Post No.: 0449
The most common types of anxiety disorders are generalised anxiety disorder (GAD), obsessive-compulsive disorder (OCD) (see Post No.: 0095 for more specifically about OCD), panic disorder, post-traumatic stress disorder (PTSD), social anxiety disorder, and specific phobias.
A person with generalised anxiety disorder is anxious about lots of various things on most days. Anxiety, as a disorder, could be regarded as an over-expression of something that’s otherwise adaptive – the conscientious vigilance of potential threats in the environment or within our own bodies. Feeling anxious means you care – care about doing a good job, care about other people’s feelings, care about being safe, and so forth. Unlike depression too, moderate levels of anxiousness increase oxytocin, which primes us to seek social connection and thus the social support to help alleviate our worries.
Being alert to dangers obviously aids one’s survival, thus some level and frequency of anxiety is normal and healthy because we need to look out for potential threats. Since humans are social animals and survive better within groups, this includes being alert to the threat of rejection, deception and other such social threats too. It’s very useful to have some people in our communities who are more conscientious, cautious and have a tendency to consider what could go wrong so that we either mitigate those anticipated problems or take safer alternative paths. (Some partnerships in business claim to owe their success down to the way the two partners counterbalance or complement each other in their confidence and caution, risk-seeking and risk-aversion, and in various other ways.)
But it becomes maladaptive if the compulsion to worry becomes extreme and our anxious thoughts overwhelm our daily life. It’s unhelpful if most of the threats or fears that are perceived aren’t realistic, or as bad as they’re imagined to be even if they do materialise. When anxious thoughts are triggered too easily, reach intense levels, last for a long time, and negatively interfere with our thinking and behaviours – this is when anxiety becomes problematic.
People with anxiety disorders can ruminate or over-think and get trapped in a spiralling cycle of worry or doubt. They may avoid whatever triggers their anxieties in ways that restrict their life materially and/or socially. And they may rely on compensatory strategies like perfectionism or feeling like an impostor at work. These strategies may reduce their anxieties temporarily but increase them in the long-term because these behaviours might hold their lives back – for instance, they might think they and their work are never good enough or they see even opportunities as threats.
They might also push people away, directly or indirectly – anxious people may become draining for those around them because of their constant stressing, worrying, pessimism and negativity (e.g. a person who constantly complains that they want to change their career path but then doesn’t, or catastrophises every little decision the team makes). This can consequently contagiously raise the anxiety levels of those around them too! This might make these people annoyed about the person who has an anxiety disorder rather than compassionate towards them.
That’s why everybody needs to be better educated about anxiety. By learning about how these conditions work, we can better help those who have them without unintentionally making their symptoms worse.
Firstly, different people tend to have a predominant way in which they respond to particular threats – some predominantly respond with irritability or stubbornness, some try to actively get away from the situation, some shut down or try to bury their heads in the sand, and some submit to the threat through people-pleasing. These correspond with the ‘fight, flight, freeze or fawn’ response to heightened stress (some researchers also claim that there’s a ‘flood’ of emotions response, and a ‘fatigue’ or sleepiness response).
So try to learn about how a loved one, as an individual, tends to respond when anxious, and when you recognise that they’re exhibiting a bout of anxiety, understand that they’re feeling scared or stressed and offer them compassion. By paying attention to how anxiety manifests in someone whom we care about, we can learn about their patterns and be better equipped to help them. Rather than guessing, it’s then best to ask them what type of support they prefer – some prefer more concrete practical forms of support, while others prefer more positive emotional support. Experiment and evaluate what works and what doesn’t with them and for them.
Loose, generic advice like, “Don’t worry” or “Relax” (which is often ironically shouted in an un-relaxing way(!)) – although incredibly natural to say and usually well-meaning – can backfire if such comments make someone feel insecure about how they’re currently behaving. It’s like if you thought you were behaving positively but someone says, “Be positive” then this can make you doubt yourself because they’re suggesting you’re being too pessimistic. The phrase, “Don’t worry” when not expected only reinforces the notion that there’s something to worry about, otherwise it wouldn’t have been needed to be said. If I served you a drink and said, “Don’t worry, it’s fine” – you’d feel more worried than if I’d just said nothing(!) So it’s better to say, “You’ve got this”, “I believe in you” or, “We’re right behind you.”
People with anxiety have a tendency to think about the worst-case scenarios. To help them assuage their anxious thinking, also prompt them to consider the best-case scenarios and the most likely or realistic scenarios. It’s not about claiming to know that everything will be fine – it’s more about emphasising their resolve, resilience or ability to cope with the situation or with whatever happens.
Our public reputation matters so much to us as a member of a social species because we cannot afford to be shunned from our communities, and the approval of others is important if we wish to survive, as well as to thrive or mate. We want a high social standing amongst our peers and community. We want to be at least liked and accepted by those we value. Criticism, insults, mockery and rejection thus threaten us, especially if dealt to us publicly. This is why the fear of public embarrassment or even just ordinary social interactions is so common. So know that if you have social anxiety or social phobia, you are barely alone and so many people will be able to empathise with you. And most people would agree that shy people are far better than loud and obnoxious people too! If you can’t be nice then be quiet. Socially anxious or extremely introverted people can therefore potentially make lots of friends; albeit the problem is they seldom go out enough to introduce themselves to find each other! This is where online social media can help.
Being less self-conscious reduces many of these social anxieties and insecurities – be less ‘how do I look?’, ‘I wish I had more’, ‘what will people think about me?’ or ‘what are they saying about me?’ This is not to say that those with social anxieties are therefore vain or selfish – their self-consciousness is due to caring too much about how others might think about them. A vain person would worry about how they look even when no one’s watching them but themselves in the mirror. A selfish person wouldn’t sufficiently care about what others think.
So if we wish to point out that someone is acting the way they are because of their anxieties, it’s best to do so with tact or sensitivity. Even if they understand their own thoughts and behaviours, it doesn’t necessarily mean they’ll be able to help it. But if even they don’t understand their own anxieties, they have trouble managing their own compulsions, or helping them is beyond what you can do for them on your own – then it’s best to seek help from a doctor who specialises in the treatment of anxiety.
Whatever the case, accept them as a person and reassure them that you don’t see them as anything less than before. Who they fundamentally are hasn’t changed – they’re just suffering from a temporary problem that can be successfully treated. Try to keep them connected to the positive aspects of their identity, such as the interests and hobbies they still enjoy. Helping someone with anxiety doesn’t have to be direct – it could be something like taking a walk outside or exercising with them.
Sometimes they aren’t interested in changing though because their condition is long-term and stable. It’s considered essentially a part of their personality or identity. In such cases, it’s not about trying to make them become ‘normal’ but being matter-of-fact about their limitations without stigmatising them. Some people with anxiety are actually afraid of getting better because that new life is a great unknown for them, and this unknown itself causes them anxiety. Almost every one of us worries about change, even if a change will be for the better for us in the long run – but for those with anxiety or who have never known anything better than living with their condition, it can be extra scary. So it’s about accepting and loving them as they are; although it can be tricky because it may still be beneficial for them to – gradually, safely and with support – learn to expand their comfort zones from time to time. This is in order to show them that they’re more courageous, capable and resolute than they realise so that the entire world can open up for them and be their oyster.
Unless they really cannot do something themselves (perhaps because they suffer from severe depression combined with anxiety), we should generally try to help them to help themselves rather than do things for them – for instance, we could offer to attend the first therapy session with them if they set up the appointment themselves. (We could take this session as an opportunity to learn more about how cognitive behavioural therapy works too.)
Coping strategies, methods to seize the impression of control, distracting oneself or avoiding sources of consternation can appear to work as temporary solutions to a sufferer’s feelings of anxiety – but they can end up underlining those fears. It’s like if one keeps on walking on the other side of the road that one knows a large dog lives, one will never conquer one’s fear of dogs, and will in fact through this repeated habit continue to cement the feeling that all dogs are sources of fear. (If you have a phobia of dogs then you can trust me when I say that the barks of most dogs are worse than their bites. Woof!)
A key feature of anxiety is avoidance, thus doing everything for them might reinforce this avoidance behaviour rather than allow them to push through it. Hence in most cases, it’s best to offer them support (i.e. be there) without taking over or overdoing the reassurance. In the long run, one will be better off facing one’s fears – gradually, systematically and with guidance – rather than letting these methods of perceived control end up controlling oneself. The reality is seldom nearly as bad as one’s imagination can be. And if you face your fears and find out that nothing terrible happened then continue doing what works!
Lastly, if you are looking after a loved one who has an anxiety disorder, it’s important to look after yourself too – taking on too much responsibility is actually a symptom of anxiety too! We become no good to others if we aren’t well ourselves. Because anxieties are emotionally contagious, it can be difficult trying to help someone with the condition and you might think you’re getting nowhere. But it helps to periodically take a step back and recognise that you love each other and everyone is trying their best.
Woof! If you suffer from anxiety or live with someone who does, and have any other advice you’d like to share that could help others, then please do through the tweet linked to the Twitter comment button just below.