Marian Eberly, MSW, LCSW, RN, BCPCC, Ph.D.
Christians who suffer with anxiety frequently report a sense of guilt and perceptions of judgment from God and others. Rebecca, a 50 year old woman, being treated for an eating disorder and anxiety symptoms, expressed incredible guilt for having ravaged her body for many years with binge-eating, purging with laxatives and bouts of starvation. She spoke of guilt for choices made that cannot be undone and remorse for the serious lifelong health, relational and spiritual consequences that followed those choices. She believed that God could not forgive her and that she was deserving of continued suffering.
One of the central tenets of the Christian faith is that of forgiveness when Christian believers are repentant for the wrongs they have done against self and others. Wise counselors intentionally tread very carefully and slowly at such times, listening more and speaking less recognizing that God is at work in the heart, and that process is worthy of respect. The recognition of self-destructive behaviors is a significant step toward repentance, after which God’s mercy and love can be received. This acceptance of God’s gift of mercy can be a challenge for the person who deems themselves unworthy of that gift in the first place. It is in this light that we better understand the spiritual effects of anxiety. If not for belief in redemption through Christ’s love and forgiveness all Christians would be extremely anxious.
Therefore, the treatment of anxiety, practiced from a distinctly Christian counseling perspective requires careful assessment to determine if anxiety has been the result of the person’s religious belief system, or whether the symptoms of anxiety have been ameliorated by one’s religious faith…or is it a combination of the two? Assessment of religious attitudes, beliefs and behaviors on initial assessment is essential to a proper diagnosis of anxiety. In the example above, it became apparent in the initial assessment, that guilt and shame had been a familiar emotional response throughout Rebecca’s childhood, having been raised in a very strict religious home. It became evident she was responding to religious abuses. As therapists we understand how important it is to discern how religious or spiritual beliefs are understood, how they have been translated and experienced, and what the effects have been on one’s spiritual development.
The language we use to describe “religion” and “spirituality” has different connotations in various Christian circles today. The therapist is susceptible to how these words are received in the counseling session. Language should be chosen in such a way as to be “genuine, professional and in synchrony” with the patients’ language (Plante, 2001). Countertransference and transference issues may interfere as the beliefs of the therapist can potentially override the needs of the client. It is always appropriate to seek supervision and or refer clients to those who specialize in any area of treatment for particular intervention.
Research on religious coping:
Research in the field of religious coping indicates that religious faith has been both positively and negatively associated with anxiety (Plante & Sherman, 2001). Negative outcomes have been found in those suffering with anxiety that had strict religious backgrounds and persons of faith with obsessive-compulsive disorder (Shooka et al., 1998). Symptoms in these populations are demonstrated as heightened anxiety related to perfectionism and approval. However, overall it appears that religious faith involvement has been shown to have a positive correlation to anxiety for those who are intrinsically religious or who employ religious coping mechanisms (Jahangit, 1995). Ultimately, there is a plethora of research that indicates a normal, healthy religious life appears to be a contributing factor to positive mental health outcomes and negatively associated with anxiety disorders (Plante & Sherman, 2001).
Spiritual effects of anxiety:
Clearly there are a multitude of effects anxiety can have on the spiritual life of a person. This discussion is limited to two infrequently mentioned effects.
Diminished faith: In regard to Rebecca (previously mentioned) she doubted God and spoke of her diminished faith. Anxiety, for a Christian, can be misunderstood as simply not having enough faith. The judgment leveled against oneself in regard to deficiency of faith reflects a type of negative thinking and coping that permeates one’s conceptualization of God. It may sound like this: “I lack the faith to believe” and “I worry instead of believing.” This perspective reveals the belief that God has essentially become non-performing because the individual does not have enough faith. The misconception is that God is dependent upon our faith to act. Since God is sovereign and self-determining he invites us to have faith to believe but does not require this faith to act on our behalf.
Non-action: Non-action when viewed as a lack of faith, passivity or hopelessness, fear or discouragement is disabling. In the book of Ezra the Israelites left the building of the temple unfinished for 17 years (Ezra 5: 1-2). What happened that they suddenly were able to get up and move and finish what God had asked them to do so many years before? They listened to two prophets, believed that they had a responsibility and acted in obedience. Noah built the ark; it didn’t build itself. Hannah, in great despair, prayed for a child actively. David picked up a stone and slung it as hard as he could to hit the bulls-eye of Goliath’s forehead, probably against all odds. Taking action one step at a time builds our faith. Taking one step at a time, being deliberate to do whatever the next thing is, is not a mere strategy for overcoming negative coping; it is essential to healing the debilitating effects of anxious thinking. This action was demonstrated by Jesus himself. In the garden of Gethsemane he prayed for the strength to do the next thing and take those next critical steps. He could have despaired, and resigned himself to the emotional pain of anxiety and walked away in hopelessness and doubt in his Father. Instead he gave us a formula to address our anxious thoughts (one of many found in Scripture) by demonstrating how to ask and pray for the Father’s will to be done. Perhaps the discouragement and anxiety so many speak of in regard to their faith experience has more to do with accepting whatever the Father’s will may be in a life.
In closing, the symptoms of anxiety can be debilitating to spiritual life…and the spiritual life can be the antidote to much of anxiety. A healthy religious life can have a positive effect on the hindering effects of anxiety. Koenig and colleagues (2000) confirmed through their research that religious helping is a coping style that correlated most strongly to positive health. When people can offer others the service of prayer support, encouragement and acts of helping it was found that this behavior related to positive outcomes such as less depression, a better quality of life and more spiritual growth. Those in emotional and physical pain need to hear the prescription to move to action, to build as the Israelites did. The ability to contribute to the lives of others is restorative to the soul and not a mere distraction from pain and suffering. The results are an increase in gratitude and often a fresh experience of peace, promised to renew the soul.
Koenig, H.G. (2000). The Healing Connection. Word Publishing: Nashville
Plante, T.G. & Sherman, A.C. (2001) Faith and Health: Psychological perspectives. Guildford Press: New York
Shooka, A., Al-Haddad, M., & Raees, A. (1998). OCD in Bahrain: A phenomenological profile. International Journal of Social Psychiatry,44, 147-154.
Jahangir, F. (1995). Third force therapy and its impact on treatment outcome. International Journal for the Psychology of Religion,5, 125-129.
Marian Eberly, Ph.D., RN, LCSW, has been practicing Christ-centered counseling for adults, adolescents and children for more than 25 years. She has served in various executive roles providing clinical and organizational leadership and program development in psychiatric inpatient programs, which encompass medical, nutritional, psychological and spiritual domains. Marian also specializes in the treatment of eating disorders and anxiety, has authored a clinical handbook on eating disorders, is a conference speaker, contributes to professional peer-reviewed journals, and operates a Christian counseling and consulting practice.