But the soul falls ill when its right judgment is impaired and it is overcome by the passions which cause disease (St. Neilos the Ascetic, Philokalia I).
Those of the Fathers of the Church who wrote about the spiritual life were keen observers of human behavior and because of that emphasized the need for “right judgment,” as in St. Neilos’s words, to control and direct human “passions,” or what we now call emotions.
Our understanding of man created by God is that he is composed of body, mind and soul-spirit. While not apprehending the complexity and nuances of brain-behavior relationships, our Church Fathers spoke about the different types of knowledge that was related to each component of mankind. St. Maximus the Confessor (Philokalia II) notes: “Since man is constituted of soul and sentient body, he is limited and defined and he himself imposes limits and makes definitions by virtue of the natural and distinctive reciprocity that exists between himself and these two aspects of creation.” The saint goes on to say: “As a compound of soul and body he is limited essentially by intelligible and sensible realities, while at the same time he himself defines these realities through the capacity to apprehend intellectually and to perceive with his senses.” In achieving our end to become “partakers of the divine nature,” (2 Pt 1:4) it behooves us to use all the gifts, natural and spiritual that God has granted to us.
Modern day scientists using their God-given intelligence and skill have brought to light many of the wonderful complexities humans possess, including insights on how human emotions are activated. Orthodox Christians who are interested in directing their “passions” by “right judgment” for the sake of advancing in holiness can benefit from a basic understanding of this scientific work.
Understanding Emotion in Nature
Various psychological studies suggest that cognition, emotion and behavior interact with each other in complex ways (Weitan, 2007). The findings of Tomkins (1991) and Plutchick (2002) indicate the presence of primary emotions shortly after birth. i Researchers agree on six emotions (fear, anger, joy, disgust, interest and surprise) out of about eight or ten primary emotionsii. Phylogenetically,iii these emotions occur before the brain structures such as the cerebral cortex and pre-frontal cortex that support cognition develop.iv These early emotions are produced by subcortical brain areas such as the amygdala and hypothalamus portions of the limbic system which develop before the cerebral cortex. Research on lower animals, species without a developed cortex, indicates that emotional responding appears to be an innate reaction to certain stimuli.v
Research on neurophysiological processes and psycho-pharmacological processes (Izard. 1993) suggests the possible neural components of emotion in humans. In summarizing the research, Izard (1993, 2001, 2002) suggests the sub-cortical and cortical pathways underlying emotion. Furthermore, they appear discrete, that is to say different from each other, at a very early age. The specific emotions are related to particular and distinctive body language and facial expressions. Izard builds support for this part of his model by citing the work of LeDoux (1987) which demonstrates “that pain receptors send afferent messages to the thalamus and on to the amygdala” (which releases emotions directly) thereby not necessarily involving the neocortex (and cognition).
A detailed model of the neural architecture of emotionvi, uncovered by the research of Joseph LeDoux (1994), elaborates on the description above and may explain in part the subjective feeling among adult humans that they respond ‘emotionally’ to a stimulus before they can ‘think.’ The work of LeDoux (1994), who initiated his research program by studying the emotion of fear, may, in part, hold the explanation of this subjective experience. LeDoux finds the connection between a part of the primitive brain called the sensory thalamus, which processes and recognizes sensory patterns, and the amygdala which contains sensory and memory traces of these stimuli which then trigger a fear response. In notes ‘v’ and 'vix' below this is depicted as the ‘short road.’ It is called the short road because the speed of the neural impulse is comparatively fast: 12 milliseconds (ms). Later in life, once the brain areas underlying cognitive processes (the cerebral cortex) develop, the pattern recognition impulse takes 3 to 4 times longer (30 to 40 ms) to reach the cortical area. It is depicted graphically, also in notes ‘vi’ and 'vix' below as the ‘long road.’ From a practical viewpoint, this means our brains are wired to react emotionally before we cognitively perceive and understand a stimulus.
In addition to learning more about the physical process involved in emotional behavior, scientists have also uncovered findings about how thoughts, or cognitive activity, interact with emotion, findings which are borne out in the success of specific psychospiritual therapies, particularly Cognitive-Behavior Therapies, which are able to show individuals how to best direct their “passions” with “right judgment.”
Izard proposes that a multisystem model of emotional activation, including thevii cognitive centers of the brain (cortex) is in place after fuller brain development has occurred. According to this model, neural processes, sensorimotor processes, affective processes, as well as cognitive processes can produce emotional experiences (LeDoux, 1994, 1996). viii Various psychological models have been developed to explain this interaction. One model based on evolutionary psychological theory is that emotion develops because of adaptive value. In human brain architecture the limbic system is connected by neural structures to these later-developing cortical structures, allowing communication between these areas as the individual increases in age (Izard,1984; LeDoux, 1994).ix
The Subcortical-Cognitive Paradox
The literature demonstrating the cognitive elicitation of emotion is ubiquitous. Appraisals, anticipations, attributions, beliefs, construals, inferences, judgments and memories of stimulus situations all fall in the cognitive domain. In one early pivotal study Richard Lazarus (1991) manipulated the appraisal strategies of subjects before they viewed a film depicting an aboriginal male puberty rite. Objectively the film depicted a shaman using a crude stone blade to ‘circumcise’ an awake, terrified, screaming pubescent male. The teen is brought up from his hut to a stone altar, surrounded by yelling, shouting male tribal members. Subjects in a neutral or “intellectualized condition,” who were told to ‘observe the surgical skill of the shaman’ displayed significantly less emotion as measured by self-report and physiological monitoring than subjects in the “sensitized condition” who were to ‘observe the hacking away at the organ, the show of pain and terror on the boy’s face and the shooting blood.’
Clinically, the work of Beck, A. (1976, 1888, 1991), Beck, J.T.(1995), Burns, (1980), Ellis (1962), Kelly (1956), Knaus (2006) and Morellix, (2006) shows the applicability of cognitive-science based psychotherapy to a wide variety of disorders and problems. Such therapy engages the patient in identifying and restructuring distorted, irrational cognitions. If initial emotional reaction is triggered by lower brain systems, (before cognitive processing), the question arises as to how cognitive psychotherapy could effectuate or modify emotional reactivity? If one were to maintain that emotions can be triggered even in humans by sub-cortical processes, would cognitive processes have any role in their modulation?xi This is not a trivial question because it is at the foundation of the various cognitive therapies and it goes to the heart of the moral and spiritual teachings of the Church Fathers as well. Fundamentally the question is: to what extent can we control our emotions or in the terms of the Church Fathers’ label, our “passions?”
The answer suggested by LeDoux’s laboratory work with animals is that new associations and memories can be formed during a period of memory consolidation. One technique of accomplishing this, used in LeDoux’s laboratory, is to use a drug such as anisomycin which effectively blocks or erases previous memory traces and allows the formation of new associations. In the memory sections of the brain neural connections are reprocessed each time a memory is activated (recollected). A reconsolidation or restructuring of the previous memory traces with new memory traces can occur during this process.
Application to Cognitive-Behavioral Therapies
A non-drug application of this technique with human subjects was reported by Schiller, Monfils, Raio, Johnson, LeDoux, & Phelps (2009). A nutshell of the experiment: a yellow and a blue square served as stimuli presented visually to two groups of subjects. One of the squares (for purposes of this summary, I will use the yellow square as the stimulus to be associated with shock-anxiety, although for some subjects the blue square was used). The other square was never associated with shock. In the next phase of the experiment, the Extinction Phase, a day later, both stimuli were presented but neither of the stimuli associated with shock. In the last phase of the experiment, for one group the stimulus associated with shock was presented after a short delay (during reconsolidation) or for the second group after a long delay (after reconsolidation had taken place). When retested a year later, the subjects who had been in the extinction phase in the short delay condition (the reconsolidation period in which the neutral stimulus (Blue square) was also presented), showed significantly less anxiety than the group which underwent extinction with the neutral stimulus presented 6 hours after presentation of the anxiety producing stimulus (yellow square) (that is to say, after memory consolidation had already taken place. The addition of the neutral stimulus during extinction was a ‘new’ memory that restructured the initial memory.xii
These findings suggest, therefore, that integrating exposure to a dysfunctional emotion-associated stimulus during cognitive-behavioral therapy, immediately followed by a restructured rational cognitive interpretation and set of associations would aid in forming a new functional interpretation of the event and thus may be a way of efficaciously attenuating dysfunctional emotion responses. This is the general procedure utilized in a variety of Cognitive Therapy called Desensitization and Exposure Therapy, which has been found to be efficacious in the treatment of various emotional disorders. (Foa, Hembree, & Rothbaum, 2007; Emmelkamp, 2004). Future research has to address the issue of the extent to which cortical and sub-cortical memory reconsolidation processes serve as the neurophysiological basis of these desensitization and exposure therapies. Also to be investigated is the role of memory networks and the range of cue-associations that may trigger a memory.xiii
Another consideration is the issue of individual differences in cognitive (cortical) control of emotion (lower brain function). In other words, are some individuals able to control the various systems of emotional activation better than others? In as much as we do not have a comprehensive individual difference model of emotion activation, we must proceed with caution and at best heuristically. Each person should be evaluated individually as to what emotion systems are influencing an emotional reaction and the person’s ability to have cognitive control of these systems. Some patients with lower levels of cognitive control may benefit from interventions targeting the neural sensorimotor or affective systems directly (i.e. psychotropic treatment, environmental change) as the primary treatment. Patients with higher levels of cognitive control may benefit from more focused cognitive treatment programs (i.e. Beck, 1995; Ellis, 1962; Morelli, 1997, 2006). It has been my clinical experience, however, that even patients with minimal intellectual resources can benefit from some cognitive intervention.xiv This makes neurophysiological sense if it is remembered that in humans the brain’s subcortical pathways (emotion) and cortical (cognitive) pathways are connected.
Keeping in mind the caveats discussed above, the cognitive-behavioral model of emotional dysfunction (Beck, Rush, Shaw and Emery, 1979; Ellis, 1962; Morelli, 2006a, 2009a 2009b ) has been shown to be effective in dealing with dysfunctional emotions, decreasing inappropriate behavior and increasing appropriate behavior. According to this model, basic dysfunctional emotions such as anger, anxiety, depression and mania, as well as more complex emotions such as anticipation, awe, jealousy and remorse (Plutchick, (2002) are produced by distorted or irrational appraisals, attitudes, beliefs and/or cognitions. Situations (something that someone has said or done or events that have happened) do not produce or cause the emotional reaction. Rather, we upset ourselves over people and events by our cognitive processing of these situations. If our thinking is clear, rational and non-distorted, we have normal feelings like annoyance, concern and disappointment. Even opening this model to a less strict position, (that is to say, allowing for subcortical activation of emotion) it would be maintained that control of emotion initiated by these subcortical centers could be modified by cognitive (cortical) methods that allow for memory reconsolidation.
Overview of the Typical Cognitive Therapy Protocol
In Beck’s model individuals have automatic thoughts, also termed primed cognitions, (Loftus, 1980) about activating events. These include selective abstraction (drawing conclusions unwarranted by the facts), personalization (attributing neutral events to be referred to oneself), polarization (viewing events in all or nothing terms), generalization (the tendency to conclude that events will never change or will always remain the same), demanding expectations ([Ellis,1962] (the belief that there are laws or rules that must or should be obeyed), and catastrophizing ([Ellis, 1962] (the perception that something is more than 100% bad, awful or terrible). Another cognitive model with clinical utility is attribution theory (Weiner, 1974; Abramson, Seligman & Teasdale, 1978). In this model, explanations of events are attributed as being due to combinations of internal or external and unstable (temporary) or stable (permanent) factors which influence felt emotion and subsequent behavior. After rapport, diagnosis and treatment goals have been established, the cognitive-behavioral treatment strategies usually involve some form of didactic presentation of the cognitive model. Bibliotherapy, that is reading clinician authored self-help books such as Burns (1980), Ellis (1961), Knaus (2006), or Morelli (2006), is often used adjunctively. The patient is then helped to recognize, pinpoint and identify his/her cognitive distortions. The patient then learns to challenge and restructure the irrational distorted cognitions that are initiating or sustaining the dysfunctional emotions and replace them with more accurate non-distorted cognitions. Use of notes and charts in the treatment session and outside the office is encouraged. It should also be remarked that sensitivity to the patient’s culture must be used in understanding the cognitive context of the problem and in devloping the treatment plan (American Psychiatric Association, 2000; McGoldrick, Giordano, & Garcia-Preto, 2005).
Application of Memory Reconsolidation Research in Cognitive-Behavior TherapyProlonged Exposure Therapy
As discussed above, a vivid, realistic representation of the activating event should precede the cognitive restructuring process in cognitive-behavioral therapy. Preferably, stimulus presentation would be direct or “in vivo” but could be done imaginably as well. This would mean exposing the patient to an actual or imaginal situation related to the dysfunctional emotion. As noted above a procedure called Prolonged Exposure Therapy has been developed by Foa, Hembree and Rothbaum (2007). The research-clinicians note: "First, the fear structure must be activated, otherwise it is not available for modifications; second, new information that is incompatible with the erroneous information embed in the fear structure [memory] must be available and incorporated into the fear structure. When this occurs, information that used to evoke anxiety symptoms no longer does so."
For example, a Post-Trauma-Stress-Disorder (PTSD) patient would be induced to hear, see, or smell a specific stimulus triggering the fear response. A soldier hearing an explosion, or a vivid videotape of a horrendous battle, for example. A patient responding to a situation by anger or depression would be made to experience as much as possible the same or most similar situation that was the accompanying activating event to his dysfunctional emotional response. Alternatively, exposure could be indirect, involving imaginal recollections of an event; sort of playing a ‘mental videotape’ in one’s mind. In imaginal exposure Foa, Hembree and Rothbaum (2007) list "probe questions" to aid the patient in facilitating the confrontation with the fear-evoking stimuli:
- What are you feeling?
- What are you thinking?
- What do you smell?
- What does it look like?
- What is your body feeling?
- Where do you feel that in your body?
Fixed Role Therapy
Another technique, role-playing, as in fixed role-therapy (Kelly, 1955) could be employed. As pointed out in Morelli, 2006a, when someone has strong concerns about something and keeps it buried within him, his level of anger frequently increases. In such cases I recommend a program which uses the fixed role-playing technique. I start with the patient imagining the setting in which a disturbing remark or action could take place similar to the one they experienced. I point out that the goal is to express their feelings and views and not necessarily to have the other person comply with their wishes. Patients who go through this process report significantly lower levels of anger and upset. LeDoux’s work suggests that memory reconsolidations would be taking place during the role-playing procedure.
A Case Study
For example, I had a patient who reported observing a truck filled with hot molten tar overturn on a convertible automobile, literally boiling the driver to a horrific death. Since his experience of the event he always avoided the intersection in which the event took place and reported extreme anxiety when approaching the general geographic area, as well as thinking (imaging) the dreadful event. In therapy, I took him to the intersection, in which the accident had happened and which triggered enormous anxiety. After imaginal stimulus activation, I introduced a competing – restful stimulus. He found classical music relaxing. I asked him to close his eyes while listening to the reposeful music and then commenced the prototypic cognitive restructuring questions: What are other ways of looking at the event?; Is it as bad as it seems? After a number of sessions his anxiety level significantly diminished. Years later, he was still able to report being able to drive through the intersection.xv
Remembering that the Church is a hospital utilizing both scientifically supported clinical interventions of every age, as well as the spiritual gifts the Church has received (Morelli 2006d; Vlachos, 1994) it is unthinkable for Orthodox Christians not to include spiritual factors in the understanding and healing of mental disorders. This is the same model employed by Sts. Basil and John Chrysostom in the establishment of their monastery hospitals, using the best of scientific medicine known in their day and the most highly trained and holy physicians. This is done in emulation of Christ, to whom in our Divine Liturgy of St. John Chrysostom we pray: "heal the sick, thou who art the physician of our souls and bodies..." Our Orthodox spiritual tradition, her Holy Mysteries, especially Penance, the Eucharist, and Holy Unction, as well as scripture and the writings of the Spiritual Fathers become synergistic with the medical and psychological sciences as noted above.
The power of the Scriptures the spiritual tradition and services of the Church are crucial in the intervention plan for the committed Christian patient or counselee. For example, in the presentation of the treatment rationale, the patient can be given readings from St. Dorotheus of Gaza:
Disturbance is the movement and stirring of thoughts, which arouse and irritate the heart (Kadloubovsky & Palmer, 1954)(italics mine).
There are three different kinds of falsehood [distortions]: There is the man who lies in his mind [cognitions]; the man who lies in word [behavior]... the man who lies in mind is given to conjecture [distorted cognition]... (Kadloubovsky & Palmer, 1954)(italics mine).
St. Paul’s words may also be helpful to the patient:
When I was a child, I spoke like a child, I thought like a child, I reasoned [distorted cognitions] like a child; when I became a man, I gave up childish ways (1 Cor 13:11).
St. Maximus the Confessor tells us the result of faulty thinking:
When our intelligence is stupefied, the incensive power precipitate and desire mindless, and when ignorance, a domineering spirit and licentiousness govern the soul and then sin becomes a habit...” (Kadloubovsky & Palmer, 1954).
The teachings of St. Anthony the Great focus on the cause of evil that today we would consider to be a cognitive process:
The cause of all evil is delusion, self deception [cognitive distortions], and ignorance of God (Kadloubovsky & Palmer, 1954) (italics mine).
Spiritual and psychological growth becomes a motivating force for the committed Orthodox Christian in psychotherapy. The observation of St. Maximos the Confessor may provide the patient with an incentive to initiate change:
We accomplish things actively in so far as our intelligence [non-distorted cognitions], whose natural task is to accomplish the virtues is active in us (Kadloubovsky & Palmer, 1954) (italics mine),
also the words of St. Hesychios the Priest (Philokalia I):
(O)ur inmost intelligence [non-distorted cognitions] will direct the passions [emotions] in a way that accords with God’s will, for we shall have set it in charge of them. The brother of the Lord declares: "He who does not lapse in his inmost intelligence is a perfect man, able also to bridle the body [behavior]" (italics mine).
The clinician, then, helps the patient to challenge the distorted cognitions related to their dysfunctional emotional reactions. There are three challenging questions that lead to restructured cognitions: Where is the evidence? Is there any other way to look at it? And is it as bad as it seems? Once again, for the committed Orthodox Christian, interweaving a spiritual dimension along with the traditional psychological approach enables the Holy Spirit to work within the individual and ensures the total person, body mind and spirit, participates in the healing process.
For example, in treating anger the clinician should be aware that the cognitive theme accompanying the distorted cognitions is significant intrusion. That is, the patient considers himself or extensions of himself (loved ones, property, etc.) to have been violated. Some effective psychological treatment techniques include anger inoculation and management (Morelli, 2005, 2006b; Novaco, 1975; Tarvis, 1987), assertiveness training (Morelli, 2006a, Rathus, 1973), and the “mental ruler” technique (Burns 1980). Once again, integration of a spiritual factor with the traditional methods can be effective for the committed Christian patient. Typically, clinicians help the patient to initially see that anger has several effects, including creating additional problems and reducing their own effectiveness in dealing with the original problem. Scriptural quotes from the book of Proverbs are useful here:
He who is slow to anger has great understanding, but he who has a hasty temper exalts folly (Prov 14:29),
A man of wrath stirs up strife, and a man given to anger causes much transgression (Prov. 29:22),
A hot tempered man stirs up strife, but he who is slow to anger quiets contention (Prov. 15:18).
Consider that those gifted with earthly intelligence are not immune from the “demon of anger.” This point is well made in the Septuagint version of Solomon’s proverbs:
Anger destroys even wise persons; a submissive answer turns away anger, but a painful word raises up anger (Pv. 15:1).
The apostles, echoing Our Lord’s teachings, tell us what is required as Christians:
(F)or the anger of man does not work the righteousness of God (Jam 1:19)
St. Paul tells the Ephesians:
Let all bitterness and wrath and anger and clamor and slander be put away from You...(Eph 4:31).
Our Spiritual Fathers have developed this theme. Abba Evagrius the Monk tells us about the effects of anger, which may also help in motivating the committed Christian patient to avoid the cognitive and situational factors associated with anger:
Anger and hatred increase the excitation of the heart and mercy and meekness extinguish it (Kadloubovsky & Palmer, 1954).
The dominant theme in anxiety is threat. The patient evaluates that some event or person will produce some harm to them or to people and/or things he/she values. Even when the threat is realistic, often the anxiety-ridden patient will have unrealistic perceptions about factors related to the threatening event. For example, a patient who may be realistic about the threat of failing an exam may have unrealistic thoughts and images about the consequences of the failure (e.g., will never be able to get a job). Once again, helping the believing, committed Christian to understand the Scriptures and the Church Fathers may be of healing value. Did not Our Lord say:
Therefore I tell you, do not be anxious about your life, what you shall eat or what you shall drink, nor about your body, what you shall put on. Is not life more that food, and the body more than clothing (Mt 6:25).
A spiritual component may also make up the rationale for anxiety treatment:
And which of you by being anxious can add one cubit to his span of life (Mt 6:27).
In the cognitive treatment of anxiety the patient is helped to work at changing what can be changed while accepting what cannot change. This is brought out in Our Lord’s words:
Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Let the day’s own trouble be sufficient for the day (Mt 6:34).
The Church Fathers, of course, echo Our Lords words. St. Neilos the Ascetic (Philokalia I ) tells us:
It is indeed ungodly to pass one’s whole life worrying about bodily things and give no thought to the blessings of the age to come. . . and not to devote even a passing moment to the soul ”
Elsewhere St. Neilos tells us:
Through our anxiety about worldly things we hinder the soul from enjoying Divine Blessings and we bestow on the flesh greater care and comfort than are good for it.
Reliance on Christ, added to our own human efforts to restructure the irrational cognitions producing anxiety, should be of special help to the Christian. Writing about anxiety, St John of Karpathos (Philokalia I) states:
We should of no account wear ourselves out with anxiety over bodily needs. With our whole soul let us trust in God...
Depression is such a debilitating mental disorder (Morelli, 2006c); its theme of significant loss and the negative view of self, world and future seems to rob us so completely of the possibility of union with God . Hopelessness followed by suicide often accompanies severe depression. (Morelli, 2009a) The sense of abandonment often felt by the depressed person broadcasts not only isolation from mankind, but from God as well, so depressed individuals become particularly susceptible to despair that they are beyond salvation even by the Holy Spirit. - the unforgivable sin. Once again, the spiritual dimension can be an integral part of healing for the patient. When an activating event that triggers depression is experienced we can integrate it into our prayer (and thus into our reconsolidated memory). The torments and suffering of Job may help the Christian patient realize that God may appear to abandon us, so we, too, may cry out:
My eye has grown dim from grief [depression], it grows weak because of all my foes (Job 17:7) (italics mine).
St. John Cassian tells us:
(D)ejection devours a man’s soul. It persuades him to shun every helpful encounter and stops him accepting advice from his true friends or giving them a courteous or peaceful reply (Philokalia I).
To see the healing hand of God in overcoming depression we can pray with the psalmist (17:2):
The Lord is my rock, and my fortress, and my deliverer, my God, my rock, in whom I take refuge, my shield, and the horn of my salvation, my stronghold.
St. John Cassian teaches that this can be accomplished with hope:
(H)ope engendered by repentance and is mingled with joy. . .eager for every good work: accessible, humble, gentle, forbearing and patient in enduring all the suffering or tribulation God may send us (Philokalia I).
St. Isaac of Syria’s reflection on the kindness of God can aid us in modifying our interpretation of the events that surround us. St. Isaac (Wensinck, 1923) tells us:
Be on thy guard against dejectedness. Thou servest not under a tyrant; thy service is under a kind Lord, who has given thee all, without taking from thee anything and who before thou didst exist at all, destined thee to occupy thy present place. Who can do justice to His grace even as shown by His calling us to existence?
Like the prophet Jeremiah (15: 18-20) we may face tribulation by realizing that God will be the source of our healing and will stand with us:
Why is my pain unceasing, my wound incurable, refusing to be healed? Wilt thou be to me like a deceitful brook, like waters that fail? Therefore thus says the Lord: "If you return, I will restore you, and you shall stand before me. If you utter what is precious, and not what is worthless, you shall be as my mouth. They shall turn to you, but you shall not turn to them. And I will make you to this people a fortified wall of bronze; they will fight against you, but they shall not prevail over you, for I am with you to save you and deliver you, says the Lord.
St. John Cassian tells us that before we can be united to God we must first overcome depression:
But first we must struggle with the demon of dejection [depression] who casts the soul into despair. We must drive him from our heart (Philokalia I) (italics mine).
St John is well aware of the devastating spiritual effects of depression; he goes on:
It was this demon that did not allow Cain to repent after he had killed his brother, or Judas after he had betrayed his Master.
Typical of treatment with depressed patients is to listen to the patient’s view of the damaging things that have happened to them that have activated their depression. Once the depressed patient describes his pain, hurt, and how he views these events, the patient is often more receptive to considering alternative options (Beck, 1976 ). Again, the spiritual dimension is a powerful tool to help in this phase of depression treatment. The expression of grief, followed by reliance and responding to God’s healing grace, can be seen in the words of Job and Jeremiah quoted above. We make ourselves open to adopting the outlook of St. Paul:
We are afflicted in every way, but we are not crushed; perplexed, but not driven to despair (2Cor 4:8)
And we can pray the prayer of the psalmist:
The Lord is my rock, and my fortress, and my deliverer, my God, my rock, in whom I take refuge, my shield, and the horn of my salvation, my stronghold (Ps 18:2).
And we can also pray this beautiful psalm:
Be gracious to me, O Lord, for I am in distress; my eye is wasted from grief, my soul and my body also. For my life is spent with sorrow, and my years with sighing; my strength fails because of my misery, and my bones waste away. I am the scorn of all my adversaries, a horror to my neighbors, an object of dread to my acquaintances; those who see me in the street flee from me. I have passed out of mind like one who is dead; I have become like a broken vessel. Yea, I hear the whispering of many— terror on every side!— as they scheme together against me, as they plot to take my life. But I trust in thee, O Lord, I say, "Thou art my God. (Ps 30: 9-14).
Prayer in times of sadness can lead to the realization that earthly travail can be a source of being united with God, and can point to a greater good. St. Peter expresses this in his epistle:
Enlivening Medicine with Christ
Now who is there to harm you if you are zealous for what is right? But even if you do suffer for righteousness' sake, you will be blessed. Have no fear of them, nor be troubled, but in your hearts reverence Christ as Lord (1Pt 3: 13-15).
In summary we can note that the trusting Christian clinician need not be limited merely to scientifically supported treatment models. Our own confidence in the vivifying power of God’s grace, coupled with sincere prayer and sacramental incorporation into the Body of Christ, His Church, can be of great aid in healing of the patient suffering from dysfunctional emotions. It should be noted that over the years the scientific community has become more receptive to the healing potential of faith systems (e.g., Benson, 1975). In the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR), (American Psychiatric Association, 2000) religious sensitivity is noted under Ethnic and Cultural Considerations. Clinicians are instructed to consider “belief, or experience that are particular to the individual’s culture” in diagnosis and treatment. This allows non-spiritual clinicians to use the patient’s religious system both for understanding and treatment, but, more importantly, empowers the spiritual clinician to actively incorporate the patient’s commitment to Christ and His indwelling in us into the healing process.
The patient’s knowledge that their clinician shares their dedication to Christ as well as a willingness to use prayer for the patient in the healing process can be a powerful therapeutic tool. [For example: After ending a therapy session with a patient, I said “Tom please pray for me.” He said to me “Father, I have never had a priest ask me to pray for them before. Why do you need prayer?” I replied something like “Tom, all of us are in need of God’s help, we are all struggling with our own problems and need His abiding in us.” He frequently made reference to this exchange in subsequent sessions. My understanding is that it helped him focus even more on the spiritual dimension of treatment]. Also, DSM IV-TR (American Psychiatric Association, 2000) has adopted a diagnostic code for the treatment of spiritual and religious problems. As we do our part, learning about the laws of neuropsychological (including emotional) functioning through continuing scientific research, we will be fulfilling the charge God gave us when creating us in His image, to use our intellect to have dominion over all the world. (Gen 1:28). In emulation of the counsel of St. Isaac the Syrian (Brock, 1997) we can recognize and act on the fact that we are creatures created by God, composed of body and soul: “Before you fall ill, search out a doctor for yourself. Before difficulties come upon you, pray; then, when the time of distress comes, you will discover [prayer], and it will provide an answer for you.”
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iii The saying: “Ontogeny recapitulates phylogeny”, is well known even to the level of high school science students. Basically it summarizes a well known biological function: an organism, in the course of growth undergoes the same sequential stages (although truncated) as the species did in evolutionary development. For example in embryonic development human embryo’s at one point resemble the embryos of ancestral species, such as fish.
x A full list of articles can be found at: www.orthodoxytoday.org/archive/morelli
xii The experiment can be conceptualized in terms of three phases (labeled T below) followed by a presentation of the stimulus associated with fear a year later:
|B-No Shock||B-No Shock||B-No Shock 10 min/6 hrs|
A year later: The group at T3 who received the B stimulus within 10 minutes (the reconsolidation period) after the Y (anxiety stimulus had no anxiety reaction when presented with the Y stimulus). The B (Non-shock stimulus was integrated into the memory. The group at T3 who received the B stimulus 6 hours later (after reconsolidation) had an anxiety reaction to the Y stimulus. The addition of the B stimulus 6 hours later had no effect in attenuating anxiety.
Y= Yellow Block
B= Blue Block
T1 conditioning phase (pairing a neutral simulus (Y or B) with shock.
T2 extinction phase (presenting the stimuli without shock).
T3 Presenting shock and the non-shock associated stimuli within (3 minutes or outside (6 hours)of reconsolidation time.
A year later: Presenting the stimulus previously associated with shock (at T1) that came to elicit anxiety: The T3 10 minute condition had lowered anxiety to Y; the T3 6 hour condition had anxiety to Y.
Alternatively a press release by the National Institute of Mental Health (www.nimh.nih.gov/science-news/2009/non-invasive-technique-blocks-a-conditioned-fear-in-humans.shtml) depicts the experimental procedure and outcome for the effects of the memory reconsolidated group in the graph below:
The red line depicts the level of anxiety initially after conditioning and a year later.
xiv This would exclude those individuals with severe or profound intellectual challenges. Professional diagnosis and clinical guidance is necessary in such cases.
xv This example is a case study. In clinical research 'follow-up' (e.g. 1-2 years) of the patient's condition is a common procedure to assess the effectiveness of treatment. Thus this naturalistic observation of the patients efficacious level of functioning is suggestive of the potential usefulness of the treatment technique.
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V. Rev. Fr. George Morelli Ph.D. is a licensed Clinical Psychologist and Marriage and Family Therapist.
Fr. Morelli is the Coordinator of the Chaplaincy and Pastoral Counseling Ministry of the Antiochian Orthodox Christian Archdiocese and Religion Coordinator (and Antiochian Archdiocesan Liaison) of the Orthodox Christian Association of Medicine, Psychology and Religion.
Fr. Morelli is a Senior Fellow at the Sophia Institute, an independent Orthodox Advanced Research Association and Philanthropic Foundation housed at Columbia University and Union Theological Seminary in New York City that serves as a gathering force for contemporary Orthodox scholars, theologians, spiritual teachers, and ethicists.
Fr. Morelli serves on the Executive Board of the San Diego Cognitive Behavior Therapy Consortium (SDCBTC)
Fr. Morelli serves as Assistant Pastor of St. George's Antiochian Orthodox Church, San Diego, California.
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