Originally posted on Psychology Today by Alice Boyes, Ph.D.
Helping someone with anxiety can be intimidating. Often the anxious person feels completely overwhelmed by their anxiety, especially if they experience panic attacks or find themselves gripped by anxious thoughts (e.g., in health anxiety where the person has an obsessive fear of having or developing a health problem, or social anxiety where the person is intensely bothered by thoughts about embarrassing themselves in social situations or being judged or rejected by others.)
If your anxious friend doesn’t understand their anxiety yet, they may not be able to be able to give you a clear answer about what you can do to be helpful to them. Use the ideas below as a starting point. The same advice applies whether the anxious person you’re trying to help is a friend, your spouse/partner, or another family member. You can always show this article to your anxious friend/loved one and get their feedback on what applies to them and what doesn’t.
If you’re particularly looking for suggestions for how to help someone with anxiety attacks, you’ll find a specific section on that at the bottom of this article. Much of the advice below also applies to how to help someone with depression. There is a lot of overlap between depression and anxiety, and many (but certainly not all) people who experience one experience both.
1. Educate Yourself About What Can Help Anxiety
If you know the specific type of anxiety your friend has, you can utilize some of the online anxiety help resources for that particular issue. Understanding what helps anxiety takes a bit of time and effort, but it’s achievable if you’re prepared to take it one step at a time and re-read any info you don’t understand straight away. For free and user-friendly resources, I like this series of mental health workbooks. The various anxiety offerings give a good overview of how a predisposition to anxiety can turn into an anxiety disorder, and how anxiety works. You’ll learn about the links between triggers and anxious thoughts, emotions, and behaviors, and how to reframe anxiety-based thinking.
Also, there are specific types of anxiety strategies that suit being done with an accountability partner.
- exercise (or any type of physical activity)
- going to a yoga class or doing meditation or breathing exercises together,
- working through a hierarchy of things someone is avoiding or putting off due to anxiety. Each person would have their own list. Start with things that feel mildly anxiety provoking and work up. A practical way to do this is as a weekly “power hour” where you have an hour once a week in which you tackle something you’ve each been avoiding due to feeling anxious or overwhelmed.
- Spotting and balancing anxiety thoughts. For example, if you don’t get an email reply back from someone straight away, does that automatically imply bad news? If you’re interested in learning how to overcome anxious thinking, there a complete “how to” in my book, The Anxiety Toolkit.
2. Help Your Anxious Friend Break Free of Avoidance Behavior
I briefly mentioned above the idea of working through an avoidance hierarchy. Avoidance behavior is a huge part of what causes anxiety. When someone avoids something they need to do due to anxiety, their anxiety will snowball over time.
Common examples of avoidance behavior include avoiding:
- making phone calls
- getting started on a task that feels intimidating (which could be anything from writing an essay, to completing an annual review for work, to choosing a new dishwasher when the current one has broken.)
- repairing mistakes
- making requests (such as asking a boss for time off)
The more the anxious person puts off what they need to do, the more likely they are to experience intrusive thoughts about it. If avoidance behavior is a major problem for the individual, there are a ton of strategies in my book that may be helpful.
Whatever the person is avoiding, they may find it helpful to talk through the steps they’d need to do to break free of their avoidance. For example, “well, the first step I’d need to do is….” Help them identify and/or take that first step.
3. De-stigmatize Your Friend’s Experience of Anxiety
People who have high anxiety are often embarrassed by their anxiety symptoms.
They may fear their anxiety showing up when they’re in a performance or social situation, or that it will be visible to others. For example, they may fear other people will notice them sweating or if their voice starts shaking during a client meeting at work. The key is not to reassure the person that those things will never happen, but do reassure them that they can cope if/when they do.
For people who have anxiety attacks, the fear of having one is often as debilitating as the attacks themselves. The person may fear having a panic attack in specific situations (e.g., due to being in the middle seat on an aircraft or at the movies) and/or that they will experience one out of the blue.
If your loved one has a clinical anxiety disorder and their anxiety feels out of control to them, they may worry they’re losing their mind or “going crazy.” They may see anxiety as a sign of being a weak person, or doubt that there are effective therapies out there that will help them overcome their anxiety.
Communicate that you don’t see their anxiety as a weakness, character flaw, or a sign of them being incompetent in their life, work, or other roles (and as being a parent or friend.)
Normalize any types of thoughts you can relate to. There are many types of anxiety-based thoughts that people with anxiety disorders experience that even relatively non-anxious people also experience from time to time. For example, most people can relate to fear of being judged or of asking for something and being told no.
Also, it’s extremely common for anyone to have fleeting thoughts that they’ll do something odd, dangerous or out of character (e.g., mow down a pedestrian while driving or develop a sudden urge to become violent). People with anxiety often don’t realize that many people have these types of thoughts. People who are not especially anxious tend to write off the thoughts as just weird, whereas people who are anxious often equate having the thoughts with real risk that they will act on one of their odd thoughts.
4. The Reassurance Seeking Trap
In particular types of anxiety, the person can become desperate for reassurance. For example, someone who has health anxiety may ask you repeatedly “Are you sure I don’t have cancer? Should I go to the doctor again? Do you think my doctor knows what s/he is doing?” A relationship partner who has interpersonal anxiety may ask you daily or weekly “Do you promise you won’t leave me, no matter what?” A friend with anxiety may repeatedly ask “Are you sure you’re not angry with me?”
If you notice these types of patterns emerging, you’ll need to set some limits. Someone who is experiencing the degree of anxiety that leads to very intense, demanding-type reassurance-seeking should likely be working with a therapist. The therapist, the person, and you, should come up with a game plan together. It is perfectly appropriate for you to attend some therapy sessions as a support person, when invited by the anxiety sufferer.
Very intense reassurance seeking is part of the process of how anxiety snowballs. It is a common anxiety symptom, and does not mean the individual is freaky, needy or a hopeless case. It can be addressed effectively, just like all other anxiety symptoms. It’s nothing to be ashamed of but it does need a game plan for disrupting the patterns.
5. Help Your Friend (Spouse / Family Member) Get Help With Anxiety
You can’t expect yourself to cure your loved one’s anxiety, no matter how smart you are, how much you care about them, or how much time you’re willing to put in.
Sometimes the best solution for how to help an anxious person is help your loved one access a therapist (e.g., you might offer to help with childcare or to go to the first appointment with them.) If they haven’t tried Cognitive Behavioral Therapy (CBT) before, then that is the best place to start for anxiety help. It’s the type of therapy with the most evidence behind it for treating anxiety.
If your friend is getting professional help for anxiety, invite them to tell you about what they’re learning and working on. If you think the person might interpret your questioning as checking up on them, you’ll need to be sensitive about how you do this.
Keep it positive by asking them about any useful insights they’ve gotten, or any anxiety management techniques they’ve learned that are working well for them.
If there is something that isn’t working for them about their sessions with their therapist, encourage them to talk to their therapist directly. People who are anxious often avoid bringing up certain topics with their therapist. There are many different options for what can help with anxiety, and it’s all about finding the best fit between the person and the strategies. It’s no big deal if one particular approach doesn’t work for an individual, since there are many other options to try.
If you’re willing, let them know you’re happy to be a partner for them in completing their therapy homework (such as trying out a meditation together or doing some thinking or behavioral exercises.)
Getting help for anxiety is often a big step for someone who habitually avoids things that make them feel anxious! Your loved one will likely need all the encouragement you’re able to give!
6. Bonus Section: What Helps With Anxiety Attacks
Anxiety attacks are false alarms of the fight/flight/freeze system. They’re different from high anxiety/worry in that they come on suddenly, and typically reach peak intensity within 10 minutes. You will generally know if someone is having an anxiety attack. They may appear frozen and not very coherent, or act very afraid and distraught. The person may fear that they’re having a heart attack or other medical emergency because their physical symptoms feel so intense.
The best thing you can do when someone is having an anxiety attack is to be physically present with the person and help them concentrate on slow breathing. Pay attention to what they seem to find calming and what they seem to find aggravating when they’re having an anxiety attack. The person’s thoughts will be all over the place when they’re in the middle of an anxiety attack, so help them focus their thoughts on their breathing. You can use this overview of breathing techniques for anxiety to learn what to do.
Note that it’s important that the person is checked out medically for any heart issues that might be contributing to their anxiety attacks, including getting a second opinion if necessary. The person may have some type of arrhythmia or atrial fibrillation that is interacting with their anxiety symptoms. This will not be the case for MOST people who have anxiety attacks, but it is also true that when someone does have a medical component to their anxiety attacks, it can be dismissed or missed.
There are many ways to help someone with anxiety. You don’t need to do all of the above. Pick the one or two suggestions that are appealing and feel manageable to you and your friend/loved one. Be prepared to experiment. You don’t need to always get it right. Remind yourself you’re doing the best you can.