Psychological definition
As defined by the American Psychological Association Dictionary of Psychology, anxiety is "an emotion characterized by apprehension and somatic symptons of tension in which an individual anticipates impending danger, catastrophe, or misfortune" (American Psychological Association, 2018). Both anxiety and fear are emotions with a physiological response, but the main difference between the two is that anxiety is considered future-oriented while fear is present-oriented. In general, anxiety also persists for a longer period than fear. There are four different kinds of symptoms experienced in anxiety: physiological, cognitive, behavioral, and effective (emotional) (Chand & Marwaha, 2023). There are multiple theoretical models for how these factors influence each other and which ones happen first, but there is not a singular "best" model at this time.
The physiological response is created by both the central nervous system (CNS) and the autonomic nervous system (ANS), especially the sympathetic nervous system. In the CNS, norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA) play a significant role in cuing the sympathetic nervous system to meditate the somatic symptoms. There are many physical symptoms of anxiety, including increased heart rate, shortness of breath, light-headedness, feeling sweaty of getting chills, nausea, trembling or shaking, tense muscles, and dry mouth. Cognitive symptoms include poor concentration or confusion, hyper-vigilance for threats, poor memory, frightening thoughts, mental images, or memories, and fears of things like "going crazy" or losing control. Behavioral symptoms tend to revolve around attacking or escaping the perceived threat or situation or becoming "frozen" (fight, flight, or freeze response), while affective symptoms encompass the emotional aspect of anxiety, such as feeling worried, fearful, and frustrated.
Anxiety is a normal response that everyone experiences at some point, but it becomes problematic when it leads to excessive or inappropriate responses based on erroneous appraisals of perceived or actual threats. This kind of pathological anxiety can come about in different ways, such as trauma, medication, or childhood experiences (Chand & Marwaha, 2023). The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) recognizes eleven anxiety disorders: separation anxiety, selective mutism, specific phobia (with five categories), social anxiety disorder (a.k.a social phobia), panic disorder, generalized anxiety disorder, agoraphobia, substance/medication-induced anxiety disorder, anxiety disorder due to another medical condition, other specified anxiety disorder, and unspecified anxiety disorder. The consequences of having an anxiety disorder can be devastating to both the individual and their relationships. Roughly 32% of adults experience one of these anxiety disorders with a lifetime prevalence (Garakani et al., 2020), so it should not be surprising that 34% of practicing Christians suffer from an anxiety disorder (Christians Struggled With Relational Health Prior to the Crisis, 2023).
Biblical definition
Perhaps the most well-known verse about anxiety is Philippians 4:6 "Be careful [anxious] for nothing; but in every thing by prayer and supplication with thanksgiving let your requests be made known unto God" (King James Bible, 1769/1970). This verse, along with others (such as Matthew 6:25-34, II Timothy 1:7, and I Peter 5:7), has often been taken out of context or misunderstood, and therefore, experiencing anxiety has become something shameful. In many Christian circles, anxiety has turned from a normal human experience into a sign that someone is not being spiritually strong or walking with the Lord the way they should. Perhaps in striving to be like Christ, many Christians forget that Christ himself experienced anxiety: In Luke 22, Jesus was so fearful and anxious about his impending crucifixion that "his sweat was as it were great drops of blood..." (King James Bible, 1769/1970). At what point does having anxiety turn from a normal human response to sin?
While the Bible does not say at exactly what point anxiety becomes sinful, we can look at how Jesus handled his anxiety - he prayed earnestly to God and accepted whatever His will was. The Bible also speaks to how we should handle anxiety when we do experience it (see the passages mentioned above). God recognized that anxiety is a normal human experience and, in His wisdom and love, made provisions for how we should handle it in a way that glorifies Him.
Treatments for anxiety disorders usually revolve around taking medication, sometimes supplemented with psychotherapy (Chand & Marwaha, 2023; Garakani et al, 2020). The problem with medication as the sole or primary treatment for anxiety disorders is that it does not get to the root of the issue, but rather, only alleviates symptoms of anxiety to make living with it more manageable. The most effective, research-backed therapy for anxiety disorders is cognitive-behavioral therapy (CBT), which targets the thought processes that create or worsen symptoms of various disorders. From the standpoint of biblical counseling, recognizing when one is anxious can be useful for seeing where our hearts and values lie (spoiler, they are not focused on God when we are anxious). Through biblical counseling methods, anxiety can be relieved by turning our focus back to God.
For anxious Christians seeking help, I find both the CBT-only approach and the biblical counseling-only approach can have different issues. By only using secular therapeutic approaches, the Christian loses the application of Scripture and the usefulness of prayer. By only using biblical techniques, the Christian loses the opportunity to learn practical toools and can even ignore personal responsibility for managing the root cause(s) of anxiety. By that, I mean Christians can mistakenly believe that praying away their problems will solve everything rather than acknowledge that often they must put in the work to get rid of certain aspects of their lifestyle. Anxiety comes in different forms (as seen by the multitude of anxiety disorders) and is experienced for reasons unique to individual situations. Biblical counseling alone may work for some, although it may need to be supplemented with CBT or medication for others. Meanwhile, some Christians may feel that CBT alone is enough to handle their anxiety and would prefer to keep their spiritual life separate from their mental health.
While both approaches are useful on their own, only one should ever be used on its own for Christians, and that's biblical counseling. CBT is a fantastic and effective form of therapy, but its foundation is not in Scripture or a biblical worldview. While the Bible sees the renewing of the mind as Christ-centered, CBT is self-centered. That is not to say CBT is selfish, but rather that it was developed from a different framework than what the Bible says about humans (i.e., being made in the image of God and how we should behavior as new creatures). Biblical counseling can always benefit from being supplemented with CBT, but while it can stand alone, CBT must have a base in the biblical worldview for it to beneficial for Christians.
Combining cognitive-behavioral therapy with a Christian worldview is not difficult, but it may look different among individuals. CBT works by challenging erroneous thoughts and beliefs with evidence to the contrary. The Bible provides evidence that can be used to challenge those thoughts and beliefs about oneself and the world (Pearce et al, 2015). Even distorted religious beliefs, such as the view of a distant and punishing God, can be challenged using CBT principles paired with evidence from the Scriptures. Common techniques used in CBT include thought challenging, journaling, relaxation techniques, behavioral experiments, and behavioral activation. These techniques are easily tailored to the individual and integrate well with religious frameworks. For example, anxious Christians could challenge erroneous thoughts with what the Bible says about God, ourselves, and the world around us. They could journal with the aid of a practical devotional or pair relaxation techniques with prayer.
Just as scientific exploration and advances can be used to glorify God, bettering oneself through the use of psychotherapy can also bring God glory. The reality of living in a fallen world is that we have to deal with the consequences of sin. Sometimes those consequences come in the form of mental illness, whether it is a biological, environmental, or spiritual issue - or a combination of all three. CBT was developed from a secular worldview, but that does not mean it is incompatible with a biblical worldview, as long as one is not compromising Scripture in favor of relying solely on human understanding.
References
American Psychological Association. (2018, April 19). APA Dictionary of Psychology. American Psychological Association. https://dictionary.apa.org/anxiety
Chand, S. P., & Marwaha, R. (2023, April 24). Anxiety. StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK470361/#:~:text=Anxiety%20is%20linked%20to%20fear,or%20circumstances%20perceived%20as%20threatening.
Christians Struggled With Relational Health Prior to the Crisis--So What Has Changed?. Barna Group. (2023, August 16). https://www.barna.com/research/christians-relational-health/
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.595584
King James Bible. (1970). Thomas Nelson, Inc. (Original work published 1769).
Pearce, M. J., Koenig, H. G., Robins, C. J., Nelson, B., Shaw, S. F., Cohen, H. J., & King, M. B. (2015). Religiously integrated cognitive behavioral therapy: a new method of treatment for major depression in patients with chronic medical illness. Psychotherapy (Chicago, Ill.), 52(1), 56–66. https://doi.org/10.1037/a0036448