times these spouses mayfind themselves completely unable to forgive an offendingparent. Wallterstein points out in her book, The Unexpected Legacy ofDivorce, the most difficult anger to resolve is often with the father whois selfish and faithless. When faced with such a challenge, spouses witha spiritual life can ask God on a regular basis to help withtheforgiveness process, that is, they can think, "God help me toforgive"or "God, please take my anger." Poloma and Gallup’s (1991)researchindicates that over 80% of adult in the United States seek God’shelpwh en faced with the challenge of forgiveness.

The process of forgiving with divorce trauma can go on for manyyears as different levels of anger within are discovered. The mostdifficult aspect of his treatment was to try to accept the pain offeeling deeply cheated. However, as parental anger diminishes, trustusually improves, as does the marital relationship. These spouses developthe confidencethat they do not have to be controlled by any longer byfears, anger and sadness of their childhood. As the emotional pain of thepast is resolved, they have a greater ability to trust their spouses.

Obsessive-Compulsive Disorder Related to Marital Conflict

Obsessive-compulsive disorder encompasses a broad range ofsymptoms that represent multiple psychological domains, includingperception, cognition, emotion, social relatedness, and diverse motorbehaviors. In one major study which followed individuals from age 3 toage 32 obsesions caused more interference in daily life thancompuslions. For example, nearly 45% who reported obsessions saidthat obsessions caused them emotional upset, whereas only 20% of thosewith compulsions were upset by them (Fullana,M., et al, 2009.)  Snaith and Taylor(1985) reported irritability in the majority ofpatients with severe OCD symptoms. 

A core feature that underlies obsessions and compulsions insome clients is the failure to recognize and deal adequately withanger. These individuals employ powerful defense mechanisms to try tocontrol their resentment and rage toward those who have hurtthem. Perfectionistic tendencies as well as guilt and fear of thepossible eruption of anger may interfere with their ability to dealhonestly with their emotional pain.  Subsequently, this anger leads toobsessions about aggressive fantasies or fears of becoming contaminated. In an attempt to reduce their anxiety or stress or to try to prevent somedreaded event from occurring, clients engage in compulsive behaviors.

The clinical use of forgiveness can be very helpful in boththeidentification and the resolution of the excessive anger in someOCDclients. The majority of clients only experience their resentmentafterthey have engaged in cognitive forgiveness exercises toward thosewhohave disappointed them at different life stages. However, clientswith OCD are so highly defended that the work of forgiveness can bequite prolonged and difficult. These individuals often comment in thisphase that they found it easier to deal with their cleaning orwashing compulsive behaviors than with their emerging anger,aggressive impulses, and impulses for revenge.

Ashley, a thirty-five year old married mother of two, sought treatmentof her obsessive fears that her children might acquire terrible diseasesfrom germs in the home. In an attempt to protect her children she spentnumerous hours cleaning the home each day.

Initially, Ashley denied that anyone had hurt her. Afterexplaining the value of forgiveness in the treatment ofobsessive-compulsive disorders, she was asked to think that she wanted totry to forgive anyone who had disappointed her or been insensitive to herin her childhood, adolescence, and adult life. It took months beforeAshley could admit that she had been hurt by anyone.  Finally, as shethought of forgiving anyone who had hurt her, her defenses diminished andher emotional pain emerged.  She acknowledged that her husband, Kurt,had been extremely insensitive to her for years. In fact, he wasextremely critical, and at times, he was verbally abusive. She recognizedthat she needed to deny her pain with him for many reasons, includingfear of his anger, fear of divorce, and strong insecurities from theconstant criticism that she had experienced during her youth.

Ashley also came to realize that she had been denyingstrong resentment from the time she was a child toward each of herparents.  Her perception was that they had favored her other siblings andhad treated her like a second class citizen.  She came to recognize thatshe had then married someone who was almost as critical as they had been.At this stage she needed an antidepressant to deal with the sadness andstrong rage associated with her betrayal experiences. At first, she feltso hurt that she was unable to think about forgiving anyone, but whenshe realized how essential it was for her to resolve her anger toovercomeher germ phobia, she decided to make a decision to forgive eventhough she did not feel like doing so.

She realized that her true fears were not of her children being harmedby germs, but of her buried rage that was emerging and the fact that shefeared hurting her husband or someone else as a result of it. During thestruggle with her powerfully angry impulses, in frustration, Ashleyresponded, "I wish I was back dealing with my germ phobia - itwas a loteasier than this." Ashley was able to continue to forgive her husband,Kurt, because she was aware of his difficult life with an alcoholicfather who continued to be a major source of stress even in their marriedlife.  She had always felt empathy for Kurt and, in the end her compassionenabled her to decide to let go of her anger with him. Finally, herforgiveness was facilitated by his participation in therapy andacknowledgment of the mistakes he had made in their relationship.

The dynamics were explained to Kurt and he was asked to considerthat he might have been misdirecting anger at Ashley meant for hisalcoholic father.  He apologized to Ashley and committed himself to worka tforgiving his father, which helped significantly in herrecovery. However, Ashley continued to have difficulty in letting go ofher angerwith her parents. She came to believe that they never reallywanted her and had always harbored a resentment against her. As she triedto tell herself that they were emotionally sick people who had no rightto havea negative influence over her emotional life, she was able tomake the cognitive decision to let go of her resentment towards them.  Shecould not develop compassion for her parents, nor was she able to absorbthe pain.

As Ashley’s unconscious rage with her husband and parentsdecreased through the use of forgiveness,  her obsessive fear concerningher children lessened also. Her husband felt guilty about his role inhiswif e’s illness and made major changes in the way he treated her;in addition, he decided to forgive his father and resolved not to act inasimilar manner. After two years of treatment,Ashley’so bsessive-compulsive symptoms were significantly resolved.

Other helpful interventions for OCD include:

• treatment of perfectionistic thinking
• growing in trust
• building confidence
• working against catastrophic thoughts by trusting more
• strengthening healthy friendships
• creating distance from negative and controlling people
• the use of serotonin reuptake inhibitors (SSRIs) for severe symptoms
• employing, when appropriate, the role of faith by meditating on trusting the Lord with one’s fears
• trying to make acts of trust before giving into compulsive behaviors such as hand washing and checking
• medication
• consulting with a Catholic priest for Catholics whose OCD is the result of severe fears of illness and death.

Obstacles in the treatment of OCD include:

• a compulsive need to control
• a desire to punish others or seek revenge with a refusal to give up anger
• withdrawal into the sick or victim role as a way to avoid or control others.

Obsessive-compulsive disorder and suicidal thoughts

Many persons with OCD report that their quality of life isvery low.  A number of studies have demonstrated that suicidalthoughts occur in over 50% of persons with OCD ( Torres AR, et al (2006);SaarenJ, et al. (2005); Bridge JA, et al (2007.) Subsequently, itis important to evaluat the degree of depression, despai and possible suicide risk in persons with OCD.

Posttraumatic Stress Disorder

Some individuals with posttraumatic stress disorders (PTSD)struggle with extreme anger and frequently have powerful impulses to seekrevengeagainst those who traumatized them. Chemtob et al. (1997a) havetermedthe anger type in some extremely hostile patients with PTSD as"ball of rage."

Excessive anger in PTSD is evident today among those who havelost their jobs through downsizing and are unable to locate comparablework, or in people who were physically or sexually abused.  Forgivenesscan enable the victim to let go of rage and impulses for revenge whileat the same time pursuing justice regarding the traumaticevent. Forgiveness also can diminish the recurrent memories of theevent, decrease fears, irritability and obsessional thoughts of theoffender. The failure to resolve the anger with the offender regularlyplaces the perpetrator in a position of power over the victim.

Earl was a fifty year old man with a successful twenty-eightyear career with a large international corporation.  He entered therapyafter being told by his employer that he would no longer be a generalmanager, but would have to return to sales.  His corporation had amarkedly small business in the limited territory he was assigned. Herealized that his new position would not be able to support his incomeand it appeared that within less than a year he would be fired. As aresult of the trauma associated with these events Earl developed severeinsomnia with recurrent dreams of the demotion.  He constantly replayedthe event, becoming depressed with markedly diminished interest insignificant activities and extreme fears for the future.

In attempting to understand why his corporation took actionagainst him,  Earl became convinced that it was due to the fact the he hadblown the whistle when he spotted collusion between another highlysuccessful salesman and someone from a different national corporation. An investigation revealed that his views were accurate and subsequentlythe salesman lost his job and the regional general manager was demoted. He was convinced that their friends higher up on the corporate ladderwere seeking revenge against him because of his honesty. His emotionaland mental state were such that the therapist and he agreed topursue disability rather than attempt to go into his new position withsevere symptoms and face the loss of his career in a short period oftime.

Earl made the decision to try to work at forgiving those whohad betrayed him,  not because he wanted to let go of his anger withthem, but because he felt so guilty about regularly overreacting inanger against innocent people. He also came to understand therelationship that existed between his anger and the accompanyinginsomnia, depression, and mistrust.  He tried to forgive to facilitate therecovery from his severe post-traumatic stress disorder symptoms.  Becausehe continued to view the actions of his employer as evil and motivatedby revenge, Earl had great difficulty in forgiving his employer.

After a number of months in therapy and as a result ofthe diminishment of his anger, he decided to take legal action againstthe corporation for the manner in which it had treated him.  Hestruggled with violent impulses against different members of thecorporation and, at that point in time, he tried to think that he wantedto let go of these thoughts and not act on them. This was a verydifficult process for him.  He realized that holding onto his strong angerwould only harm him, but he was not able to use the word forgive. Overthe course of several months he did find relief from thinking daily thathe wanted to let go of his desires for revenge and not act on them.

The thought of obtaining justice through legal means was an additionalencouragement to him. The trauma, however, was so severe that Earlremained in the process of forgiveness for several years unable to absorbthe pain or to find any meaning in his suffering.  His major method forcoping was regular reflection that he did not want his former employer tocontrol him and that he had the desire to let go of his rage and impulsesfor revenge. These steps helped diminish his posttraumatic stressdisorder symptoms as he continued to pursue legal action against hisemployer.

While the virtue of forgiveness is essential to diminishinganxiety, other virtues are also very important in the healing process.These include virtues of trusting, fortitude, prudence, wisdom, andthe theological virtue of faith. The growth in virtues is achallenging process that requires much patience and perseverance.

Mistrust/anxiety from a previous marriage and divorce

Spouses who were previously married have experienced severe emotional betrayal pain which is often unconscious, Perhaps the greatest damage from divorce, which by the way is referred to in the Catechism of the Catholic Church as a plague because of its far reaching harm, is to the person¡¦s ability to trust, that is, to maintain an ongoing safe feeling in a marital relationship. Trust is the essential foundation for self-giving in marriage. Unless the serious conflict with trust is addressed, it is very likely that mistrust will emerge in a second marriage and greatly harm that the marital friendship. Perhaps, the greatest damage is done by the compulsive need to control and by markedly limited self-giving as a result of the weakness in feeling safe.

In our clinical experience most spouses who were previously married lack both self-knowledge of their trust weakness and of how this conflict can be healed. We believe self-knowledge can increase by completing the mistrust and anger checklists in this chapter.

Post divorce mistrust can be resolved by uncovering anger with the ex and by committing to engage in the hard work of forgiving the former spouse. In addition we have found it helpful for the spouse to meditate that he/she is powerless over their fears of being betrayed again and then turn them over to God. Also, meditating daily on first trusting God and then trusting one¡¦s spouse assists in the healing of the serious trust wound. Finally, many individuals have found it helpful to meditate regularly, ¡§Lord help me to feel safe with my spouse and heal my fears of being betrayed again."

The more trusting spouse must exercise patience as the other spouse works through the mistrust issues from the previous marriage and should not be afraid to point out mistrustful behaviors and to discuss healing of the loved one's pain. There can be a significant resistance to the idea that he or she even has such mistrust wound. Thus, the spouse who was not divorced will have to bear a burden of that previous marital wound for a period of time. Couples who are dealing with this type of mistrust stress can benefit from counseling with a mental health professional who is skilled in the psychotherapeutic uses of forgiveness,

The more trusting spouse can feel shocked, confused and at times angered when he or she encounters the mistrust wound and behaviors. The mistrust is experienced regularly as being foreign to him/her because the expectation was that the loved one would enjoy cheerful self-giving and a very close loving marital friendship. Subsequently, major adjustments are necessary to not only accommodate the mistrust but also to participate in the healing. Here the virtues of forgiveness, patience, hope and fortitude are essential. The forgiveness used is not only of the spouse , but also of the former spouse who inflicted the trust wound. Finally, the ongoing use of the mistrust and marital self-giving checklists can be beneficial in documenting the degree of progress.

The Role of Medication

Tranquilizing medication can be very helpful for those withserious anxiety symptoms. Due to the high co-morbidity of anxietywith depression and excessive anger, the serotonin reuptake inhibitorsare very effective because they are proven to diminish each ofthese emotions.

Ideally, medication should be used in conjunction with atreatment plan that attempts to uncover and address the origins of theanxiety. When the numerous origins of anxiety are being successfullytreated, it is then possible to decrease and later taper many individualsoff medication.  However, people need to be patient with this processbecause strengthening trust and confidence and resolving loneliness, three of the most common causes of anxiety, can be a lengthy process.

Difficulty in Going off Medication

Unfortunately, medication is often prescribed for seriousanxiety disorders without proper effort being made to attempt to identifyand to resolve the causes of the anxiety. As a result, when peopletreated in this manner want to go off their medications, they regularlyexperience the re-emergence of symptoms of anxiety including dizziness,insomnia, irritability, lightheadedness, difficulty in concentrating andmemory, fatigue, weakness, etc.

These symptoms are often incorrectly viewed as withdrawalsymptoms from anti-anxiety medication when, in fact, they develop often becausethe basic conflicts have not been adequately treated, particularly difficulties in trusting in relatonships in one's personal life or work, an obsession with controlling others, and weaknesses with confidence and loneliness.  These unresolved emotionalwounds can intensify when medication is withdrawn resulting in a excessive anxiety particularly under various types ofstresses.

The Ongoing Need for Medication

A number of traumatic life events from the past, such assubstance abuse, divorce and betrayals in loving relationships, canresult in a prolonged vulnerability to weaknesses in trusting and inconfidence. Furthermore, in many work environments today, it is difficultfor the employee to maintain trust in the employer which can also renderone vulnerable to ongoing anxiety. Another important issue is theongoing severe stress with loved ones one cannot trust fully.  Individualswith these stressors from the past and present often need to usemedication for an indefinite period of time in order to functioneffectively as do those with chronic medical conditions such as diabetesand arthritis.

The Course of Anxiety Disorders

Although anxiety disorders resolve in many individuals, studies describe the anxiety disorders in some as insidious, with a chronic clinical course, low rates of recovery, and relatively high probabilities of recurrence. The presence of particular associated or co-morbid psychiatric disorders, such as depression, significantly lowered the likelihood of recovery from anxiety disorders and increased the likelihood of their recurrence, Bruce SE, 2005.

Studies on the role of faith in diminishing anxiety

A number of studies have demonstrated the benefits of faithinaddressing anxiety disorders. They include the following:

• In a survey of 37,000 men and women those who attend church, synagogue or other religious services, the higher the worship frequency, the lower the prevalence of depression, mania and panic disorder. Baetz, M., et al. (2006) How spiritual values and worship attendance relate to psychiatric disorders in the Canadian population. Can J Psychiatry 51:654-61. The lead researcher Marilyn Baetz, MD, of the University of Saskatchewan in Canada, stated, "The higher the worship frequency, the lower the odds of depression, panic disorders and mania."
• The importance of religion was a predictor of improvement in panic disorder after one year.  Over time, the improvement was seen for the religion was very important. Bowen, R, et al. (2006) Self-rated importance of religion predicts one year outcome of patients with panic disorder. Depress Anxiety 23:266-73.
• Also, in a systematic review of 850 studies the majority of well-conducted studies found that higher levels of religious involvement are positively associated with indicators of psychological well-being, life satisfaction, happiness, positive affect, and with less depression, suicidal thoughts and behavior, drug/alcohol abuse. (Moreira-Almeida, A., Neto, F., Koenig, H.G. (2006) Religiousness and mental health:a review.Rev Bras Psiquiatr.28:242-50.)

As stated in other sections of maritalhealing.com, faith can playa beneficial role in the resolution of emotional pain and conflicts.(Seehealing and faith at the National Library of Medicine web site, www.ncbi.nlm.nih.gov/pubmed/.) A number ofspiritualinterventions help in resolving anxiety and conflicts and in building deepertrust in marriages. These include employing daily a modification of thefirst two steps of Alcoholics Anonymous and thinking"I am powerless overmy anxieties and my tendency to control and want to turn them over toGod."

Pope Benedict commented on the role of faithinaddressing anxiety when he stated, "" In the face of the ample and diversified panorama of human fears, the word of God is clear: He who'fears' the Lord is 'not afraid.' The fear of God, which the Scriptures define as the 'beginning of true wisdom,' coincides with faith in God, with the sacred respect for his authority over life and the world. Being'without the fear of God' is equivalent to putting ourselves in his place, feeling ourselves to be masters of good and evil, of life and death.  But he who fears God feels interiorly the security of a child in the arms of his mother: He who fears God is calm even in the midst of storms, because God, as Jesus has revealed to us, is a Father who is full of mercy and goodness. He who loves God is not afraid," 6/22/2008.

The Role of Meditation

Dr. Herbert Benson at the Mind Body Institute (www.mbmi.org)andthe Harvard Medical School has written of his success of using mediationin treating medical illnesses in his book, Spiritual Healing.  Herecommended that patients with cardiovascular and hypertensive diseasesmeditate for two fifteen minute periods daily on a prayer consistent withtheir faith.  We have had similar success in using meditation for thosewith anxiety disorders.

Spiritual meditations which are helpful to Catholics indiminishing anxiety when used for two 15 minute periods daily are:

• Lord help me to feel safe and protected so that I can give myself and so that I can receive love.
• Lord protect my confidence in my God given gifts for my marriage, work, friendships, etc..
• Lord you are in control, not me. Help me give up my tendency to want to control.
• Lord help me not to repeat the fears or catastrophic thiniking of a parent.
• Our Lady, I am totally yours (Totus Tuus prayer of John Paul II.)

Spiritual Activities

Many Catholic couples also report being helped with their anxietyby the following spiritual activities

• reading the psalms
• meditating on the gospel of the day
• saying the rosary
• making a holy hour
• praying to a particular saint
• meditating upon being protected by one's guardian angel
• meditating upon the Holy Spirit strengthening one
• engaging in spiritual reading
• going to mass daily
• having a spiritual director
• meditating upon God the Father as one’s loving, protective father
• meditating upon certain passages of the Gospel such as -
  "The Lord is near, have no anxiety..." Phil.4:5
  "Do not be afraid, you are of more value than many sparrows." Luke 12:7
  "Do not be afraid. Luke 5:16.
  "Do not be afraid any longer, little flock, for your Father is pleased to give you the kingdom." Lk 12:32
  "Perfect love casts our fear." 1 Jn 4: 18
  "Do not be afraid, only believe." Mk 5: 36.
  

Anxiety disorders usually resolve with proper treatment, however,in some people they can be serious, long term illnesses which caninterfere with martial happiness.  Forgiveness has been shown to beeffective in our clinical experience and in research studies in thehealing of anxiety disorders, in part, by resolving the various degreesof anger associated with them.  Also, faith has been demonstrated to beanother virtue which is helpful in building trust and confidence andin diminishing anxiety. There is every reason to hope that anxietyand fears can decrease in married life.

References in this chapter can be foundat the National Library of Medicine website, PubMed.

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