Anxiety (panic, OCD, PTSD, Generalized, phobias, etc.) is a multidetermined event. Any attempt to simplify down to either physiology or spiritual will be problematic. It is always a bodily event (everything we do is mediated through the cells), and it is always a spiritual event (nothing we do is neutral, everything either glorifies God or self). Multidetermined problems need multifaceted attacks. I think we do best to challenge our anxiety on these three fronts. Each front requires both body and soul so be careful not to think that one of the fronts is spiritual, one psychological, and one physical. All are involved in each front.
1. Attacking deception and self-deception. All anxiety has some level of intrusive thinking. We hear and repeat concerns, fears, worries, etc. that are based on misperception of self, other, and God. We accept deceptions given to us (naively) and at some point begin rehearsing them as our own. They work for us in some way (e.g., if we stay focused on what we think is the present danger, then maybe we can protect ourselves). How do we do this attack? We must rehearse God’s truth about us. We must rehearse a better reality. If you are inclined to think of yourself as rubbish, a lesser creature, then you must attack this thinking with the truth. If you are inclined to worry about self-protection, then you must remember that you are the lost sheep and lost sheep need to stop trying to find their way out of the wilderness and wait on God for rescue. The heart of anxiety is telling you to worry about one thing while another is really the problem. If I worry about my health, I’m missing the present opportunities that God is giving me to serve him in my weakness. If I worry about whether I’m a fraud, then I’m missing the fact that God uses cracked clay pots to do his service. This work requires us to use our minds, to consider God’s truth, and to consider the environmental influences on us.
2. Meditation and Worship. Its one thing to challenge misperceptions and worries directly, but it is also useful to forcefully put our minds on other things. Again, anxiety tells you to sit up and take notice of this particular concern. Treatment requires you to focus on other things instead. There is a level of distraction involved here, but it is more than that. It is choosing to place one’s mind over and over on other things, completely unrelated to the fear. While the fearful may find this very difficult, it is a practiced event, to be mindful of one thing while another is screaming for your attention in the background. Have you ever had a paper cut? It hurts. But by placing your mind on something else and practicing that habit again and again, you can choose to not enlarge the pain to fill up your entire existence. Or how about at the dentist? I do not like getting shots but I have found that if I calm myself and focus my mind on another reality, the pain is distant and does not need to command my full attention. One good way to practice this worship is to pick one idea, one meditation to return to over and over again. Like returning to savor a coffee, a piece of chocolate, a smell, the sight of something beautiful, meditating on one truth allows you be become expert in its many facets. This work requires you to gain control over you mind and body and to submit yourself to some bit of worship of God.
3. New Habits. All anxiety contains some level of compulsive behavior. It calls you to do something about it to relieve the fear. You are afraid of dying? Check your pulse, call the doctor. You are afraid of attack? Avoid all possible danger? You are afraid of going to hell? Say 3 hours of prayers, do something good for God. You fear a conversation with your boss? Ruminate on every little detail of what you want to say to her. This is why cognitive-behavioral therapy consists of systematic exposure to feared things/ideas and yet not allowing the bad response to happen. What habits do you need to practice to break the cycle of “if A, then B” (A is feared stimulus, B is cognitive/physical response to fear). If you find yourself ruminating, choose to listen to music, to talk with a friend, to exercise. If you find yourself worrying about your health, choose to avoid the little checks you do. If you have a friend who listens to you dump your worries on them, choose to have them review the new habits you are practicing. Use medications if necessary and appropriate. Get connected to others–if evenings are hard, practice the art of helping someone else then. If you wake up at night, practice praying immediately for someone else and thank the Lord for the opportunity to bless that person again and again. Then you will be less likely to repeat core beliefs that you are in a tough spot. Habits require your body, heart and mind to maintain them on a consistent level. There are times when you can’t talk back to the fears (#1) or keep your mind focused (#2), but you can pick yourself up and do something physical for someone else.
Musings on Faith and Psychology 
From time to time I talk with women who are struggling with food issues, whether it’s binge eating or binging and purging–and these three approaches to the problem often come up: examinging what we really believe; focusing on truth and then “putting off and putting on.”
For many years I hid behind a label called the “eating disorder.” I was diagnosed as both a bulimic and anorexic–and there was somethign about these labels that became part of my identity. They served as a kind of self-fulfilling prophecy for my future behavior.
How true do you think this is of psychology and the labels it provides for behavior? Psychology seems to be excellent at description of behavior; but does it provide the prescriptive answer?
P.S. Not trying to take pot shots at you… I’m interested in counseling, though today am wholly persuaded by the nouthetic approach. Like to dialogue (or should I say engage in discussion?)
Nan, big questions there. Labels can be used in a self-fulfilling prophecy way. If I reduce my son to “hyperactive” then I will see him in that dimension more than others. If I label him “rebellious” then I will see his fidgetyness in that light and not others. The problem is not the label so much as it is us who use them. Labels describe, they don’t prescribe. Psychiatric labels do not prescribe and don’t intend to. That doesn’t make psychiatric labels useless but does limit their value. For example, those struggling with eating disorders may see themselves as wholly different from those with addictions. In fact, there are many (not all) similarities.
So, the problem is not with psychiatry, psychology, medications, etc. Its with the hearts of those who use labels and meds to otherize themselves from the rest of the community.
As to nouthetic, I guess you’d have to tell me why you are wholly persuaded by that approach and what you mean by that. Nouthetic is not very well defined in my opinion–and not something many people use even when they have significant sympathies with Adams or the next generation of biblical counselors. Nouthetic spent more time saying what it wasn’t and even Adams described himself as a bulldozer and expecting that others would come along and build on what he started.
For me I become anxious about being anxious. I start to feel anxious and I am concerned that I will always feel this way. Somehow I have to break that pattern but it becomes VERY difficult. I pray and I read the bible and I call out to God but it almost becomes a self-fulfilling prophecy; I become anxous about being anxious and I end up being anxious.
Me too. My hope is that God will reveal to me his truth and that I’ll over this.
Thank you so much for sharing your wisdom on this topic. I’ve always been a worry wart ever since I was a child. But recently I’ve been struggling with persistent anxiety. Mainly concerning my health. I’m blessed and (as far as I know) healthy. But I worry so much about sudden illness or cancer. Like you wrote in your post, I find myself doing multiple self checks and endless research online. I see myself turning into a hypochondriac and I hate it! Your post really spoke to my heart. Giving the Lord my anxiety and choosing not to dwell on my fears is a daily struggle. I’m so thankful the Lord is patient with us! Thanks again!