Caring for someone who has anxiety

Anxiety has been found to be the most common mental health problem in Canada (alongside mood disorders) with the Anxiety Disorders Association of Canada reporting that one in four Canadians – a whopping 25 per cent – will have at least one anxiety disorder in their lifetime.

If you are a family caregiver caring for (or supporting) someone with anxiety, there are different coping strategies that you may have already tried. You may have told them to “just stop worrying.” (You have probably noticed that this does nothing to help the person to stop worrying!) Perhaps you have tried to support the person by taking on the activity that the person has been avoiding.

For example, if the person is anxious about driving, going to the grocery store, or dealing with finances, you may have taken on these tasks and responsibilities. You may have thought that taking on these responsibilities would be a temporary fix until the person feels more comfortable.

The problem is when “temporary fixes” become the new normal and while well intentioned, these types of coping strategies don’t assist the person in reducing or even managing their anxiety in the longer run. Also, if your strategy as a family caregiver has been to avoid the anxiety triggers for the person in your care (and for yourself), such as declining party invitations, you have by default made your own world smaller.

While it is understandable that you want to try and reduce the stressors or triggers for the person with anxiety, it may not be possible or realistic to sustain this on a long-term basis.

Making accommodations for the person in your care can actually increase the person’s anxiety. Why?

• You are inadvertently sending a message that there really is something to fear or that they do not have the ability to manage their anxiety.
• Equally important, making these accommodations may increase your responsibilities and workload as a caregiver. This reduces and limits the resources that are available to you both.
• Finally, it may diminish your ability to be a resource to and be an active part of your own social circle.

Understanding anxiety

Like a physical illness, you can best help someone with anxiety by first understanding the illness. Once the condition of anxiety is understood, you will be better able to assist them when you see them struggling with their anxiety. And helping them helps you!

First of all, it is important to understand that anxiety disorders are not the same as the nervousness you may feel before an important meeting, or the worry that may arise right before checking your bank account balance or before your kids arrive home from a party. Being temporarily anxious or nervous about exams, job interviews, winter weather, new situations, first dates, joining new social groups or volunteer groups, etc. is to be expected. However, this is not the case for people experiencing moderate to severe anxiety.

When someone has an anxiety disorder – whether diagnosed or not – they are living with difficult symptoms on a regular basis, and these symptoms can be severe and interfere with all facets of life – home life, work life, social life, and relationships.  Excessive, uncontrollable anxiety is quite different from the anxiety that we all experience as part of everyday life.

Anxiety can be best understood as a continuum. It can range from mild, moderate, or severe, to panic. When there is real danger or a real threat, anxiety can propel us into action and eventually to safety.  Anxiety becomes problematic when a person experiences moderate or severe anxiety or panic when there is in fact no immediate danger or threat.

Dealing with the anxiety and attempting to cope with anxiety symptoms day in and day out can quickly become a full-time occupation, consuming most of the person’s time and energy. This can be equally true for family caregivers.

As mentioned earlier, when a person has moderate to severe anxiety (whether diagnosed or not) they are living with symptoms on a regular basis. These symptoms may be severe (even if they are not evident to others) and may interfere with self-care, as well as all facets of life at home, at work, and for social life and relationships. In order to be considered an anxiety “disorder” there has to be significant distress or impairment in the person’s life for a prolonged period of time as a result of the anxiety.

Anxiety can affect thinking, feeling, behaviour, how one relates to others, and how one views oneself. Listed below are a few examples of how the person in your care may be affected by anxiety.

• Thinking – The person may experience persistent thoughts about being hurt, something bad happening, or being judged. Amongst other reactions, they may have poor concentration as a result.
• Feeling – The person may worry excessively, be fearful, irritable, angry, or experience guilt. The person may feel that no one understands their situation.
• Behaviour – The person may avoid people, situations, or objects. They may avoid situations that they were once interested in and provided the opportunity for pleasure, rest, and relaxation or stimulation.
• Relating to others – The person may be very nervous when meeting new people, worried about saying the wrong thing, oversensitive about criticism from others, or display signs of withdrawal.
• Physical – The person may be sweating or nauseous, have a racing heart, fatigue, insomnia, muscle tension, or be easily startled when experiencing anxiety. They may neither eat nor sleep well. They may avoid exercise, which could in fact be a de-stressor for them. They may gain or lose weight and/or pick up unhealthy habits. They may find it very difficult to concentrate or to be comfortable “in their own skin.”

Are there treatments available for anxiety?

Fortunately, there are effective strategies and treatments for the management of anxiety.  

It is best to consult with a health care professional for a full health assessment and management plan. There are prescription medications that can be used to treat anxiety and there are non-pharmacologic (non-drug) therapies such as relaxation therapies (acceptance and mindfulness-based therapy in particular), cognitive therapies (cognitive behavioural therapy), or exposure therapy.

Self-help workbooks

There are a number of self-help workbooks that come highly recommended by mental health professionals. These may be particularly helpful for those who suffer from anxiety and for people who are reluctant or refuse to seek professional help. Here are just a few of the recommended workbooks:

Antony, M.M., and Norton, P.J., The anti-anxiety workbook: Proven strategies to overcome worry, phobias, and obsessions, 2009.

Forsyth, J.P., and Eifert, G.H., The mindfulness and acceptance workbook for anxiety:  A guide to breaking free from anxiety, phobias, and worry using acceptance and commitment therapy (2nd edition), 2016

Tull, M., K. Gratz and A. Chapman, The cognitive behavioural coping skills workbook for PTSD, 2017.

How can I help?

• Learn relaxation techniques together – See our Elizz articles on Progressive muscle relaxation exercise and S.T.O.P.

As a caregiver, there are some things that you can do to help yourself and the person living with anxiety:

• Listen without judgement to their experiences. Don’t minimize or dismiss their experience as this will create more distance between the two of you.
• Encourage the person to get enough sleep, be physically active, and eat healthy food.
• Discourage the use of alcohol and/or drugs as a way to manage anxiety symptoms.
• Provide support and encouragement (not pressure) to stay connected with friends and family members.
• Talk openly about what is happening. Feeling ashamed is often what prevents people from seeking professional help and support. It may also cause some people to deny that they are struggling or experiencing anxiety altogether.
• Take care of yourself as a person and as a caregiver by setting boundaries (consider not making the anxiety your own by limiting and restricting your behaviour and activities).
• Suggest a consultation with a health care professional. This could be a doctor, nurse practitioner, or mental health professional. Begging, pleading, or threatening generally does not work – you may have already noticed this!

We can all play a role in removing the stigma of mental health struggles. As a caregiver, you are particularly well placed to do so by approaching the person you are caring for with openness and compassion as well as becoming informed yourself.

Patience with ourselves, and those we care for, is an essential ingredient even though it may seem beyond our reach at times. All of these resourceful approaches can foster hope and the certainty that life can feel better than it currently does – for both of you and for the entire family.