Restoration Therapy: Distinguishing Between Anxiety and Fear

In October of 2016 I spoke at the first ever Restoration Therapy Summit on the topic of anxiety and fear in the Restoration Therapy model, and more specifically, trying to differentiate between what exactly is anxiety, and what is fear. I even recorded a Part 1 and Part 2 podcast episodes on this topic after I spoke.

When Dr. Terry Hargrave first asked me to speak on this topic I didn’t think there would be much to speak on because in my mind I hadn’t thought much about the difference between anxiety and fear, and I think for most people the two words are often synonymous. Often when I’m working with someone in the context of my counseling practice and I talk about what they are feeling or what coping behaviors they are moving into, anxiety and fear are often used interchangeably. In earlier posts I tried to be more specific about trying to define anxiety as well as trying to explain what the is difference between healthy and unhealthy anxiety.

But in this post, let’s focus on the difference between anxiety and fear, and why that is not only crucial, but can be very helpful for not only your own life, but in working with someone else.

Simplifying the Difference Between Anxiety and Fear

Anxiety is best understood in two ways: a) as an issue with our identity, and more specifically our individual and relational personhood; b) struggles with ultimate concerns such as purpose, meaningless, faith and death.

Fear is best understood in terms of specific circumstances and situations.

Let me give you an example of what these two different understands might look and sound like with someone in the context of a conversation, or some form of pastoral counseling:

For example, let’s say that a 22 year old is talking to you about graduation, and the next step in their career journey. And let’s say that they are struggling with what type of work would fulfill them, and they are struggling with knowing when to take action on something, or sit back and wait for “God’s will” to unfold for them as they try and discern next steps. You are more than likely looking at a situation with someone wrestling with anxiety because there seem to be a lot of questions and concerns about what it means for them to be….them. Essentially they are questions of identity and vocation and what to do next, mixed in with where and how is God involved in this process. These are questions of ultimate concern for people.

Let’s try another example. Let’s say that you are talking with a 50 year old man who is at the height of his career, but he has this gnawing feeling that won’t go away because he feels like there is something more to life than what he is living. He can’t place his finger on what is wrong with him, and there is nothing specific he can identify. He just feels that his work feels meaningless in some ways, and since he turned 50 he has been thinking more about his mortality and how much time he has left in life. Again, you are looking more at issues around anxiety because they are dealing with personhood and struggles with ultimate concern like meaning in life, death, and what is the purpose of our work and vocation.

So if these are questions surrounding what is ultimately anxiety, what does it look like for someone to be experiencing fear?

For example, let’s say that a woman comes to you and is concerned about her teenage son. She recently found some drugs in her son’s room, and that combined with the fact that her son was suspended from school for two days for fighting last week, has her very fearful about his future. In this situation we are probably dealing more with the issue of fear because she can locate the object of her fear, which is the discovery of drugs in her son’s room, and the knowledge of him getting into a fight at school and receiving a subsequent suspension. She is not wondering where her feelings are coming from, but she can locate them and describe what the situation is with accuracy.

Let’s try and other example. Let’s say you are talking to a high school student who is about to take the ACT exam next week and they have noticed these really uncomfortable feelings emerging within them a few days earlier. And as you explore these feelings with them you realize that everything goes back to the upcoming ACT exam. The student is a good student, but they are very fearful that they are not going to do well on the exam, and are then fearful of jeopardizing some of their scholarship opportunities. Because the issue is located to a specific situation or circumstance you are more than likely dealing with fear in this situation.

Are Anxiety and Fear Connected?

Though I have spent a good amount of time explaining the difference between anxiety and fear, I wouldn’t go as far to say that they are never related or linked in some manner. For example, in the situation above about the mom whose son was suspended from school and then she finds drugs in his room. That is a great example of a situation where there is potentially both fear because the feelings are located in a specific situation and circumstance that is identifiable (i.e. suspension, drugs, son, etc.), but there is potentially some underlying anxiety for the mom about feelings of inadequacy as a mom, which hit on issues around identity and questions of ultimate concern (i.e. her relationship to him, and what will become of him if he keeps on this path, etc.).

Distinguishing between the two is important because it can help give you guidance about what you are really dealing with as a counselor, pastor, lay leader, etc., but ultimately you may find both anxiety and fear interweaving themselves a times and it’s important to discern that as it may aid in the direction you help the person with. In the book, Restoration Therapy: Understanding and Guiding Healing in Marriage and Family Therapy by Terry Hargrave and Franz Pfitzer, they write the following:

“In the Restoration Therapy model, we believe that if the psychotherapist can accurately understand the emotions as they relate to this love and trust and then make sense of the coping behaviors of the individual, then the psychotherapy is in a position to clearly assess the distressed individual and draw direction in terms of goal setting and intervention.”

Though this quote is about love and trust, ultimately as someone who is working with people in a specific context, you want to be able to distinguish between anxiety and fear so that you know what kind of direction you are working towards as it will help in being clear in terms of goal setting and intervention.

In fact, I could re-write the quote above as saying something like this:

“In the Restoration Therapy model, we believe that if the pastor can accurately understand the difference between anxiety and fear, then the pastor is in a position to clearly assess the distressed individual and draw spiritual direction in terms of goal setting and intervention.” (Rhett Smith)

Anxiety and Fear in the New Testament

I wrote about the topic of anxiety and the Bible in an earlier post, specifically noting the many ways that the topic of anxiety is expressed in a variety of contexts, and more specifically the treatment of the Greek word merimnao in the New Testament. For a fuller understanding of the use of this word in the New Testament check out that earlier post, or look at the work of New Testament Greek scholar Bill Mounce’s definition of the word.

I believe that in the book of Philippians you get a good understanding of how multi-faceted the idea of anxiety can be. We see Paul use the word for anxiety, merimnao in Philippians 2:20, when speaking of Timothy, Paul writes the following words: “I have no one else like him, who will show genuine concern for your welfare.” Literally, what Paul says is I have no one else like Timothy who will show genuine anxiety for your welfare. Anxiety in this context is indicative of the relational care that one person has for another. Their anxiety is something that conveys a real care and concern.

In a couple of chapters later we get to the famous text of Philippians 4:6 where Paul writes, “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God.” Here we see that Paul simply encourages us not to be anxious about anything, but if we are, here is the prescription to help ease the anxiety. Literally, we are to go be in prayer, thankful, and present our requests to God. There is no indication that being anxious is a sin, or that something is wrong with our faith.

What I think is interesting about the use of the word merimnao in both of these instances in Philippians is that one could make a case that they are both about specific situations and circumstances, that is fear, as well as about issues of personhood and ultimate concerns in life, which is anxiety. For example, Paul is in prison in chains which is a very fearful situation that is easily located in time and space. It’s not an existential exercise, but one grounded in a very specific reality. The same can be said of the early church who Paul is writing to, in that there is genuine fear for their lives and what will become of them if they follow the person of Jesus Christ. But there is also anxiety, in that, what does it mean to be a follower of Jesus, and what does it mean to find one’s identity in Jesus. On top of that there are real anxious and ultimate concerns about death and dying and meaning in this context.

Often the Bible translates the word merimnao as fear or worry, but I think when that is done, one can miss out on the deeper meaning in the text. For example, when the Gospel writer in Matthew 6:25-34 uses the word worry instead of anxiety or anxious, it’s because of context. The writer is encouraging those not to worry about what they shall eat, drink, or wear, all of which are very specific and identifiable things. Rather we are to trust in God’s provision for us. But it’s not just a worry, that is a fear located in a specific time and place. But it’s an anxiety, as one wonders, what does it mean to trust God for provision, and what does it mean to trust God in the 1st century when lives are literally at stake.

The Intertwining of Anxiety and Fear

So you can see anxiety and fear, though distinguishable, often at their roots are intertwined at a very deep and meaningful level. And whether you are a counselor, pastor, lay leader, or a concerned parent, spouse, or friend, it is worth exploring this intertwining with those we love and are in relationship and community with. When we separate the two we can gain a better understanding early on of what is exactly going on, and we can draw interventions and set goals more clearly. Understanding the difference between anxiety and fear can also provide clarity to the person who is unclear about what is going on with them, and in the process create a deeper connection between the caregiver and the person receiving care. When one feels understood they often feel more emotionally safe, which can lead to more vulnerability, which can lead to a deeper transformation.

But as you do the work of exploring anxiety and fear I think that you can provide more insight and depth in the process when you can clearly identify and communicate how the two might be intertwined. In my own life for example I remember the season of transition where I began to explore what it might be like for me to leave full-time ministry and head into full-time counseling. That was a very worrisome and anxious time for me. I was worried about switching careers having just gotten married and wanting to start a family. I wondered how I would provide financially, as well as wondering about what changes that might bring to my marriage and life as we would have to explore paying for school, possibly moving at some point, etc. And I also wondered about whether or not I had what it took to become a good therapist, and if I could really trust God in this process. Luckily I had a really good therapist who helped me more clearly identify some of my fears and what I could do to work on them at a real practical level. And he also helped me identify my anxieties and how I could work at them at really deep spiritual level. They were separate, but intertwined, and both informed and helped the other.

How You Can Help Those Struggling With Anxiety and Fear

If you are in the position of helping others I would recommend a few things that I have found to be helpful when talking about these topics.

First, do all that you can to communicate that struggling with fear and anxiety is okay. Let them now that part of being human means that these are things that we struggle with. And though these are things that can ultimately point to ways we can change our life and things we can work on, it’s okay to have fear and anxiety. When you can communicate this, then you are communicating that you are a safe person to talk with. If you aren’t a safe person to talk with, people will go somewhere else.

Second, try to listen to and draw a distinction between what might be fear for them, that is some worry located in a very specific and identifiable location (i.e. relationship, job, upcoming situation, etc.). And listen for what might be anxiety, that is some feeling that is connected to deep issues around their sense of identity and personhood, or feelings that are connected to issues of ultimate concern in life (meaning, faith, relationships, death, etc.). This will help you understand them better, as well as helping them feel understood.

Third, listen to how anxiety and fear might be working together in this person’s life, therefore, giving you direction in terms of goals and next steps.

Fourth, let them know that anxiety and fear are simply ways that our body is communicating to us, and when we stop and listen to this communication, we ultimately have an opportunity to change our lives and to grow from it. Ultimately, communicate that anxiety and fear are opportunities for growth, and help a person identify where God might be at work on the midst of it.

I hope this has been helpful for you on your journey learning to work with anxiety and fear.

Rhett Smith is a Licensed Marriage and Family Therapist in private practice in Plano, TX. He specializes in helping people struggling with anxiety find new opportunities for growth, as well as spending a majority of his week with couples as they navigate relational issues. He is the author of The Anxious Christian: Can God Use Your Anxiety for Good? and What It Means to Be a Man: God’s Design for Us in a World Full of Extremes. Rhett lives in McKinney, TX with his wife Heather and their two children. You can discover more about Rhett’s work through his writing and podcast at

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