Counseling Manual: Walking Alongside Others Struggling with Anxiety

Transcription

1 Counseling Manual: Walking Alongside Others Struggling with Anxiety A) WHAT IS ANXIETY? Fear is a natural response to the notion - The world is really big, and I am really small comparatively. Dr Sam Williams Many people live and deal with their anxieties on their own, without the help of a counselor. Anxiety can become disordered, however, and require individuals to seek additional help. Anxiety becomes disordered when anxieties have come to a point of affecting a person internally and functionally, dominating the person s life. 25% of Americans will experience one of the ten anxiety disorders in their lifetime. (DSM-V American Psychiatric Assoc.) Short of addiction, anxiety disorders are the most common mental disorders in the country. PANIC DISORDER Panic disorder is a controlling fear of having a panic attack. A panic attack is a sudden feeling of internal terror, extreme fear accompanied by a variety of physical symptoms of fear. Not all people who experience panic attacks have panic disorder. Once an individual has a panic attack, he or she can become preoccupied with preventing another attack. They can dread another attack, and become disabled by the fear. Usually the preceding year, the individual has undergone high levels of stress. Panic can then descend, seemingly out of the blue. When someone is having a panic attack, the worst thing you can do is to ask the person about their feelings. Ask them about almost anything else, to distract them until they get through the episode. Most panic attacks generally last anywhere from 5-45 minutes. Phobia is a intense, persistent fear of an object or

2 PHOBIA situation that poses no real threat. The individual then begins to avoid that which is feared. If the individual is able to avoid the phobia without much life disruption, most people manage phobias without counseling. Agoraphobia is a common phobia, a fear of having a fear incident away from an individual s safe place, usually their home. SOCIAL ANXIETY DISORDER SAD is an extreme phobia or fear of humiliation and social embarrassment. This disorder causes individuals to be highly anxious in everyday social situations, interfering with work, life, and friendships. Often related to particular actions speaking, eating, using the bathroom. How is SAD different than a phobia? The individual has a profound fear of the disapproval of others and social situations, not just an object. People are everywhere, and cannot be avoided. Many individuals with SAD limit themselves and choices to avoid embarrassment, and then create situations that cause difficulty in social settings. Their anxieties then become self-fulfilling prophecies. 50% of people with social phobias self-medicate and abuse drugs or alcohol. GENERALIZED ANXIETY DISORDER GAD is a chronic, diffuse anxiety or constant worry about many different areas of life, not simply one thing. The individual is always waiting for something bad to happen. When life circumstances go wrong, the GAD is activated. OBSESSIVE COMPULSIVE Obsessions are thoughts, worries, images, impulses that are intrusive or unwanted, resulting in intense levels of anxiety. The worry or impulse gets stuck in the mind. Compulsions are the rituals or behaviors performed in order to limit anxiety. People may realize that thoughts/behaviors are irrational. But feel they must perform

3 DISORDER compulsions in order to experience relief. What distinguishes OCD rituals from healthy rituals? OCD rituals interfere with daily life, consuming at least one hour of time. OCD sufferers become slaves to the sin that they don t want to commit. Depression and shame often accompany this disorder. Huge relief when counselees seek counseling. POST TRAUMATIC STRESS DISORDER PTSD is an anxiety disorder resulting from a failure to psychologically process a horrific experience. Not all traumatized individuals develop PTSD. People can be resilient. More likely when an individual has been traumatized by another human being, rather than natural event/occurrence. Variables affecting likelihood of PTSD: a. Intensity of trauma b. Duration of trauma c. Extent of threat d. Nature of trauma What are common symptoms? o Re-experiencing symptoms flashbacks, dreams, children repeating actions in play. o Emotional numbing, detachment o Variety of anxiety symptoms, often physical responses o Hyper-vigilant. Startles easily. Women are more likely to experience PTSD than men, possibly because of greater sense of helplessness. Our emotions speak for us they reveal our hearts. But strong emotions also speak to us, want to interpret life and take charge, tell us the way things are and direct our course. Ed Welch Symptoms

4 Physical Elevated Heart Rate Rapid breathing/difficulty breathing Chest Pain Head Ache/Body Ache Muscle Tension Stomach Ache Insomnia Appetite Reduced/Elevated Mental Paralyzing Indecisive Overactive Autonomic Nervous System Fight or Flight Difficult to Focus/Think Emotional Emotional Upheaval Irritable/Impatient Edgy Frustrated Angry Depression Spiritual Object of fear is HUGE while God is small B) WHAT ARE VALUABLE KEY POINTS TO REMEMBER ABOUT ANXIETY? Fear is a spiritual and moral matter, always occurring with respect to God. Anxiety is a spiritual battle against sin and Satan, a battle to trust and fear God alone. Fear is innate, not something we need to learn. Somehow children seem to know that they live in a world that is not safe. Fear can be godly, when it is a response to properly understanding the holiness, justice, and power of God motivating us to love, honor, respect, and obey. Godly fear promotes love, respect, and faithful obedience. Love moves towards problems, solutions, persons, and God. Fear can also be ungodly, when it is a response of submission to what God forbids (fear of man, fear of death, fear of condemnation, fear of fear, fear of future). Ungodly fear fails to love and fear God above all else, love others more than self, and runs from problems instead of solving them.

5 Fear cannot be overcome by focusing on fear itself. Our focus must shift from self-focus to God-focus. Loving God and others conquers fear. God reserves some of His most comforting words in Scripture for those who are afraid. Anxiety is real affecting body, mind, and emotions. Anxiety comes in all shapes and sizes, appearing differently in the lives of different people. It is important for the counselor to understand how anxiety shows up in this individual s life. The biblical counselor should not focus on the spiritual to the exclusion of the body, nor should the presence of physical diagnosis/bodily needs overshadow the need for spiritual direction and counseling. We counsel embodied souls, who require a holistic approach. Rule out potential medical causes for anxiety. Know that some individuals may require counseling AND medication to mediate the effects of anxiety on the body and mind. Medication is a grace gift from God, to be used wisely as a resource but NOT a cure-all. To that end, the biblical counselor should seek to work in concert with a team of helpers family, friends, psychiatrists, etc for the good of the counselee. How can you best help an anxious person? Help them to recover hope and trust in Christ. Listen to your fears and you hear them speak about things that have personal meaning to you. They appear to be attached to things we value. Ed Welch There s nobody you listen to more than yourself. Paul Tripp C) WHAT ARE 5 CRITICAL QUESTIONS TO CONSIDER WHEN COUNSELING AN ANXIOUS PERSON? The counselor must seek to understand: How does anxiety show up in your life? What does your anxiety say? What messages does your anxiety want you to believe about yourself? Your situation? God? Who or what do you trust for peace or provision or protection or power?

6 What is your greatest worry? What do you fear above all else? What do you feel like you need that you re not getting or might not get? D) WHAT ARE 5 THEOLOGICAL INSIGHTS TO CONSIDER WHEN COUNSELING AN ANXIOUS PERSON? All life is lived coram Deo (before the face of God). Everything is connected to God. God s Word gives wonderful hope to the person struggling with sinful fear. God graciously seeks to reveal the root and fruit of sin in a person s life, and he intentionally, lovingly provides the means to uproot these sinful desires from the heart. Tasks for the biblical counselor: o Help the counselee to understand the love of God. o Help the counselee to understand fear biblically. o Help the counselee to truthfully and gracefully confront fear as sin. o Help the counselee to work through biblical passages to address anxiety (Phil 4:4-9, Psalm 34, Matt 6). o Help the counselee to focus on what they can do, think, and believe. o Cooperatively develop a plan to help counselee to love and obey God in thought/action. o Cooperatively develop a plan to help counselee to love others. o Utilize cognitive/behavioral strategies such as thought stopping or substitution. COUNSELING OVERVIEW: 1. Enter into the person s world. 2. Incarnate the love of Christ. 3. Identify with suffering. 4. Accept with agenda. From Paul Tripp s book, Instruments in the Redeemer s Hands THRONE/STAIRCASE DIAGRAM: HOW LEGITIMATE DESIRES BECOME RULING DEMANDS

7 A B C D E F G o We all have unfulfilled desires. They must be submitted to the lordship of Jesus Christ. o Each of our desires has the potential to sprout a pair of legs and climb the stairs of the throne of our hearts, becoming ruling desires. o Ruling desires compete with Christ for the rulership of our hearts. ADDRESSING RULING DEMANDS: 1. Recognize the source of fear which is ascending the throne. The counselor must help the counselee see and verbalize. 2. Repent, on both the heart and behavioral levels (James 4:4-12). Repent of the ascending desire itself. 3. Refocus on God and his grace, provisions, and promises in Christ. (2 Peter 1:3) 4. Replace sinful fear with Christ-like attitudes and actions. (Ephesians 4:17-32) CLUES TO DETECT A RULING DESIRE: 1. Does it consume me? Do I obsess about it? 2. Do I sin to get it? Do I manipulate to create a situation in my favor? 3. Do I sin when I don t get it? Do I pull away from the relationship? Do I explode and attack?

8 Worriers are false prophets worriers are visionaries without optimism. Ed Welch E) WHAT ARE 5 KEY BIBLICAL PASSAGES TO CONSIDER WHEN COUNSELING AN ANXIOUS PERSON? Matthew 6:25-33 Matthew 11:28-30 Mark 4: Peter 5:6-7 2 Timothy 1:7 F) WHAT ARE 5 HOMEWORK ASSIGNMENTS TO CONSIDER WHEN COUNSELING AN ANXIOUS PERSON? A faithful biblical counselor must help the anxious person learn to see the danger of worry and do battle against unbelief with the Word of God. The counselor must work to cultivate trust and obedience with the counselee, through compassion, encouragement, and genuine care for the individual NOT just a counseling agenda. The counselee must accept the challenge of faithful and uncomfortable obedience, even though they do not feel like it and are skeptical that anything will help. a) Address the source(s) of fear. Have the counselee identify and make a detailed list of ungodly fears and how they show up in the person s life. Seek God s forgiveness through specific prayers of confession (1 John 1:9). End with prayers of confidence in God s sovereignty, providence, and gracious sufficiency (Phil 4:13). b) Memorize Scripture. Develop an arsenal of God s promises in Scripture and have the counselee commit them to memory. Choose 1-2 verses to meditate and memorize at a time. Psalm 27:1 Psalm 34 Psalm 46:10 Psalm 50:15 Psalm 56:3 Isaiah 41:10, 13 Matthew 6 Luke 12:32 Philippians 4:4-9 Hebrews 13:5-6 1 Peter 5:7

9 c) Develop a biblical perspective on trials/suffering. Have the counselee read passages in Scripture that deal with suffering and pain and God s power and deliverance (Exodus 16, Psalm 130, 2 Corinthians 4). Journal their response to the following questions: How did the biblical author or characters respond to pain, suffering, and hard circumstances? How did God instruct them to respond? How did God reveal Himself in the midst of trials or pain? d) Practice godly patterns of thinking, believing and trusting by Listening to Jesus. Have the counselee read John 14:1-15:11. Meditate and journal on the following questions: How does Jesus address the cares of this world? What do you notice about his character/tone? What promises do you see Him express? What commands do you see Him give? What do these commands mean for your life? Renewing the mind instead of defaulting to anxious thoughts. Have counselee monitor situations or persons that lead to anxiety, and practice taking steps to address the situation with prayer and a renewed mind instead. Practical steps for renewing the mind: CATCH your thought or attitude as sinful. (2 Corinthians 10:5) CONFESS your thought or attitude as sinful. (1 John 1:9) CLAIM the Holy Spirit s power to overcome the sinful thought or attitude. (Philippians 4:13) FORCE your mind to change from the sinful thoughts or attitudes to godly ones. (Philippians 4:8-9) REPEAT these steps when sinful thoughts or attitudes occur again. (Galatians 6:9) e) Address lifestyle rhythms that may be influencing or exacerbating anxiety. Help counselee to choose 1-2 areas of their lifestyle - diet, sleep, work/schedule, exercise and make a manageable goal to change within this area. (Ex: Exercise - Take a 45 minute walk after work everyday. Sleep Get at least 7 hours each night.) Encourage counselee to share goal(s) with a friend, and ask them to hold them accountable.