Monday, March 19, 2012

Critique of "The Anxiety Cure" by Dr. Archibald D. Hart

          
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          Dr. Archibald D. Hart’s (1999) book, The Anxiety Cure, is a comprehensive work detailing the issues of stress, anxiety, and panic in adults, adolescents, and children. His goal is to help those who struggle with the after-effects of stress to find and maintain a balanced life of tranquility (p. 254). This critique explores Hart’s theoretical and theological approach, the strengths and weaknesses of this model, and this author’s plan to integrate information from the book into a personal theory of Christian counseling.
            Hart describes anxiety as “a disease of stress” that can result in a multitude of physical and emotional symptoms and illnesses (p. 139). They include panic and panic attacks, post traumatic stress disorder, adrenaline exhaustion, and obsessive compulsive disorder (p. 9-10) Anxiety strikes the strong and leaders among us, male and female, young and old, day or night (p. 37, 42). Anxiety is a warning to change our fast-paced, adrenaline pumping, stress-filled lifestyle (p. 3, 144-145).
            Scientific understanding of anxiety begins in the brain where neurotransmitters send information resulting in emotional responses (p. 19-20). Hart teaches that stress robs us from “happy messengers” or neurotransmitters that keep us tranquil. Balance between happy (GABA) and sad messengers (Cortisol) is determined by levels of stress which causes a chemical imbalance allowing anxiety to dominate. Prolonged stress causes a biochemical change that can start a panic attack. Hart insists that in order to be free from panic, the right medications must be used, stress must be lowered by changes in thinking and lifestyle, and relaxation must be learned (p. 23-26, 39). Hart also teaches that laughter, rest and relaxation, a positive outlook, Sabbath rest, finding life’s purpose, and meditation enhance the natural tranquilizers in the brain.
            Phobias are learned fears gone wrong and may be secondary to panic attacks. For example, if a panic attack occurs while crossing a bridge, the driver may develop a phobia of driving across bridges (p. 41, 178). Hart states, “Self-empowerment is the key to achieving tranquility and surviving the long-term ravages of anxiety.” Those who suffer from anxiety, panic attacks, and fear must be responsible to take personal control (p. 47-49).
            Although he acknowledges that God walks with the patient, Hart believes that the more severe the disorder, the longer therapy and faith building will take to resolve the issue (p. 53). Medication is necessary to break the fear cycle and stop attacks while cognitive behavioral therapy continues (p. 62, 70-71).Throughout the book, Hart offers charts to back his findings regarding anxiety and panic, lists of anti-anxiety medications, and steps and suggestions for ways to be aware of and combat anxiety. Hart devotes three chapters to anti-anxiety medication, the types, need for, duration of use, and side effects. He describes these medications as “food supplements” and “food for the brain” (p. 107). He discusses the food, drink, and other substances that may affect our natural tranquilizers for better or worse depending on the substance.
            Hart teaches a seven week plan for breaking the habit of worry. In week one, the patient records worries and reviews their validity. Week two, patients differentiate concerns from worry. In week three, patients reframe worries into momentary concerns. In the fourth week, patients catch worrisome thoughts and discern if they can do anything to change the concern. Week five, patients replace worries with pleasant thoughts. In week six, patients listen to their self talk in order to change it. In week seven, patients choose to focus on worry for less than ten minutes to break the cycle of worry (p. 149-165).
            Hart discusses “Christian meditation” and “spirituality for tranquility” in his final chapters. He insists that concentrative meditation minus the religious underpinnings of Eastern cultures can reap great benefits (p. 240). He briefly discusses the blessing of focusing on Christ as a role model of stress-free living (p. 256).
Hart’s work is largely clinical and offers aspects of treatment for anxiety sufferers with an end goal of living and dealing with stress and anxiety in a healthy way. That being said, there are several concerns to be considered. First, although Hart mentions Scripture and faith in God, they are hardly secondary to all other recommendations of treatment. Hart reiterates the importance of medications and psychotherapy for most anxiety-related disorders, insisting that medications are safe for long term use (p. 108). He later states that anti-anxiety medications may cause natural tranquilizers in the brain to shut down (p. 31).
Hart believes in a short-term form of “good stress” that helps us have a fulfilled life (p. 21). He states that some fear is normal and even necessary (p. 180). He goes so far as to say that “normal anxiety in children helps their development” (p. 227). Contradicting these beliefs are Scriptures that state, “Perfect love casts out all fear,” (1John 4:18) and “Be anxious for nothing…” (Philippians 4:6). In his seven week plan, Hart suggests that deliberate worry under controlled circumstances helps resolve the problem. (p. 165-166) Philippians 4:8 says, “Finally, brothers, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable--if anything is excellent or praiseworthy--think about such things.” There is no provision in the Bible for focusing on worry.
Hart suggests that worry is what happens to God’s people when they attempt to live independently from Him. He shares Scriptural antidotes and states that a life of intimacy with Christ is the solution for anxiety (p. 16). However, Hart leaves the Word of God, the Holy Spirit, and Christ’s model almost as an afterthought rather than the primary means of “treatment” for stress and anxiety. Neil T. Anderson (2000) teaches that our attitudes, actions, responses, and reactions will reflect what we believe about ourselves. As we meditate on God’s Word and what He says about us, we can be freed from the lies that victimize us (p. 41-46). Hart teaches that we are responsible to lower stress levels and gives techniques so that we can do so (p. 31, 124, 129, 132-135). Even so, the book is greatly given to treatment with medication and therapy.
While working with victims of abuse, there are often issues of fear that are revealed. Hart offers excellent tools for assisting people in breaking the power over stress and fear. Understanding post traumatic stress disorder and other illness related to anxiety as well as treatment options is essential for counselors working with these victims (p. 10).
As a Christian counselor, the overarching goal must always be to bring the client to the image of Christ (Hawkins, 2007, p. 5). In order to accomplish this, the counselor guides the client into the truth of God’s Word. There will be instances where trauma is deep enough to require more than a short-term approach and may even require medication. The first line of defense against the attacks we face should come from God and His Word. While clinical therapy may be indicated, it must always be integrated into a Christian worldview, not vice versa. A blanket acceptance of psychotherapy may prove not to be helpful and even be damaging to clients, taking them further from the image of Christ (Adams, 1986, p. 8).
                                                            References
Adams, J.E. (1986). How to help people change. Grand Rapids, MI: Zondervan.
Anderson, N.T. (2000). The Bondage Breaker. Eugene, OR: Harvest House Publishers.
Hart, A. D. The Anxiety Cure. (1999). Nashville, TN: Thomas Nelson.
Hawkins, R. (2007).  Hawkins' pastoral assessment model. Accessed @
http://bb7.liberty.edu/webapps/portal/frameset.jsp?tab_tab_group_id=_2_1&;url=%2Fwebapps%2Fblackboard%2Fexecute%2Flauncher%3Ftype%3DCourse%26id%3D_1599976_ on January 15, 2012.

Video Lecture, Liberty University. (2012). The contribution of Archibald D. Hart. Accessed @
http://bb7.liberty.edu/bbcswebdav/pid-14265533-dt-content-rid62103708_1/courses/PACO507_B03_201220/PACO507_LUO_8wk_DEV_ImportedContent_20110317103102/PACO507_LUO_8WK_MASTER_ImportedContent_20101122110804/PACO507_LUO_8wk_DEV_ImportedContent_20100726035342/Presentation%20Hart/index.html on March 3, 2011.