Puritan CBT

Depression, Anxiety, and the Christian Life: Practical Wisdom from Richard Baxter by Michael S. Lundy with an introduction by J. I. Packer.

The past couple of days I’ve highlighted some of the Puritans’ teaching on depression that J. I. Packer and Michael Lundy explore in their introductory chapters of Depression, Anxiety, and the Christian Life: Practical WisdomBut where did they get this wisdom, asks Lundy, wisdom that is remarkably accurate when compared with modern knowledge.

On the basis of his research he identifies three general sources of Baxter’s wisdom in these issues: an undergirding biblical theology, his metaphysical philosophy, and his personal and professional experience. Lundy goes on to explain the details of Baxter’s holistic approach

The Puritans Borrowed Widely

While the Bible is the absolute, carefully examined basis for faith and life among Baxter and his many colleagues, in practical terms he and they borrowed widely from many sources, and used Aristotelian principles of logic, which they made to conform to Christian theology.

The Puritans held all truth was God’s Truth

The Puritans unabashedly took what they could from a variety of sources, holding that all truth was ultimately from God, and that such truth as was revealed to ancient pagans through general revelation could be legitimately recycled, with care, and applied in an explicitly Christian context.

The Puritans found truth in anti-christian sources

What emerges in Baxter’s material is a curious and compelling mixture of sound Christian doctrines and general holistic medical principles, applying reframed Stoic concepts to those doctrines and principles, and formulated as irrefutable logic. Baxter’s use of logic was characteristic of the highly educated clergy of his day. The Stoics had numerous ideas that were antithetical to Christian belief and practice, such as suicide; that did not keep the Puritans from appreciating those elements of the Stoics’ philosophy which were general and adaptable to Christian thought.

The Puritans saw that distorted beliefs led to wrong actions

Belief and behavior were inextricably linked for Baxter, as they were for the Stoics. What you believed determined how you thought about matters and predetermined how you would respond to possible choices along the path of life. Distorted beliefs would inevitably lead to wrong interpretations of circumstances and so to wrong choices and unethical behavior.

The Puritans addressed Depression and Anxiety with early CBT and medication

What Baxter employed was a clear forerunner of what we now call cognitive-behavioral therapy (CBT). His version of CBT would be deemed rudimentary and highly tailored to his relatively homogenous clinical population. Yet, it must still be recognized as a forerunner of a very powerful and highly respected tool for dealing with many otherwise intractable clinical problems, particularly those of a severe and chronic nature, including the aforementioned ones. Baxter begins by advising his readers to get their personal theology straight, goes on to tell them how practically to do that using his own antecedent to CBT, and makes sure that his readers understand that their problems have somatic as well as emotional and spiritual dimensions. Then he concludes by telling his readers to trust their physicians and to take their medicines! Describing this as a confluence of belief, behavior, and medicine oversimplifies Baxter’s approach but is a good synopsis for those willing to explore the sort of advice he so freely gives.

Depression, Anxiety, and the Christian Life: Practical Wisdom from Richard Baxter by Michael S. Lundy with an introduction by J. I. Packer.

What can the Puritans Teach us About Depression?

Depression, Anxiety, and the Christian Life: Practical Wisdom from Richard Baxter by Michael S. Lundy with an introduction by J. I. Packer.

The Causes of Depression

In his introductory essay to this book, J. I. Packer discusses how the Puritans understood the body-soul connection in depression and how problems in one can lead to problems in the other. Referring to Richard Baxter in particular, he viewed depression as “a psychophysical reality, a ‘diseased craziness . . . of the imagination’ that might be caused by the body being out of sorts (“sorrows that come from your spleen”), or by overload or overstrain on the mind, or perhaps both together.”

The Condition of Depression

In addition to spiritual symptoms such as terrors of hell and temptations to blaspheme and commit suicide, “Melancholics characteristically could not control their thoughts; they were unable to stop despairing about everything, or to begin a discipline of thanksgiving and rejoicing in Christ, or to concentrate on anything but their own hopelessness and felt certainty of damnation. They would cultivate solitariness and idleness; they would spend hours doing nothing. They would insist that others did not understand them, and that they were not sick but only realistic about themselves, and they would prove perversely obstinate in the matter of taking medication.”

The Cure of Depression

Baxter’s prescription included

1. “Never letting melancholics lose sight of the redeeming love of God, the free offer of life in Christ, and the greatness of grace at every point in the gospel.”

2. “Not attempting to practice the secret duty of meditation and prayer on one’s own, but praying aloud in company.”

4. Cultivating cheerful Christian community.

5. Avoiding idleness.

6. “Making good use of a skilled physician, a discerning pastor, and other faithful Christian mentors and friends, for support, guidance, and hopefully a cure.”

“Baxter wrote about the care of the soul and the care of the body as if they were indivisible if not indistinguishable components of the same person.”

Depression, Anxiety, and the Christian Life: Practical Wisdom from Richard Baxter by Michael S. Lundy with an introduction by J. I. Packer.

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J. I. Packer’s Definition of Depression

Depression, Anxiety, and the Christian Life: Practical Wisdom from Richard Baxter by Michael S. Lundy with an introduction by J. I. Packer.

Three Authors

J. I. Packer writes a chapter introducing Baxter. Michael Lundy is a clinical psychiatrist who has modernized two texts of Baxter on the subject of depression. Richard Baxter was a Puritan with many pastoral interests, but one of his primary concerns was to relieve depression, as reflected in two of his addresses on the subject published together in this book, together with a shorter essay in the appendix.

The Authors’ Definition

The books provides a dictionary definition of depression:

A recent dictionary defines depression as “a state of extreme dejection or morbidly excessive melancholy; a mood of hopelessness and feelings of inadequacy, often with physical symptoms such as loss of appetite, insomnia, etc.”

But it then supplies J I Packer’s extensive and vivid definition:

Fretful heaviness seizes the mind, sometimes slowing it down to a point of virtual paralysis where thought ceases, sometimes driving it into unfruitful randomness, or a fixed attitude of gloom, or an incessant harping on things felt to be incurably wrong. Depressed persons feel themselves isolated and distant from others— even their nearest and dearest— and from projects in which hitherto their hearts had been fully engaged. Conduct may become eccentric, randomness or inaction may set in, focused creativity may fade away, or sadness may become habitual. Feelings of anxiety, worthlessness, and hopelessness develop, and defensive pessimism takes over. Upset by others’ cheerfulness, the depressed may seem cross-grained and combative. Some depressions are cyclical, low points in bipolar mood swings, where they may be followed by bursts of energetic overconfidence. What medication can do to modify these extremes varies from person to person.

The Authors’ Aims

Why did Packer and Lundy write this book? They wrote it for two reasons.

1. They want Christians “to live as far as possible in the outgoing love, stability, and joy— along with patience, kindness, faithfulness, and self-control—that form the moral profile of Jesus Christ in his disciples. We see such living as true human flourishing, and the promotion of it as central to all forms of pastoral care, church worship and fellowship, personal therapy, and Christian family life. And we see depression in all its forms as a prima facie obstruction to this, in which Satan regularly has a hand.”

2. They believe that mental and emotional thorns in the flesh, such as depression, “may become means of spiritual advance that would not otherwise take place..”

3. “We believe that greater wisdom in this matter than we are used to is found in the pastoral heritage of seventeenth-century Puritanism. Supreme here is the wisdom of Richard Baxter, who in his day was viewed and consulted as a top authority regarding ministry to Christians afflicted by what was then called “melancholy,” but would today be labeled depression. Our hope is that by presenting what Baxter wrote in this field we may contribute to wise pastoral care in Bible-believing, gospel-centered, Christ-honoring churches at this time.

The Authors’ Rejection

Packer and Lundy reject the idea of some Christians that depression in Christians is always a sign of unbelief or some other major sin.

Depression, Anxiety, and the Christian Life: Practical Wisdom from Richard Baxter by Michael S. Lundy with an introduction by J. I. Packer.

Expedition 33: Water in the Desert

Here’s the video for Expedition 33 in Exploring the Bible. If you want to bookmark a page where all the videos are posted, you can find them on my blog, on YouTube, or the Facebook page for Exploring the Bible.

If you haven’t started your kids on the book yet, you can begin anytime and use it with any Bible version. Here are some sample pages.

You can get it at RHBWestminster BooksCrossway, or Amazon. If you’re in Canada use Reformed Book Services. Some of these retailers have good discounts for bulk purchases by churches and schools.

Tolerating Uncertainty

Summary of Chapter Six in The End of Worry: Why We Worry and How to Stop by Will Van der Hart and Rob Waller. Will is a  pastor working in London and Rob is a Christian psychiatrist. Both are recovering worriers.

1. Although we love to be certain about things, we must learn to accept and live with uncertainty.

2. People who worry have unhelpful positive beliefs about worry (see the golden worry beliefs), and unhelpful beliefs about certainty. They maintain worry by setting such high standards for certainty that they are quite unachievable. These include:

  • Being uncertain is an unpleasant experience
  • You should act only when you are absolutely certain.
  • Better safe than sorry
  • I can’t be safe when I’m not sure
  • If I am sure, then I can predict bad things and so prevent them.

3. These beliefs about certainty create a desire to control any uncertainty, creating more worry when they can’t, and so on.

4. Present contemplation is the gold-standard technique for overcoming worry. Two lesser techniques that will train us for that are “thought records: and “making new appraisals.”

5. “Thought records” help us to recognize the irrationality of worry thoughts and the link between thoughts and feelings. An example of a “thought record” can be seen here. The general format is:

  • Situation: The moment when you had a worry thought.
  • Mood: Your feelings in response to your worry thought (rate intensity out of 10)
  • Automatic thoughts (and images): The thoughts that result from your worry.
  • Evidence for: The evidence that supports the likelihood of your worry coming true.
  • Evidence against: Evidence that opposes your worry thought.
  • Alternative thought: Review original worry in light of the evidence.
  • Review and plan: Re-read your original worry and review your mood/feelings (rate intensity out of 10)

Thought records can really help us familiarize ourselves with worry and help us see that most of our worries are poorly founded.

6. “Making new appraisals.” This is a less controlled version of thought records that operates in our thoughts not on paper. It involves the assumption that we are overestimating our worries and starts to consider a range of more probably alternative outcomes and conclusions. We look at our predicament from different angles and produce alternative conclusions.

7. Unhelpful techniques for worry include:

  • Trying to get more information. Looking up stuff on the internet usually increases worry and keeps you on the “I-must-be-in-control” treadmill.
  • Journaling. Unless you keep it to a couple of paragraphs a day, this can set your mind racing when you are trying to sleep.
  • Phoning a friend. This is often a way of avoiding responsibility for decisions and only produces short-term reassurance.
  • Alcohol. And any other addiction like shopping, eating, self-harm.

8. Experiment with losing control. Try a mini-experiment by not trying to control what you usually demand control over. Before doing it, predict what will happen. Then write down what did happen. Keep trying this with various control issues until you learn that there really is nothing to worry about.

The End of Worry: Why We Worry and How to Stop by Will Van der Hart and Rob Waller.