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Knowing how anxiety works can help you to better support loved ones without inadvertently making their anxiety worse.
When I first moved into my (now) spouse’s house in 2001, she didn’t want to include my name in our answering machine greeting. Because of our big age gap and same-sex relationship, she was justifiably anxious about how her parents would react to my having moved in; so she kept it from them for several months. Though I felt a great deal of compassion for her and her situation, I was also frustrated that her anxiety was affecting me—and I didn’t like acting as though we had something to be ashamed of.
Scenarios like this are common when someone in your life is struggling with anxiety. Your loved one may feel so fearful that they avoid taking action, or act in ways that are inconsiderate or that increase your own anxiety. This might look like a boyfriend constantly putting off important tasks or discussions, a friend complaining about being lonely but refusing to date, or a boss always focusing on what could go wrong, making everyone miserable. It’s difficult to witness anxiety in someone you know, and it’s even harder when their anxiety triggers yours.
But what can you do to help anxious people?
First you need to understand that anxiety is a human feature, not a flaw. Most of us get anxious from time to time, because it’s a generally useful emotion that helps us to see potential threats, makes us concerned with social rejection, and keeps us on alert to being deceived. While being anxiety-prone might seem like a fault, it’s actually helpful to have some people in a population who are more cautious and who frequently think about what could go wrong.
However, sometimes people get into patterns of coping with anxiety that cause it to snowball. They overthink (ruminating about the past or worrying about the future), avoid whatever triggers their anxiety, and use compensatory strategies—like being extremely perfectionist to avoid feeling like an imposter at work—that decrease their anxiety temporarily but increase it over the long-term. These coping strategies can also push people away—people like you.
While it’s upsetting and frustrating to see these folks suffer, there are things you can do to help. Here are some of the strategies I recommend based on my book, The Anxiety Toolkit.
Because of evolution, we’re wired to respond to fear by either fight, flight, or freeze. For different people, one of these responses will typically dominate. For instance, my spouse tends to freeze and will bury her head in the sand rather than deal with things that make her feel stressed and panicky. I tend more toward fighting, and will become irritable, excessively perfectionistic, or dogmatic if I feel stressed.
When you understand that anxiety is designed to put us into a mode of threat sensitivity, it’s easier to understand someone who is feeling scared (or stressed) and acting out by being irritable or defensive, and to find compassion for them. By paying attention to how anxiety manifests in the person you care about, you can learn their patterns and be in a better position to help.
It’s best to ask someone what type of support they prefer rather than guess! However, we know from research that people who have an avoidant attachment style (typically those who’ve experienced rejecting caregiving or relationships in the past) are likely to respond best to strong displays of concrete practical support. That could include helping the anxious person break tasks down into manageable steps, or talking through specific options for how to deal with a difficult situation, like how to respond to an angry email, but still acknowledging their autonomy and independence while doing so.
Other people are more likely to prefer emotional support, especially those who are securely attached, or who have a “preoccupied” attachment style due to a fear of being abandoned or of their emotions being overwhelming to others. Folks like this respond well to statements emphasizing that they’re part of a tight team—for example, their supporter saying, “This is tough but we love each other and we’ll get through it together.”
Of course these are generalizations, and you need to tailor your support by observing what works in your particular situation. But when you have a very close relationship with someone, you can offer support based on intimately understanding your loved one’s anxiety patterns.
If your loved one has insight into their anxiety, you can help them spot when their anxiety-driven patterns are occurring. I find it helpful when my spouse notices that I’m expressing my anxiety about work by being irritable with her or by being too fussy. Because we know each other’s patterns so well and have a trusting relationship, we can point out each other’s habits. Not that this is always met with grace, but the message sinks in anyway.
If you’re going to do this, it’s a good idea to have their permission first. Keep in mind that people who have insight into their anxiety often still feel compelled to “give in” to their anxious thoughts. For instance, a person with health anxiety might logically know that going to the doctor every week for multiple tests is unnecessary, but they can’t help themselves. If your loved one lacks insight into their anxiety or has trouble managing compulsions, it’s probably best to encourage them to see a clinical psychologist who specializes in the treatment of anxiety.
You’ll be a more useful support person if you educate yourself about cognitive-behavioral models of anxiety, which you can do by reading or attending a therapy session with your loved one. But, in lieu of that, you might try using some techniques that can be helpful to people suffering from anxiety.
Typically, anxious people have a natural bias towards thinking about worst-case scenarios. To help them get some perspective on this, you can use a cognitive therapy technique where you ask them to consider three questions:
- What’s the worst that could happen?
- What’s the best that could happen?
- What’s most realistic or likely?
So, if your loved one is anxious that they were supposed to hear from their parents hours ago but haven’t, you can suggest they consider the worst, best, and most likely explanations for the lack of contact.
Take care not to overly reassure your loved one that their fears won’t come to pass. It’s more useful to emphasize their coping ability. For example, if they’re worried about having a panic attack on a plane, you could say, “That would be extremely unpleasant and scary, but you’d deal with it.” And, if your loved one is feeling anxious that someone else is angry with them or disappointed in them, it’s often useful to remind them that you can only ever choose your own actions and not completely control other people’s responses.
Avoidance is a core feature of anxiety, so sometimes we may feel pulled to “help out” by doing things for our avoidant loved ones and inadvertently feed their avoidance. For instance, if your anxious roommate finds making phone calls incredibly stressful and you end up doing this for them, they never push through their avoidance.
A good general principle to keep in mind is that support means helping someone to help themselves, not doing things for them, which includes virtually anything that stops short of actually doing it yourself. For example, you might offer to attend a first therapy session with your loved one if they set up the appointment. Or, if they’re not sure how to choose a therapist, you might brainstorm ways of doing that, but let them choose.
An exception might be when someone’s anxiety is accompanied by severe depression. If they can’t get themselves out of bed, they may be so shut down that they temporarily need people to do whatever is needed to help them stay alive. Also, sometimes loved ones are so gripped by an anxiety disorder that they’re in pure survival mode and need more hands-on help to get things done. In less extreme circumstances, however, it’s best to offer support without taking over or overdoing the reassurance.
What can we do for folks with more serious issues? People experiencing things like panic disorder, depression mixed with anxiety, post-traumatic stress, or obsessional thinking (including thoughts related to eating disorders) may fear that they’re literally going crazy. Helping them may feel beyond your ability.
You can still be supportive in many ways. When someone is experiencing significant anxiety, it’s helpful to reassure them that your overall perception of them hasn’t changed. They’re still the same person; they’re just suffering a temporary problem situation that has become out of control. They’re not broken and who they are hasn’t changed. To the extent possible, you can help the person stay connected to positive aspects of their identity by participating in or encouraging their interests and hobbies.
Sometimes, individuals who have chronic anxiety problems aren’t interested in changing. For example, you might be friends with someone who has agoraphobia or an eating disorder, but their condition is long-term and stable. In these cases, you can be accepting of that person so that they don’t feel isolated. Being matter-of-fact about their limitations without excessively shaming them or insisting they should pursue becoming “normal” is often the best strategy.
Recognize that your goal is to help, not to cure the person or relieve them from their anxiety. Taking too much responsibility is actually a symptom of anxiety, so make sure you’re not falling into that trap yourself.
Keep in mind that your support doesn’t need to be directly focused on anxiety. For example, exercise is extremely helpful for anxiety; so perhaps you could simply offer to go for a walk or attend a yoga class together. It’s also fine to put some limits on your support. A 20-minute de-stressing conversation while taking a walk is far more likely to be useful (and less exhausting) than a two-hour marathon discussion.
Helping someone with anxiety isn’t always easy and you may feel like you’re getting it wrong. But, if you remind yourself that you and your loved one are both doing your best, it can help you keep things in perspective. It’s important to remain compassionate and, as the saying goes, to put on your own oxygen mask first. That way, you’ll have a clearer head for figuring out what’s going on with your anxious loved one and how you can truly be of help.
This article originally appeared on Greater Good, the online magazine of the Greater Good Science Center at UC Berkeley.
Alice Boyes, Ph.D., is author of the The Healthy Mind Toolkit, from which this essay is adapted. She is also the author of The Anxiety Toolkit and a frequent blogger for Psychology Today. Her research has been published by the American Psychological Association.