A Manual for Counseling People Who Struggle with Worry, Fear and Anxiety
I. Definitions, Descriptions and Symptoms
- Psychiatric definitions:
[The DSM-IV lists all worry-related problems under the category of “anxiety.” This category is then subdivided into three main sub-categories (although there are other specialized conditions as well, such as OCD and PTSD)]:
- Generalized Anxiety: this fear is a long lasting sense of dread that is not tied to any specific object or situation
- Phobia: this fear is tied to a specific thing, whether real or imaginary, that presents itself as a legitimate threat to the person’s sense of well being
- Panic: this is a brief but intense fear occurring without the presence of real danger that is accompanied by at least 4 of 13 somatic or cognitive symptoms (listed in DSM-IV)
b. Some Common Symptoms:
- Constant worrying
- Panic attacks
- Racing heartbeat
- Fear of losing control
c. Causes of Worry, Anxiety and Fear
- Psychiatric theory mainly assigns causation to physical problems, although cognitive problems are also included. However, even cognitive problems are often seen to be caused by physical problems.
- The Bible assigns causation to spiritual (“heart”) issues. Although it does not ignore the fact that the body can be one of the causes. “All issues are spiritual even if some issues are physical” (Ed Welch). We must be sensitive to see where anxiety might be exacerbated by bodily issues like the following:
- Endocrine disorders (e.g., hypothyroidism) or electrolyte imbalances
- Medications, drugs (legal or illegal; prescription or OTC)
- Mitral valve prolapse
d. Biblical definitions:
- φοβέω –phobeō – positively, to have a profound respect for God or another person (in a healthy acknowledgement of authority); negatively, to be afraid of someone or something
[This is not an exhaustive list of references; some that are positive could become negative]:
1. Matthew 10:28 – respect for God
2. Romans 13:3 – healthy respect for human authority
3. 1 Corinthians 2:3 – perhaps a fear that comes with proclaiming truth to people
4. 2 Corinthians 12:20 – fear of people you shepherd falling into sin
5. Philippians 2:12; Hebrews 4:1 – healthy fear of making sure one is saved
6. Jude 1:23 – fear of falling into sin
7. Matthew 10:28 – unhealthy fear of Man
8. Matthew 14:26, 17:7 – terror due to supernatural incidents (angels, “ghosts”, etc.)
9. Hebrews 2:15 – fear of death
10. 1 Peter 3:6 – fear of spouse or uncertainties in marriage context
11. Revelation 2:10 – fear of suffering
- μεριμνάω – merimnaō – positively this means to be concerned about the things God is concerned about; negatively this means to be inappropriately concerned about your own desires and potential disappointment of those desires (i.e., “worry”)
[This is not an exhaustive list of references]:
1. 1 Corinthians 7:32-34 –concern to take care of the needs of one’s spouse; concern to serve the Lord
2. 1 Corinthians 12:25 – concern for others in the Body of Christ
3. 2 Corinthians 11:28 – concern for the Church
4. Philippians 2:20 – concern for the welfare of others
5. Matthew 6:25, 31, 34 – worry about daily needs
6. Matthew 10:19 – worry about what to say to people hostile against the faith
7. Matthew 13:22 – worry about the distractions and issues of life
8. Philippians 4:6 – being worried and anxious about many things
9. 1 Peter 5:7 – we have anxieties that need to be given over to Jesus
II. Key Truths and Principles (Jones, BC401 Course Lectures)
- Concern is a “worry” seen with God’s perspective.
- Worry is a “concern” seen with our own perspective.
- Anxiety, Fear and Panic are just worry in greater intensity.
- “Panic is fear in high gear.”
- Reflect on whether a godly concern has begun to move out from under its submissive position under the throne of Jesus in your heart. Has it begun to climb the staircase (see attached diagram)? Has it become the king of your heart? If it has, worry, fear and anxiety are sure to follow!
III. Key Verses (Jones, BC401 Course Lectures)
- Matthew 6:19-34 – contrasts the desire to worry with the desire to singularly trust in God
Insights on worry:
- Worry is sin…which means it is solvable, not a hopeless, fatalistic “disorder”! (v. 23)
- Even Christians can worry (“Oh you of little faith!”) (v. 30)
- Jesus gives hope and help for worriers (vv. 32-33)
- Worry is wrong because it expresses heart idolatry (vv. 19-24) and unbelief (vv. 25-34).
Remedy for worry: repentance and faith in God for His promises and character (vv. 25-33).
- Philippians 4:6-9 – Paul gives a prohibition not to worry (v. 6a), a prescription to solve our worry problem (Pray: v. 6b; Think: v. 8; Obey: v.9) and a promise to sustain us in our faith (vv.7, 9). [Make sure to place the prescription in the context of Jesus who strengthens (v. 13)]
- Others: 1 Peter 5:6-7; John 14; Psalms (especially chapters 3; 4; 23; 27; 34; 37; 46)
IV. Ministry Strategies and Steps to Counsel
Helpful diagnostic questions: (Jones, BC401 Course Lectures)
- “Tell me what you are concerned about.” You will get more info than if you call it “worry”.
- “Do you ever find your legitimate concerns crossing over into worry? How are you handling that?”
- “What good things do you fear you won’t get? What bad things do you fear you will get?”
- “What do you crave, savor, fear, focus on, etc? What ‘one thing’ do you live for?”
Counseling Steps: (Jones, BC401 Course Lectures)
- Give Hope according to the promises of Christ.
- Get to know the person and gather information, with compassion
- Understand their situational “heat” and behavior patterns “fruit/thorns” (see attached diagram)
- Remember that some worries are legitimate even if responded to sinfully
Establish your goal for your counselee.
- Present a progressive sanctification agenda (i.e., remember that change is a process)
Identify and deal with sinful behavior (bad fruits)
- Watch for sins of omission as well as commission
- Use two great commandments to discern kingdom allegiances (theirs or God’s)
Identify and deal with heart issues (bad roots) to expose idolatry and unbelief and to call people to repent and believe God’s Word.
- Idolatry: serving yourself, people or things more than God
- Unbelief: believing lies more than God’s promises
- “When anything other than Jesus is your ‘one thing,’ you will be susceptible to anxiety.” – (Tim Keller citing Augustine)
- Any time you love or want something deeply, you will notice fear and anxieties because you might not get them.” – (Ed Welch, Running Scared, 28)
Stress God’s promises and provisions in Christ and call people to growing faith.
- Form of Anxiety Promise for Battling Unbelief
- Risky new adventure/meeting Isaiah 41:10
- My ministry being useless/empty Isaiah 55:11
- Being too weak to do my work 2 Cor 12:9
- Decisions about the future Psalm 32:8
- Facing opponents Rom 8:31
- Welfare of those I love Matt 7:11; Mark 10:29-30
- Being sick Psalm 34:19; Rom 5:3-5
- Getting old Isaiah 46:4
- Dying Rom 14:7-9
- Shipwreck faith/fall away from God Phil 1:6; Heb 7:25
(Piper, Future Grace, 59-61)
Help the person sort out his legitimate concerns and God-given responsibilities.
- Circle of concerns vs. Circle of Responsibilities chart (Paul Tripp, Instruments in the Redeemer’s Hands, 250-257) (see attached diagram)
Be sure the person includes loving concern for others as a focus (Phil. 2:20; 1 Cor. 12:25)
For those legitimate concerns, teach the person to pray specifically.
For those God-given responsibilities, train the person to pursue them boldly, diligently and with dependence on God’s power (2 Tim. 1:7; 1 Thess. 5:14)
Share appropriate testimonies of how God has helped you and others fight against worry, anxiety, and fear.
V. Assignment Ideas
- Gathering Information: “Worry Inventories 1 & 2” by Wayne Mack; “Anxiety Journal” – Priolo
- Discerning Heart Issues: walk through throne and staircase diagram with concerns of counselee
(see attached diagram)
- Discerning Heart Issues: “Sorting Out Your Concerns and Your Worries” by Robert D. Jones
- Provisions of Christ: “John 14 and the Problem of Anxiety”; “God as our Refuge in the Psalms” by Robert D. Jones
- New Fruit: “Handling Fear God’s Way” by Robert D. Jones
VI. Recommended Resources
- Bridges, Jerry. Trusting God: Even When Life Hurts. NavPress, 1988.
- Jones, Robert D. “Getting to the Heart of Your Worry,” Journal of Biblical Counseling 17:3 (Spring 1999), 21-25
- Keller, Timothy. “Psalm 27 and the Problem of Anxiety.” Message in series from Psalms on “Ancient Solutions to Modern Problems.” Redeemer Presbyterian Church (New York, NY), 212-808-4450.
- Piper, John. “Faith in Future Grace vs. Anxiety.” Chap 3 in Future Grace. Sister, OR: Multnomah, 1995, pp.50-61.
- Welch, Edward T. Running Scared: Fear, Worry & the God of Rest. New Growth Press, 2007
Homework Assignment: Discerning Your Treasure
Jesus says in Matthew 6:21 that “where your treasure is, there your heart will be also.” Our hearts love the things that we value. Unfortunately, the things that we love, our treasures, are easy to lose (Matthew 6:19). The thought of losing these treasures causes our hearts to worry and fear. Most of the time when we feel worried, fearful, anxious or panicked we don’t know why. It seems to just come upon us and we find ourselves paralyzed in our thoughts, and perhaps even paralyzed in our bodies during a panic attack.Some keys to preventing these anxious behaviors is to first discern the treasures our heart has fallen in love with and to begin to see God as our highest and only true treasure (Matthew 6:24).
Answer the following questions with the first thoughts that come to mind:
1. If you didn’t have _______________ you would be unhappy.
2. If ______________ were taken away from you, you would not want to live.
3. If you had to choose between [your answers above] and God, which would you choose? Why?
God as Treasure:
Reflect on the following verses and write how they make you feel about God. Do you desire God more? Less? Are you indifferent? Why?
Psalm 37:4 –
Psalm 145 –
Hebrews 13:5-6 –