ANXIETY, STRESS, FEAR, TENSION€”TECHNICALLY THESE WORDS HAVE different meanings but they are often used interchangeably to describe one of the most prevailing characteristics of twentieth-century human beings. Psychologist RoIlo May has called anxiety €œone of the most urgent problems of our day. It has been termed the €œofficial emotion of our age, the basis of all neuroses, and €œthe most pervasive psychological phenomenon of our time. Although anxiety is as old as human existence, the complexities and pace of modern life have alerted us to its presence and perhaps have increased its influence.
Anxiety might be defined as an inner feeling of apprehension, uneasiness, concern, worry, and/or dread which is accompanied by heightened physical arousal. It can arise in reaction to some specific identifiable danger (many writers call this €œfear rather than anxiety), or it can come in response to an imaginary or unknown danger. This latter kind of anxiety has been termed €œfree-floating. The person senses that something terrible is going to happen but he or she does not know what it is or why.
Various kinds of anxiety have been identified (e.g., real, phobic, ego neurotic, basic, and separation), but for our purposes let us consider only a few of these: acute and chronic, normal and neurotic, moderate and high.
Acute anxiety comes quickly, is of high intensity, and has a short duration. When people are suddenly and unexpectedly overwhelmed by anxiety, the condition usually is acute. Chronic anxiety, in contrast, is persistent and long-lasting, but of lower intensity. Chronically anxious people seem to worry all the time and in response to a variety of situations. Much of their anxiety is free-floating.
Normal anxiety comes when there is real threat or situational danger. The anxiety is proportional to the danger (the greater the threat the greater the anxiety). It can be recognized, managed, and reduced, especially when outward circumstances change. Neurotic anxiety involves intense exaggerated feelings of helplessness and dread even when the danger is mild or nonexistent. It cannot be faced squarely and dealt with rationally, perhaps because it arises from unconscious inner conflicts (which is what Freud believed). To quote Rollo May`s precise but technical description, neurotic anxiety €œis disproportionate to the objective danger because some intrapsychic conflict is involved.
Anxiety can vary in its intensity. Moderate anxiety can be desirable and healthy. Often it motivates, helps people avoid dangerous situations, and leads to increased efficiency. High anxiety can shorten one`s attention span, make concentration difficult, adversely affect memory, hinder performance skills, interfere with problem solving, block effective communication, arouse panic, and sometimes cause undesirable physical symptoms such as paralysis or intense headaches.
The Bible and Anxiety
In the Bible €œanxiety is used in two ways, as fret or worry and as healthy concern.
First, let us consider anxiety as fret and worry. In his Sermon on the Mount, Jesus taught that we should not be anxious (worrying) about life`s basic needs, such as food and clothing or about the future. We have a heavenly Father, Jesus said, who knows what we need and will provide. In the New Testament Epistles, both Peter and Paul echoed this conclusion. €œStop perpetually worrying about even one thing, we read in Philippians. Instead, Christians are to bring their requests to God, with an attitude of thanksgiving, expecting to experience the €œpeace of God which surpasses all comprehension. We can cast our anxieties upon the Lord knowing that he cares for us.
Anxiety as fret and worry comes because of a sinful turning from God. Instead of acknowledging His sovereignty and preeminence we have shifted the burdens of life onto ourselves and assumed that we alone can handle the problems that we face. When man turns from God and becomes his own god increased anxiety is inevitable. Perhaps it is not surprising, then, that in an age of increased godlessness there is also increased anxiety.
In contrast, anxiety in the form of a realistic concern is neither condemned nor forbidden. Although Paul could write that he was not anxious (that is, worried) about the possibility of being beaten, cold, hungry or in danger, he said that he was anxious (that is, concerned) about the welfare of the churches. This sincere care for others put a €œdaily pressure on Paul and made Timothy €œgenuinely anxious (that is, concerned) as well.
According to the Bible, therefore, there is nothing wrong with realistically acknowledging and trying to deal with the identifiable problems of life. To ignore danger is foolish and wrong. But it is also wrong, as well as unhealthy, to be immobilized by excessive worry. Such worry must be committed in prayer to God, who can release us from paralyzing fear or anxiety, and tree us to deal realistically with the needs and welfare both of others and of ourselves.
Admittedly, however, it isn`t always easy to €œstop perpetually worrying. It is difficult for people to €œcast their burdens on the Lord, to trust that God will meet their needs, to wait for his help and to know when they should take some responsibility for meeting a difficult situation. Anxious people often are impatient people who need help in handling their pressures realistically and within God`s perfect time schedule. The counselor can help such people to see God`s promises, to recognize his power and influence in our daily lives, and to take action when appropriate. For many counselees it is also helpful if they can understand the causes and effects of the anxiety which may be persisting in a troublesome way.
The Causes of Anxiety
For a condition so widespread as anxiety, it should come as no surprise that numerous causes have been identified. For example, in a little book titled The Problem of Anxiety, Freud discussed this condition in terms of his view that human personality has three parts: the id which consists of instincts that demand immediate gratification, the ego which is aware of the external world and keeps the personality in contact with reality, and the superego which is the moral sense of right and wrong. Anxiety arises, Freud wrote, (a) when the ego recognizes a clear threat to the person (this was called €œrealistic anxiety);
(b) when the id begins to get too powerful, so that it threatens to overwhelm the ego and cause the person to act with socially aggressive or sexually unacceptable behavior (neurotic anxiety); or
(c) when the superego gets too powerful, so that the person is overwhelmed by guilt or shame (moral anxiety). Later writers shifted away from this Freudian view and described anxiety as being less an internal instinctual struggle and more the result of cultural pressures or threats from the world in which we live. Then came an emphasis on learning, with the proposal that anxiety is a condition that we acquire through conditioning.
Sifting through these and other theories we might conclude that anxiety arises as the result of threat, conflict, fear, unmet needs, and individual differences.
1. Threat. Following an in-depth survey of the literature, psychologist Rollo May concluded that anxiety is an apprehension that is always
cued off by a threat to some value that the individual holds essential to his (or her) existence as a personality. The threat may be to physical life (the threat of death), or to psychological existence (the loss of freedom, meaninglessness). Or the threat may be to some other value which one identifies with one`s existence: (patriotism, the love of another person, €œsuccess, etc.)
Threats, therefore, can be of different kinds including those which come from perceived danger, a threat to one`s feelings of self-worth, separation and unconscious influences.
(a) Danger, Crime, war, violent weather, unexplained illnesses, even visits to the dentist, can be among those events which threaten individuals and cause anxiety. The anxiety arises because the individual feels uncertain about what is coming and helpless to prevent or reduce the threat. At times, most people are anxious about applying for a job, giving a speech or taking a test. Often this apprehension comes because of our uncertainty and feelings of helplessness.
(b) Self-esteem. Most people like to look good and to perform competently. When anything comes along to threaten our image or to imply (to others or to ourselves) that we are not competent, then we feel threatened. On a simple level, self-conscious people often sense a mild anxiety in new social situations because they are threatened by the reactions of others. On a more serious level, some people avoid taking exams or risking failure because the failure which might come would be too threatening to their self-esteem.
(c) Separation. It is never easy to be separated from significant other people. It can be confusing to be on our own and painful to realize that an important person in our life has left or rejected us. Concerned about the uncertainty of the future, faced with a gaping inner void, and sometimes wondering €œWhat do I do now?, individuals often feel threatened and saddened when losses occur through moves, death, divorce, or other separations. So significant is this in explaining anxiety, that a psychologist named Otto Rank once proposed that all anxiety arises from separation, beginning with separation from the mother`s womb at the time of birth and ending with the separation from human existence at death.
(d) Unconscious Influence. Even counselors who reject many of Freud`s theories often agree that unconscious influences may be at the basis of at least some anxiety. There are so many (real and imagined) dangers in our society that to keep free from immobilizing fear most people have to ignore some potential stresses and push these out of their minds. This is not necessarily bad if done deliberately and temporarily, but according to Freud, when threats and concerns are pushed into the unconscious they may fester away from our conscious awareness. Later these unconscious ideas move toward becoming conscious and that can be threatening because we are then forced to face difficult problems which we don`t understand or know how to solve.
Consider, for example, the case of a young man who was seized with intense anxiety one evening while watching a ballet. He felt better upon leaving the theater but subsequently decided to go for counseling. As the incident was discussed, the counselor concluded that this man had strong unconscious homosexual tendencies which he was struggling to keep from becoming conscious. During the performance, he was attracted unconsciously to the male ballet dancers. The anxiety which followed was thought to be in reaction to the threat that his defenses might break down and that his homosexual tendencies might become apparent to himself or to others.
Such an interpretation is difficult for the counselor to see at first, but the man`s panic is a good example of anxiety which arises in response to a specific situation. By considering the times and places when anxiety was aroused, the counselor often is able to get a clue concerning the specific danger which threatens the counselee.
2. Conflict. Another cause of anxiety is conflict. When a person is influenced by two or more pressures there is a sense of uncertainty which often leads to anxiety. Most general psychology books suggest that conflicts come from two tendencies: approach and avoidance. To approach is to have a tendency to do something or to move in a direction which will be pleasurable and satisfying. To avoid is to resist doing something, perhaps because it will not be pleasurable or satisfying. There are three kinds of conflicts: approach-approach, approach-avoidance, and avoidance-avoidance.
(a) Approach-approach conflict. Here is a conflict over the tendency to pursue two desirable but incompatible goals. We may be faced with two dinner invitations on the same night, either of which would be pleasant. Often making such a decision is difficult and sometimes it is anxiety arousing.
(b) Approach-avoidance conflict. Here there is a desire both to do something and not to do it. For example, a person may grapple with the offer of a new job. To accept might bring more pay and opportunity (approach), but it also may bring the necessity of a move and the inconvenience of a training program (avoidance). Making such decisions can involve considerable anxiety.
(c) Avoidance-avoidance conflict. Here there are two alternatives, both of which may be unpleasant: like having pain versus having an operation which might in time relieve the pain.
Most conflicts involve a struggle between two or three alternatives, each of which may have both approach and avoidance characteristics. A young person may wonder, for example, whether to stay in the present job, shift to another job, or return to school. Each of these alternatives has both positive and negative aspects, and anxiety persists until the choice is made (and sometimes, lasts after the decision while we ponder €œdid I make a mistake?).
3. Fear. As we indicated earlier, some counselors would distinguish fear from anxiety. Let us recognize, however, that the same inner apprehension which characterizes anxiety can also come in response to fear. Fear and anxiety, therefore, are similar, even though they may not be identical.
Fears can come in response to a variety of situations. Different people are afraid of failure, the future, achieving success, rejection, intimacy, conflict, meaninglessness in life (sometimes called existential anxiety), sickness, death, loneliness, and a host of other real or imagined possibilities. Sometimes these fears can build up in one`s mind and create extreme anxiety€”often in the absence of any real danger.
4. Unmet needs. For many years psychologists and other writers have tried to identify the basic needs of human beings. Cecil Osborne, for example, has concluded that six needs are fundamental:
survival (the need to have continued existence)
security (economic and emotional)
sex (as an _expression of love; as a sexual being)
significance (to amount to something; to be worthwhile)
self-fulfillment (to achieve fulfilling goals)
selfhood (a sense of identity)
If we fail to meet these or other needs, Osborne believes, we are anxious, €œup-in-the-air, afraid, and often frustrated.
But what if all of these needs are met? Would life be complete and satisfying? Probably not! There still would be questions that transcend life on earth: Where will I go after death? Does existence consist of only a few short years on earth? One writer has lumped these and related questions into something called finite-eschatological anxiety and paired this with the anxiety of sin€”that which comes when our thoughts and actions have violated divine commandments and broken our communication with God and others. We can have no real freedom from anxiety until we are at peace with God, resting in his promises for eternity, and know the stability of sins confessed and completely forgiven.
5. Individual Differences. It is well known, of course, that people react differently to anxiety-producing situations. Some people are almost never anxious, some seem highly anxious most of the time, many are in between. Some people are made anxious by a variety of situations; others find that only one or two issues trigger anxiety. Free-floating anxiety€”the kind with no clear cause€”characterizes some; others are made anxious by clearly identified dangers. Then there are those with claustrophobia, hydrophobia and the other phobias€”irrational fears of enclosed spaces, water, heights, or additional circumstances most of which are not in themselves dangerous.
Why are there differences like this? Perhaps the answer comes in terms of the person`s psychology, personality, sociology, physiology or theology.
(a) Psychology. Most behavior is learned as a result of personal experience or teaching by parents and other significant persons. When we have failed and must try again, when we have been hurt in the past, when others have demanded more than we could give, when we have seen anxiety in other people (e.g., the child who learns to be anxious in thunderstorms because his mother was always anxious), when we have developed the capacity to think of the potential dangers in a situation, when our perception of a situation gives us reason to suspect danger€”all of these are psychological reactions which arouse anxiety. Since we each have different experiences and different ways of viewing the world, we differ in our intensity and frequency of anxiety.
(b) Personality. It maybe that some people are more fearful or €œhigh strung than others. Some are more sensitive, self-centered, hostile, or insecure than others. These personality differences arise from a combination of inherited and learning influences which, in turn, create individual differences in anxiety.
(c) Sociology. A past president of the American Psychological Association once suggested that the causes of anxiety rest in our society: political instability, mobility which disturbs our sense of rootedness, shifting values, changing moral standards and religious beliefs, and so on. While these are not the only reasons for anxiety, it surely is true that the culture and subcultures stimulate anxiety in some people but give others such a secure environment that anxiety is much less prominent.
(d) Physiology. The presence of disease can stimulate anxiety, but so can dietary imbalance, neurological malfunctioning and chemical factors within the body. Anxiety, of course, can trigger physiological reactions, but physiology can also contribute to increased anxiety.
(e) Theology. Beliefs have a great €˜bearing on one`s anxiety level. If God is seen as all-powerful, loving, good, and in ultimate control of the universe (which is the biblical teaching), then there can be trust and security even in the midst of turmoil. If we believe that God forgives when we confess our sin, that he promises life eternal, and that he meets our needs on earth, then there is less cause for anxiety.
It should not be assumed, however, that nonbelievers necessarily are more anxious than believers. (Some Christians, for example, are so worried about pleasing God that their theology increases anxiety.) Nor should it be concluded that anxiety always reflects a lack of faith. The causes of anxiety are too complex for such a simplistic explanation. Nevertheless what we believe or do not believe does contribute to individual differences in the extent to which we experience anxiety.
The Effects of Anxiety
It should not be assumed that anxiety is always bad. When anxiety is nonexistent, life can be boring, inefficient, and unsatisfying. A moderate amount of anxiety (not too little, not too much) motivates us and adds zest to life. When anxiety is great, however, we begin to experience crippling physical, psychological, defensive, and spiritual reactions.
(a) Physical Reactions. It is common knowledge that anxiety can produce ulcers, headaches, skin rashes, backaches and a variety of other physical problems. Almost everyone has experienced stomach discomfort (€œbutterflies), shortness of breath, an inability to sleep, increased fatigue, loss of appetite, and a frequent desire to urinate during times of anxiety. Less conscious are changes in blood pressure, increased muscle tension, a slowing of digestion, and chemical changes in the blood. If these are temporary they cause little, if any, harm. When they persist over time the body begins to break under the pressure. This is the origin of the psychosomatic (psychologically caused) illnesses.
(b) Psychological Reactions. Everyone who has taken an examination knows how anxiety can influence psychological functioning. Research has shown that anxiety reduces one`s level of productivity, stifles creativity and originality, hinders the capacity to relate to others smoothly, dulls the personality, and interferes with the ability to think or to remember. It is interesting to notice Rollo May`s conclusion that people with higher intelligence and originality likewise are more inclined to be anxious. At the same time, intelligent persons also are able to develop more effective ways of managing and controlling their anxiety.
(c) Defensive Reactions. When anxiety builds up, most people unconsciously rely on behaviors and thinking which dull the pain of anxiety and enable us to cope. These defensive reactions, which are well-known and often seen in counseling, include denial of the anxiety, pretending the anxiety-producing situation does not exist, blaming others for a fault which really is our own, rationalizing by logically explaining away the symptoms and their causes, slipping back into childish ways of reacting, and so on. Sometimes people escape through alcohol, drugs, a host of hypochondriacal complaints or even withdrawal into bizarre behavior and mental illness. These are all ways of trying to cope.
(d) Spiritual Reactions. Anxiety can motivate us to seek divine help where it might be ignored otherwise. But anxiety can also drive us away from God at a time when he is most needed. Fraught with worry and distracted by pressures, even religious people find that there is a lack of time for prayer, decreased ability to concentrate on Bible reading, reduced interest in church worship services, impatience and sometimes bitterness with heaven`s seeming silence. The Christian counselor may be welcomed as a spiritual minister, or rejected because he or she represents a God who has permitted the stresses and left the impression that he doesn`t care.
Counseling and Anxiety
It is not easy to counsel anxious persons, partially because it can be very difficult to uncover and cope with the causes of the anxiety and partly because anxiety is psychologically contagious. Anxious people often make others anxious€”including the counselor who is trying to help. To counsel anxious people, therefore, the counselor first must be alert to his or her own feelings.
1. Recognizing the Counselor`s Own Anxieties. When a counselor feels anxious in the presence of an anxious counselee, it is well to ask oneself several questions: What in this situation is making me anxious? Is the counselee anxious about something which makes me anxious too? What does my anxiety tell me about the counselee? By considering one`s own anxiety it is sometimes possible to gain insight into the counselee`s anxiety. By asking these questions, counselors are able to learn about themselves and about the counselee. These questions also enable the counselor to keep from confusing his or her anxieties with those of the counselee.
2. Demonstrating Love. Love has been called the greatest therapeutic force of all, but nowhere is this more true than in the reduction of fear and anxiety. The Bible states that €œperfect love casts out fear and while this statement concerns fear of future judgment it surely demands a broader application. One writer has suggested that €œthe enemy of fear is love: the way to put off fear, then, is to put on love. … Love is self-giving; fear is self-protecting. Love moves toward others; fear shrinks away from them. . . . The more fear, the less love; the more love, the less fear. To show love, especially mixed with patient understanding, to introduce counselees to the love of Christ, and to help them experience the joy of loving others, can all help to cast out fear and anxiety.
3. Identifying Causes. Of course it would be unrealistic and inconsistent with both biblical exegesis and sound psychology if we were to assume that anxious people should simply experience and show love without ever attempting to identify the causes of their anxieties. Fear and anxiety are God-created emotions. They warn of danger of internal conflict and the sensitive, loving counselor does not tell the counselee to €œbuck up or €œstop being anxious. Instead the counselor seeks to assist the counselee in the difficult task of uncovering the sources of anxiety. This can be done in several ways.
(a) Observation. In counseling, does the counselee show evidence of added anxiety (shifting position, deep breathing, perspiration) when certain topics are discussed? What are these topics?
(b) Reflection. Can the counselee suggest circumstances which have raised or currently raise anxiety? It might be helpful to ask, €œWhen are you most anxious? €œWhen are you not anxious? €œWhen was the last time you felt really anxious? €œWhat was happening in your life then?
(c) Contemplation. As a counselor, remind yourself of the previously listed causes of anxiety. Ask yourself if any of these might be creating the counselee`s anxiety. Raise some of the issues and as the counselee talks about them watch for signs of anxiety. Then discuss your hunches.
In all of this, remember the need for patience and understanding. By its very nature, anxiety often arises in response to threats which are vague and difficult to identify. By pushing the counselee to €œsnap out of it or to €œhurry and tell toe what is wrong, we increase the anxiety, create more confusion, and risk losing or alienating the anxious person. Once again it is important to emphasize loving patience.
4. Encouraging Action. The goal in counseling is not to eliminate all anxiety. Instead the goal is to help counselees become aware of the sources of anxiety and then learn how to cope. To do this, the counselee can be helped to identify some specific actions to be taken, goals to be achieved, and skills to be learned. The counselee must be helped to confront the anxiety-producing situation directly, admitting his or her apprehensions, but moving ahead (with the counselor`s support) in spite of the anxiety. €œCourage consists not of the absence of fear and anxiety but of the capacity to move ahead even though one is afraid. The counselee is helped to take action and to move through the anxiety-producing situations rather than moving around them or retrenching before them. The counselee must be helped to see that there is more to be gained by facing and trying to overcome the anxiety€”even though this can be risky€”than by wallowing in a state of anxiety which may be painful but also familiar. In all of this be careful to avoid intellectual discussions which may sound reassuring but which do nothing to help one take action to deal with the anxiety.
5. Giving Support. As we have seen, anxious counselees can get little help from tense, impatient counselors. The helper, therefore, must be calm, supportive, and patient as he or she watches progress which may, at times, be very slow in coming. There may be times when there really is nothing that a counselee can do to take action against the source of his or her anxiety. At such times it is of special importance to feel the caring support of a warm relationship with an understanding counselor.
6. Encouraging a Christian Response. The Bible gives an unusually specific and clear formula for overcoming anxiety. In Philippians 4:6 we are instructed to stop being anxious about anything. As we have seen, however, it is practically impossible to simply stop worrying. Such deliberate effort directs our attention to the problem and can increase anxiety rather than decrease it. A better approach is to focus on activities and thoughts which indirectly reduce anxiety. The Bible describes how this can be done and in so doing gives a formula to be shared with counselees:
(a) Rejoice. This is a command, repeated twice in Philippians 4:4. When the world is dark and dreary, the Christian still can €œrejoice in the Lord. This is because of Jesus` promise that he would never leave us, that he would give us peace, and that he would come again to take believers into a place prepared for us in heaven. With this knowledge we can believe in God and not let our minds be troubled or fearful.
(b) Forbear. €œLet your forbearing spirit be known to all, we read in Philippians 4:5. It has been said that the Greek word translated €œforbear has no real equivalent in English. It means: let everybody see your kind, sweet, gentle, considerate, gracious attitude. These qualities do not come naturally. They come with God`s help and as we work to control our tendencies to condemn or demand our rights. A negative condemning outlook on life builds anxiety; a gracious forbearing attitude reduces it.
(c) Pray. Philippians 4:6 gives several instructions about prayer in times of anxiety. Such prayer should be about everything (even small details), should include definite and precise petitions, should involve thanksgiving for divine goodness, and should be accompanied by the expectation that supernatural peace will be forthcoming. A major cure for anxiety, therefore, is prayer.
(d) Think. Anxiety surely arises when we think about injustice, problems, human weakness and what might go wrong. Philippians 4:8 instructs us, instead, to let our minds dwell on positive things such as that which is honorable, right, pure, lovely, good, excellent, and praiseworthy. Here is evidence for the power of positive, biblically based thinking.
(e) Act. The Apostle Paul sets himself up as a model for action. €œThe things you have learned and received and heard and seen in me, put into constant practice. The Christian`s task is to do what the Bible teaches and not simply to sit listening. Anxiety reduction involves godly behavior even in the midst of the anxiety.
The previous paragraphs, which comment on Philippians 4, give a formula for preventing anxiety as well as an approach to counseling. When people can be helped to rejoice, forbear, pray, think and act in accordance with scriptural teachings, there is progress toward anxiety control.
Studies of military personnel in combat situations reveal other ways in which people defend themselves against anxiety. First there is the development of self-confidence€”a belief in one`s ability to meet the challenges of life (see chapter 24). Second, there is involvement in work and other activities which presumably expends nervous energy and distracts one from the anxiety-producing situation. Work has been described as one of the handiest ways of preventing and relieving anxiety, but work can become compulsive and be a way to keep from dealing with the causes of one`s anxiety. Third, there is faith in the ability and confidence of leaders who can deal with dangers. Then, these military studies showed, there is belief in God.
1. Trust in God. The person who learns to walk in daily contact with God comes to agree with the hymnwriter who wrote, €œI know not what the future holds, but I know who holds the future. This conviction can bring great security when others are inclined to be anxious.
At times, however, such trust leads to a blind denial of reality, to a refusal to accept responsibilities, or to a rigidity of thinking which ultimately prevents the person from adapting to changing circumstances. In contrast, the Bible encourages realistic confrontation with problems and flexible decision-making. This enables people to grow and adapt to change or danger, while they maintain an underlying confidence in the sovereignty and wisdom of an all-powerful God.
2. Learn to Cope. Coping with the causes of anxiety, when and before they arise, can prevent the development of anxiety. Such coping involves the following, each of which can become part of a person`s life style:
€” admitting fears, insecurities, conflicts, and anxieties when they arise;
€” talking these over with someone else€”on a regular basis if necessary;
€” building self-esteem;
€” acknowledging that separation hurts, attempting to maintain contact with separated friends, and building new relationships with others;
€” seeking help from God and others in meeting one`s needs;
€” learning to communicate;
€” learning some principles and techniques of relaxation;
€” periodically evaluating one`s priorities, life goals, and time management.
Conclusions about Anxiety
Writing about physicians, psychiatrist O. Quentin Hyder summarized much of what we have said about anxiety.
Patients who do not get well quickly sometimes become very impatient at their apparent lack of progress. . . . The fact is, however, that the patient`s feelings of helplessness, apprehension, imminent danger, loneliness, and frustration would be far worse if he did not during the crisis period have the security of knowing that at regular intervals he could unburden his thoughts and feelings to someone who he believed really cared and was equipped by training and experience to help him. The doctor on his part must convey understanding, sympathy, confidence, ability to help, and genuine concern. Once the patient is sufficiently confident in his doctor`s ability and care he can pour out his fears and admit to other emotions that are troubling him such as depression, hostility, anger, and guilt. As the patient does this, the doctor uses a skillful blend of authoritative persuasion, suggestion, and directive advice with supportive reassurance and nondirective sympathetic listening and understanding.
That blend of skills enables the counselee and counselor to face and deal with the problem of anxiety