I was 24 and a week into marriage when I walked into my first intensive care unit as a trauma chaplain. I had never seen a dead body before. I had never experienced deep grief before. Within two hours of my first day on the job—a 28-hour overnight shift—I was standing in a room with a dozen screaming people. Their mother had suddenly died on the surgery table; the doctor and nurses had just ushered the family into the room to give the news. I showed up about three minutes later to utter mayhem: wailing and flailing, one person hitting her head against the wall in a steady rhythm, another dry heaving into a trashcan. I felt completely detached, like I was watching a scene from a movie. I remember thinking, “At least the doctors and nurses are here, they will know what to do.” But within a minute, they were gone. It was just me and the distraught family. I wonder if they were thinking, “At least the chaplain is here, he will know what to do.”
Over the course of a year of death and tragedy, I slowly learned how much was also bubbling under the surface of my own life and how it would boil over in moments of trauma. For example, every time a gurney burst through the double doors of the emergency room, with an EMT straddling the person frantically doing chest compressions and shouting commands, I would pray a prayer: “Please God, don’t let it be my wife. Don’t let it be anyone I know.” When it wasn’t my wife, I would breathe a sigh of relief and pray, “Thank you, God, that it is not my wife or anyone I know.” Or, when I was asleep in the overnight room having already attended to four deaths and the beeper went off to announce a fifth death, my response would be anger at the person for dying and inconveniencing me.
Of course, these are very human reactions to pain and trauma. But a pastor or counselor cannot be present to those in pain without empathy or while reacting angrily or with judgment.
I attended to more than 300 deaths that year. When I later I transitioned into a lead pastor role, I was surprised to learn that even though I was no longer in a daily environment of trauma and death, triggers and stresses bubbling just under the surface still existed. In fact, they inhibited my ability to be emotionally available and fully connect with people.
Over the years, I have dedicated my vocation to helping pastors move from stress and burnout to emotional and spiritual health. I have found that understanding the nature of chronic anxiety, why it shows up and how to move through it, can mitigate a good deal of pastoral stress.
Diagnose the anxiety
Though there are many excellent pathways to emotional health for pastors, I have found Murray Bowen’s family systems theory the most effective and accessible. Bowen’s groundbreaking framework can help us understand stress, pressure, and chronic anxiety.
Anxiety covers broad territory, from PTSD to acute anxiety to chronic anxiety. All of these diagnoses are quite different and require a different set of tools and treatments to manage. In his book Family Systems and Congregational Life, Bowen defines acute anxiety as an automatic reaction to a real, short-term threat—such as hyperventilating after a near car accident.
Chronic anxiety looks and acts like acute anxiety but is a reaction to a perceived threat rather than a real or immediate one. And rather than having a short duration, it is almost continuous. Bowen noted that chronic anxiety is frequently generated by relational issues because it is often in our relationships that we form our perceived needs.
I have found it helpful to define Bowen’s theory as “what happens after you don’t get what you think you need.” Chronic anxiety is generated in the gap between what is happening in the moment and what we think we need to be okay. For example, I have a constant need for people to like me. I always need to know the answer. I need every sermon to be gold standard.
These are not real needs, of course. They are perceived needs. But when I don’t get them, I get reactive. I behave oddly. Maybe I work harder to impress someone; maybe I fish for a compliment after a sermon. Maybe I raise my voice in a meeting or try to get the last word in.
This is why I find Bowen’s theory of anxiety so helpful—it is less focused on worry or fear and more focused on identifying perceived needs in our lives. And identification is key: Our bodies cannot discern the difference between acute and chronic anxiety unless we train them to. Our bodies behave as if we are under threat even when we are not. My body cannot discern between the real danger of an impending car accident and the perceived danger of a negative email hitting my inbox Monday morning.
Recognize symptoms of anxiety
The initial step from being controlled by anxiety to managing itis to notice its presence through three simple questions.
First, where does anxiety start for you? Anxiety technically starts in false belief, but I have found that we first notice it physiologically: a spinning mind, a racing heart, or a tightening body. For me, it manifests in spinning thoughts. If I am worrying about something while I fall asleep and return to it as soon as I wake up, I know that I am anxious. The key is to know it, name it, and then (as discussed later) form the habit of immediate intervention.
Second, how do you react once your anxiety shows itself? One sign of anxiety is that your attempted solution to anxiety only makes your anxiety worse. For example, those of us who need to be understood might get quite anxious when we are misunderstood in an elders’ meeting. We might react by speaking more or exerting more authority, but that very rarely accomplishes anything other than increased anxiety. Some people will simply misunderstand us—and some people even have a vested interest in doing so when resisting leadership or change. Noticing our reactions can interrupt the cycle.
Finally, what do you think you need that you do not really need? If chronic anxiety is the engine, false beliefs are the fuel. This could be having people’s approval, appearing impressive, or always being right. Awareness is a powerful tool to flip the dynamic of anxiety. When we are anxious but unaware, we are in its grip. When we notice it early, we can manage it instead of letting it manage us.
Because pastors are often others-focused, we can be the last to know that we are anxious. If you don’t think of yourself as an anxious person, you can ask a loved one or team member. Chances are they already know when you are anxious, and if they feel safe, they may offer you the gift of telling you. None of us is immune to the impact of chronic anxiety.
A spiritual response to anxiety
As I have studied the nature of chronic anxiety, I have concluded that it has a spiritual nature, not just a psychological one. Chronic anxiety competes for the space in our awareness where God resides, so it is difficult to be aware of God’s presence when we are in the grip of chronic anxiety.
Once we detect anxiety, we can use it to discern between perceived and real needs, and we can have a profound encounter with grace in the moment.
Sometimes several times per day I pray, “Jesus died to free me from _______.” Jesus died to free me from the need to preach perfect sermons. Jesus died to free me from the need to be understood. Jesus died to free me from needing to have the last word.
At the core of these prayers lies a crucial question: In my pastoral vocation, am I seeking self to meet my needs—which often generates chronic anxiety—or God? In our early efforts to detect where anxiety is at play, we have to be kind to ourselves. It will take brave practice and time to learn to depend on God in our pastoral pressure, moment by moment.
These truths took me almost a decade to really live, but the results are real. Now that I know my triggers, I can move from being in the grip of anxiety and not knowing it to recognizing anxiety much earlier and preempting it. When I am walking into an elders’ meeting and I know I may not have every answer to every question, rather than get anxious or defensive I can simply acknowledge ahead of time that Jesus died so that I can be fully present even if I do not have an answer. Or when a critic takes a cheap shot, I am able to give the gift of the last word and truly be at peace.
Anxiety may say, “It is all on me,” or, “There are no good options.” But the good news is that not only is God with us, but he is ahead of us, already at work in that difficult meeting or upcoming Sunday service. That was perhaps the most profound lesson I learned as a trauma chaplain—when I walked into rooms saturated in anxiety, it wasn’t my job to fix things. Rather, my job was to pay attention to the God who was already present with these people.
This was the lesson as a chaplain, and this is my ongoing lesson as a pastor: It is not all on me. God with me is good news. And recognizing that God is already at work ahead of me truly sets me free.
Steve Cuss is the author of Managing Leadership Anxiety: Yours and Theirs. He holds a Master of Divinity degree from Emmanuel Christian Seminary and serves as lead pastor at Discovery Christian Church in Colorado.