“And what does your anxiety do? It does not empty tomorrow, brother, of its sorrows; but, ah! it empties today of its strength.” In 1859, Baptist minister Alexander McLaren preached these words in Manchester, England. He continued, “It does not make you escape the evil, it makes you unfit to cope with it when it comes. It does not bless tomorrow, and it robs today. For every day has its own burden. We have always strength to bear the evil when it comes. We have not strength to bear the foreboding of it.”1
These words by the nineteenth-century preacher, later echoed by the more famous preacher Charles Spurgeon, are echoes of Jesus’ words two millennia before. He dedicated an entire passage of the Sermon on the Mount to the problem of anxiety. “Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient for the day is its own trouble” (Matt 6:34, ESV), He said.
Since sin entered this world, fear, worries, and anxieties have been a part of the everyday human experience. In the garden after having eaten the forbidden fruit, Adam said, “I heard the sound of you in the garden, and I was afraid” (Gen 3:10, ESV). God knows our propensity to anxiety. Again and again, throughout the Bible, the appeal is “fear not.” But there is never any condemnation of the fear itself. On our own, we have every reason to be anxious. The appeal is to surrender our anxieties to God because we trust in Him. In this world, we are surrounded by threats and dangers. The natural response is to be anxious. Yet, by focusing on them, by worrying about what might happen tomorrow, we risk missing out on not only today but on so much in life.
WHAT IS ANXIETY?
Occasional fear, worries, and anxieties are part of normal life. Many people worry about health, money, family problems, and other things. When normal everyday fears and worries are triggered, they help us to protect ourselves and focus on finding solutions. But when they become excessive, they become counterproductive. Instead of helping us solve problems, they become the problem. When that occurs, these excessive responses have become anxiety disorders we most likely need help to manage. For people with an anxiety disorder, the anxiety may pop up when it is not needed, or be a rather constant companion that becomes a distraction from living well. The symptoms can interfere with daily activities such as job performance, schoolwork, and relationships.
There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, social anxiety disorder, and various phobia-related disorders. They take on many shapes and forms and may change over time. But the defining characteristic of an anxiety disorder is that it causes more pain than gain.
WHO STRUGGLES WITH ANXIETY?
Anxiety disorders are the most common mental illnesses. Reports indicate that up to one in three at some point in life will experience an anxiety disorder.2 It is estimated that about three hundred million people in this world right now are suffering from an anxiety disorder, which means they are in need of professional treatment. Many more are struggling with anxiety issues. It is safe to say that if we are not struggling ourselves, we for sure know someone who is struggling. Many struggle without showing or telling it to anyone.
As is the case with most illnesses, both genetic and environmental factors contribute to the risk of developing an anxiety disorder. The risk factors for each type of anxiety disorder vary. However, some general risk factors include:
• shyness or feeling distressed or nervous in new situations in childhood
• exposure to stressful and negative life or environmental events
• a history of anxiety or other mental disorders in biological relatives
Anxiety symptoms can be produced or aggravated by:
• some physical health conditions, such as thyroid problems or heart arrhythmia
• caffeine or other substances/medications
If you think someone may have an anxiety disorder, getting a physical examination from a health care provider may help them in diagnosing the disorder and finding the right treatment.3
WHAT GOES ON IN THE ANXIOUS BRAIN?
Based on what we now know from brain research on anxiety, we may say that there are two main types of anxiety. The worrying kind of anxiety begins in the thinking part of the brain known as the cerebral cortex. It is the large, convoluted, gray part of the brain that makes up its outer surface, and involves our perceptions and thoughts about situations. The fear kind of anxiety begins in the deep er feeling part of the brain, especially the amygdala. The amygdala triggers the quick fight-or-flight-orfreeze response that is activated long before we are able to think about the perceived danger we have encountered.
Both the thinking and feeling parts of the brain are involved in all kinds of anxiety, but for our understanding of how to work with and help someone with anxiety, it is relevant to understand if it is the kind that starts with thinking and then later leads to troublesome feelings, or if it starts with intense feelings that we only later are able to start reflecting upon. If certain ideas, images, or worries trigger the anxiety, it is most likely a thinking-brain-based anxiety. If the anxiety is more sudden attacks of fear with strong physical reactions without apparent causes or which does not make much sense, it is more likely a feeling-brain-based anxiety.4
SELF-HELP FOR THE ANXIOUS
Worries, fears, and anxieties take on exaggerated proportions when someone is suffering from an anxiety disorder. The first step in dealing with it is to acknowledge that even though the thoughts and feelings are intense, they are not helpful. And, beyond that, they are excessive and are not the whole truth about whatever situation we are facing. Often, we have to do the opposite of what anxiety tells us to do. Instead of giving in to the thoughts and feelings, we have to manage them, counter them, and push back. This is usually hard work, and that is why the anxious need social support, encouragement, and help along the way.
To build one’s resilience, a healthy body will help the mind function better and be more balanced. Exercise, healthy nutrition, and optimizing for quality sleep are excellent places to start. Beyond that, it is important to connect. Connecting with God and with other people gives life meaning and fulfillment. The church could be and should be a place where social and spiritual connection is fostered and developed.
The earlier that treatment begins, the more effective it may be and the sooner and easier one may recover.
TREATMENT FOR ANXIETY
Milder cases of anxiety disorders may not require professional treatment, but whenever symptoms persist and negatively affect life, treatment should be considered. The earlier that treatment begins, the more effective it may be and the sooner and easier one may recover. Unfortunately, it is common for people to struggle on their own for years before seeking treatment.
Anxiety disorders are generally treated with psychotherapy, medication, or both. There are many ways to treat anxiety, and one should work with a health care provider to choose the best available treatment option.
Psychotherapy or “talk therapy” can help people with anxiety disorders. Processing thoughts, emotions, and behaviors is necessary to come up with strategies to manage them. To be effective, psychotherapy must be directed at your specific anxieties and tailored to your needs. For thinking-brainbased anxiety disorders, the focus will often be on rewiring our thinking pathways. For feeling-brainbased anxiety disorders, the focus will often be on rewiring our feeling pathways.
Medication does not cure anxiety disorders but can help relieve symptoms and make them more manageable. Health care providers—such as a psychiatrist, primary care provider, or sometimes a psychologist—can prescribe medication for anxiety. The most common classes of medications used to combat anxiety disorders are antidepressants that are equally effective for anxiety, specific anti-anxiety medications (such as benzodiazepines), antipsychotic medications, and beta-blockers. If someone does not experience the desired effect of one medication, or if the side effects are excessive, there are usually many other options.
Since mental disorders are complex, there is often some element of trial and error before the patient and the health care provider figure out what works best for the specific patient. Patience is therefore often necessary, so one does not give up if the first attempts do not achieve the desired outcomes.
MINISTERING TO THOSE WITH ANXIETY
When someone is struggling with anxiety, it may be clear to them and others that they are struggling with excessive fears and worries. It does not help though, when others tell them they are exaggerating, tell them to stop it, that it is nonsense, that it is not real. And it is definitely not helpful to suggest that what they are struggling with is rooted in a spiritual problem. Every human being who suffers and struggles needs and deserves empathy and compassion. Provide consistent practical, emotional, social, and spiritual support. Let the person share with you or someone else they want to talk to about what they are experiencing. Try to understand and empathize with what it feels like to be on the inside of the head of that person. If you are a safe person to them, that may be a starting point for them to feel safer in the world.
WHERE IS GOD FOR THE ANXIOUS?
In writing to the Philippians, the apostle Paul said, “Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus” (Phil 4:6–7, ESV). I believe Paul knew that we humans have a propensity to be anxious about many things. In this world, on our own, we are like children who have lost their parents. On our own, we struggle with fears and worries. But we are not lost children in this world. We have a Father who cares for us and “he is actually not far from each one of us” (Acts 17:27, ESV). The more “we live and move and have our being” (Acts 17:28, ESV) in Him, the more we may have the peace that Paul pointed the Philippians towards. Then we may say with the psalmist, “he is my steadfast love and my fortress, my stronghold and my deliverer, my shield and he in whom I take refuge” (Ps 144:2, ESV).
1 Alexander McLaren, “Anxious Care,” Sermon 21 in Sermons Preached in Union Chapel, Manchester (Manchester: Dunnill, Palmer, 1859), 288.
2 “Anxiety Disorders,” American Psychiatric Association, accessed March 31, 2022, https://www.psychiatry.org/patients-families/anxiety-disorders.
3 “Anxiety Disorders,” National Institute of Mental Health, accessed July 11, 2022, https://www.nimh.nih.gov/health/topics/ anxiety-disorders.
4 Catherine M. Pittman, Rewire Your Anxious Brain: How to Use the Neuroscience of Fear to End Anxiety, Panic, and Worry (Oakland, CA: New Harbinger, 2015).
Torben Bergland, MD, is a psychiatrist and an associate director of Health Ministries at the General Conference of Seventh-day Adventists, Silver Spring, MD, USA.