Supporting Someone with Anxiety

Anxiety disorders are mental health conditions that cause overwhelming feelings of nervousness or worry. These feelings interfere with daily activities and relationships. Anxiety disorders include:

• Generalized anxiety disorder (GAD).
• Social Anxiety.
• Post-traumatic stress disorder (PTSD).

When a person has an anxiety disorder, his or her condition can affect others around him or her, such as friends and family members. Friends and family can help by offering support and understanding.

What do I need to know about this condition?
Anxiety is the mental and physical experience of nervousness or worry that you might feel when you think about a stressful event. Occasional anxiety is normal, but a person with an anxiety disorder becomes preoccupied with this worry. He or she may know that the anxiety is not logical, but knowing this does not relieve the discomfort that he or she feels. Anxiety disorders cause a great deal of distress and prevent someone from having a normal daily life. Someone with an anxiety disorder may:

• Experience anxiety that:
  • May or may not not have a specific trigger.
  • Lasts for long periods of time.
  • Causes physical problems over time.
  • Is far more intense than normal anticipation.
  • Occurs at unpredictable times.
• Feel restless or edgy.
• Get fatigued easily.
• Have trouble focusing.
• Have muscle tension.
• Have trouble falling asleep or staying asleep.
• Be irritable and occasionally have sudden expressions of strong feelings (outbursts).
• Have worries that do not make sense to you.

What do I need to know about the treatment options?
Anxiety disorders are generally very treatable by mental health providers such as psychologists, psychiatrists, and clinical social workers. Treatment may include one or more of the following:

• Psychotherapy, also called talk therapy or counseling. Types of psychotherapy that are used to treat anxiety include:
  • Cognitive behavioral therapy (CBT). This type of therapy teaches a person how to recognize unhealthy feelings, thoughts, and behaviors, and how to replace those feelings with positive thoughts and actions.
  • Behavior therapy that trains a person to relax and self-soothe. This also involves gradually exposing the person to the cause of the anxiety (progressive exposure therapy).
  • Biofeedback. This type of therapy focuses on trying to control certain body functions, like heart rate, to lessen the physical impact of anxiety.
  • Mindfulness-based stress reduction training. This uses education, meditation, and yoga to help a person stay focused on the present instead of living in the past or worrying about the future.
  • Acceptance and commitment therapy (ACT). This helps a person to focus on acceptance, rather than trying to control every situation.
  • Family therapy. This treatment helps family members to communicate and deal with conflict in healthy ways.
• Medicine to treat anxiety and help to control certain emotions and behaviors.
• Mind-body programs. These programs encourage the person with anxiety to be involved in his or her treatment and feel empowered. Mind-body programs may include mindfulness-based stress reduction training, yoga, or tai chi.

How can I support my loved one?
Talk about the condition
Good communication is the key to supporting your friend or family member. Here are a few things to keep in mind:

• Be careful about too much prodding. Try not to overdo reminders to an adult friend or family member about things like taking medicines. Ask how your loved one prefers that you help.
• Ask questions and then listen to your loved one's response. Be available if your friend or family member wants to talk, but give your loved one space if he or she does not feel like talking.
• Never ignore comments about suicide, and do not try to avoid the subject of suicide. Talking about suicide will not make your loved one want to act on it. You or your loved one can reach out 24 hours a day to get free, private support (on the phone or a live online chat) from a suicide crisis helpline, such as the National Suicide Prevention Lifeline at 1-800-273-8255.
• Be encouraging and offer emotional support. This can help to lower stress. Even saying something simple to comfort your loved one may help.
• If your loved one is open to it, go with him or her to visits with a counselor or health care provider. Get suggestions directly from your loved one's care providers about when to get help if you are concerned about behavior changes. Privacy laws limit how much a person's health care provider can share with you without your loved one's permission, but if you feel that a situation is an emergency, do not wait to call a health care provider or emergency services.

Find support and resources
A health care provider may be able to recommend mental health resources that are available online or over the phone. You could start with:

• Government sites such as the Substance Abuse and Mental Health Services Administration (SAMHSA): www.samhsa.gov
• National mental health organizations such as the National Alliance on Mental Illness (NAMI): www.nami.org

You may also consider:

• Joining self-help and support groups, not only for your friend or family member, but also for yourself. People in these peer and family support groups understand what you and your loved one are going through. They can help you feel a sense of hope and connect you with local resources to help you learn more.
• Family therapy.

General support

• Make an effort to learn all you can about your loved one's form of anxiety.
• Include your loved one in activities. Invite him or her to go for walks and outings.
• Help your loved one follow his or her treatment plan as directed by health care providers. This could mean driving him or her to therapy sessions or suggesting ways to cope with stress.
• Remember that your support really matters. Social support is a huge benefit for someone who is coping with anxiety.

How can I create a safe environment?

• For certain types of anxiety, such as PTSD, you may want to:
  • Remove alcohol and prescription medicines from your loved one's home, or limit the amount of these substances in the home. This can help to prevent your loved one from abusing alcohol and prescription medicines.
  • Remove or lock up guns and other weapons. If you do not have a safe place to keep a gun, local law enforcement may store a gun for you.
• Make a written crisis plan. Include important phone numbers, such as the local crisis intervention team. Make sure that:
  • The person with anxiety knows about this plan and agrees with it.
  • Everyone who has regular contact with the person knows about the plan and knows what to do in an emergency.
  • The written plan is easily accessible and can be quickly put into action.

How should I care for myself?
It is important to find ways to care for your body, mind, and well-being while supporting someone with anxiety.

• Try to maintain your normal routines. This can help you remember that your life is about more than your loved one's condition.
• Understand what your limits are. Say "no" to requests or events that lead to a schedule that is too busy.
• Make time for activities that help you relax, and try to not feel guilty about taking time for yourself.
• Spend time with friends and family.
• Consider trying meditation and deep breathing exercises to lower your stress. Attend some mind-body classes by yourself or with your loved one.
• Get plenty of sleep.
• Exercise, even if it is just taking a short walk a few times a week.
• If you are struggling emotionally with guilt, fear, or anger, consider working with a therapist.

What are some signs that the condition is getting worse?
Signs that your loved one's condition may be getting worse include:

• Dramatic mood swings.
• Staying away from activities that he or she used to enjoy.
• Drinking more alcohol than normal.
• Either seeming tearful or seeming to lack emotion.
• Talking about "not feeling right."
• Staying away from others (isolating himself or herself).

Get help right away if:

• Your loved one expresses thoughts about harming himself or herself or others.
• Your loved one's behavior becomes hard to predict (erratic).
• Your loved one shows behavior that does not make sense with the current time, place, or circumstances. These behaviors may include seeing, feeling, tasting, or hearing things that are not real (hallucinations) or having flashbacks.

If you ever feel like your loved one may hurt himself or herself or others, or may have thoughts about taking his or her own life, get help right away. You can go to your nearest emergency department or call:

• Your local emergency services (911 in the U.S.).
• A suicide crisis helpline, such as the National Suicide Prevention Lifeline at 1-800-273-8255. This is open 24 hours a day.

Summary

• People with anxiety disorders experience overwhelming feelings of nervousness or worry. Friends and family can help by offering support and understanding.
• Anxiety disorders are generally very treatable by mental health providers. They can be treated with psychotherapy (also known as talk therapy), behavior therapy, medicine, and mind-body programs.
• Be compassionate and listen to your loved one. Be available if your friend or family member wants to talk, but give your loved one space if he or she does not feel like talking.
• Find ways to care for your own body, mind, and well-being while supporting someone with anxiety. Try to maintain your normal routines and make time to do things that you enjoy.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.

Document Released: 05/01/2018 Document Revised: 05/01/2018 Document Reviewed: 05/01/2018
Elsevier Interactive Patient Education © 2018 Elsevier Inc.