Imagine finding two cross-cultural puzzles that both have the same missing piece. Read through the scenarios below to determine the common element that often leaves cross-cultural workers feeling hollow or in pain. Also, think of strategies you might try to take care of these friends, colleagues, and family members.

Scenario 1: Just three months earlier, Katie had arrived on the field and started language school. She was joining a team that had served together for several years, and the last thing that Katie wanted to do was to let down her teammates and supporters back home. Yet she felt petrified. Even the thought of going shopping for her food overwhelmed her. The immersion classes made it even worse. Always thought of as the smart one in her family, Katie had wonderful grades from kindergarten through college. Sure, she was a perfectionist, but that had always served her well. But not anymore. Overthinking her word choices left Katie close to tears daily if she could even go to class or make her shopping trek in the small town. She wondered if she could make it through language school, much less a few years of work. She seriously considered packing up and returning home in disgrace.

Scenario 2: For Julio, seven years in the tropics had been part adventure and part exhausting. He had learned the language of wider communication and already hit a good level of fluency in the local language. He and his wife, Miriam, seemed to excel in everything they tried. Folks back home were proud. The locals bragged about how the dynamic duo were the first foreigners to ever learn and work in the local language. But Julio had a sinking feeling in the pit of his stomach. At first, he thought it was another parasite, but the doctor assured him that it was simply a “matter of nerves.” Anger and humiliation welled up in Julio. However, Miriam tried to reassure him. Soon to become new parents in a country far from home with limited medical care seemed like reasonable causes of stress. She had never seen Julio like this but was sure he would bounce back soon. But as they entered their last trimester of pregnancy, Julio was struggling more than when she had first announced to him what she thought would be joyful news. Embarrassed, Julio felt trapped with nowhere to turn. What would people back home think of him if they knew his feelings? How would the locals react if he suddenly took his family back home?

Did you catch the common element in both of these vignettes? Did you notice ideas of fearing to let others down, overthinking, or feeling like a disgrace? How about “a matter of nerves” and a string of stressors and transitions? And how individuals and families were affected by multiple cultures and communication issues?

Nervousness or anxious symptoms are common to all people around the world, but people living cross-culturally often experience additional and unique stressors. To effectively address these symptoms, you may have noticed that I avoided the word anxiety, at least so far. This is due to some common misconceptions and possible “re-conceptions” that I’d like to address:

Misconception One: Any form of worry or stress is unhealthy. According to the American Psychiatric Association, anxiety is a normal response to stress and can even be beneficial in some situations, such as increasing attention and focus on a test or work task. ¹ By contrast, anxiety disorders differ from the temporary feelings of anxiousness or nervousness with more intense and long-lasting feelings of fear or anxiety.

Re-conception One: We must recognize that it is nearly impossible to move to a foreign country without stress and worry but that adjustment is often only attainable by facing into the struggles, especially in the early months and years. Cross-cultural stress is not necessarily unhealthy and is an expected aspect of living abroad. Work, parenting, and countless other situations that cross-cultural workers face will require attention and focus that can be rewarding once completed. We as care givers always need to keep in mind, though, that excessive worry or long-term stress (defined as more than six months) may require special strategies to help your worker successfully navigate them.

Misconception Two: Any form of worry or stress is sinful. Not only is there often a social stigma about anxiety and the accompanying symptoms, but some well-meaning Christians have unfortunately added elements of shame.

Re-conception Two: “Do not be anxious about anything” (Phil. 4:6) is God’s word and truth, but the context seems to be describing a mindset rather than a command. Knowing that “The Lord is near,” we are told to rejoice, show gentleness, and think about the good. It is supposed to be an encouragement rather than a threat! Jesus tries to comfort those who are stressed in Matthew 11 when he says, “Come to me, all who are weary and heavy burdened, and I will give you rest.” And in John 14, he reassures us with “My peace I give you… do not be troubled or afraid.” 1 Peter 5:7 reminds us to “Cast all your anxiety on him because he cares for you.” He doesn’t say not to be anxiety-free but tells us what to do when we are anxious. Even Jesus was perplexed before his death. As people showing care to cross-culture workers, we are all called to “Carry each other’s burdens, and in this way, you will fulfill the law of Christ” (Galatians 6:2).

In one recent study, almost one in five U.S. adults had experienced some form of an anxiety disorder in the past year alone, ² while almost one in three U.S. adults experience an anxiety disorder at some time in their life. ³ Pandemic-related spikes in anxiety are still being studied, but levels are thought to have been heightened in all levels of society, including children and teens. If levels of anxiety are this high across the broader society, it stands to reason that those levels are even higher among those living cross-culturally.

Assisting others: Just as wounds often leave scars as evidence of healing, when dealing with anxious symptoms and a possible diagnosis of an anxiety disorder, it is good to consider using a plan such as the SCAR Process:

Symptoms: What are the feelings, thoughts, and behaviors that seem different rather than normal? Are there signs of panic attack (sudden fear or terror that peaks within minutes and can come with heart palpitations, sweats, chest pain, or dizziness)? Is there fear and avoidance of places or situations that cause panic and feelings of being trapped, helpless, or embarrassed? In children, is there an exaggerated fear of separation from their primary caregiver(s)? Is there hopelessness or suicidal thinking? Are the symptoms seasonal, at a certain time of day, or occurring in particular settings? How long have the symptoms been present? Has anything helped relieve the symptoms?

Causes: What are contributing sources of the current or long-term stress, worries, or nervousness? Could the feelings of worry and nervousness be attributed to a medical condition or hormonal imbalance? Are there prescription or self-administered drugs with possible anxiety-inducing side effects? What about alcohol abuse? How might climate, sunshine levels, and other environmental factors contribute to their current feelings? Are there disruptions to needed sleep, exercise, and proper diet? What are some of the work and family stresses? How is the healing or processing of old wounds occurring? What possible mitigation strategies are possible or already helping?

Attend to the person (not the problem): Walk with the person and realize that healing may take time as they move toward new thoughts, feelings, and behaviors. It may help to provide acts of service and demonstrations of care. Prayer with and for the person is one of the best ways to place our burdens upon the Lord and share them with one another. Proverbs 12:25 reminds us that “Anxiety weighs down, but an encouraging word will make him joyful.” Encourage without minimizing or denying the struggle.Work to differentiate between the person and what they are struggling with; there is a big difference between saying “you are anxious” and “you are feeling anxious today.” Persevere with the person over time because symptoms may persist or recur. Consider sharing mindfulness practices from a Christian perspective to lower stress and anxiousness. ^4,5

Refer to professionals: Throughout the process, it is important to be aware of your limitations and encourage appropriate medical or mental health diagnosis and treatment when needed. If the cross-cultural worker is experiencing severe, worsening, or constant symptoms, particularly if they are occurring more days than not over a six-month period, they need to speak with doctors or mental health specialists. Keep in mind that in times of deep anxiety some people may need assistance finding, scheduling, and even getting to professional services.

Considering the facts that anxious symptoms are common throughout the general society and that our cross-cultural workers are often flooded with unique stressors, we as care providers must be aware of the symptoms of anxiety. These symptoms affect individuals, families, and teams regardless of gender, marital status, and age--even children and teens. As people showing care to those serving internationally, we must listen well and show compassion while helping to identify the root causes of their feelings of worry, or nervousness. Our job is to pray with and for those we serve, to provide appropriate resources, and to attend to the person more than we fixate on the struggle. However, we must also seek additional resources and professional help when necessary. Seeking to do all of this, we minister in ways that profess in word and action, “May the God of all hope fill you with all joy and peace as you trust in him so that you may overflow with hope by the power of the Holy Spirit” (Roman 15:13).

References:

¹American Psychiatric Association. What are anxiety disorders? (June 2021). Available at https://psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders.

²Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 2: 12-month prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.

³Harvard Medical School, 2007. National Comorbidity Survey (NCS). (2017, August 21). Retrieved from https://www.hcp.med.harvard.edu/ncs/index.php. Data Table 1: Lifetime prevalence DSM-IV/WMH-CIDI disorders by sex and cohort.

⁴Timbers, V. I., & Hollenberger, J. C. (2022). Christian Mindfulness and Mental Health: Coping through Sacred Traditions and Embodied Awareness. Religions13: 62. Retrieved from https://doi.org/10.3390/rel13010062

⁵Johnston, R. H. H., (2017). Christian Mindfulness at Vital Connexions Workshop. Retrieved from https://christianmindfulness.co.uk/wp-content/uploads/2017/07/Christian-Mindfulness-at-Vital-Connexions-Slide-Pdfs.pdf