This post is intended for Christians looking to deepen their faith and mental health.
The Bible has a lot to say about fear and anxiety. In fact, some variation of “do not be afraid” is the most common directive in Scripture, occurring in some fashion more than ‘do not steal,’ ‘do not kill,’ and even ‘love your neighbor.’
How do anxiety and fear work? When we study these constructs in research, we are understanding mechanisms through which the body/brain is informed to face a threat or danger. We can argue these responses are inherently good, with their purpose being survival, protection, and preparedness. Its activation results in the sympathetic nervous system being primed: adrenalin and noradrenalin are produced, cortisol increases, heart rate increases, blood flow moves to muscles and away from extremities, speed and depth of breathing increases, and many other physiological changes occur. I’m grateful to have these responses- when they are in context. Out of context, they suck, to put it bluntly. Problems like panic attacks, worry, phobias, obsessiveness, skin/hair picking/pulling, preoccupation, social fears, avoidance, and more can be quite terrible.
One of the things I love most in my walk with Christ is context. Direction.
“The Lord is at hand; do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God” (Philippians 4:5b-6, ESV).
What is being said here? Partly, “Do not be anxious about anything.” Since anxiety is a feeling of imminent threat- or in other words, it’s at hand- it’s very interesting that immediately before this phrase in Scripture we have another observation revealing a different type of imminence: “The Lord is at hand.”
In the context of the Lord being near we are told, “Do not be anxious.” This Greek word for ‘be anxious,’ μεριμνᾶτε (transliterated as “merimnate”), means to be divided and distracted, fearful, and caring for things that are out of context.
Sounds a lot like anxiety disorders, right? Yep. Or even just day to day worry/anxiety? Yep. When a person feels anxiety and fear and misinterprets this as significant, a person’s entire life and values can shift to focus on whatever is the subject of their fear, whether classified medically as a disorder or not. This can lead to a preoccupation with avoiding something or someone (spiders, relationships, sex, social situations) to obsessively checking to make sure everything is okay (car, stove, locks, bodily sensations, health, perfectionistic behavior), or pursuing something (money, security, approval of others)- and MUCH more.
To help work through these things and avoid pathological responses, I believe we need supports like therapy, help from friends, breathing techniques, mindfulness, exposure techniques, etc. This only underscores our complexity (we are “fearfully and wonderfully made” yet simultaneously all messed up) and highlights what we are told in Scripture about our limits. We can rightly use these tools to help us, just as we do nutrition, medicine, community, and so forth. But there is one thing these tools can’t do on their own: attach us to the very God of the universe and give us a lasting hope and focus- with meaning and purpose at the highest level.
So God gives us a jewel of a passage in Philippians 4 where we are kindly reminded what our attention is to be on (context), and a little bit of how we can live it out (practice). It is well known within the anxiety treatment world that even the most effective therapies (here’s looking at you, classic CBT, which I love and specialize in) often need supports to connect to larger beliefs, values, and commitments (ACT, DBT, and MI are some of the most common modalities). If we don’t connect a person to larger motivations and goals than “I just want to feel better,” it is often near impossible for a person to grow with sustainable change for the long term because they don’t have a sufficient reason and value to keep them invested. God gives us this.
Want more? Well, there’s two tips in the next two verses, Philippians 4:8-9
“Anxious for nothing” will take a lifetime to put into practice. I’m grateful to have the opportunity.
 Continued misinterpretation and repetitive experience of these symptoms worsens disorder, like in Panic Disorder, GAD, Phobias, OCD, PTSD, and more.
 Bible Hub. (n.d.). 3309. merimnaó. Retrieved July 13, 2019, from https://biblehub.com/greek/3309.htm
 I think it’s very important to note that we have to be very careful with saying anxiety/fear is sin- and what we mean by this. A lot of Christians get tripped up on this, and many, ironically, become more anxious. The extent of this point would likely require an entire book, so I will not take the space here to elaborate.
 Psalm 139:14; Genesis 1:26-27
 Jeremiah 17:9; Romans 3:23
 Psalm 73:26; 2 Corinthians 12:9-10
 Oh yes, there’s a whole lot more in Scripture on this topic. Let's not reduce a couple sentences into a "how-to-manual."
The Myth of Disappearing Distress. If I do the right things, I won't have to face suffering, right?
It's easy for me as a therapist to exhort my clients to stay focused on the prize DESPITE the distress they feel. How easy it is to get off track! And while it's also easy for me to tell someone else this, it can be very cumbersome to do in practice. I, too, struggle to keep focused when challenges hit. But I'm always best prepared when I lean on my team: #support #faith #accountability #truth.
In Vivo Exposure
Directly facing feared objects or situations, examples include:
Getting on a flight, touching a doorknob that feels “contaminated,” not going back to check a lock, or going to a social gathering.
Good exposure attempts to match the content and detail of a person's fear as close as possible. So, for example, if a person fears “going crazy” in a social setting, the best exercise will be working up to facing that, not just exposing to the thought or word. On the other hand, if the fear is that a person will have inappropriate impulses (to harm, sexually, etc.), sitting with the intrusive thought and being present will serve best.
Imaginal exposure involves accessing the content of fears and anxieties through cognitive means. For example, a fear that someone will fail, make the wrong decision, harm someone, die, or choose the wrong relationship are not accessed by activating these life occurrences. They are addressed imaginally.
There are many ways to practice Exposure imaginally, but the most common are writing scripts, stories, listening to recordings, watching videos, or using visualization.
To be clear, Imaginal exposure often is the most confusing and hardest to grasp of exposure practices, as it seems to be creating negative thoughts or “bringing” unrealistic and negative thoughts on- the seeming antithesis of most of psychology and cognitive therapy. But what is really done here is only facing what a person is already experiencing, thinking and feeling.
Intentionally bringing up physical sensations that are feared, such as:
Heart racing, shortness of breath, sweaty palms.
Ways to do this when a person's health allows are breathing through a cocktail straw, breathing rapidly, or sitting up quickly.
Virtual Reality (VR) Exposure
With the advent of new technology, we have a recently emerging type of exposure. Some may class Virtual Reality into imaginal exposure, but it can be seen as a cross between in vivo (situational) and imaginal. This is especially helpful with treating disorders such as Flying Phobia, where the access to an actual plane and flight to practice can be cost-prohibitive and difficult.
What is Exposure Therapy?
Exposure therapy is a psychological treatment that is practiced in Behavioral and Cognitive Behavioral Therapy (CBT). It is indicated as a first line treatment for a number of disorders such as
Exposure therapy helps clients to systematically confront fearful stimuli along with changing fearful responses. This relearning increases confidence and decreases disruption in life. Over time, discomfort and fear typically decreases through active engagement rather than avoidance, suppression, neutralization, or ritualization.
The evidence base is very strong for its use and effectiveness, though it is currently only applied a minority of the time in clinical settings.
How Do You Do Exposure Therapy?
The principles of exposure may be simple, but the specifics- personalized to any one individual- involve many working parts.
Do I want this, or do I not? Is this my actual desire, or what I don't want? Does this thought or desire define me? What if it's terrible or horrible?
Sometimes the things I think about are because I value them or desire them.
Sometimes the things I think about are because I don't value them or desire them.
What the heck?
Egosyntonic and Egodystonic are two psychological terms to describe phenomena of thoughts/urges that are synonymous and antonymous to what a person desires or wants. Sometimes our thoughts reflect very much what we desire or want, but around 90% of people endorse having "intrusive thoughts," or unwanted thoughts.
It is crucial to do a good functional analysis on a thought/behavior to determine whether someone is doing something in order to pursue- or to avoid- the very same thing.
“Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing.” – Helen Keller
I don’t want to live my life being overly cautious, but rather appropriately cautious.
We are discovering in the research of anxiety disorders, OCD, and now depressive disorders, that possessing an Intolerance of Uncertainty (IU) is a common construct linked with higher anxiety and life disruption.
What is IU?
My favorite definition: “Belief that uncertainty, newness, and change are intolerable because they are potentially dangerous” (Steketee et. al 2005, p. 125). IU links threat with uncertainty.
But is uncertainty a threat? Take a moment and ponder one of your favorite memories. What did it involve? Was there any risk? Any vulnerability? Any chance of failure? Most of the best life stories I hear are of those that involve, well, all of these things.
A person who cannot tolerate not knowing actually misses out. How? Isn’t knowledge power?
What happens is this: the more control a person must have, the less control a person has. The more certainty that is sought, the more narrowly circumscribed life becomes. Quick examples:
Want to know how you handle uncertainty? Take the free IUS-12 assessment here. [Go to "Read More" below to find out how to score the assessment.]
Let’s be clear: everyone is uncomfortable with some uncertainty. And reasonable protection from risks is part of being wise- which can also be subjective. But the more you necessitate that certainty must exist, the following is more likely to happen:
In the research on IU, there are also two subset strategies identified: Prospective anxiety (desire for predictability) and Inhibitory anxiety (uncertainty paralysis) (Fourtounas et. al 2016).
If you struggle with any of these, the next questions is this: How do I live with uncertainty and anxiety, while also taking suitable precautions?
The solution is fairly straightforward, but not easy.
Once a problem area has been identified (along with what is reasonable, normative, or within your values), gradually and consistently gain ground by pressing into your fear without using a false reassurance strategy that reinforces the false threat of uncertainty.
In therapy, one of the most powerful tools that exists to deal with uncertainty is what we call Exposure and Response Prevention (ERP). This is the single most effective tool in treating OCD, and it is very valuable in other disorders. The reasons it usually has to be done in therapy are several:
I personally love Exposure because it helps me face life with a “bring-it-on” attitude rather than a “stumble-through-best-I-can.” ERP in therapy is very specific, very structured, and very powerful. However, even the person who is not in therapy can benefit from its principles:
“Some men storm imaginary Alps all their lives, and die in the foothills cursing difficulties which do not exist.” ~Edgar Watson Howe
So what uncertainty are you not letting yourself live with? When is ‘not knowing’ unacceptable to you? Uncertainty is not the problem. It is unrealistic to be 100% certain about most everything in life. Life has few certificates of guarantee, and those are only as good as what is backing them. Ready to face your uncertainty?
In this season of rush....
I hate to admit it. Mom and Dad, please don't laugh too hard when I say....this.... I sometimes miss being told what to do. There. I said it.
I remember the drill of childhood. "When did you last eat? Here, have some food." "Looks like you could use a hug." "You're getting cranky; it's time for a nap."
In my super-mature “I'm-smarter-than-a-child” mentality, I miss some of the plainest truths in life. One of these is the importance of rest. It’s the weekend before Christmas, and all through my house are temptations to “achieve” and find my worth in what I do and the approval of others.
I’m trying to step back and rest. And I often will remind myself, “I’m more efficient when I rest.” What’s funny about that statement is that I still am finding an excuse for resting. What would it be like if I stop running the show for a moment? Slowing down the crazy pace of life is not only a discipline, it is an act of faith- one that acknowledges that I don’t control all and know all. And I don’t have to carry the universe on my shoulders. That’s freeing. I hope you “achieve” some great rest during this time of the year. Merry Christmas and Happy Holidays!!
A Psychotherapists' thoughts on healthy living.
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