Mental Health
Case Examples

Seth F. Nieding

Seth F. Nieding

8936 Riverwood Drive
North Ridgeville,
Ohio 44039-6313


I was surprised, and you may be too, that the Bible contains prescriptive treatment plans for anxiety, damaged self-esteem, depression, anger, marital difficulties, sexual problems, family problems, parenting issues, relational conflicts, as well as pathological gambling, over spending, over eating, alcohol/drug dependence, and other life dominating problems.

Biblical precepts, if precisely followed, provided hope and the power to dramatically and effectively change our emotional, cognitive, behavioral, and relational health.

This manual is written for individuals suffering from depression, anxiety, damaged self-esteem, anger, marital, family and life dominating problems such as pathological gambling, over spending, over eating, and alchol/drug dependence.

Why do we look for answers to these problems everywhere, including sociology, psychology, medicine, literature, our friends, our experiences, fortune tellers, and the most current professional therapeutic treatment fads, but ignore the wisdom of the Bible?

Seth F. Nieding,


  • Depressed / Happy
  • Holiday Depression
  • Negative Thoughts
  • Childhood Hurts
  • ADHD
  • Be Aware of What You See
  • Anxiety / Panic
  • Taking Thoughts Captive
  • Victory Over Anger
  • Damaged Self-esteem
  • Anguish to Empathy
  • Life Dominating Problems
  • Marijuana in Ohio

Depressed, Un-depressed, Numb,
Happy, Overflowing Joy

Depressed people tend to inextricable link their mood to their circumstance, focus on where their glass is partially empty, place their hope only in themselves to overcome their depression, shut down and not function, believing their own cognitive distortions associated with their damaged self-esteem, isolate, and practice pessimism, negativity, detachment, and avoidance.

If one focuses on where their glass is partially empty, it has the same effect as rehearsing, feeding, and strengthening depression. In some ways it's like the skill of being depressed. Frequently depressed patients will settle for not being depressed or for being numb on antidepressants.

For the majority of depressed patients they have the ability to learn the skills practiced by happy people. Recent research has shown that the two most frequent qualities associated with the habits of happy people, are a positive relationship and a positive spiritual life. A positive relationship includes good communication, companionship or spending quality time, development of empathy and emotional support, physical touch such as giving hugs and kisses, and in the context of marriage frequent other-focused physical intimacy.

The qualities of an active spiritual life, for a Christian, include reading the Bible, praying, doing devotionals, forming close relationships with other Christians, active involvement and service in the church, and involvement in a ministry focused on serving others.

Twenty years ago I contracted with an outside researcher to study out comes in a large residential treatment center for alcohol and drug rehabilitation. The top two qualities associated with long-term abstinence from alcohol and drugs were active involvement in Alcoholics Anonymous and an active spiritual life. At the time I was not a believing Christian but an agnostic. It would seem that active involvement in Alcoholics Anonymous included attending meetings, having a positive relationship with a sponsor, and serving to help run the meetings. I do not believe that it is a coincidence that the two variables relate to overcoming alcohol and drug addiction and overcoming depression, are the same as those associated with the habits of happy people.

Overcoming Post-Holiday Depression

Many people who experience even minor to moderate amounts of depression throughout the year can experience severe stress and post-holiday depression. If you experienced anxiety, stress, and internal conflict related to shopping; if your holiday expectations were far beyond the reality of what happened over the holidays; if friends and family relationships are broken or in conflict; if the presents you received left you feeling empty; if you are now financially stressed out having to now pay for Christmas, consider the following: all earthly things have the potential to lead to stress, temporary but empty joy, anxiety and depression.

Make this the year that you make a major lifestyle change. Pastor Jonathan Schaeffer of Grace Church in Middleburg Heights perhaps frames it the clearest: Everything Minus Jesus Equals Nothing. Nothing Plus Jesus Equals Everything. Make 2015 the year that you seek out and immerse yourself in your spiritual life.

Overcoming Automatic Negative Thoughts

Most of us will at some time experience damaged self-esteem, depression , anxiety, and anger. When this happens we tend to have an automatic negative thought process. We may interpret even neutral events in a negative, pessimistic, critical manner. In order to have victory over our automatic negative thoughts, we need to develop and practice an automatic positive, optimistic, encouraging thought process.

With low or damaged self-esteem, we need to remember that God created us in His image, gave us our physical appearance, intellect, emotions, capacity for relationship, and both our good and bad life experiences, all for His purpose. When we are faced with anxieties, we need to acknowledge God's sovereignty, that He is in charge of our lives, that we are to be good stewards of the time He has given us, the money He has given us, and our very lives which He purchased on the cross and which we are to devote for His purposes.

When we are angry we need to develop the perspective of whether we are angry about what God cares about, or about our own selfish desires. I have found it very helpful to seek out God's purpose for my life, and to adopt and practice a daily gratitude list or blessings inventory, which is the antidote to my automatic negative thoughts.

Overcoming the Hurts of Childhood

Adults who present with current emotional stress from childhood traumas usually reference death or divorce of parents, abandonment; emotional, physical, or sexual abuse; witnessing or being a victim of anger, rage, or violence; being sent off to foster care; being rejected, harassed, or bullied... The normal reaction to these abnormal situations is to become highly anxious, develop panic attacks, become withdrawn or depressed with shutting down, difficulties with focus or concentration, anger and/or resentment with rebelliousness, defiance, and Becoming Preoccupied with the Past.

Typical dysfunctional coping or avoidance patterns may emerge with abuse of alcohol, drugs, seeking love by becoming prematurely sexually active, sexual promiscuity, gambling, overspending, pornography, overeating, or acting out of anger with violence. For recent traumas, critical incident stress debriefing, listening to the hurt child, being supportive, and comforting is highly therapeutic.

For distant traumas however, psychological research indicates that we should encourage the traumatized to quit looking in the rearview mirror and start looking in the windshield of their life. Being preoccupied with one's past hurts is like rehearsing, reliving, feeding, and strengthening the trauma. From a cognitive behavioral and Biblical perspective, our thoughts become our words, which strengthens our feelings, which influences our behavior and develops our behavioral patterns or habits, and eventually develops our character and where we end up in life.

God knows that we have scars and disabilities but He also knows that we have strengths and abilities. We can learn to take our thoughts captive by taking off the past and substitute putting on our goals. We can utilize our unique giftedness as well as our good and bad experiences to develop our character and our strengths. Many successful people have turned their childhood hurts and traumas into a positive life of purpose and service. Helpful Biblical references include Romans 12:1-2, Philippians 4:8, Isaiah 26:3, and Ephesians 4:22-24 which will guide the reader on how to overcome painful thoughts, and find incredible peace.

It May Not Be ADHD

Today in a television interview with Channel 19 Action News I was asked about the importance of the role of fathers in the lives of their children. I am currently working with an intact family with a stay-at-home mother, professional father, and three children. Parents presented to therapy because their children were arguing, fighting, and being disobedient. The parents were frustrated and overwhelmed, having unsuccessfully tried timeouts, consequences, groundings, and other forms of discipline.

I prescribed that the father be actively engaged with his children for one hour a day. This does not mean sitting and watching television together, but engaging in playing board games, reading books, building Lego blocks, and even working together by making a game of raking leaves. Within several weeks the parents reported dramatic positive changes in family relationships.

When fathers are absent, working long hours, being disengaged, or are part-time fathers due to divorce, children typically develop the following symptoms: worries, anxiety, abandonment fears, regression with bedwetting, somatic complaints of headaches or stomach aches, depressed mood, withdrawing, shutting down, loss of joy, decline in cognitive functioning with inability to focus or be attentive at school, and/or become angry with acting out, becoming rebellious or defiant.

Such children are frequently diagnosed with ADHD, put into therapy, or placed on medication management. Children's misbehavior may be diagnostic of a marital, parenting, or family relationship problem.

Be Aware of What You See

Ralph Waldo Emerson stated that if we sow a thought, we will reap an action; if we sow an action, we will reap a habit; if we sow a habit, we will reap our character; and if we sow our character, we will reap our destiny.

For my psychotherapy patients who suffer from severe post-traumatic stress disorder with anxiety/panic, depression, anger/rage, and relational conflicts, I encourage them to remove television from their lives. While watching evening television shows, and even commercials for movies, depicting anger/violence, murders, mutilations of bodies, sex intertwined with violence, and demonic spirits, many clients have reported experiencing panic attacks, reemergence of childhood traumas, horrific nightmares, suicidal urges, and for those patients prone to anger/rage and violent behavior, urges to act out violence.

If our popular culture continues on this path, there will not be enough police, prisons, or mental health facilities to protect us from ourselves. I encourage children, adolescents, and families to immerse themselves in the studying of the character of Jesus.

Victory Over Anxiety/Panic

To all of you who experience severe anxiety/panic
or have friends or family who do, there is a set of powerful interventions that you may find helpful. We tend to have expectations that we should always be happy, not be inconvenienced, have no losses, have no job stress, have prosperity, be accepted by everyone, be popular, have no relational conflicts, be healthy, youthful, have what others have, not go through traumas, be in romantic relationships... etc. When we don't have these things were when terrible situations occur we become anxious, have panic attacks, or become depressed.

Once we learn to take our thoughts captive and cognitively reframe our experience we can have victory over anxiety/panic. We would do better not to ask why is this happening to me?, But rather, ask where is God's hand in my life and what am I suppose to be learning by going through this difficult time? The Bible states that such experiences, if managed correctly through following Biblical precepts, can produce personality growth and maturation, strength and perseverance, and draw us into a closer relationship with God.

I have many patients who went through quite horrific traumas, only to come out as very nurturing protective mothers, caring mentors or teachers, or loyal sensitive empathetic friends. Secular tools for addressing severe anxiety/panic, such as progressive exposure therapy or desensitization therapy can be extremely helpful, but tend to fall short of producing a peace that passes all understanding that can come from following biblical precepts related to peace of mind.

Learn How to Take Your Thoughts Captive

Many of my patients struggling with depression have learned how to take their thoughts captive as a powerful technique for overcoming depression.

For the most part depression is a choice. Most people do not want to hear that. For all of us, it is true that our glass is partially empty, or full of hurt, pain, neglect, abuse, and/or betrayal. But it is also true that our glass is partially full of joy, love, and innumerable blessings.

We can choose where we camp out in our heads. We can dwell on, and thereby keep rehearsing and keep strengthening the negatives, or we can choose to take our thoughts captive and focus on the positives.

In psychology you know that stop thought is insufficient for change, without thought substitution. I am not suggesting that we lie to ourselves and say that the negatives do not exist. The negatives are real and powerful, but also are the blessings.

Making a gratitude list, an appreciation inventory, or a blessings journal can strengthen our appreciation for where our glass is partially full. You can also create and strengthen hope, optimism, and create an attitude of joy.

Having Victory over Anger

We seem to live in a time where there is so much anger and conflict. The manifestation of our anger can be sinful anger, which is selfish and self-centered, all about what we want. There is also righteous anger, which is concerned about those things which God is concerned about such as injustice, dishonesty, corruption, sexual immorality, and violence.

Anger and its expression is a choice. Our thoughts determine our emotions, our emotions determine our behavior, our behavior determines our habits, and eventually our habits determine our character. Since I'm not like Jesus, I have been struggling with my own anger. Although big events that take a turn for the worse do not seem to rattle me, little events like mastering my smart phone or this computer can send me over the top.

Looking at my own thought pattern I have the mistaken notion/expectations/cognitive distortion, that things should always go my way, and that my life should be stress free. When things don't go my way, I get upset and outwardly express or act out anger. My treatment plan, when this computer has its own will, or when my smart phone is smarter than I am, is to put on thankfulness, thanking God that I have a computer, a smart phone, a home, good finances, a great wife, a great family etc. Putting things back into proper perspective.

Anger expressed is not necessarily anger resolved. Any solid anger management process should involve gratitude and/or forgiveness. Making a blessings inventory, or gratitude list can be a powerful antidote to anger.

How to Repair Damaged Self-Esteem

Many of my patients struggle with damaged self-esteem. They often feel as if they are a burden to others, in the way, defective, unworthy, not good enough, and/or shame filled.

Damaged self-esteem can come from many places, such as growing up with frequent criticism, being neglected, abused, excluded, rejected, bullied, and/or betrayed. When individuals end up feeling that what they do is not good enough, they frequently end up feeling as though "they are not enough". They either fail to see or they minimize their strengths, and consequently do not try or give up on themselves. They seldom perceive, believe, or utilize their unique giftedness.

The best therapy for low or damaged self-esteem is to cognitively reframe from how we perceive ourselves to how God perceives us. Genesis 1:27 God created us in his own image. God knew us before we were born and we are his creation. He gave us our physical appearance, our intellect, our emotions, our personalities, our capacity for relationship, and gave or allowed us to go through our life experiences, both good and bad. All for his purpose.

Many of my most damaged patients, who have sought out God's purpose for their lives, have utilize their trials for good, to be more sensitive, empathetic, caring, teaching, counseling, coaching, mentoring, and being an encouragement to others. Throughout the Bible God has used many damaged individuals to fulfill his purpose. God does not call on the qualified to fulfill his purpose, he qualifies those who are willing to answer the call.

From Anguish to Empathy

Nicole grew up with a father who abused alcohol and drugs, was unpredictable, at times paranoid and violent. Afterward he would break down into tears and seek hugs, kisses, and affection. Mother was passive, needy, disorganized, and undependable.

Nicole would be severely punished/abused if she cried, smiled, or at times even spoke. She grew up being hyper-vigilant and highly aware and perceptive of her father's facial expressions, body language, emotions, and his needs, in an attempt to escape violence.

After several therapy visits she adopted Romans 5:3-4 as her Life Verse. Despite a high level of anxiety, fear, damaged self-esteem, and lack of self-confidence, she used her survival skills to develop a high level of sensitivity and empathy for others. She has become involved in promoting peace and nonviolent communication. Nicole has adopted a sense of humor, being thoughtful, supportive, witty, empathetic, and caring towards others.

She now perceives her childhood traumas as a training ground that developed her character, strength and perseverance, and spirituality. She now feels like a tool, although an imperfect tool, that can be used by God to further His agenda.

Cognitive Therapy for Life Dominating Problems

Life dominating problems are those problems which have occurred for a long period of time and which have come to define our character. These may include anger/raging, alcohol/drug dependence, pathological gambling, pornography, pathological lying, severe obesity, etc. which within our culture have come to be defined as addictions.

The Bible interestingly, does not talk about addictions, only life dominating problems or sinful choices. Whatever we "immerse ourselves in" or "give ourselves over to", will determine our thoughts, which will impact our emotions, which will influence our behavior, which will develop our habits, which will come to define our character and where we end up in life.

The Good News is that we can have victory over these problems. Here is the recipe: Romans 6:16 When you offer yourself to someone/something you are a slave to the one whom you obey. 1 Corinthians 10:13 No temptation has seized you except what is common to man. God will provide a way out. Romans 8:12-13 You have no obligation whatsoever to do what your sinful nature urges you to do. If you keep on following it, you will perish(spiritual death). But if through the power of the Holy Spirit you turn from it, you will live. 1Timothy 4:7-8 Train yourself for spiritual fitness. Ephesians 4:21-24 Put off your old self which is being corrupted by its deceitful desires; Put on your new self to be made new in the attitude of your mind. Colossians 3:5-10 In its place you have clothed yourself with a brand-new nature that is continuously being renewed as you learn more about Jesus. (Putting on the mind of Christ).

Legalization of Marijuana in Ohio

Over the years as a licensed independent mental health therapist and a licensed independent chemical dependency counselor, I have observed the downside of marijuana use. Adults have presented to my practice with their primary presenting problem as cognitive impairment.

Those individuals who have used marijuana daily from adolescence through their late 20s or early 30s reveal cognitive problems of tangential thinking, loose associations, paranoia, poverty of content, while maintaining enough intelligence to know that they are impaired. Additionally individuals presenting with short-term use of marijuana, frequently reveal loss of motivation and irritability, anger, and/or rage somewhere between 8 and 12 hours after their last use.

If the state of Ohio is considering legalization of marijuana, I would suggest a large increase in taxation on the sale of marijuana to help offset the associated costs we will see in emotional, cognitive, and behavioral problems, damaged marital and family relationships, impaired teens and adults, impaired drivers, and increased applications for welfare and Social Security disability.

Unfortunately, the financial cost will never outweigh the human cost, which will be staggering.