America today sees one of the highest levels of anxiety of any place in the world.[1] We are clamoring for attention online, wanting to be seen, to be loved.  Suicides by teens and young adults appear to be higher than they’ve been in years.[2]  We are the wealthiest nation on the face of the planet,[3] and we can’t rest.  We have more than anyone else (as a whole), and we can’t stop.  Children who are now becoming adults are feeling this crushing weight of anxiety and expectation (whether on themselves or from outside)- ‘get the degree and the top job, get married, have the house, have children, don’t screw it up.’   And we know that anxiety has biological and genetic influences, but these are not 100% causal by any means.  Our response makes a difference.[4]

• “Like most individual characteristics, psychopathologic symptoms are determined by many factors. The individual family environment is a relatively weak predictor of neuroticism and other personality traits, with genetics explaining much more of the variance…. There are also strong cultural influences on psychiatric symptoms — that is, an environmental influence outside of the individual family. Over time, American culture has increasingly shifted toward an environment in which more and more young people experience poor mental health and psychopathology, possibly due to an increased focus on money, appearance, and status rather than on community and close relationships” (emphasis mine).[6]

Generalized Anxiety Disorder (or GAD, the disorder most connected to general worries) is more impairing in higher income countries.[6]  The occurrence of GAD (lifetime prevalence) boiled down to:

• Countries with the following incomes:
• Low:        1.6%
• Middle:        2.8%
• High [U.S.]:    5.0% 

This is different from OCD, for instance, which sees about a 1-2% worldwide occurrence and doesn’t seem to vary a whole lot from country to country.  Depression seems to occur fairly consistently across the world, as well.  

I think the ultimate answer lies in Christ.  Hebrews 4:9 says, “...there remains a Sabbath rest for the people of God.”  Matthew 11:30: “My yoke is easy and my burden is light.”  

*Insert deep relaxing breath.
  
God ordained rest from the beginning of creation.  Genesis 2:2-3: says, “And on the seventh day God finished his work that he had done, and he rested on the seventh day from all his work that he had done. So God blessed the seventh day and made it holy, because on it God rested from all his work that he had done in creation.”  God purposed rest for us, his creation.  God wasn’t winded and saying, “Oh boy, that creating sure made me tired...let me sit back and take it easy.”  We know he created it for us.  Jesus states, “The Sabbath was made for man, not man for the Sabbath” (Mark 2:27).  If we back up to the institution of the Sabbath given as law to the Israelites, in Deuteronomy 5:15 we are given a reason why God so seriously wanted His people to be obedient in this: “remember that you were a slave….and the Lord your God brought you out…”  So to pause and rest is to say, GOD is my provider, and my striving only results in results because of God (Seriously, check out these passages: Deuteronomy 2:7; 1 Chronicles 29:12; Psalms 23 and 147:8; Matthew 6:25-33; Philippians 4:19).

Observationally, we don’t have to look far to understand our need for regenerative rest.  Sleep is one of the greatest things we can “do” for our well being.[7]  Our bodies need one third of our day just to be restored.  ⅓!!  Living to 75 that’s 25 years of our life spent sleeping!  When we try to cheat this, various problems ensue.  And by the way, the U.S. has a tremendous problem with sleep, as well.[8]  It’s hard to even grasp the scope of this due to the myriad ways people attempt to rest that may not be directly researched or studied in any one experiment (sleep aids, watching media, abusing substances- including over-the-counter cough syrup and benadryl).

The Doctor Who episode “Sleep No More” features the attempt to cheat sleep and maximize productivity.  Scientists discover a device (“Morpheus”) that takes only a few minutes to compress a month of sleep.  Serious problems ensue (enter evil “Sandmen” into the equation, for any of you Doctor Who nerds).  Sleep and rest are common themes in literature and life.  No doubt, they play a substantial role in our well-being- or downfall. 

Though therapy is highly efficacious in addressing disorders specifically and often helpful for much personal growth, it is not set up to be a worldview (a personal understanding or philosophy of the world)- it was never meant to be!  Therapy is the clinical application resulting from theories and science on human thought and behavior, just like medical practitioners study from a particular perspective and approach (“Western”, naturopathic, Traditional/Chinese, etc.).  Psychology cannot be an entire worldview, by definition, because it’s only one subset of study, research, observation, and experience.

Back to Jesus: “Come to me, all who labor and are heavy laden, and I will give you rest.” (Matthew 11:28). 

Are you tired of striving in your own strength?  Jesus speaks to the question of trying to be good enough. The Bible presents a very large pill to swallow that is offensive to our Western, pluralistic and politically correct sensibilities: your striving is empty without God.  BUT, here is the hope, and this is the Gospel: being made right with the God of the universe through Christ, we have peace. We have freedom. We have hope. We have purpose. We are forgiven.  We are loved.

• “Therefore, since we have been justified by faith, we have peace with God through our Lord Jesus Christ” (Rom 5:1).
• “Thou hast made us for thyself, O Lord, and our heart is restless until it finds its rest in thee” (St. Augustine of Hippo).
• “Unless the Lord builds the house, those who build it labor in vain.  Unless the Lord watches over the city, the watchman stays awake in vain.  It is in vain that you rise up early and go late to rest, eating the bread of anxious toil; for he gives to his beloved sleep” (Psalm 127:1-2).
• “Cease striving and know that I am God” (Psalm 46:10a).

From the poorest and most overlooked member in the slums of Calcutta to the Billionaire on 57th Street in NYC: You are loved. You are valuable. Striving and anxious pursuits are nothing without God- let us seek his rest.

References:
[1] Newman, T. (n.d.). Is anxiety increasing in the United States? Retrieved October 07, 2020, from https://www.medicalnewstoday.com/articles/322877.  “When they compare the levels of depression, no single area has significantly higher rates. When it comes to anxiety disorders, however, it’s a different story; the Americas are head and shoulders above all other regions, including Africa and Europe.”
[2] 

• ​Oren Miron, M. (2019, June 18). Suicide Rates in Adolescents and Young Adults, 2000 to 2017. Retrieved October 07, 2020, from https://jamanetwork.com/journals/jama/fullarticle/2735809
• Santhanam, L. (2019, October 18). Youth suicide rates are on the rise in the U.S. Retrieved October 07, 2020, from https://www.pbs.org/newshour/health/youth-suicide-rates-are-on-the-rise-in-the-u-s
• https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_09-508.pdf
• https://www.cdc.gov/nchs/data/databriefs/db352-h.pdf

[3] Silver, C. (2020, September 18). The Top 20 Economies in the World. Retrieved October 07, 2020, from https://www.investopedia.com/insights/worlds-top-economies/
[4] This is not to shame you.  You may have a legit challenge with anxiety due to disorder- if so, I’m sorry!  You may have tried seemingly everything to feel better and it just hangs around.  Keep reading, if this is you, because the post still applies, it’s just that I want you to know that you may have it harder than others, and you may need treatment.  Truly, this world is not fair.  But stay with me; there’s hope.
[5] http://www-personal.umich.edu/~daneis/symposium/2012/readings/Twenge2010.pdf
[6] The disorder is significantly more prevalent and impairing in high-income countries than in low- or middle-income countries.
[7] Walker, M. P. (2018). Why we sleep: The new science of sleep and dreams. London, UK: Penguin Books.
[8] CDC - Data and Statistics - Sleep and Sleep Disorders. (2017, May 02). Retrieved October 07, 2020, from https://www.cdc.gov/sleep/data_statistics.html
All Scripture quotations are ESV.  

“You want me to do what?!”  Many of my clients, and particularly for the sake of this article, Christian clients, are a bit surprised when I ask them to practice exposure.  Repeating scary, terrible thoughts on paper or aloud.  Doing things that feel risky.  It seems as a clinician I’m disrespecting your beliefs and don’t really get it.  Maybe I’m asking you to do something unbiblical, blasphemous, against what God would want.  But what if I do understand and am helping you live in line with your beliefs?  What if exposure is a powerful tool under God’s grace (Matthew 5:45) to help you get over a disorder?

The Great Hesitation.  When some clients start their treatment with me, I come across familiar hesitations when we begin discussing Exposure Therapy and facing one’s fears:

• What if I really am at risk of doing this thing I fear?  Won’t exposure make it worse?
• Are you asking me to do something that could go counter to my faith?
• Don’t I need to avoid this thing rather than giving it more credit?
• Isn’t this a spiritual problem?  Shouldn’t I pray more about this?
• Isn’t this Satan telling me lies?  
• If I have “bad thoughts” (thoughts of harming someone, making someone or myself sick, perverted sexual thoughts), shouldn’t I be on guard?  Flee temptation?  

Maybe.  I of course do not know your (the reader’s) story, so I cannot say for you personally.  Though, here’s the problem many of my clients run into: they are reinforcing fear every time they avoid and run from thoughts/urges/impulses/feelings that are out of fear rather than a want (see an important article on this for more: FACE fear, FLEE Temptation).  Some basic science is in order here: when you fight and resist a thought, it persists (e.g., don’t think of the pink elephant, trying to get a song out of your head, etc.).  That’s the way it’s supposed to work- a threat believed to be a threat is supposed to feel like a threat.

This is where exposure therapy comes in.  As a summary, exposure is the systematic and intentional triggering of fear while minimizing- and ideally eliminating- all pathological responses.  In the therapy process, when I start to introduce clients to the idea of sitting with fear mindfully and not fighting it, most have hesitations.  “You’re telling me to do what?!  You want me to repeat these horrific thoughts again and again?!”  I get it; it seems paradoxical.  Most people can rather quickly wrap their heads around an exposure to an overt situational fear (like holding a kitchen knife when you have an intrusive harm fear) but have a harder time understanding exposure for other “Pure O” intrusions, such as harm and scrupulosity, like the following:

• “I’ll be responsible for my child’s death.”
• “I’ve picked the wrong person to be with.”
• “Maybe that bump I heard in my car was a person.  Should I check to see if they’re okay?”
• “Was I just attracted to a dog?  Did I just get turned on?”
• “I must not believe in God because I feel numb when I say His name.”
• “What if I just get up and run into oncoming traffic?”

The above are examples of intrusive thoughts; they are counter to what a person holds as their overall value and pursuit, or “ego-dystonic.”  If you want to know all about treating these thoughts through imaginal exposure, check out the article “Flip the Script- A Guide to Imaginal Exposure.”  And yes, I’ll tell you right now that if a person obsesses on the above or has ritualistic behaviors and avoidances, we are going to work with leaning into the discomfort of these, not ignoring them.  


The clinical rationale.  In all disorders featuring anxiety and fear, there is a problem with the system that signals something is wrong.  It’s broken.  Doesn’t work right.  It’s a fire alarm that goes off when there’s no fire.  A missile alert with no missile.  Depending on fear, a person might feel a range of things: fear, disgust, anger, sadness, loneliness, dread, regret, chest tightness, racing heart, sweaty palms, neck and back tension, and extensively more.  We tend to feel the feelings that a signal dictates.  For example:

• If you have ever thought someone nefarious was following you, you might have felt fear, suspicion, anger.  
• If a child cries after something you say, you might would feel sadness, regret, or shame.  
• When you say something socially that is a ‘miss,’ you might think you’ve totally embarrassed yourself.

When is a time you felt something strongly that turned out to be fine?  

In disordered behavior, people become over-focused (or under) on a narrow set of experiences.  People who are overly vigilant can run into some of the very problems they seek to avoid, or a different set of problems.  Examples: 

• If you repeatedly fear you might say something wrong and avoid talking in social settings, in time others may actually start to avoid you or stop talking to you altogether since they can’t have a conversation with someone who won’t engage them!  
• Overwashing and cleaning the body leads to less resistance to germs, increased cuts and open skin with greater risks of various health problems.  
• Spiritually, a person who compulsively prays that they will be kept safe will be over-focused on small details (saying a certain thing a certain way, fearfully repeating the same thing, or maybe focused on only a narrow scope of safety like driving, contamination, or health).  This will lead to loss of seeing the bigger picture.  

The Biblical rationale.
If we are to change the outcomes for people who suffer from disorders, psychology has developed some very solid tools.  If you believe, like I do, that the Bible is God’s Word and is meant to have authority in your life, then you’ll likely need a good biblical rationale for exposure therapy.  Here goes on my end, but I am going to ask you personally to dig in.  This is your decision.  Don’t rely on some therapist to tell you what to think- talk to God, pray, use the brain He’s given and be open to the teaching of trustworthy others (2 Timothy 4:2).

Truth is very important in the Christian faith (John 17:17; Psalm 145:18; Proverbs 12:22; John 4:24; 1 Corinthians 13:4-6).  If part of being the church of Christ is to speak the truth to one another, including difficult things like anger (Ephesians 4:15, 26), I remind clients often that if you have intrusive, obsessive, or otherwise bothersome thought or feeling, being open about them and calling them out is simply being honest.  It’s being truthful.  God knows what’s going on in your head (1 John 3:20)!

When Philippians 4:8 is brought up, it is sometimes a “proof text” on how you “should always thinking positive.”  That’s a remarkably short-sighted, superficial view.  
“Finally, brothers, whatever is true, whatever is honorable, whatever is just, whatever is pure, whatever is lovely, whatever is commendable, if there is any excellence, if there is anything worthy of praise, think about these things.”  
This clearly can’t mean to not think about negative things, evil, or something terrible.  If so, we’d never be able to ask forgiveness of our sins by calling them out and repenting!  One of the ways that we can think on things like justice, honor, love, etc. is by calling out the opposite: injustice, dishonor, and selfishness.  It is in acknowledgement of problems that the solution can be instilled.  

God knows our hearts (Proverbs 21:2; 1 Samuel 16:7; Jeremiah 17:10; Acts 15:8; Romans 8:27).  If you’re afraid you might do something bad, do you believe God knows that?  And if you’re going to do something bad and be unrepentant, then you aren’t going to repent, right?  And if that’s the case, why are you trying?  If you’re doomed, what’s the point in trying to change that?  If there’s a chance- even if you don’t feel like it in the moment- just a small chance that you can take to God your innermost thoughts and feelings and get love and grace and forgiveness and peace and patience, is it worth it to you?  Would you be willing to try?  

Walking with God means we are “...casting all your anxieties on him, because he cares for you” (1 Peter 5:7).  Nowhere in the Bible does it say you will not feel anxiety or struggle with anxiety.  It tells us how to frame it (1 Peter 5:7; Philippians 4:6-8), that fear is not God’s heart for us (1 John 4:19), and that he loves us in it (each of these references prior reflects God’s gentle, patient love).  The Bible is not a psychology textbook or methods and techniques class.  While we walk with Christ, we learn to depend on God by faith.  Sometimes that’s therapy, medication, prayer, community, repentance, exercise, gratitude, acceptance, rest, or any number of things.  

Obviously, we are not going to find a passage that says, “do exposure therapy”  (and of course, “pay good money for it”, ha!).  

Compassion and Understanding to You
When clients come to me with thoughts and behaviors they are bothered by, the last thing they want to do is to look it squarely in the face or write it down or say it aloud (It’s called exposure for a reason).  But in reality, this is what helps shine the light on it- calling it out in truth.  It calls it to the table to do business.  In the end, you must personally seek the Lord, and I hope through prayer, His Word, and community to determine what steps you will take in anything important in life.  I do hope that if you can benefit from something like Exposure Therapy, you will find, as I have, that it is a tool, albeit human and imperfect, that God has graciously allowed us to discover, maybe like penicillin, insulin, the benefits of exercise, or Vitamin D..  May the created point back to The Creator and show His goodness and love.  

“If you then, who are evil, know how to give good gifts to your children, how much more will your Father who is in heaven give good things to those who ask him! (Matthew 7:11, ESV).  

“For he makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust” (Matthew 5:45 b, ESV).

“...He cares for you” (1 Peter 5:7b).

 

Katherine didn’t understand why this pandemic hit her so hard. In fact, she was embarrassed that it did. “I mean, my routines and orderliness can be a little overboard, but I’ve never had difficulty getting by day-to-day. I cry at the drop of a hat and just don't know what to do." I was so honored that she admitted she was struggling, because in that honest vulnerability, she is now getting help.*

In this time of COVID-19, there is a common expectation: the misconception that "healthy" means we won't feel anxious - or the opposite: success is defined by feeling completely safe, confident, or certain. That's crap.
​
Though it’s nice to feel less anxious, it’s not always reality, even if we’re doing all the right things. I mostly work with clients by helping them learn to stay focused on things of value, regardless of how they feel. Overall anxiety reduction is a result of various factors and is rarely immediate. In time, with supportive factors, anxiety often will go down. Jesus himself felt greatly distressed and overwhelmed, at times, too, if you didn’t know. He wept, sweated, pleaded, was scared, bled, and got angry and frustrated. He understands because he can actually relate - physically and emotionally. He gets Katherine's suffering - and yours, too.
Life involves not only facing bad things that don't happen, but also bad things that do. The question is, are you trained and ready? Can you still keep your focus even when the world around you and inside of you seems to be in chaos? Here are some quick tips to help you stay grounded in reality.


1. Be assertive. Routines have changed. We have to communicate to make the covert overt, like telling your loved one if you need a break to recharge (they can't read your mind!).
2. Be careful of untrue thoughts. Unrealistic thought patterns negatively impact our entire life, like All-or-Nothing Thinking. For example, "Since I’ve been eating poorly it doesn't make a difference if I exercise.” Katherine, mentioned earlier, fell into this trap by believing she was doing a terrible job simply because she felt overwhelmed. Mental health is based on grasping reality to the extent we can. Watch your thoughts and line them up with reality as much as possible.
3. Don't over-consume on substances. Caffeine and alcohol are certainly the most popular substances to monitor.
4. Downtime/Mindfulness/Quiet. The importance of giving our brain pauses and rest cannot be overstated. During a crisis, we need more intentionality to slow down unhealthy processes that are automatic or deeply ingrained. Learn to be mindful, slow down the process, and/or meditate on something beneficial- like how much God cares for you and promises to never leave or forsake you. Benefits range from increased focus and function to decreased stress and disease.
5. Emotions, Thoughts, and Behaviors - Tune In. Be aware of your thoughts, emotions, and behaviors. God gave you these - learn to pay attention to them and discover how to respond - sometimes in ways you might not expect.
6. Exercise. Exercise is highly connected to mental health. If you’re stuck in the house, there are ways to get creative. Make a game with a fitness tracker! Compete with others! Set up prizes for yourself or children! Get outside where possible and get moving.
7. Get Support. Use trustworthy support. Few things in life (if any) are done well without support. One place to get support is through an online or in-person Live Second Group.
8. Have fun! We all need reminding to pursue fun. Even the term ‘recreation’ is based on the concept 'recreate '- “to give new life.”
9. Medication. Medication can play a necessary role in well-being. You don’t need to feel shame if you can use a physiological boost for your brain health. Consult a health professional if this would be the right option for you.
10. Normal structure. Our brains integrate information we don't need to remember and becomes second nature. So when you change your routine massively, you will feel out of balance. That’s okay! Try to make use of old structures while learning to develop new ones!
11. Nutrition/Diet. Be careful not to overindulge on carbs and sugars - the snacky & sweet food you may feel the urge to “pound,”which can offer quick energy and pleasure, but overconsumption won’t benefit you. In fact, it will impact you negatively.
12. Prayer. Open communication and presence with the God of the universe is what we access through prayer! His power is what I need; it's really good to follow a big God who is over all our circumstances.
13. Prioritize. Limit inputs of information and stimulation or your brain will do its best to force limits and push you back into what’s called “homeostasis” (or balance), which can lead to feeling burnout and depression.
14. Serve others. Loving our neighbor as ourselves is beautiful. Not only does it help them, but we also can find much encouragement and joy. Learning and growth is often solidified when we can teach, pass along, and serve. Win-win.
15. Sleep. As one of the most important contributors to all aspects of health, good sleep is a necessary foundation to good health.
16. Spend/Save/Give money. Work from a budget. Spending money can be satisfying. Giving it away is powerful to others and ourselves. Taking on unnecessary debts, overspending and being miserly or hypervigilant all lead to stress in different ways.
17. Socialize. We are social beings. Direct contact releases neurotransmitters! But so can positive interactions in this time where we can’t touch much. Wow! For the time being, technology, phones, letters, or writing on messages on cardboard goes a long way.
18. Spirituality/Faith. What do you live for? What do you believe? And are you living congruently with it? Are you allowing yourself to ask questions and pursue guidance, support, and practices around what is good and true and beautiful and lovely? To discover more about what it looks like to follow Jesus watch this.
19. Sunlight. Not only is sunlight important in Vitamin D production, natural light is linked with numerous processes ranging from sleep to mood and much more. If you must be indoors or have limitations on natural light, find ways to maximize it.
20. Supplements. There is good evidence that several supplements can aid in mental health; some linked most commonly to mental health are Vitamin D, B Complex, and Omega-3 Fatty Acids (always follow your doctor’s advice).
21. Your context is your context. Don't compare. "Comparison is the thief of joy." When we look at where we are, don't let expectations crowd out what you're supposed to be about.
Keep in mind this is educational content and not intended as a substitute for professional advice, treatment, or diagnosis. Any of these tips will come across as too simple for someone suffering highly.

“Gotta go!” Dave looks at his watch, kisses his wife, and walks out the door.  With just enough time to get ready and leave for work, Dave doesn’t have any time to reflect on the day and pray.  “I’ll do it later,” he thinks to himself.  At lunch, quickly bowing his head over his chicken casserole leftovers, he says a perfunctory, “Thanks, God.  Keep me focused today on what I need to get done.  Amen.”  As with most days, since the job is particularly tiring, once Dave gets home, he relaxes with some TV, dinner, and conversation with his wife.  Exhausted when he heads to bed, he says a prayer before he jumps under the covers, but he loses his train of thought.  “Goodnight.”  On to the next day.

Noted speaker, author, and pastor- John Ortberg- asked of his good friend and spiritual mentor, Dallas Willard, what he needed to do to be spiritually healthy.  Expecting some bullet points and great wisdom from this spiritual giant, Willard said, “You must ruthlessly eliminate hurry from your life.”  After pausing and a re-emphasis of the same statement by Dallas, John wrote it down.  In a hurried fashion, then he asked what was next.  “There is nothing else,” said the wise man he spoke to.  “You must ruthlessly eliminate hurry from your life, for hurry is the great enemy of spiritual life in our world today.” (Find the story here.)

This hurry is the same thing that keeps us running around with just one more thing to do and one more place to go.  It is a problem of a hurried heart.  It is not the same as having many responsibilities.  Hurry is the rush of “one more thing,” being busy is having a lot to do.  The latter can be done with peace, a calm heart, rest, and love.  The former cannot.  It is not settled, is not content, and it does not rest.

How does hurry hurt us?  It keeps us thinking outside of the moment.  It requires another accomplishment to be satisfied.  It has no end.  It does not fulfill.  We cannot have a close relationship without spending time, without sitting and listening and being with someone.  The hurried spiritual life is as fallacious as the hurried relationship.  Sprinkle a few minutes in here or there, say some nice things, and be on your way.  It does not work.

Distractions abound.  Tasks require our attention.  There is a limitless ocean of needs.  But a healthy spiritual life requires slowing down.  It re-prioritizes.  It takes a breath.  To quote Psalm 46:10 (ESV): “Be still, and know that I am God.”  I am now closing my computer to do just that.

Yours truly,
Justin