In the Age of Anxiety

Panic, compulsions, phobias, and more

What to Do When Someone You Love Is Anxious

If helping doesn’t work and not helping doesn’t work.

Whether they worry, obsess or panic, if you have a loved one struggling with anxiety it can be almost as painful for you as it is for them. The first impulse is often to reassure—“everything will be fine”, “ don’t worry about it”, “it’s nothing”. Then perhaps you begin to pick up the slack, helping out with more and more to lighten their load and lower their stress. But, over time, this wears on you, especially when you find that it doesn’t really result in much improvement anyway—and may even makes things worse! Eventually, frustrated, you move to cajoling, criticizing or threatening in a desperate attempt to control the anxiety and regain some sense of normality in your life. Sadly, this just leads to more stress, tension and anxiety and, feeling stuck, you may disengage from the relationship altogether.

So, if helping doesn’t work and not helping doesn’t work, what do you do when someone you love is anxious? There is no formula guaranteed to work for everyone, but you may find that some of the concepts below can guide you in developing a plan to cope with your loved one’s anxiety.

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Knowledge. Here, the old adage is true—knowledge is power. Learn as much as you can about anxiety and its symptoms, causes and treatments. Share this information with your loved one as well. Understanding the available treatment options for anxiety may be an important first step to recovery for them. And the better you understand what they are experiencing, the better you’ll be able to cope with it. 

Criticism. You might be surprised to learn that criticism is not always a bad thing when dealing with an anxious spouse, child or friend. While high levels of anger, hostility or criticism are almost always detrimental, some studies have found that focused criticism—criticism that is not globally rejecting of the person—may actually result in improved outcomes (e.g., Zinbarg, Lee and Yoon, 2007). Fair criticism directed at specific behaviors may actually work better than unconditional acceptance.

Accommodating. In fact, too much acceptance can often inadvertently lead to a poorer prognosis through accommodating behaviors and reassurance. While giving in to anxious requests can keep the peace in the short-term, in the long-run it feeds into the cycle of anxiety and dysfunction. It is easiest to refuse these traps right off the bat, but if you’ve already fallen prey to modifying your behavior or given in to repeated requests for reassurance it is not too late to make a change and set some limits. 

Limit setting. This is a simple concept but surprisingly hard to implement because setting limits requires patience, strength and consistency. Patience because, despite how frustrated you may be, it works best to decrease rituals or reassurance gradually—a good rule of thumb is by about half every two weeks. Strength because when you set a limit, things will often get a little worse before they get better. In behavioral theory, this is called an extinction burst. It essentially means that when someone is accustomed to their behavior being met in a particular way—like getting a reassuring answer when they voice a worry—it is a shock to suddenly not hear that response and the first reaction will be to try harder, or ask more, to get it. The good news is that if you stay consistent in your new stance, eventually things will improve.

Setting limits is a difficult but necessary part of living with someone with anxiety but it goes without saying that this should never be done as a surprise. Talk to your loved one in advance and let them know that things will be changing and why. It doesn’t hurt to have a supportive, alternative statement prepared for when tough situations come up—something along the lines of “I love you, so I refuse to participate in this behavior because we know it is harmful to you in the long-run.”

Coaching. If your relationship is a good one and you feel you can manage it, work with your loved one to coach them in their battle with anxiety. If emotions run too deep for you to be objective and supportive when the anxiety is high, help them to identify someone else in their life to play this role. Whether it is supporting and practicing their therapy goals or helping them work through a self-help program, a good coach should be encouraging, not forceful or ridiculing, and can provide an important model for recovery.

Contracting. Though the word has legal connotations, contracting is not just for lawyers anymore. Clearly outlining--in writing--the goals and the plan to reach them can help to organize and commit to the purpose. This would ideally include vows on both sides—what each of you will do to improve the situation. Be as specific as possible and be sure to note the time frame for achieving these goals as well as the contingencies if they aren’t met.  Then stick to it.

Self-care. Perhaps the most important point, remember to take care of you. When someone you care about is struggling with anxiety, it is all too easy to focus on helping them and to forget about your own needs. Be sure to stay well yourself—talk to friends for support, get your own therapist, consider joining a support group or an online discussion board.

 

 

References

Zinbarg, R., Lee, J.E. & Yoon, L. (2007). Dyadic Predictors of Outcome in a Cognitive-Behavioral Program for Patients with Generalized Anxiety Disorder in Committed Relationships: A ‘Spoonful of Sugar’ and a Dose of Non-Hostile Criticism May Help. Behaviour Research and Therapy, 45, 699 – 713.

Pamela Wiegartz, Ph.D., is the Director of CBT Services and Training in the Department of Psychiatry at Brigham and Women's Hospital and on faculty at Harvard Medical School. more...

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