Counseling Anxiety & Worry

Anxiety.  Fear.  Depression. Anger.  We are collegiate missionaries and not counselors, yet we are regularly encountering these emotions among students on nearly every campus we serve.  Over the next 3 weeks, we will be posting papers written by TJ Chesnut for a seminary class on Biblically counseling individuals experiencing these emotions.  Hopefully each paper will give you Scriptural direction as you relate with students.  - Andy

Description of the Problem

Defining fear and anxiety, while two separate topics, can be tricky because they do overlap with one another. The American Psychiatric Association (APA) defines fear as an “emotional response to a real or perceived immanent threat”[1] and defines anxiety as “anticipation of future threat.”[2] While these are distinct definitions they do have shared aspects in that an individual cannot experience anxiety without fear because to be anxious about something is to fear the possibility of threat. And while fear is a natural response due to vulnerability, it is the moment when fear rules an individual’s life that it becomes an anxiety disorder.

The differences given by the APA tends to focus on how fear and anxiety manifest themselves. Fear is more often “associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors.” Again, these are natural responses. On the other hand, anxiety tends to be shown via more extreme characteristics like muscle tension, hyper-vigilance, preparation for possible future threats, and excessively cautious behavior. A person with an anxiety disorder has allowed their fear to influence the patterns and habits of their life. The symptoms of most anxiety disorders include indecision, difficulty focusing, affects to sleep patterns, irritability and anger, increase in respiratory rate/heartbeat, headaches, and stomachaches.

Anxiety manifests itself in seven different disorders. Panic Disorder is caused by a controlling fear of experiencing a panic attack. For a person to suffer this disorder they first experience a panic attack, either cued or un-cued. General Anxiety Disorder (GAD) can be diagnosed when a person worries about multiple things (basically whatever they are thinking about at that moment) and have been experiencing this series of overwhelming concerns for more than six months. GAD usually has an early (more likely to form during childhood) and gradual onset. Another indicator of GAD is that a person will tend to live with the expectation of something bad happening to them. Obsessive-Compulsive Disorder (OCD) is made of two distinct components. The first component is obsessions, which are intense thoughts, worries, and images that are intrusive and unwanted that result in intense levels of anxiety. The second component is the compulsions, which are rituals, behaviors, or mental processes that are performed to limit anxiety. A person suffering from Post-Traumatic Stress Disorder (PTSD) has generally experienced or witnessed a form of physical harm or threat of harm/trauma. Symptoms of PTSD can include re-experiencing the event [flashbacks, dreams, playing out the trauma with toys (most likely with children)], emotional detachment, and other general anxiety symptoms. To be diagnosed with PTSD a person must show symptoms for more than a month. The two most common causes of PTSD are the sudden death of a loved one and being the victim of abuse. A person suffering from Acute Stress Disorder temporarily, for less than a month, experiences the symptoms of anxiety. An individual experiencing Phobia will have an intense and persistent fear of an object or circumstance, which actually does not pose a real threat to them or their situation. This irrational fear will result in the person avoiding the object or setting that fear. A couple of examples are agoraphobia (fear of public places) and acrophobia (fear of heights). The final anxiety disorder is Social Anxiety Disorder, which is an extreme fear of social embarrassment. This disorder tends to have an early age of onset with a child/adolescent developing a fear of doing something humiliating in front of their peers.

Each these disorders carry their own scale of severity – take OCD as an example. A person diagnosed with OCD does not have to display both obsessions and compulsions; they can be suffering from either one of those two characteristics and still be diagnosed with Obsessive-Compulsive Disorder. But anxiety is different from some other forms of problematic emotions because, unlike depression, there is not a defined progressive order of severity. While it is clear that Acute Stress Disorder is certainly less life-altering than the other anxiety disorders, the reality is that a person suffering from PTSD or Phobia will both have life-altering experiences and depending on the severity will also need counseling.

Five Key Bible Passages

1. Psalm 27 – This passage provides both a reassurance of God’s protection and provision while also reminding the reader to put his/her focus on Him. The Psalmists starts by asking the rhetorical question, “Whom shall I fear?” and he is insinuating that if God is the one protecting us then there is nothing or no one to be afraid of. In the same chapter the Psalmist also emphasizes the importance of seeking after God because it is in searching earnestly for God that an individual will find Him, not because He is hidden but that He is actually always present if we only lift our eyes to search for His presence.

2. Psalm 34 – In this Psalm the writer describes how he sought the Lord in his time of need and that God answered his cry for help. The Psalmist then continues by calling others to “taste and see that the Lord is good.” For a person suffering from anxiety, directing he/she to look up from his or her own troubles and fear see God. The Psalm then concludes with assuring readers that God sees the affliction of the righteous and that He is near to them in their suffering.

3. Psalm 46:1-3 – In this passage the Psalmist declares that God is a refuge and a source of strength in times of trouble and need. Even if the foundations of the world itself were collapsing in an apocalyptic fashion, God is still the one who can provide refuge because He is sovereign over all creation. The same God who has the power to protect the Psalmist from such calamities is the same God Who is sovereign over the circumstances of each person, even over their fears and anxieties.

4. Matthew 6:25-34 – During the Sermon on the Mount Jesus takes a considerable portion of his sermon to describe God’s love and provision. Jesus’ point is that if God provides for the needs of the birds and the flowers then how could he possibly not provide for the needs of people who are made in His image. There is no need for follower of Jesus to be dominated by a fear what will happen tomorrow. Rather, Jesus tells his listeners – including Christian’s today – to be more concerned with the matters of today because tomorrow will have its own problems and concerns.

5. Hebrews 11:39-40 – In Hebrews 11 the author writes about many individuals who followed God faithfully, even at great cost. In the final two verses of the chapter the author reminds his readers that even these faithful men and women lived and died without seeing the full promise of God being fulfilled in Jesus. Continuing that point the writer then points out that modern day Christian’s now live on the other side of the promised Messiah, Jesus Christ. A person suffering with anxiety today can rely upon the reality that God has provided ultimately through Jesus to resolve humanities spiritual need. Though there may be pain, sorrow, fear, and suffering in this life the follower of Jesus can know that all such suffering will come to an end.

Five Crucial Questions

1. What do you fear losing the most/worry about the most?

2. What does the Bible say about your fear and worry?

3. Does fear/anxiety show up in your family history?

4. What particular events precede an anxiety attack?

5. How do I know when to refer a person for medicine?

Five Theological Insights about Depression

1. The thing(s)/person(s) an individual worries about most are what they treasure and what a person treasures most is what they tend to be most concerned about losing.

2. If a person is afraid, it is because they believe that a person/circumstance are greater than God in that moment.

3. To overcome fear a person must look to and love God the most. Then a person must be concerned about the needs of others more than their own. It is only by putting God and others before one’s self that an individual will be able to have a healthy perspective of their place in the context of God’s purpose versus their inward turn to focus on himself/herself.

4. Anxiety is ultimately the result of a lack of faith in God’s promise to provide what we need when we need it.

5. While fear and anxiety may be the battle for some people during their earthly lives such a reality is only temporary because there will be no anxiety in eternity.

Five Best Homework Assignments

1. Battling Unbelief with the Word – Help the counselee to see the nature of the relationship between faith in God and fear/anxiety. As faith in God increases the counselee will typically notice that their fear and anxiety will decrease and vice versa. Have the counselee memorize Scripture that raises their eyes and thoughts from themselves to God. Some recommended passages are Psalm 50:15, Isaiah 41:10&13, and Hebrews 13:5-6.

2. Sing with the Psalmist – Have the counselee read Psalm 27 and draw their attention to how David communicates with God in this Psalm. Have the counselee practice recounting who God is. Next, let the counselee be reminded that God is near to those who seek Him. Then, have the counselee review stories of God’s beauty and majesty until he/she have come to a place of confidence in Him – some places to begin are Genesis 1&2, Job 38-42, and Psalm 29.

3. Study of Character Traits of God – Assign to the counselee passages of Scripture to study that lead them to meditate on aspects of God’s character that counter fear and anxiety. Some great characteristics are God’s sovereignty (Romans 8), His love (1 John 4:7-19), His provision (Genesis 22), and His power (Mark 4:35-41).

4. Evaluation of Physical Habits – Have the counselee record how they tend to spend their free time (watching TV, practicing an instrument, outdoors activities, etc.). Also, have the counselee keep a journal of what they eat in between counseling sessions to help determine if part of their emotional condition is being affected by their diet (for example, high caffeine consumption can cause a person to feel more anxious). Another lifestyle trait to analyze is physical exercise to determine if the counselee is leading a sedentary lifestyle or a healthier one.

5. Study of the Promise Future Hope – Assign passages for the counselee to study that will guide them to meditate on Scripture that points them to the promise of a future hope far greater than this current life. Some passages that can be useful for this are Revelation 21:1-7, 1 Peter 1:3-12, John 6:48-58, and Romans 8:18-30.

Recommended Resource:

[1] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders: 5th edition, “Anxiety Disorders.” Digital Text.

[2] American Psychiatric Association, Ibid.