There is a spectrum of anxiety disorders that can make worshiping and serving difficult.
Mental Health and the Church
By Stephen Grcevich
Let’s consider two additional sources of anxiety. Anxiety may result from a propensity to misinterpret information. Children and adults with anxiety disorders often hold wildly inaccurate perceptions—some conscious, some unconscious—of the impressions they make on others. For example, you spot someone at the mall you think you know from high school. Instead of approaching them to say hello, you duck into the first store you can find and pretend to shop, because the first thought that popped into your mind when you spotted them was that they won’t remember you and you will have made a fool of yourself. These irrational assumptions often cause those with anxiety disorders to deliberately avoid pleasurable activities and relationships. The most common evidence-based treatment for children and adults with anxiety disorders—cognitive-behavioral therapy (CBT)—is predicated in part on identifying and managing thinking errors that contribute to emotional and physical distress.
We experience anxiety because of the choices we make. I know firsthand how choices affect our lives. My procrastination in high school—when I needed to be studying for chemistry or calculus tests, for example—frequently resulted in intense anxiety. Kids who give in to the urge to stick their hands in the cookie jar and adults who do things they know they shouldn’t do may experience anxiety because they know they are being disobedient and worry about getting caught. As we saw in our exploration of stigma, we sometimes experience anxiety because of sin.
Medical and mental health professionals use a diagnostic classification system to describe common patterns of anxiety organized around either the nature of their symptoms or the situations in which they experience functional impairment. Persons with anxiety may experience symptoms of more than one anxiety disorder, and over time, a person predisposed to anxiety may meet the criteria for different anxiety disorders at different times in life. I’ve found that each anxiety disorder is often associated with specific challenges to church involvement.
Children and teens with separation anxiety disorder typically experience excessive fear or distress when away from home or significant attachment figures, usually parents. Church activities in which children and parents are served in different physical locations where they can’t see one another may result in heightened anxiety, manifested by tearfulness, anger or irritability. Retreats and mission trips involving one or more nights away from home often cause intense anxiety for older children and teens unless they’re accompanied by a parent.
Children or adults with a specific phobia experience fear of certain objects or situations. Their fear in the presence of the object or situation often leads to the development of elaborate avoidance strategies. Someone with a fear of germs may avoid shaking hands with members of the welcome team positioned at church entrances or dread the prospect of greeting fellow worshipers at the direction of the pastor during a service. A fear of flying may be a more plausible explanation than a lack of faithfulness for someone’s reluctance to participate in an overseas mission trip. Someone with a fear of flames may avoid volunteering at candlelight services.
Children and adults with social anxiety disorder experience significant fear and distress in situations where their words or actions may be exposed to the scrutiny of others. The person often fears they will act in a way that will result in embarrassment or humiliation. A first-time visitor to church may be preoccupied by concerns that they are being judged on the basis of their words or personal appearance. They may avoid church entirely because of horror stories of newcomers being handed a microphone to speak or being introduced to the entire congregation in the middle of a worship service.
Children and adults with panic disorder experience brief, recurrent, unanticipated episodes of intense fear, accompanied by a characteristic set of physical symptoms, a sense of impending doom and the urge to flee the place where they experience symptoms. Agoraphobia is a closely related condition in which intense symptoms of anxiety occur in situations experienced as unsafe with no easy way to escape—often experienced in cars, trains, planes, elevators and tunnels. The absence of an aisle seat at church located near an exit to facilitate an unobtrusive escape may be sufficient to trigger an attack for someone with agoraphobia.
Children and adults with obsessive-compulsive disorder (OCD) experience recurrent, intrusive thoughts or compulsive, recurrent, repetitive behaviors associated with significant mental distress. They may struggle with excessive perfectionism or with making and sticking to decisions, or they may fear they will be compelled to perform certain actions against their will. They may develop time-consuming rituals for counting, checking, arranging or ordering items; grooming; or washing. Someone with OCD who also has contamination fears may go to great lengths to avoid physical contact with other worshipers or with objects or furniture at church that have been contaminated. Children and teens with OCD in our practice who come from Christian families are especially prone to episodes of intense anxiety if they begin questioning their salvation, developing obsessive fears of acting violently toward loved ones or engaging in sexual behavior against their will.
Full participation in the church often requires vulnerability, social risk and change—all of which can be incredibly challenging for those with anxiety. We as church leaders can demonstrate Christ’s love for persons who struggle with anxiety by graciously helping them join our ministry environments and providing them with the necessary supports that will allow them to grow alongside the rest of the church.