The Anxious Spouse Healing
"Anxiety is the greatest evil that can befall us except sin," St. Francis de Sales, Introduction to the Devout Life.
In this chapter we'll be looking at the nature of anxiety and its association with excessive anger, its manifestations, causes and healing. We'll be discussing the healing of generalized anxiety disorder, social anxiety, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder and the anxiety associated with divorce trauma.
If you would be interested in viewing now my 90 minute anxioius spouse webinar, please feel free to go here.
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 important relationships. Anxiety disorders are serious illnesses that can be as incapacitating as severe arthritis or other medical illnesses.
Not infrequently, family of origin mistrust, particularly 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 and communities has increased significantly over the past year because of worldwide economic problems resulting in a 50% loss of value in the stock market, an epidemic of defaults on mortgages and bankruptcies,massive layoffs, severe banking difficulties, pay reductions and furloughs, major losses in retirement accounts and great difficulty in keeping up with the bills.
Such financial and job worries regularly lead to a serious difficulty in sleeping and then to more intense fears, irritability, and, in many, an intense sadness. The insomnia needs to be addressed promptly because a stable sleep pattern is essential in dealing withlife's pressures. Those who struggle with insomnia should consider starting on one of the numerous safe sleep medications that can reduce anxiety and result in a good night's sleep.
In view of the many psychiatric research studies which have demonstrated the benefits of faith in addressing emotional conflicts, we recommend regularly to people of faith that they consider employing a faith meditation to deal with their financial and work anxieties several times a day and, particularly, before going to bed. Such meditations focus on trusting God with all of one's fears. Scriptural prayer that can found both in the psalms and in the New Testament can be very helpful because it can be effective in building trust, one of the most important virtues that can assist in reducing anxiety.
The present economic crisis may also result in the experience of strong anger toward many in the government, financial markets, banking and other institutions because in many instances where their selfishness, greed, high risk taking, desire to control or poor judgment have contributed to the present hard times. This anger can also contribute to insomnia and blocks the ability to resolve anxiety. The anger must be addressed and the most effective way is through the practice of the virtue of forgiveness through reflection several times each day and at bedtime. If a person of faith finds it difficult to forgive, he or she can give the anger to God, accept personal powerlessness and in an act of trust, surrender all to God.
Sue is a thirty three year old attractive, married mother of three who struggled with anxiety symptoms that seriously interfered with her life. She attributed her anxiety to feeling overwhelmed by her responsibilities and lack of support from her husband.Sue's husband's demanding career resulted in his frequent absence from dinners and travel that kept him away from home several nights each month. She missed his comforting presence, particularly at night, and did 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 of excessive sense of responsibility and to determine if her husband could make changes in his work schedule in order to be more present to her and the children.
When Sue explored other sources of anxiety from the past, she came to realize that her family background contributed to her anxiety. Her parents divorced when she was 11 years old. It seriously wounded her safe feeling and unconsciously led her to overreact in anxiety. She discovered a strong fear that her marriage might also end. In therapy she was surprised to discover significant amounts of unresolved anger with her father whom she viewed as being responsible for the parental divorce because of his selfish behaviors. She decided to work at forgiving him in order to resolve the pain from her past that was leading her to overreact emotionally. Sue experienced emotional relief and growth in her ability to trust as she worked at forgiving her father.
Addressing Sue's emotional pain from her parent's divorce and her husband's travel greatly diminished her anxiety, Also, she discovered that her faith was beneficial as she began to meditate more upon theLord's loving presence with her and upon trusting him with her burdens and fears. As described later in this chapter, a number of research studies have proven empirically the benefits of faith in the treatment of anxiety disorders.
The Journey of Anxiety
As with anger, anxiety or mistrust can develop at one stage of life,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 adult life. Anxiety is strongly associated with both the sadness and anger of life hurts and unjust treatment which explains the high prevalence of these emotions when one is anxious and in anxiety disorders.
The diagram below demonstrates the relationship between life hurts,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 which needs to be understood and addressed. For example, anxious feelings may develop because one�s confidence is shaken by marital, family, or professional relationships or stresses. Then, the spouse can reflect upon and be thankful for his/her special gifts and take other steps to address the stresses, such as recognizing the need to have more balance in one's life, to set aside more time for the marital friendship, to have proper sleep hygiene, to correct selfish or controlling individuals or to learn to surrender more often one's worries..
Anxiety and irritability often arise when a spouse is not being treated with proper respect in the marriage. When this conflict is identified, a request should be made to be treated with appropriate respect.
The good news is that most marital conflicts can be resolved, particularly, if the spouses are open to self-knowledge and to growth in virtues.
Prevalence of Anxiety
Anxiety is the most common psychiatric disorder. The national co-morbidity study of 2005 revealed that 28.8 % of Americans will have an anxiety disorder in their lifetime with the median age of onset being 11 years of age (Kessler, R., et al, 2005.)
The recent downturn in the American and world economy is damaging the basic ability of many people to feel safe resulting in higher levels of anxiety, sadness and irritability.
An increase in anxiety disorders is occurring in children, in our opinion, because of many factors that are damaging a child's basic ability to feel safe and protected. This basic trust is established first and foremost in a child's early life bonding with the mother. Unfortunately, in the present narcissistic culture the material and emotional needs of parents too often are placed before the most basic need of children to have a securely attached mother relationship and to 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 the serious problem they have with excessive anxiety. Major factors contributing to this problem in young adults in addition to those listed 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 so that anxiety and mistrust do not dominate person's life. A clear and powerful example of this fact and reason for hope is the life of John Paul II whose mother died when he was a child, whose only older brother died when he was 9 and whose father died when he was 19 . If the nineteen year old Karol Wotyla had been evaluated during the war in Poland by a team of mental health professionals who were then asked to offer an opinion of his future emotional and mental health based on the numerous losses in his family life, most would have said that this young man would probably experience ongoing problems with serious anxiety in his life. They would have probably suggested that he might later struggle with various types of anxiety symptoms of the following disorders: generalized anxiety disorder, panic disorder (due to catastrophic thinking), social anxiety disorder and post-traumatic stress disorder.
Childhood trust wounds in children, young adults and adults take time to heal. Again, growing in virtues, establishing healthy trustworthy relationships and utilizing faith, when appropriate, can create within an individual as sense of safety, trust and hope which are essential to self-giving and to maintaining a healthy personality.
Damage from Anxiety
Excessive anxiety is a major source of tension and stress in marriages and families. The ability to feel safe is essential to giving love and to receiving love. St. Teresa of Avila referred to this when she wrote, "Trust and only trust should lead to love."
It significantly interferes with marital happiness because a spouse becomes preoccupied and turns in on himself/herself that can markedly limit the ability to give oneself, to receive love and to cope with the demands of daily life. Many spouses respond to anxiety or the loss of a safe feeling in life by developing a need to control, irritability, sadness, weaknesses in confidence and social isolation. All these conflicts then damage romantic feelings, the marital friendship and betrothed love. Unless addressed properly, the loss of trust leads to the loss of the feelings of love and can tempt some spouses to consider separation or worse divorce.
Again, one of the major ways in which anxiety damages marriages and children is being interfering with the safe feeling that is essential to self-giving. Consider now rating your own self-giving and that of your spouse on the self-giving checklist in the evaluate your marriage chapter. After completing that checklist, ask yourself if anxiety/mistrust could be a factor limiting your cheerful giving.
Symptoms of Anxiety
The Diagnostic and Statistical Manual of the APA (DSM IV-R) lists the following symptoms which constitute a (generalized) anxiety disorder which 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
- 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 additional symptoms of mistrust or anxiety as they effect our emotions, thinking, behaviors, physical health and spiritual life. Now please rate yourself and your spouse on this checklist that is meant insight into manfestations of anxiety.
- Catastrophic thinking (something bad is going to happen)
- Rigid thinking-a lack of openness
- Excessive criticism of others (as an unconscious way to distance people)
- Negative thinking
- 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
- 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)
- 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
- 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)
- Irritable bowel syndrome
- Muscle spasms in different parts of the body
- Coronary artery disease
- Vulnerability to all major diseases if mistrust persists for years
- Severe headaches
- Muscle tension
- Light headedness
- Rapid heart beat
- 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
What are the most common symptoms of anxiety in your spouse and in you?
Origins of Anxiety/Mistrust
The most common cause of anxiety in our clinical experience is the result of the loss of trust or a safe feeling at different life stages.One develops trust or a safe feeling in life through the establishment of secure attachment relationships first in the home with one's mother, then one's father, siblings and then outside the home with friends, peers, teachers, coaches and dating relationships. Many young adult shave their trust badly damaged by relying excessively upon romantic feelings and giving themselves to others who turn out not to be trustworthy. In adult life trust or ones safe feeling can be damaged in numerous ways including by hurts in friendships, dating relationships, work, and by one's spouse.
Cultural factors also are contributing to the damage of trust and growth in anxiety. These include the collapse of the nuclear family through divorce, day care, the sexual utilitarian philosophy resulting in people being treated as objects, the growth of narcissism in the culture, single parenthood, the growing hostility against Judeo-Christian morality and marriage in the media, school systems and the judicial and legislative branches of government.
In evaluating the origins of anxiety it is essential, as with Sue, to try to determine how secure the spouse felt in important loving relationships, as well as in peer and in work relationships at each life stage. For numerous reasons most of us enter our adult lives and then our marriages with trust "wounds."
Please rate yourself and your spouse on the origins of mistrust/anxiety below.
Origins of Mistrust at Different Life Stages
- 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
- Same causes as in childhood
- Poor body image
- Difficulty in playing sports
- Parental separation or divorce
- Post abortion trauma
- Treatment as a sexual object
- 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
- 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 pare
Were there any surprises here in regard to trust wounds from childhood, adolescence and adult life in you and in your spouse? In our clinical work we find that hurts in the father relationship are the most common sources of trust weaknesses prior to marriage, but that hurts in the mother relationship are the most difficult to heal since the relationship with the mother is the basic foundation to trust people.
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 generalized anxiety disorder and OCD, as well as performance anxiety are often the result primarily of weaknesses in confidence.
Pope Benedict in June 2008 described another source of anxiety. He stated, "But there is also -- and today above all -- a more profound form of fear of an existential type that sometimes overflows into anxiety. It is born from a sense of emptiness that is linked to a culture that is permeated by a widespread theoretical and practical nihilism (6/22/2008)."
The 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 decades later. This dynamic is seen frequently in spouses whose parents were controlling, angry or emotionally distant, all of which can damage a child's trust. Later, under various types of stress in married life, this mistrust and anxiety with associated irritability can be misdirected unconsciously at one's spouse.
In reviewing the origins of mistrust, do you think you may have overreacted to your spouse because of trust weaknesses you brought into your marriage or acquired due to hurts outside your marriage?
Anxiety and other disorders
Anxiety is strongly associated with sadness, weaknesses in confidence and excessive anger. The diagram below attempts to demonstrate graphically the relationship between life hurts and these powerful emotions.
The presence of other mood disorders (co-morbidity) is being shown to be a fundamental characteristic of the course and nature of anxiety disorders. The National Co-morbidity Study demonstrated that 8 of 10 subjects with lifetime generalized anxiety disorder also had a co-morbid mood disorder during their lifetime. Also, when co-morbid mood disorders are present in generalized anxiety disorder, a significant increase 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 symptoms associated with the diagnosis of generalized anxiety disorder, the evaluation of anger and hostility in anxiety disorders does not received enough attention even though many studies demonstrate high levels of anger and anger attacks in anxious patients. Many anxious spouses simplydon't realize how angry they are with those who have damaged their ability to trust. Also, the presence of anger attacks contributes to a poorer treatment outcome for anxious patients.
High levels of anger have been reported in post-traumatic stress disorder and recommendations have been made that clinicians incorporate anger management strategies into treatment plans for PTSD.
Clinical experience has shown that many clients with anxiety disorders have significant levels of anger. While anger attacks are an extreme manifestation of anger, many clients with anxiety disorder struggle 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 and subsequently can interfere with recovery from both anxiety and depressive disorders. Forgiveness removes the anger from this emotional complex, thereby helping with the reduction of anxiety and sadness often while marital or family of origin conflicts are also being addressed.
The Treatment of the Anger Associated with Anxiety Disorders
We will describe now the uncovering and the treatment of the strong anger which is found in anxiety disorders, review the four phases of forgiveness therapy and describe how to use forgiveness in the healing of anxiety disorders. Forgiveness is a powerful virtue which can decrease both anger and the anxiety associated with it. Our approach is one aspect of the newer field of positive psychology with its focus on growth in virtues. Too often the anger associated with anxiety disorders is not identified and subsequently not treated. In our professional opinion failure to do so interferes with recovery from these disorders.
The uses of forgiveness can make a significant contribution to the treatment of anxiety disorders. My colleague and coauthor, Dr.Bob Enright at the University of Wisconsin, Madison, has demonstrated in many research studies that forgiveness can significantly symptoms of anxiety as well as symptoms of depression, anger and insecurity. It's effectiveness is accomplished by removing the anger associated with hurts from different life stages which have damaged a person's basic ability to trust or to feel safe. Forgiveness will decrease anxiety directly as a result of the resolution of anger especially in clients whose anxieties are caused by fears of their unconscious anger, as occurs in many spouses with obsessive-compulsive disorders.
As anger from past hurts decreases, past fears and mistrust seem to have less influence over the present. In fact, the healing of anger appears to facilitate a growth in trust or a safe feeling, as well as inability to be assertive. At the same, it frees individuals from the negative influence of others who have hurt them, for example, a controlling, 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 some initial difficulty in identifying specific hurts or stresses in their lives that have predisposed them to anxiety. Because anger locks into the unconscious at different developmental stages, especially childhood and adolescence, the resentment only emerges when traumatic life events are examined. The initial uncovering of anger rarely is the final word on the true cause of the anger; additional causes will be discovered at a later point in the work phase.
Based on the spouse's history of their anxiety, forgiveness exercises are often used to uncover anger during this period. The spouse is asked to focus on the desire to understand and forgive an insensitive parent, spouse or employer who hurt them. As in the treatment of depressive illness, this exercise can lead to the emergence into consciousness of significant emotional pain from past hurts.
The Decision Phase
As a person begins to understand the connection between anxiety and fear on the one hand, and being treated unjustly on the other, a person'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 regularly given written assignments that describe who they should try to understand and forgive and how they should approach the task cognitively or emotionally. Those with obsessive-compulsive disorders often demonstrate the greatest resistance during this phase. The defenses surrounding their anger and betrayal pain are powerful and they dissolve slowly as they face the reality of their hurts. In addition, perfectionistic tendencies can make the work quite difficult because it involves admitting the depth of the anger that has been denied.
Individuals with posttraumatic stress disorders tend to be the most aware of both their anger and who their offenders are. However,they often have the strongest impulse to seek revenge and to strike back at those who have hurt them. In this phase, many of these individuals want to approach the offender and express their anger, while they are working at forgiveness. They need to be cautious of the possibility of losing control of their intense anger and of the limitations of expression in the resolution of anger. Although healthy assertiveness is important, it can have limited value because mere words or behaviors often cannot compensate for the depth of pain and anger from a significant hurt. Also, the expression of anger rarely results in a true sense of justice or in freedom from the desire for revenge.
In contrast to revenge, healthy assertiveness in association with forgiveness is an important aspect of the treatment of those with excessive anxiety. Many of the spouses develop an excessive sense of responsibility which makes it difficult for them to relax, sleep, and lead healthy lives. In addition to forgiving an offender who has caused tension in their lives, they benefit from taking steps to protect themselves from the unreasonable and damaging demands of others.Assertiveness may be needed with an employer who has unreasonable expectations concerning work hours or children who demand participation in numerous sports activities to the detriment of a balanced family life. It may also be of benefit with an insensitive or emotionally unsupportive spouse who has damaged one's ability to feel safe, as well as demanding people who attempt to make the spouse feel overly responsible for them or others. Assertiveness is employed with forgiveness in these cases so that one will learn to express anger in a healthy way, minimizing the possibility of overreacting. Here the spouse works at first forgiving and then, as the anger diminishes, gives a correction to a spouse in a gentle manner if he or she has been insensitive, controlling, critical, angry, selfish or emotionally distant.
A number of men with generalized anxiety disorder related to their work identify a lack of confidence as a major factor in their vulnerability to excessive anxiety. They discover that a major factor in this conflict is also their relationship with their fathers who failed to 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 fathers is quite difficult, but they feel guilty and conflicted about being angry with them. Fortunately, as their understanding of their fathers childhood experiences grow, they are usually able to recognize that their fathers modeled their behavior after their own fathers (the spouse's grandfather) and they realize that the hurts were rarely inflicted deliberately.
An exception to this father whose selfishness turned him in on himself and completely blocked his self-giving and sense of responsibility. In these cases spiritual forgiveness can be effective during which the person thinks either "God forgive my father" or "I am powerless 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 decrease in an excessive sense of responsibility, increased self-esteem, an improved ability to trust one's spouse, an enhanced ability to lead a more balanced life, and an improved ability to be assertive in a gentle way 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 their suffering. Often they become much wiser and more assertive, take better care of themselves in relationships and they usually become more careful about whom they trust. The role of forgiveness within the context of specific 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,"Men and women are on a journey of discovery which is humanly unstoppable search for the truth and a search for a person to whom they might entrust themselves."
Most spouses believe they have completed their journey of discovery and found someone whom they can trust and give themselves to completely. Unfortunately, for numerous reasons this ability to trust often is weakened either by the emergence of mistrust wounds from family pain or hurts in previous relationships, from marital hurts or from both. As trust decreases, so too does the feeling of love with a subsequent decreased ability to give and to receive love and to view the spouse as a special gift.
Marital Hurts and Anxiety
Also, in our clinical experience a number of spouses experience anxiety in their marriages because their ability to trust their spouses is 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 the other spouse. Approaches to spouses with the conflicts above are addressed in other chapters on this site. The offended spouse should try to understand why a spouse is acting in these ways, work on trying to forgive this spouse and ask the spouse to grow in various virtues to diminish these conflicts. In addition to forgiving those who have damaged one's trust, it can be helpful to consider forgiving those who have damaged the trust of one's spouse because their trust wounds may well 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) love emerges most clearly when the beloved stumbles, when his or her weaknesses or sins come into the open. One who truly loves does not then withdraw love, but loves all the more, loves in full consciousness of the other's shortcomings and faults, and without in the least approving of them. For the person as such never loses his/her essential value. The emotion which attaches to the value of the person is 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 mind with the resultant development of unhealthy and distorted thinking patterns. For example, damage to trust can lead to a distorted thoughts that "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 distortions such 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 and addressed so that they no longer keep one as a prisoner of one's past.
Here are some of the common cognitive distortions seen in anxiety disorders:
- 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 of trust. 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."
The following cases will illustrate the value of employing forgiveness therapy in the healing of anxiety disorders.
Generalized Anxiety Disorder Related to a Lack of Balance
Inge was a thirty-four year old mother of two children who sought treatment for extreme anxiety, insomnia, and fatigue. She felt overwhelmed by the responsibilities involved in caring for her family and actually feared insanity. The family rarely ate together and she and her husband had little quality time with each other because of numerous pressures and demands.
Initially, Inge was unable to recognize the cause of her anxiety. Slowly, she identified a number of significant stresses and then felt quite angry about them. She was particularly upset by her children's participation in numerous sports, including traveling sports teams and the excessive importance her husband placed upon such involvement by the children. She became overwhelmed with the demands of practices and games as well as long weekend tournaments. Family dinners, relaxing weekends at 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 her effort to please her husband and her children. She even felt somewhat guilty about her anger, but eventually came to accept it as being appropriate. As her true feelings emerged, she was able to communicate to her husband, Mike, that she thought compulsive participation in sports was more important to him than to their children. She insisted that changes had to be made in the family schedule because she was being emotionally harmed by the pressures she felt from him and their children.
Her decision to forgive her husband and her children for being self-absorbed and insensitive was motivated by a desire to be healthy and by a desire for a better relationship with her family. The work of forgiveness was facilitated by her husband's apology and immediate decision to limit each child to playing only one sport per season and to exclude all participation in traveling sports teams. Regular attempts to ward understanding Mike's needs and insecurities that arose from his own lack of success in sports helped her to feel more compassion for him and enabled her to truly feel like forgiving him.
As balance was established in her family life and as she continued to forgive, Inge's anxiety symptoms abated. Later, she was able to help several other friends who felt overwhelmed by similar pressures in their families 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 an older sister who directed anger against her when she was young. Finally, she felt betrayed in a number of valued relationships with men in her life. She recognized that the hurts in the relationships with her father made it difficult to trust men and led her to overreact in relationships.
Joy was motivated to forgive in order to break the unhealthy pattern in relationships with men and to sever the control of past emotional pain.
In re framing, she came to understand that her sister brother harbored a great deal of resentment toward their father and misdirected it at her. She came to see her father as someone who was unable to control his fears of being betrayed, who employed sarcasm and anger to keep others at a distance and who feared giving himself to anyone.
Joy employed past forgiveness exercises during which she pictured herself as a girl and teenager and thought that she wanted to forgive her father and her sister for ways in which they had hurt her. These forgiveness exercises were initially cognitive in nature. Asher understanding of her father's difficult childhood and adolescence with each of his parents grew, she began to feel sorry for him. Eventually, her feelings of empathy helped her to truly feel like forgiving him.
The forgiveness exercises with her sister were more difficult because he continued to direct anger at her that she did not deserve. She wanted to honestly discuss with her the disappointments in their relationship but was so mistrustful of her that she decided to communicate through writing. Unfortunately, she was unable to acknowledge her misdirected anger. In spite of her denial, Laura worked at forgiving her sister on a cognitive level, but did not progress to feel like forgiving her, because she was unable to develop empathy for her.
In the sessions Joy regularly expressed her anger toward her father, sister, and other males who had hurt her and followed this release by stating that she wanted to understand and to forgive them. She recognized that at various times she had misdirected this resentment toward other men she had dated, her mother, her daughter, and coworkers. She came to admit that the betrayal experiences from her family background and from dating relationships had resulted in a need to be in control. These insights enabled her to go to others and ask for their forgiveness.
As her resentment diminished over the next eight months, she experienced a greater ability to trust in relationships and she also felt much calmer. She overreacted less in anger and grew in her ability to 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 disorders today is the marked changes in the workplace with subsequent mistrust and fears. Some people believe that their employer no longer makes a commitment to them regardless of the quality of their work or their years of loyalty to the employer. Large numbers of people live daily with the fear of losing their jobs and of not being able to find another good position. Others suffer under unreasonable work demands coupled with a significant insensitivity on the part of their employer to the effects that this pressure has upon them and their families.
Andrew, a single thirty-five year old man, was a successful professional who experienced insomnia, lightheadedness, and muscular tension as well as periodic severe anxiety before going to work. As the number two man in his office, Andrew had a demanding career in which he felt overly responsible and he worried constantly about various work projects. His boss was a critical person who never affirmed or complimented him. There were days he was so overwhelmed by work pressures 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. As his insight grew, he soon came to recognize that he had been denying a great deal of anger with his boss, Fred, who expected Andrew to do the work of 2 or 3 people and to work sixty to seventy hours over a six day week. In the uncovering phase Andrew manifested significant resistance to admitting anger with his boss for the unreasonable demands he had placed upon him. It was suggested to him that he was denying his anger because he rarely honestly faced his emotional pain and because he feared exploding at his boss and subsequently losing his job. He reluctantly agreed to try thinking of forgiving Fred because of his trust in the therapists advice that this would help his treatment.
The approach used to deal with Andrew's reluctance was to assign a cognitive forgiveness exercise in which he was asked to try to forgive his boss daily for being so critical, demanding, and perfectionistic. When Andrew realized that he had an option for dealing with his anger with Fred other than expressing it, he slowly began to admit he was denying strong resentment towards his boss. He was motivated to resolve this newly discovered anger and as he continued to forgive, his anxiety diminished.
The work phase of forgiveness was quite difficult for Andrew because he continued to deal with the same problems daily and he doubted that his boss would change. He did, however, experience symptomatic relief by daily thinking that he wanted to forgive his boss because he recognized that his unconscious anger and resentment had been a constant source o tension. There were days when Andrew found himself so upset with Fred and so drained from his work pressures that he was completely unable to forgive. Andrew related in session, "I am so furious with Fred that I cannot forgive him." My response was, "Try to think of Fred as a very troubled man and then think I want to try to forgive him so that he doesn't control me." This suggestion helped with the work of forgiveness which was proceeding basically on a cognitive level. However, on some days when he was feeling stronger, he was surprised that he actually felt sorry for his boss because he knew that Fred's personal life was miserable.
Andrew's anger diminished gradually over the course of eight months as he worked to let go of his excessive sense of responsibility and to commit himself to have more balance in his life. Fortunately for Andrew, a change transpired at the office. His boss' health could no longer tolerate a seventy hour work week and Fred had to take a leave of absence. When he returned he could only work part time. Andrew, then,was appointed director of the office and he took steps to establish balance in his life and career. In that role he finally felt secure enough to be assertive with Fred that was of great benefit to him. His determination to provide his associates with a healthier work environment helped him discover some meaning in the suffering he had endured.
Generalized Anxiety Disorder and Motherhood
The vocation to motherhood is one of the greatest blessings and sources of happiness in life. While most women are very happy in their pregnancy, after the birth of a first child some mothers can become overly anxious which is often the result of the pressures of taking care of the baby, morning, noon and night. These stresses and associated anxiety can diminish their happiness, result in sadness and 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 baby can diminish by seeking balance in life. Time should be set aside for supportive relationships with other young mothers and for the marital friendship. In those with faith these anxieties can also diminish by trusting the Lord several times daily with all the responsibilities for the baby and by meditating that the Lord and Our Lady are also responsible for the baby. Surrendering the burdens and responsibilities for children regularly helps parents to enjoy children more and to appreciate them more as special gifts from God. Another effective meditation which can be helpful in coping with the stresses of caring for children is, "Lord fill me with love so that I can give."
The other common source of anxiety in young mothers is the result of an inner conflict with selfishness. The complete self-giving required in mothering a baby can lead to the emergence of this inner character weakness because selfishness turns one in upon oneself and subsequently can make the self-giving to a baby difficult. Growth in a number of virtues can decrease selfishness and, subsequently, anxiety. These virtues include generosity, self-denial, humility, kindness and temperance. The chapter on the selfish spouse on this website can be helpful in resolving this character weakness.
Social Anxiety Disorder
Social anxiety disorder is the most common subtype of anxiety with a has a lifetime prevalence of 7 to 13.3%. It has an early onset (80% of cases occur before age 18 years, Otto, M.W., et al,2001.) and usually precedes other anxiety, mood/depressive and substance abuse disorders. Only major depression and alcohol dependence are more prevalent in the United States (Kessler, R., et al.,1994.) In one study thirty-seven percent of people with lifetime social anxiety had comorbid major depression, 39% had substance abuse disorder, and 81% had at least one other lifetime disorder. In another study more than 50% of young adults with anorexia nervosa or bulimia nervosa had comorbid social anxiety disorder (Flament & Godard,1995.) Social anxiety is associated with significant distress and functional impairment in work and social domains and usually persists if not treated.
The DSM- IV states that the onset also may abruptly follow a stressful or humiliating experience, or it may be insidious. Some people develop social anxiety due to emotional trauma within the family or in other important relationships leading to low self-esteem, patterns of isolation, and difficulties in trusting in relationships. Although anger associated with these traumas is often unconscious, it should uncovered with those who have hurt them. Also, many adolescents and young adults with social anxiety drink excessively prior to socializing.
Those with social anxiety benefit greatly from working at understanding and resolving their hostile feelings toward those who have hurt them. Forgiveness can diminish resentment but it is often a difficult process, especially for those ridiculed or badly betrayed because such individuals may have powerful fantasies of revenge. Continued denial of these fantasies can lead to violent impulses and later to aggressive behaviors in those who once appeared to be quiet and withdrawn.
The treatment of the anger associated with anxiety disorders is essential. We caution individuals that the failure to forgive will essentially lead them to be prisoners of their past and block the healing of their anxiety. The case study below describes the healing process.
Rocco came from a stable family and enjoyed good relationships with his parents and his sister. As a twenty-six year old single professional, he sought treatment for extreme anxiety and fears associated with socializing with his peers. His fears were so intense that he began to avoid his friends and to isolate himself. Also, fear began to invade his work and he obsessed about the people he would meet in new work assignments. Finally, he found that he needed to allay his anxieties by drinking before he could go out socially.
Rocco’s symptoms developed shortly after ending a five year relationship with a girlfriend whom he had hoped to marry. Prior to the ending of their relationship, he was outgoing and socially a tease but now he harbored an intense fear of being hurt or betrayed by others. He began to blame his ex-girlfriend, Marina, for his fears and started to feel powerful resentment towards her. Rocco had been affectionate and devoted to Marina, but he ended the relationship because of her unwillingness to be warm and giving.
When he began to uncover the depths of his anger, he made the decision to forgive Marina as a way to overcome his fears. In the work of understanding and reframing Rocco was able to recognize that Marina’s father manifested narcissistic behavior toward her mother and sister which resulted in extreme fears of being hurt in a similarmanner. “He used Marina’s Mom,” he said,“and then abandoned her when Marina was young. No wonder she grew up feeling afraid that the same thing would happen to her,”he pondered. Rocco began to feel compassion for her and he was able to work at forgiving Marina. It took many months of hard work for him to experience a decrease in his social anxieties and resentment, but the personal commitment to the process produced concrete results. During that time he was able to be honest with Marina about his social phobia, his resentment towards her, his desire to forgive, 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 three who awakened with a racing heart, trembling, and shortness of breath. He was evaluated in an emergency room and informed that he was physically healthy but was experiencing a panic attack. Over the previous year, Justin was under a great deal of stress as a result of beginning a new business which had not yet been successful. He became obsessed with fears of failing financially and had great difficulty in sleeping. Although he knew that he was overreacting, he could not control his fears.
Justin was raised in a stressful home as a result of his father's inability to maintain a stable job due to his alcoholism and explosive temper. The severe financial stress on the family resulted infrequent moves and other hardships. Initially, he denied being angry with his father, but later stated, "I'm just extremely disappointed with my Dad's irresponsible behavior and, yeah, I guess it does make me angry when I think about all the pain he caused our family. I know you're telling me that the reason I have this uncontrollable fear comes from the stresses of my childhood and adolescence; I am angry."
Later he experienced some guilt with his newly discovered anger because he believed that his father had had a terrible childhood himself. Justin's love for his father in spite of his weakness became one of the major motivations for entering into the work of forgiveness. Over a period of four to six months, as he persistently thought about forgiving his father for all the fears of his childhood at the advice of the therapist, he began to experience significant improvement. In this process Justin tried to view his father as someone who had never felt safe with his own mother and who had subsequent difficulty trusting in relationships. This awareness of the wounded boy inside his father enabled Justin to truly feel like forgiving his father. The understanding of the origin of his fears, the resolution of his resentment with his father for his role in the development of those fears, medication, and cognitive behavior therapy resulted in the resolution of his catastrophic thinking and fears. Finally, Justin believed that good could come from his pain. He planned in the future to suggest to his father, who was still an episodic binge drinker,that if he would work on letting go of his own strong resentment toward his deceased mother, it might help him to maintain his sobriety.
Panic Disorders related to Spousal Substance Abuse and Excessive Anger
Clinical experience and research studies indicate that the majority of clients with a panic disorder have significant amounts of unresolved anger and have great difficulty in honestly dealing with this emotion. This anger regularly originates from betrayal experiences at different life stages and often interferes with the resolution of panic attacks. With the use of forgiveness in treating panic disorders, it is possible to resolve the betrayal anger and facilitate the healing process.
The most common events for adults which damage the ability to trust and which predispose individuals to panic disorders include: marital infidelity, substance abuse, physical or emotional abuse, job insecurity, severe financial pressure, or a extremely excessive sense of responsibility. Childhood factors leading to panic disorders include death or loss of a parent, serious illness, abuse by peers, or poverty. Forgiveness is employed in such life events through childhood, adolescence, and adulthood to resolve anger with the offenders.
The anger in panic attacks seen in spouses of substance abusers is difficult to treat when there is a lack of motivation for the offending individuals to commit themselves to a recovery program. These spouses are regularly told that their drinking damages the ability of their spouse to trust and to feel safe, thereby predisposing them to anxiety and to panic attacks. Forgiving someone who continues to offend in the same manner on a regular basis is extremely challenging. However,if the offended one does not try to resolve the justifiable anger, it will cause additional personal harm. Spouses can be helped by thinking that they are powerless over their anger and want to turn it over to God or by meditating, "God forgive my spouse." At times the anger in panic attacks only abates after alcoholic offender goes into a treatment program.
The ability to trust in the spouse of a substance abuser can also be helped by regular participation in Alanon groups.
Equally difficult to resolve is the resentment associated with panic attacks in those who are married to extremely angry and abusive spouses. When spouses are subjected on a regular basis to excessive anger, critical comments and controlling behaviors, they can lose their basic ability to trust without their even being aware that this is occurring. Then, suddenly, in a supermarket, movie theater, or department store, they can experience a panic attack.
Also, the hostile feelings and rage in those with panic disorders as a result of sexual abuse in childhood and adolescence can be extremely intense. The feelings of revenge can be overwhelming and at times only respond over time to a cognitive decision to let go of this resentment so that one is not controlled by the past and by spiritual forgiveness.
Adult Children of Divorce and Anxiety
Numerous studies have reported difficulty in trusting and anxiety as long term conflicts in the children, adolescents and adult children of divorce. These anxieties are viewed by psychologist, Dr. Judith Wallerstein (1991) perhaps the leading researcher on the long term impact of divorce, as the universal legacy of divorce, affecting not only the especially vulnerable. Difficulties in trusting and fears of abandonment can interfere with the safe feeling which is essential to marital friendship and betrothed love.
Many married adult children of divorce are aware that the instability of their family background resulted in a great deal of anxiety which makes it difficult for them at times to trust their spouses consistently. Under stress they can easily overreact with anger and anxiety toward their spouse. Their mistrust regularly limits their self-giving to the marital friendship and they often give much more to their children emotionally than to their spouses because unconsciously they feel safer in those relationships. Also, they are often aware of strong unresolved anger with one or both parents but they can come to realize that their fears are associated with this inner resentment.
Their decision to work on forgiveness is often based on the hope that it will help their marriage and help them to feel better by decreasing their inner anger and fears. They often begin the work of forgiveness by thinking daily, "I want to understand the most offending parent more and his/her life struggles and hurts so that they can let go of their resentment with this parent."
This work of forgiveness can result in the emergence of a deep sadness from feeling profoundly cheated. At times these spouses may find themselves completely unable to forgive an offending parent. Wallterstein points out in her book, The Unexpected Legacy of Divorce, the most difficult anger to resolve is often with the father who is selfish and faithless. When faced with such a challenge, spouses with a spiritual life can ask God on a regular basis to help with the forgiveness process, that is, they can think, "God help me to forgive"or "God, please take my anger." Poloma and Gallup's (1991) research indicates that over 80% of adult in the United States seek God's help when faced with the challenge of forgiveness.
The process of forgiving with divorce trauma can go on for many years as different levels of anger within are discovered. The most difficult aspect of his treatment was to try to accept the pain of feeling deeply cheated. However, as parental anger diminishes, trust usually improves, as does the marital relationship. These spouses develop the confidence that they do not have to be controlled by any longer by fears, anger and sadness of their childhood. As the emotional pain of the past is resolved, they have a greater ability to trust their spouses.
Obsessive-Compulsive Disorder from family and marital conflicts
Obsessive-compulsive disorder (OCD) is characterized by repetitive, ritualistic behaviors and thought patterns. Persons with OCD are often unable to stop their compulsive beahviors.
Obsessive-compulsive disorder encompasses a broad range of symptoms that represent multiple psychological domains, including perception, thinking, emotions, friendships, and behaviors. In one study that followed individuals from age 3 to age 32 obsessions caused more interference in daily life than compulsions. For example, nearly 45% who reported obsessions said that obsessions caused them emotional upset, whereas only 20% of those with compulsions were upset by them (Fullana,M., et al, 2009.) Many of these obsessions are angry, intrusive thoughts or aggressive impulses.
A core feature that underlies obsessions and compulsions in some spouses is the failure to recognize and deal adequately with anger from childhood and from married life. These individuals employ powerful defense mechanisms to try to control their resentment and rage toward those who have hurt them. Perfectionistic tendencies as well as guilt and fear of the possible eruption of anger may interfere with their ability to deal honestly with their emotional pain. Subsequently, this anger leads to obsessions about aggressive fantasies or fears of becoming contaminated. In an attempt to reduce their anxiety or stress or to try to prevent some dreaded event from occurring, spouses can engage in compulsive behaviors.
Excessive anger, which is often unconscious, then is often a major, if not the most important, factor in the development of OCD. This anger can manifest itself as obsessional fears of being aggressive, of yelling out, of throwing things and also as intrusive thoughts of cursing of yelling.'
In a 2008 study of 236 children (149 boys and 87 girls) with OCD (Mataix-Cols, D., et al.), the most common obsessions were aggressive (81%), contamination (79%), symmetry (41.9%) and religious (40.7%), Girls had significantly more aggressive obsessions, while boys had significantly more religious and sexual obsessions. The most common compulsions were checking (80%), cleaning (79%), repeating (75%), ordering (59%) and counting (49%). Girls had significantly more hoarding compulsions while boys had significantly more counting compulsions. This pattern is also common in many adults.
In one study of OCD in women with postpartum depression aggressive obsessional thoughts were the most frequently encountered (Wisner, et al., 1999). Another study reported irritability in the majority of patients with severe OCD symptoms, (Snaith and Taylor(1985). Aggressive obsessions are often seen in OCD and are included as symptoms to be evaluated in the Yale Brown Obsessive Compulsive Checklist (Goodman et al, 1989).' Also, Primeau and Fontaine (1987) have reported that self-destructive behavior and OCD share some significant characteristics and that the driving force behind self-mutilation is relief from tension which is similar to the performance of a compulsive ritual (Jenike, Baer,& Minichiello 1990).
The bottom line here is that an attempt should be made to attempt to identify and resolve excessive anger in those with OCD much of which arises from childhood and adolescnt conflicts.
The clinical use of forgiveness can be very helpful in both the identification and the resolution of the excessive anger in spouses with OCD. The majority of clients only experience their resentment after they have engaged in cognitive forgiveness exercises toward those who have disappointed them at different life stages. However, clients with OCD are so highly defended that the work of forgiveness can be quite prolonged and difficult. These individuals often comment in this phase that they found it easier to deal with their cleaning or washing compulsive behaviors than with their emerging anger,aggressive impulses, and impulses for revenge.
Ashley, a thirty-five year old married mother of two, sought treatment of her obsessive fears that her children might acquire terrible diseases from germs in the home. In an attempt to protect her children she spent numerous hours cleaning the home each day.
Initially, Ashley denied that anyone had hurt her. After explaining the value of forgiveness in the treatment of obsessive-compulsive disorders, she was asked to think that she wanted to try to forgive anyone who had disappointed her or been insensitive to her in her childhood, adolescence, and adult life. It took months before Ashley could admit that she had been hurt by anyone. Finally, as she thought of forgiving anyone who had hurt her, her defenses diminished and her emotional pain emerged. She acknowledged that her husband, Kurt, had been extremely insensitive to her for years. In fact, he was extremely critical, and at times, he was verbally abusive. She recognized that she needed to deny her pain with him for many reasons, including fear of his anger, fear of divorce, and strong insecurities from the constant criticism that she had experienced during her youth.
Ashley also came to realize that she had been denying strong resentment from the time she was a child toward each of her parents. Her perception was that they had favored her other siblings and had treated her like a second class citizen. She came to recognize that she 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 and strong rage associated with her betrayal experiences. At first, she felt so hurt that she was unable to think about forgiving anyone, but when she realized how essential it was for her to resolve her anger to overcome her germ phobia, she decided to make a decision to forgive even though she did not feel like doing so.
She realized that her true fears were not of her children being harmed by germs, but of her buried rage that was emerging and the fact that she feared hurting her husband or someone else as a result of it. During the struggle with her powerfully angry impulses, in frustration, Ashley responded, "I wish I was back dealing with my germ phobia - it was a lot easier than this." Ashley was able to continue to forgive her husband, Kurt, because she was aware of his difficult life with an alcoholic father who continued to be a major source of stress even in their married life. She had always felt empathy for Kurt and, in the end her compassion enabled her to decide to let go of her anger with him. Finally, her forgiveness was facilitated by his participation in therapy and acknowledgment of the mistakes he had made in their relationship.
The dynamics were explained to Kurt and he was asked to consider that he might have been misdirecting anger at Ashley meant for his alcoholic father. He apologized to Ashley and committed himself to work at forgiving his father, which helped significantly in her recovery. However, Ashley continued to have difficulty in letting go of her anger with her parents. She came to believe that they never really wanted her and had always harbored a resentment against her. As she tried to tell herself that they were emotionally sick people who had no right to have a negative influence over her emotional life, she was able to make the cognitive decision to let go of her resentment towards them. She could not develop compassion for her parents, nor was she able to absorb the pain.
As Ashley's unconscious rage with her husband and parents decreased through the use of forgiveness, her obsessive fear concerning her children lessened also. Her husband felt guilty about his role in his wife'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 in a similar manner. After two years of treatment, Ashley's obsessive-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
- 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 is very low. A number of studies have demonstrated that suicidal thoughts occur in over 50% of persons with OCD ( Torres AR, et al (2006);SaarenJ, et al. (2005); Bridge JA, et al (2007.) Subsequently, it is important to evaluate the degree of depression, despair 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 seek revenge against those who traumatized them. Chemtob et al. (1997a) have termed the anger type in some extremely hostile patients with PTSD as "ball of rage."
Excessive anger in PTSD is evident today among those who have lost their jobs through downsizing and are unable to locate comparable work, or in people who were physically or sexually abused. Forgiveness can enable the victim to let go of rage and impulses for revenge while at the same time pursuing justice regarding the traumatic event. Forgiveness also can diminish the recurrent memories of the event, decrease fears, irritability and obsessional thoughts of the offender. The failure to resolve the anger with the offender regularly places the perpetrator in a position of power over the victim.
Earl was a fifty year old man with a successful twenty-eight year career with a large international corporation. He entered therapy after being told by his employer that he would no longer be a general manager, but would have to return to sales. His corporation had a markedly small business in the limited territory he was assigned. He realized that his new position would not be able to support his income and it appeared that within less than a year he would be fired. As a result of the trauma associated with these events Earl developed severe insomnia with recurrent dreams of the demotion. He constantly replayed the event, becoming depressed with markedly diminished interest in significant activities and extreme fears for the future.
In attempting to understand why his corporation took action against him, Earl became convinced that it was due to the fact the he had blown the whistle when he spotted collusion between another highly successful salesman and someone from a different national corporation. An investigation revealed that his views were accurate and subsequently the salesman lost his job and the regional general manager was demoted. He was convinced that their friends higher up on the corporate ladder were seeking revenge against him because of his honesty. His emotional and mental state were such that the therapist and he agreed to pursue disability rather than attempt to go into his new position with severe symptoms and face the loss of his career in a short period of time.
Earl made the decision to try to work at forgiving those who had betrayed him, not because he wanted to let go of his anger with them, but because he felt so guilty about regularly overreacting in anger against innocent people. He also came to understand the relationship that existed between his anger and the accompanying insomnia, depression, and mistrust. He tried to forgive to facilitate the recovery from his severe post-traumatic stress disorder symptoms. Because he continued to view the actions of his employer as evil and motivated by revenge, Earl had great difficulty in forgiving his employer.
After a number of months in therapy and as a result of the diminishment of his anger, he decided to take legal action against the corporation for the manner in which it had treated him. He struggled with violent impulses against different members of the corporation and, at that point in time, he tried to think that he wanted to let go of these thoughts and not act on them. This was a very difficult process for him. He realized that holding onto his strong anger would only harm him, but he was not able to use the word forgive. Over the course of several months he did find relief from thinking daily that he wanted to let go of his desires for revenge and not act on them.
The thought of obtaining justice through legal means was an additional encouragement to him. The trauma, however, was so severe that Earl remained in the process of forgiveness for several years unable to absorb the pain or to find any meaning in his suffering. His major method for coping was regular reflection that he did not want his former employer to control him and that he had the desire to let go of his rage and impulses for revenge. These steps helped diminish his posttraumatic stress disorder symptoms as he continued to pursue legal action against his employer.
While the virtue of forgiveness is essential to diminishing anxiety, other virtues are also very important in the healing process. These include virtues of trusting, fortitude, prudence, wisdom, and the theological virtue of faith. The growth in virtues is a challenging 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 with serious anxiety symptoms. Due to the high co-morbidity of anxiety with depression and excessive anger, the serotonin reuptake inhibitors are very effective because they are proven to diminish symptoms of depression and anxiety.
Ideally, medication should be used in conjunction with a treatment plan that attempts to uncover and address the origins of the anxiety. When the numerous origins of anxiety are being successfully treated, it is then possible to decrease and later taper many individuals off medication. However, people need to be patient with this process because 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 serious anxiety disorders without proper effort being made to attempt to identify and to resolve the causes of the anxiety. As a result, when people treated in this manner want to go off their medications, they regularly experience the re-emergence of symptoms of anxiety including dizziness, insomnia, irritability, lightheadedness, difficulty in concentrating and memory, fatigue, weakness, etc.
These symptoms are often incorrectly viewed as withdrawalsymptoms from anti-anxiety medication when, in fact, they develop often because the basic conflicts have not been adequately treated, particularly difficulties in trusting in relationships in one's personal life or work, an obsession with controlling others, and weaknesses with confidence and loneliness. These unresolved emotional wounds can intensify when medication is withdrawn resulting in a excessive anxiety particularly under various types of stresses.
The Ongoing Need for Medication
A number of traumatic life events from the past, such as substance abuse, divorce and betrayals in loving relationships, can result in a prolonged vulnerability to weaknesses in trusting and in confidence. Furthermore, in many work environments today, it is difficult for the employee to maintain trust in the employer which can also render one vulnerable to ongoing anxiety. Another important issue is the ongoing severe stress with loved ones one cannot trust fully. Individuals with these stressors from the past and present often need to use medication for an indefinite period of time in order to function effectively as do those with chronic medical conditions such as diabetes and 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 faith in addressing 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 play a beneficial role in the resolution of emotional pain and conflicts. (See healing and faith at the National Library of Medicine web site, www.ncbi.nlm.nih.gov/pubmed/.) A number of spiritual interventions help in resolving anxiety and conflicts and in building deeper trust in marriages. These include employing daily a modification of the first two steps of Alcoholics Anonymous and thinking"I am powerless over my anxieties and my tendency to control and want to turn them over to God."
Pope Benedict commented on the role of faith in addressing 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)and the Harvard Medical School has written of his success of using mediation in treating medical illnesses in his book, Spiritual Healing. He recommended that patients with cardiovascular and hypertensive diseases meditate for two fifteen minute periods daily on a prayer consistent with their faith. We have had similar success in using meditation for those with 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.)
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 can interfere with martial happiness. Forgiveness has been shown to be effective in our clinical experience and in research studies in the healing of anxiety disorders, in part, by resolving the various degrees of anger associated with them. Also, faith has been demonstrated to be another virtue which is helpful in building trust and confidence and in diminishing anxiety. There is every reason to hope that anxiety and fears can decrease in married life.
References in this chapter can be found at the National Library of Medicine website, PubMed.