Anxiety is something that everyone experiences from time to time in their lives. It is also something that many people can fight off by various psychological strategies for e.g. telling ourselves that our fears are irrational, by prayer i.e. by “casting all your anxieties on him, because he cares for you” (1 Peter 5:7), or simply by forcing ourselves to face our fears and push through them.
As a result of the universality of fear, I think many Christians struggle with accepting the idea of anxiety disorders as an illness. In fact anxiety disorders can be very severe, in common with the other major groups of disorders (depression, Bipolar Disorder, and Psychotic disorders). What we are talking about here is anxiety that you can’t simply ignore or “pull yourself together” over. We are talking about anxiety that is crushing, that grips the heart, that can come on from nowhere, and that can be very disabling.
Anxiety disorders are subdivided as follows
- Generalized Anxiety Disorder To be given this diagnosis people must be filled with a sense of generalized uncontrollable worry that affects their ability to function most days for at least six months.
- Panic Disorder Patients have repeated panic attacks that can be severe enough to send them to Emergency rooms believing they are having a serious medical condition like a heart attack. These lead to anticipatory anxiety and can be very disabling.
- Phobias Are specific fears of for example being in public places (agoraphobia), being in social situations (social phobia), or of specific things, eg dogs.
- Obsessive-Compulsive Disorder Intrustive thoughts and compulsive actions are incredibly disruptive to a person’s normal life.
- Post Traumatic Stress Disorder Which can arise after terrifying and life-threatening situations, and can include disabling flashbacks.
It is clear that these disorders are quite varied, but anxiety is at the core of all of them. Treatment for anxiety disorders should again follow the bio-psycho-social model, and for a Christian the spiritual element should not be forgotten. Best success will be found in targeting each of these elements.
Medications have been shown to be of use in these conditions, antidepressants definitely have a role, and the short term use of benzodiazepines can also bring relief. I have heard of very disciplined people who carry a couple of tablets of something like diazepam around with them, knowing that they could always take one if they had a panic attack, but not having to actually use the tablets. The use of benzodiazepines in the long term is not advised due to their habit-forming properties.
Cognitive Behavioral Therapy (CBT) has been shown to have a very important role in treating these conditions, and some other forms of therapy can also play a role.
Helping people around the sufferer to know how to respond to these disorders can be invaluable. Some families can actually reinforce the problems and make them worse, while others may respond with inappropriate frustration.
Here, spiritual disciplines like prayer, meditation, and the reading and application of specific Bible verses can all be beneficial. The key challenge is that the Bible seems to offer promises like “perfect love casts out all fear” (1 John 4:18). How should we deal with those verses when we are gripped with anxiety? The answer is not to try to force ourselves not to be anxious, as the illnesses can have such a grip that is not possible. Rather, the way forward is to grip on to these verses as promises that will one day be fulfilled in our lives, turn them into a prayer, and allow their words to run through our minds repeatedly. I remember one patient I met who had taken some favorite Bible verses and repeated them to herself three times a day for years. In the morning she had prayed them to God “thank you that you have promised….”, at lunch time she had told them to herself “God will make you….” and in the evening she boldly declared them to the devil and anybody else who could hear “God has said of me….!”. After months or years of such spiritual exercises their impact can be massive. We need to appreciate that such spiritual treatments should be used in conjunction with medical treatments, and that they often take a long time to take effect.
Anxiety disorders can be hard to treat, but there is hope, and it is important to be patient with all four of these kinds of treatment rather than try something briefly and conclude it doesn’t work. Gentle, compassionate pastoral care can go a long way. A person with anxiety disorder does not usually need your rebuke, but rather that you demonstrate the love of God to them. It was said of Jesus that,
“a bruised reed he will not break, and a smoldering wick he will not quench” (Matthew 12:20).