Participants: Shelley Quinn (Host), Jennifer Jill Schwirzer
Series Code: IAA
Program Code: IAA000315
00:30 Hello, I'm Shelley Quinn and welcome again to
00:33 Issues and Answers. We're glad that you've tuned in.
00:35 Let me share something. If you are a sad or anxious person or
00:40 if you know someone who may be a sad or anxious person then
00:43 you're going to be glad that you tuned in today. Tell somebody
00:47 else to tune as well. That's what our topic is today.
00:51 Let me share with you one of my favorite Bible verses and it
00:56 comes from Romans 15:13. You talk about hope for sad, anxious
01:02 people, here it is. The Bible says: May the God of hope so
01:08 fill you with all joy and peace in believing that by the power
01:13 of the Holy Spirit you may be overflowing, bubbling over, with
01:18 hope. And you know what, in the Greek hope means eager
01:22 expectation. You can go to God eagerly expecting him to fulfill
01:29 his promises to you. We want to welcome again
01:32 Jennifer Schwirzer and Jennifer comes to us from Philadelphia.
01:37 She is a Christian counselor, a song writer, ministry director
01:41 and we're just so glad that you're back with us.
01:44 It's great to be here.
01:45 These programs have been so good that you've been coming and
01:48 doing and we really appreciate them.
01:50 I've been the most blessed.
01:51 Well, you're a very wonderful person. Let's just jump into
01:56 this. We're going to be talking about cognitive behavioral
02:00 therapy today and I know you know Dr. Neal Nedley and
02:04 Dr. Nedley believes in this. There are so many people that
02:07 are springing up everywhere I look they talk about cognitive
02:11 behavioral therapy. First of all explain to me what that means.
02:14 Okay well it is kind of the cutting edge of treatment for
02:19 anxiety disorders. It's most effective with anxiety disorders
02:25 and mood disorders and this is a very serious problem just even
02:29 in the United States of America we have a lot of anxiety and a
02:33 lot of mood disorders so...
02:35 I guess depression would be considered a mood disorder.
02:38 It's a mood disorder. The mood disorders are depression, major
02:41 depressive disorder, bipolar disorder and something called
02:44 dysthymic disorder which is actually kind of a mild form of
02:48 depression. What they call the 12-month prevalence rate which
02:53 means in one year's time 20 million people will have a
02:56 diagnosis of one of those disorders. That's a lot of
02:59 people. Just in the United States?
03:01 Just in the United States. Major depressive disorder is the
03:05 leading cause of disability in the U.S. today. That's a lot of
03:09 sad people. But there are even more anxious people because in
03:13 one year's time 40 million, double the amount as mood
03:17 disorders, 40 million will develop an anxiety disorder.
03:21 Let me just give you what some of those are: Panic disorder,
03:25 obsessive/compulsive disorder which is considered an anxiety
03:29 disorder, post-traumatic stress disorder, generalized anxiety
03:33 disorder, social phobia which is the most common, and
03:37 agoraphobia which is the fear of crowds and specific phobias.
03:41 So all of those are considered anxiety disorders. Forty million
03:45 people in one year's time will develop an anxiety disorder.
03:49 Okay when we're talking about these mood disorders and anxiety
03:53 disorders and for our international viewers we
03:55 understand that we are giving quotes and statistics from the
04:00 United States, but I know the Scandinavian countries really
04:06 have some very difficult times with depressive disorders but
04:10 we know it is a very prevalent problem. That's just what we're
04:14 trying to establish. So it is becoming even more so. I mean
04:18 I know that I've seen the statistics with how things are
04:22 coming with anxiety and mood disorders.
04:24 Well for instance, social phobia which is the most common kind
04:28 of anxiety disorder... It's estimated that 50% of people
04:33 are chronically shy, this is the U.S. again, but that's a 10%
04:37 increase over the last three decades. So there's an increase
04:40 in social phobia. And it's thought that the reason for that
04:44 is that our society is becoming increasingly isolative, there's
04:48 more loneliness, there's more isolation and there's a more
04:51 competitive atmosphere in society so those things kind of
04:54 breed these disorders.
04:55 So when you're talking about this chronic shyness what you're
04:59 saying is we have this tendency nowadays to cocoon ourselves.
05:03 We've got the internet there and all these things. I know one
05:07 lady that hasn't been out of her home for several months. She
05:11 orders her groceries by internet everything's done online.
05:15 And it's not good. Yeah I used to go to my neighbor to find out
05:18 how to make leaf mulch or how to bake a certain kind of cake.
05:22 But now I just go online and get the recipe. It's so easy to get
05:26 information and I'm and information junkie. I love it.
05:29 But I can see where it doesn't push me into certain social
05:33 situations and I can end up living my life in a form of
05:36 isolation that is not healthy.
05:38 So now let's go back to you said cognitive behavior therapy was
05:42 the most popular way to treat these disorders. What is
05:46 cognitive behavior therapy?
05:47 Okay. Cognitive therapy rests on the basic concept that cognitive
05:53 processing is what causes these disorders.
05:55 All right. So now describe cognitive processing.
05:58 You have negative life events and then negative emotions that
06:01 come out of negative life events and you might assume that there
06:05 is a direct line from the negative life event to the
06:08 negative emotion. However, the CBT theory has said no there's
06:12 something mediating between the negative life event and the
06:15 negative emotion and that is what we call cognitive
06:18 processing or the way that you think about an event. And if the
06:24 processing is negatively biased or distorted in some way often
06:29 times the bad feelings will sustain much longer than they
06:34 normally would because of the way the person is thinking about
06:37 it or they would be more intense than they need to be
06:39 because of the way the person is thinking about it. So that's
06:42 what I mean by cognitive processing and what the CBT
06:46 theorists have discovered...
06:47 CBT being Cognitive Behavioral Therapy.
06:49 I'm like running down the road with this thing. But what these
06:54 researchers have found is that people that are depressed and
06:58 anxious suffer from these disorders are negatively biased
07:02 and they do tend to think of things in very negative ways.
07:06 So what they do is they go in and try to correct those
07:08 negative thoughts. So what you're saying is that...
07:11 Let's say that we have five people attending a group event.
07:17 Something happens at this group event. All five people could
07:22 experience the same thing but they're going to process,
07:26 cognitively they will process this in their mind differently.
07:30 And someone might feel like what happened was a personal affront
07:34 to them and they're taking it very negatively. There's all
07:38 these various aspects that has to do with how we think.
07:41 And we really can't control the events, but we can control how
07:45 we think about them. So what you do when you use CBT with a
07:48 person is you give them a sense of empowerment. You know
07:51 something since I've gotten into counseling is that we were
07:54 created for mastery. You know, God gave us dominion over the
07:57 fish and the animals. We were created to be in control of
08:00 things, but because of the fall we've lost control. However,
08:04 God has still called us to mastery. The first thing that we
08:07 must master is our self, our own behaviors and then of course our
08:11 thought life. See now that makes me think of
08:13 2 Corinthians chapter 10, verses 4 and 5, that we are to take
08:17 every thought captive and make it obedient.
08:20 Oh, exactly. That was my verse that I was going to use but
08:23 that's okay. Well we're on the same page.
08:26 So my experience has been... We've already discussed how
08:31 I like to do is take Bible promises, confess them over my
08:36 life, pray them back to the Lord and my experience has been that
08:41 if I'm trying to take a negative thought captive, I have to
08:45 replace it with something else. If I just tell myself you can't
08:49 think about that, or you shouldn't think this way, I have
08:51 a tendency to think about it more. But if I'll go to the word
08:54 of God and replace it with something then it helps me to
08:59 take that thought captive because suddenly my focus is off
09:02 self and the way I'm thinking to what the Lord has said.
09:06 So would that be kind of a form of cognitive behavioral
09:10 therapy? Oh yes. Definitely. In fact, I
09:11 use a technique called FAR and I told you that I use these
09:15 mnemonics because their easy to remember. People can remember
09:17 them in the heat of the moment when they're about to lose it.
09:21 They can remember this and they can put it to use. FAR, based on
09:24 the verse, I don't know where it is, you probably do, This light
09:28 affliction which is but for a moment works for us a far more
09:31 exceeding and eternal weight of glory. The Lord has given us
09:34 wonderful coping mechanisms for the hardships of life and these
09:36 things will someday be far from us but we can make them as far
09:39 from us, but we can make them as far as possible from us even
09:42 today by thinking correctly about them. So FAR is Find,
09:47 Argue and Replace. This is a very technical approach to
09:53 dealing with one's thought life. But basically it's thought life
09:56 management. Very technical approach. Find, first step, find
10:00 People have to find out what they're thinking. Now it's
10:04 pretty easy, and I find this in therapy, it's pretty easy to
10:07 figure out what happened that's upset you. In fact, people
10:11 ruminate on what happened. They'll talk about it in
10:14 excruciating details sometimes; just reliving it over and over
10:18 again. They can summon up tremendous amounts of detail and
10:21 really kind of bring the story alive and they want to do that
10:25 in therapy and I allow that to a certain extent. But then what
10:28 I'll do is I'll tell them to identify the feelings that came
10:32 out of that event and they learn how to use descriptive words to
10:35 describe their feelings. And that's usually pretty easy for
10:39 people. Then I try to find out what they're thinking. I say now
10:42 let's try to find out what it is that you're thinking about this
10:46 event. And all of a sudden it gets very difficult. Often times
10:49 they'll say I don't know what I'm thinking. I'm not thinking
10:53 at all. I'm just feeling this way. But then I'll start to
10:56 probe and I'll work with them and like we talked about before
11:00 there's a certain amount of intuition that you have in
11:03 developing this with the person but sooner or later we find out
11:08 that they are thinking something that is distorted in some way.
11:12 Let's say that something has happened and you're taking
11:16 somebody through this process and to try to find out what
11:20 they're thinking have you had someone say I'm just so angry
11:24 and that's what I'm feeling is anger. And then as they go
11:27 through this process about these feelings they find out
11:31 it wasn't anger at all. They were wounded by something and
11:35 so there's a disassociation with their true feelings so they can
11:39 never really get at the root of it if they don't understand what
11:44 they're feeling, is that what your saying?
11:45 That's part of it. Let me give you a specific example on that
11:48 issue of anger. I had a fellow come to therapy when I was in
11:52 my internship. This guy was six foot four, a big booming voice.
11:55 He used to be a law enforcement official. He was disabled
11:59 because he had some joint problem. But he was roughly my
12:03 age, just a very large person and a very kind of energetic
12:07 interesting person but a very, very sad person and often times
12:12 depressed people have struggles with anger. So what happened in
12:16 therapy was... Well first of all the first session he cried the
12:19 entire session. Great big strapping man, big booming voice
12:24 cried the entire first hour, just weeping. But anyway we were
12:29 dealing with some of his issues using the CBT. One of the issues
12:33 was anger. He was angry at a neighbor for saying something
12:37 insulting about his dog and he got in the neighbor's face and
12:40 did something kind of aggressive and then, as is typical, felt
12:44 kind of bad about that afterward and really kind of ashamed of
12:47 himself for losing his composure. Okay, so we
12:49 processed this using Find, Argue and Replace technique. So first
12:54 we had to find out what he was thinking. Well after talking it
12:58 through for a while he realized that he was thinking that he had
13:01 to fix that right then and there That he could not allow that
13:05 person to say something insulting to him about his dog.
13:08 He just couldn't tolerate that and he had to make it right then
13:11 and there. So I refuted that with him. I said, did you really
13:15 have to fix that right then and there; was that necessary?
13:18 What would be so bad about just letting it go? Do you have to
13:22 make that person act the way you think they should act or are
13:25 there times when you can just let people be obnoxious. And he
13:29 realized, You know what, I don't have to make people behave the
13:33 way I think that they should behave. And he started to
13:35 realize that he could have boundaries and he could let
13:37 people make their own choices and he could make his choices
13:41 and he did not have to allow things to bother him. So that's
13:45 just one example of using the Find, Argue and Replace. So what
13:48 we do is we find the thought and once you isolate that thought
13:53 then you teach the person how to argue with themselves. That
13:57 is a really important skill. You don't argue with someone unless
14:01 you respect them. They have to have some kind of power over you
14:05 some kind of prominence in your life, some kind of power in your
14:08 life in order for you to feel like you need to argue with
14:11 them. You don't argue with kitty cats and the mailman or little
14:15 children. You argue with people that threaten you on some level.
14:20 So what you do when you learn how to argue with yourself is
14:23 you kind of take responsibility for the management of your own
14:27 thought life. And it's amazing how people respond to this as
14:31 they learn how to deal with themselves and hold themselves
14:35 accountable. I do this all the time.
14:38 Do you really. So I teach them how to argue with themselves and
14:41 what I do is I give them a sheet of various types of distorted
14:45 thoughts. And I say now isolate the thought and then tell
14:48 yourself what's wrong with that thought. So if the thought is
14:52 something like, you know I had this bad experience and my whole
14:55 life is just going to be one bad experience after another. I'll
14:58 say, what is wrong with that thought that your whole life is
15:01 going to be one bad experience after another? And they look at
15:04 the list and they say oh I'm generalizing. I'm taking one
15:08 incident and I'm generalizing it to the rest of my life. And
15:11 then they learn to argue with themselves and say look, you're
15:14 generalizing. Don't generalize. That's not a healthy thing to do
15:18 and it's also not true. So once they accomplish that arguing,
15:21 then they replace the thought with a true thought. And this is
15:25 what you were talking about a minute ago. What I find though
15:28 is that the replacement does not work unless they first do the
15:32 arguing and it's very easy to skip over the arguing step.
15:36 Arguing with yourself. With yourself. What I tell
15:41 people is that their heart and their mind is like a garden and
15:44 if the ground is hard the seed will not grow. What they have to
15:47 do is they have to break up the fallow ground of their thinking
15:50 and that's where that verse that you quoted comes into play.
15:54 Casting down imaginations and every high thing that exalts
15:58 itself against the knowledge of God. 2 Corinthians 10:5. And
16:02 bringing into captivity every thought to the obedience of
16:05 Christ. You know, casting down. There's a certain amount of
16:09 force to casting something down. And imaginations is sometimes
16:13 translated arguments. It's logismo and it means like
16:16 calculations, these things we come up with in our heads. We
16:19 need to cast them down. We need to deal with our own thinking
16:22 and break it up. And once we learn how to break it up and
16:25 get that ground all nice and loose and ready for the seed
16:29 then we can replace those distorted automatic thoughts
16:32 those misbeliefs with truth. Now truth, I'm really into this,
16:37 I'm sorry. I'm taking over a little bit. But truth is more
16:42 nuanced and more detailed than a lie. What I typically run into
16:47 with depressed and anxious people is they often say things
16:51 like he's an idiot or life sucks or, you know, they make these
16:55 general comments that apply to everything and they're just too
17:00 black and white. What I teach them to do is replace that lie
17:03 with the truth, which is much more detailed and nuanced. So
17:07 he's not an idiot. It's like taking the diamond in
17:11 the jeweler's hand. The truth has all these different facets
17:15 that you can see. The truth sparkles; it's not just... It's
17:19 detailed. It's multifaceted. So what they
17:23 do is they replace that he's an idiot. They don't go to the
17:26 other extreme of he's a wonderful guy, because the
17:29 reason that a lie has power is because it's partly true. So I
17:33 teach them to take the truth about the he's an idiot
17:37 statement and not to exclude that because if they don't
17:41 replace that lie with the truth then it won't have staying
17:45 power. If they replace that lie with another positivized lie
17:49 it's not going to stay with them So I teach them how to say well
17:53 he has some challenging character traits and sometimes
17:58 I feel very offended by things he says, but he does have some
18:01 really good qualities too. And I choose to see him through the
18:05 eyes of love because God sees me through the eyes of love. And so
18:09 I choose to regard him as a brother in Christ.
18:12 That's good. So I replace the misbelief with
18:15 the truth. That's really good. You know
18:16 you're talking about plowing up your heart. In Hosea 10:12, I
18:22 love that scripture that Hosea says: I may not be able to quote
18:26 it but anyway he says sow for yourselves righteousness. Plow
18:33 up your fallow ground, untilled ground and then seek the Lord
18:38 till he rains righteousness on you. And I was just thinking
18:42 that when you're talking about this cognitive behavior, that's
18:47 what you're doing with the FAR. You're looking at this fallow
18:52 ground of yours, this hardened ground and you have to break it
18:56 up and say okay what am I really feeling and thinking here. Now
19:00 the Argue, some people have a difficult time with the word
19:04 argue but it's reasoning with yourself. It's coming with that
19:07 positive reasoning, the argument with yourself. You know, I find
19:10 myself doing this all the time. Especially, we've got to
19:12 remember that the devil can plant thoughts in our mind as
19:16 well. He tries to pass off this condemnation. Sometimes if I
19:20 feel like... if I'm really tired and I've been overworked and
19:23 I'll think oh Lord I'm just failing you here and I hear
19:27 these generalized statements coming out and then I realize
19:31 am I relying on works or am I relying on grace. I start
19:35 arguing with myself and thinking that thought's not coming from
19:39 the Lord. I'm not failing the Lord and I have this little
19:42 running conversation that goes on. So then to replace it...
19:46 That's really healthy. You don't even have to go to therapy.
19:49 You just figured out how to do it on your own.
19:51 I've just always done this. Well not always. Since I've been in
19:54 the Word I think is when it started that I've realized boy
19:58 this isn't lining up with God's word and I need to find a
20:02 scripture, replace this and just start trusting and believing
20:06 that God's working in me to will and to act according to his good
20:09 purpose. Well that's why CBT even though
20:12 it is a secular theory the principles are found in the word
20:18 of God. As a man thinks in his heart so is he.
20:21 Be ye transformed by the renewing of your mind. So the
20:25 principles are in the word of God and the reason that it works
20:28 is because it's found in the word of God. I would insert one
20:31 caution and that is that sometimes when the Holy Spirit
20:34 is striving with a person they experience depression, they
20:37 experience despair. I am careful with my clients not to interrupt
20:41 that. I'm careful to let the Lord work with them; of course
20:45 guarding against suicidality, if the person's at the point of
20:48 taking their own life. It's a real tight rope walk I have to
20:52 walk at that point.
20:53 So explain that. Go into that a little bit deeper when you say
20:57 that sometimes when the Holy Spirit is working with people
21:00 they get to that point of despair.
21:02 If I was a strictly secular cognitive behavioral therapist
21:06 I would probably if someone was in despair because they felt
21:11 unworthy I would probably say Oh no, you're worthy and I would
21:14 argue with that thought. But I can't really argue with that
21:17 thought on the basis of scripture. It could be that the
21:20 Holy Spirit is striving with a person and bringing them to the
21:23 end of their own resources realizing that they are nothing
21:28 before God. I don't want to reason that away. You know I
21:32 should put in a little bit of a disclaimer here because no
21:35 secular theory is... we're not safe to follow any secular
21:39 theory, but I think that cognitive behavioral therapy
21:43 is in the word of God and that there are many people in despair
21:45 that don't need to be in despair
21:47 Absolutely. Now I'm going to have to correct something you
21:49 said that when you say we realize we're nothing before
21:52 God. Just semantics but I don't want someone to get the wrong
21:56 idea. That we have no goodness, nothing in our self that we can
22:01 present to God as good or worthy but that we're not nothing to
22:05 him because he did send his Son to die for us and he does see
22:10 great value in us and he loves us unconditionally. So if you're
22:16 feeling that way, God would have you come to him and say
22:19 I'm the God of hope and if you will trust me I will change your
22:25 life and understand that I do love you with an everlasting
22:31 love and therefore with loving kindness I am drawing you.
22:34 Can I give more illustration here? This fellow that I
22:37 worked with one of the distorted thoughts that he had, he had
22:41 done some things wrong in his youth and he was feeling this
22:44 residual guilt because of it. I'm not allowed to preach
22:47 religion but I'm allowed to look on their intake form and
22:50 if they say that faith is an important part of their life
22:52 I can say well let's pursue that So I said you know faith is an
22:55 important part of your life; how do you view God. And he
22:58 basically said, Well God is holy and I try to earn his
23:00 forgiveness but no matter how hard I try it just doesn't seem
23:03 to be... I'm not good enough to earn his forgiveness. So I had
23:07 the privilege of introducing the gospel to this man and it all
23:10 happened very naturally in the context of a counseling office.
23:13 I want to say this one more thing just to give you an idea
23:17 of how powerful this type of therapy, biblically based CBT,
23:22 can be. The man came to me for eight sessions. At the last
23:26 session I was moving out of my internship and kind of ending
23:30 our sessions. He was doing better. He had quit
23:33 antidepressants on his own, he had quit smoking and he had
23:36 gotten a job and he basically pronounced himself cured.
23:39 And he said to me, I have been coming to this counseling office
23:42 for 15 years talking to different therapists and I come
23:46 to this lowly intern, and it's true, I had no idea what I was
23:50 doing, you know, really as far as experience went, but he had
23:53 eight sessions with me and he said he was better. He said this
23:56 thing you're doing keep doing it because it works.
23:58 And the reason, it was more than eight sessions with you.
24:02 He had eight sessions with the Lord, Jesus Christ in you and
24:06 you sharing the gospel, the good news with him. Praise the Lord.
24:12 So cognitive behavioral therapy is simply taking someone and
24:17 showing them that many times behind these mood disorders and
24:22 this anxiety is that people are making generalized statements.
24:28 They are overreacting. They are assigning values to things that
24:33 don't really belong there and it's simply taking them through
24:37 to help them recognize their own thinking, to help them then
24:42 confront themselves, argue, have this reasoning this argument
24:47 within themselves to say you know what I'm saying and
24:52 thinking isn't really true. Life isn't over for me because I
24:57 embarrassed myself so badly. Life isn't over for me, my life
25:00 is not over because I got a divorce. You know that's a good
25:04 one. That's right. It doesn't mean I
25:05 can never be loved again and often times people will
25:08 generalize a very negative experience like that to the rest
25:11 of their lives. But you can say to them, you know, is that true?
25:14 And then you can start to work with that and then you realize
25:16 well no. Just because this person rejected me doesn't mean
25:19 that I can never have another relationship. What am I saying
25:22 about everybody else who's been divorced if I say that about
25:25 myself. And they can start to deal with their own thinking.
25:27 Just because one spouse may have had an adulterous affair doesn't
25:32 mean that everybody of the opposite sex is untrustworthy.
25:36 Then the replacement though I think as a Christian what you're
25:42 helping people to do is to see the replacement thoughts
25:46 should line up with the word of God.
25:48 That's right, that's right. Amen You got it.
25:51 That is so exciting. Let's run through you FAR again because
25:56 we've just got about a minute to encapsulate this.
25:59 First you find what it is that you're thinking. What are you
26:03 thinking about this negative event. That's going to take some
26:06 work. It's going to take some effort. You're going to really
26:10 sort of grill yourself and you are going to have to try to get
26:13 under the layers and some of these thoughts are actually kind
26:16 of unconscious thoughts. But once you identify those thoughts
26:19 once you found those negative thoughts then you argue with the
26:23 thought then like you said you start to engage in a reasoning
26:26 process with yourself. Hold yourself accountable for your
26:29 own thought life. Then when you finally have convinced yourself
26:32 that this is not the way to think about this negative event
26:36 then you replace that misbelief with the truth which is going to
26:40 be nuanced, it's going to be detailed. It's also going to
26:44 contain the negative elements. It's not going to be Pollyanna.
26:47 But it's going to be more whole and it's not going to be
26:50 negatively biased. Then you'll find that your mood will lift.
26:53 Thank you so much Jennifer for being with us again today.
26:56 It's been a pleasure. We have enjoyed having you.
26:59 You know for those of you at home 2 Corinthians 10:4 and 5
27:02 God isn't just saying take your thought captive and not telling
27:07 you how to do it. He starts off by saying, The weapons of our
27:11 warfare are not carnal but they are mighty to the pulling down
27:15 of strongholds. Whatever the devil's trying to set up in here
27:19 and casting down any vain argument, anything that would
27:23 exalt itself against the knowledge of God. So what I
27:27 want to encourage you to do, you don't have to see a
27:31 behavioral therapist to do this, just get into the word even and
27:36 have the Lord give you promises and show his truth to you that
27:40 you can replace some of that negative stinkin' thinking with.
27:44 Well our time is all gone already. We just ask in the
27:47 name of Jesus that his grace will be with you, that the
27:51 Father's love will be with you and the fellowship of the
27:55 Holy Spirit will be with you throughout today and always.