It has been well overserved (Megalakaki & Kokou-Kpolou 2021:1; Taylor 2021b:1), that the rapid spread of COVID-19 infections, combined with unprecedented preventive measures globally, have brought about numerous stress-inducing elements, physical and mental health complications and mortality risks. Recent studies (Lei et al. 2020:9; Shevlin et al. 2020:8) showed that the drastic social behavioural changes and uncertainties connected to COVID-19 treatment and prevention, generated heightened levels of chronic stress, depression and anxiety among patients, healthcare workers, and the general public. As observed by Zaami, Marinelli and Varì (2020:1), ‘people have been going through a moment of anxiety and fear for their health and their jobs, and they are forced to live an unfamiliar lifestyle, deprived of relationships’. Post-traumatic stress syndrome symptoms emerged in post-COVID cases (Tu et al. 2021:4). Taylor et al. (2020:712) proposed the COVID Stress Syndrome, consisting of the following five inter-correlated elements that people have been struggling with: (1) fear of infection (e.g. avoiding certain people or places because of the perceived risk of infectability), (2) fear of socio-economic effects (e.g. the financial strain related to job loss or stockpiling supplies for quarantine or self-isolation), (3) fear of foreigners (e.g. homophobia toward certain people groups who might be perceived as spreader-groups), (4) compulsive reassurance-seeking (e.g. obsessive-compulsive checking for latest news updates and health reports, or obsessive-compulsive cleaning of surfaces and objects for germ aversion), (5) traumatic stress symptoms (e.g. pandemic specific worries, anxiety, stress, or depression). Taylor (2020) finds that the COVID Stress Syndrome has been associated with:

Thus, many people avoided public places and healthcare workers out of fear of infection, and stockpiled supplies to prepare for extended quarantine periods. The most common COVID-19 related health risk indicators (Orrù et al. 2021:2) included a combination of physiological, neurological, and psychological symptoms such as mental fatigue, impaired cognitive functioning, loss of concertation, anxiety, depression, and loneliness. Megalakaki and Kokou-Kpolou (2021:2) argued that public health directives, such as practising social distancing and wearing masks, brought about a sense of isolation and loneliness, seeing that ‘in the context of the COVID-19 crisis, research indicates that greater loneliness is positively associated with greater anxiety and depressive symptoms’. Whereas the human immune system protecting the body against viral infections, Paluszek et al. (2021:11) showed how anxiety and chronic stress have proven to weaken the immune system. In support, the stress phenotype reflected hypo-activity of the hypothalamic-pituitary-adrenal axis (HPAA) stress pathway, and suppression of immunoreactivity (Malan et al. 2021a:14). COVID-19 induced stress and anxiety may therefore weaken the immune system, thus increasing vulnerability to viral infection. A related study warned against the major psychological trauma associated with the pandemic, putting COVID survivors at high risk of posttraumatic stress disorder (Xiao, Luo & Xiao 2020:2), and potentially, prolonging ineffective coping. In addition, the stress and trauma caused by infections, hospitalisations, and excess mortalities have resulted in increased depression, anxiety, and grief (Lei et al. 2020:9; Shevlin et al. 2020:8). Dein et al. (2020:5) pointed out that significant life crises could impact humans not only psychologically, socially, and physically, but also on a spiritual level. In light of the abovementioned indications, even though unprecedented chronic stress levels may have initially been induced by the onset of COVID-19, it could potentially linger long post-pandemic. Until recently, the ability to identify chronic stress risk per se remained a challenge. Hence identifying the chronic stress phenotype (Malan & Malan 2021) might aid medical and pastoral counselling interventions, to improve psychophysiological well-being. Amid the potential increase of pandemic related chronic stress, anxiety and depression, this article aimed to identify positive coping skills that could help the Christian handle prevalent chronic stress from a faith perspective.

Two well-recognised empirically derived coping questionnaires were reviewed, namely the Coping Strategy Indicator (CSI) (Amirkhan 1990:1070) and the Africultural Coping Systems Inventory (ACSI) (Utsey, Adams & Bolden 2000:194). The CSI identifies three coping strategies: defensive problem-solving, seeking social support, and avoidance or loss-of-control. The ACSI identifies four coping strategies: cognitive or emotional debriefing, spiritual-centred coping, collective coping, and ritual-centred coping.

The chronic stress risk phenotype score (index) revealed discriminatory ability for the positive prediction of chronic stress and stroke risk (area-under-the-curve 0.77, 85% sensitivity) (Malan & Malan 2021:PCT/IB2020/057269).

Recent findings in clinical psychology (Knabb et al. 2019) showed the benefit of incorporating various theoretical orientations in the treatment of stress and suffering, thus including a distinctly Christian approach to psychotherapy. A review of Google search data from 95 different countries (Bentzen 2020) found that the frequency of people searching for the term ‘prayer’ spiked dramatically in March 2020 amid the rise of COVID-19 cases globally, thus providing evidence that many people chose to turn to faith in God during times of crises and distress. A cross-sectional survey of 200 COVID-19 healthcare workers suggested (Chow et al. 2021:12) that ‘positive religious coping remains a significant coping mechanism to boost mental health, commonly via prayers, attending religious services, reading scriptures or meditation’. This may support the notion that many people have turned to faith practices to help them cope during the current pandemic. Furthermore, (Jans-Beken 2021:5) it showed that a positive way of coping with pandemic-induced chronic stress, is to foster an attitude of gratitude toward God and to show actions of kindness while enjoying the small things in life. Koenig et al. (2020:270) suggested that ‘religious involvement can serve as a resource that enhances individuals’ mental health and well-being, and can prevent the development of mental disorders or speed their resolution’. Having a sense of life purpose, allowed people to regulate the loneliness caused by COVID-19 restrictions (White 2020:683; Yıldırım et al. 2021:9). The pandemic hindered numerous faith practices due to ‘the cancellation of live religious services, closing religious schools, cancelling pilgrimages and prohibiting group interactions during festivals and celebrations’ (Dein et al. 2020:3). Bryson, Andres and Davies (2020:370) highlighted how ‘clergy have been challenged to improvise alternative worship forms to sustain their congregations while providing pastoral support for the apprehensive, ill and bereaved’. Fortunately, the ‘mediatization of religion’ (Singarimbun 2021:97) has enabled churches globally to incorporate communication technology as a new strategy for church institutions to function during the pandemic. Virtual church has enabled religious participation through initiatives such as live-stream worship services, online giving, and digital prayer meetings, small groups, youth meetings, and children’s church (Bryson et al. 2020:370). As observed by Koenig (2020):

Thus according to Shevlin et al. (2020), amid the complex restrictions of the pandemic as it relates to religious practices, local churches could still provide support for certain groups of people, groups:

Hence understanding spiritual coping related to chronic stress, could help psychotherapeutic practitioners to integrate religious and spiritual dimensions into treatment programmes (Knabb et al. 2019), preventing mental health problems from relapsing. Thus, utilising chronic spiritual coping skills might help preserve mental health.

Knabb et al. (2019) suggested that ‘Christians have historically sought psychological and spiritual insight – that is, a psychospiritual understanding of the human predicament – from the characters and teachings in the Bible’. Hence, from a psychospiritual perspective, this section highlights some thought-provoking similarities between a Scriptural narrative and the human defence response that could hint toward spiritual coping. While the Gospel narratives recorded numerous stressful and threatening circumstances that Jesus Christ and his disciples faced during their ministry (Köstenberger 2009; Talbert 1994), this article focused on the Garden of Gethsemane arrest (Jn 18). While we did not aim to add new meaning to the traditional understanding of the passion narrative, we made certain comparisons and highlighted some observed similarities based on the disciples’ response to perceived threats to the notion that the fight-or-flight response is inherent. We cautiously compared their response to Christ’s reaction to suggest that the disciples defaulted to a fight-or-flight response while Christ, in contrast, demonstrated a faith response. In Table 1 (Le Roux 2020:212) the disciples’ seemingly fear-driven reactions to Christ’s seemingly faith-driven response during his arrest, were reviewed.

At this juncture in the Gospels (Mt 26; Lk 22; Jn 18) the disciples had witnessed Jesus overcoming numerous adversities (Köstenberger 2009). Yet, even though Jesus forewarned them about his imminent suffering (Talbert 1994), they appeared ill-prepared for his arrest. A parallel between the disciples’ fear-driven reaction and the innate fight-or-flight response (Table 1), could hint toward negative stress coping strategies (Le Roux 2020:212). Initially, the disciples correctly recognised the arrival of the guards as a threat (Jn 18:3) (stress appraisal – perceived threat). However, some disciples chose to flee out of fear (Mt 26:56) (emotional avoidance coping or defence – flight response). In contrast, Peter resorted to the sword in self-defence (Jn 18:10) (defence – fight response). Christ’s command to Peter to put away his sword (Jn 18:11) encouraged instead faith-based coping of self-directed coping (spiritually based coping). However, Peter continued his negative coping style when he later denied Christ publicly (Jn 18:26–27) (emotional avoidance coping). Le Roux (2020:213) showed how Peter, despite his fear-responses and failures, became a prominent leader in the Early Church after Christ restored him publicly (Jn 21:7). Later on, Peter penned a very practical example of positive spiritual coping on handling stress from a faith perspective: ‘Cast all your anxiety on him because He cares for you’ (1 Pt 5:7 – NIV).

Even though the Gospels recorded Jesus performing numerous miracles, signs, and wonders, Christ accepted his impending suffering as the fulfilment of Scripture (Jn 18:4; Talbert 1994). He was, in a sense, divinely prepared for his arrest (Köstenberger 2009). A cautious comparison between the disciples’ fear-driven reaction and Christ’s faith-driven response, could hint toward positive spiritual coping strategies (Le Roux 2020:213). Before his arrest, Jesus Christ surrendered his will to God’s in prayer (Mt 26:23; Jn 18:1) (spiritually based coping). Indeed, Christ’s surrender to his preordained suffering caused Him great distress, to the point of sweating blood (Lk 22:22) (prolonged intense stress and sympathetic nervous system (SNS) activation (facilitating hematohidrosis). Recently, Duffin (2017:13) reported cases of hematohidrosis where chronic stress, intense trauma, and extreme mental strain caused a person to literally sweat blood, due to the rupture of capillary blood vessels that feed the sweat glands. This rare phenomenon could be compared to the intense pain and suffering of Christ (Holoubek & Holoubek 1996:115) and might reflect the negative effects of extreme levels of stress (Duffin 2017:13). Jesus knew that the armed soldiers came for his arrest (Jn 18:3) (stress appraisal). However, in understanding God’s redemptive plan through His suffering, He surrendered without a fight (Jn 18:8) (spiritually based coping). Amid the false accusation and being mocked, tortured and flogged (Jn 19:1–3), the Servant Lamb (Is 53:1–9) surrendered to God’s bigger plan by finding the inner strength to endure (spiritually based coping). Christ’s humble example of spiritual coping will show the Christian how to resist the temptation to react swiftly (flight response) or aggressively (fight response) to perceived threats and to find the God-given inner strength, patience, and discernment to utilise positive spiritual coping methods (faith response). Interestingly, not long before his arrest, Jesus Christ taught his disciples how stress could be handled from a faith perspective: ‘I have told you these things, so that in me you might have peace. In this world you will have trouble. But take heart! I have overcome the world’ (Jn 16:33 – NIV). Therefore, scriptural interventions for the improvement of stress coping were proposed.

Faith and trust in God’s divine nature, combined with certain spiritual practices, can promote positive ways to cope with chronic stress. The various components of the Believe-Belong-Behave model (Le Roux (2020:225) could be used in harmony to promote the Christian’s spiritual formation within the local church upon identification of chronic stress prevalence and potential adverse outcomes (Malan et al. 2021b:1).

The Believe-Belong-Behave pastoral model provided a comprehensive overview, to show the Christian how specific spiritual coping skills and practices could be implemented to cope with chronic stress. However, many of the spiritual coping clinical reviews and case studies reviewed in this article, focused on only a small number of solitary religious practices. Some of the relevant findings on positive spiritual coping, thus appeared to be fragmented and interdisciplinary. We aimed to present a combined and collective summary and description to show the Christian how spiritual coping skills could be applied consistently and in harmony, to cope with chronic stress amid COVID-19 and beyond. Jesus Christ warned of stressful circumstances in life, yet He promised an inner peace that can be found in Him, regardless of outward circumstances, ‘Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus’ (Phlp 4:6-7). The Believe-Belong-Behave pastoral model could be used to cope with chronic stress caused by the COVID Stress Syndrome and beyond, as presented in a flow diagramme (Figure 3).

An inter-disciplinary approach was applied to assess recent findings within Theology, Neurophysiology, Bio-engineering and Psychology. Interactive factors involved religion, bio-engineered stress-phenotyping, dorsolateral prefrontal cortex and amygdala dissociated connection (top-down regulation), coping strategies and mental health. Specific stress-coping strategies have shown to adversely affect psychophysiological functioning, resulting in serious stress-induced health threats (Le Roux et al. 2018:373; Malan et al. 2021b:1–2) and risk for COVID-19 related posttraumatic stress syndrome (Tu et al. 2021:4). This practical-theological approach emphasised a scriptural foundation to encourage a faith-in-action response to chronic stress during the ongoing COVID-19 pandemic and beyond. Spiritual coping was defined as an individual’s ability to utilise trust and faith in God, combined with certain Christian beliefs and religious practices to appraise, understand, and effectively cope with chronic stress during COVID-19 and beyond. In support, positive and negative coping strategies during the COVID-19 era were identified and highlighted the adverse effects of chronic stress and defensiveness. Finally, certain Bible passages and theological perspectives regarding spiritual coping were explored to contrast typical fight-or-flight responses with faith responses.

The detrimental effects of increased alertness, anxiety, and depression on brain circuitry due to chronic stress, as reported during COVID-19 and beyond, were discussed. In addition, the adverse effects of loneliness and chronic defensiveness due to reduced social interaction, public gathering restrictions, and prolonged periods of quarantine or self-isolation were approached. Furthermore, a stress phenotype and related symptoms may hold true for post-traumatic stress syndrome in the wake of the pandemic and beyond. Coping strategies in response to the COVID Stress Syndrome, by using the CSI and the ACSI could be used to identify positive and negative stress-coping strategies. Certain spiritual coping techniques, like having faith in God as Redeemer, engaging in religious involvement, and utilising religious practices could help many to cope with COVID-19 related chronic stress or trauma. Theological perspectives and biblical practices within the basic tenets of reformed theology were reviewed to identify resemblances to stress appraisal and human defensiveness in the Garden of Gethsemane narrative. From a psychospiritual perspective, some thought-provoking similarities between the disciples’ seemingly fear-driven reactions, and the fight-or-flight response were identified. While not aiming to add new meaning to the traditional scriptural interpretation of Christ’s arrest, the disciples’ fear-driven reactions were compared to Christ’s faith-driven response. Finally, implementing the Believe-Belong-Behave pastoral model, consisting of individual skills, corporate practices, and practical action steps, could show the Christian certain spiritual coping skills and practices to cope with chronic stress effectively. The individual skills recommended were: having faith in God, dialoguing with God, reading the Word of God, finding hope in God, and pursuing purpose from God. The corporate practices recommended were: finding social support, engaging in corporate worship, undergoing discipleship training, engaging in missional servanthood, and seeking pastoral care. The practical action steps recommended were: proactively deciding to firstly pray, pausing for a Selah-moment, choosing faith over fear, thinking positively, and gaining perspective.

The current Practical Neuro-Theological approach emphasised a scriptural and theological foundation to encourage a faith-in-action response to chronic stress, induced by the ongoing COVID-18 pandemic and beyond. A Christians’ faith and trust in God’s divine nature, combined with certain spiritual practices could promote positive ways to cope with chronic stress during COVID-19 and beyond. The identified positive coping strategies and spiritual coping skills utilised as a faith response in stress-coping could strengthen resiliency to stress.

Even though the current article relied more on literature study than on focus group discussions, this review is a crucial research tool that might help to incorporate Theology into clinical practice, especially in light of the seemingly renewed interest in the prevalence of chronic stress and the concept of spiritual coping, as found in many of the case studies cited.

Much of the current relevant findings on determining chronic stress prevalence and positive effects of spiritual coping, remain fragmented and interdisciplinary. Ongoing dialogue in academia and clinical medicine, on how spirituality and religious components relate to quality-of-life assessments during chronic stress events, should therefore be expanded globally. Collective evidence on coping with chronic stress from a faith perspective, presented a practical model that pastors can use to equip local church congregations.