In all but the mildest cases of anxiety, a professional should oversee the coaching process. Be sure to read Chapter 8 for important details about exposure prior to attempting to help your partner carry out an exposure plan. If your partner resists or argues with you, consult a professional. Of course you want to help, but it isn't worth harming your relationship to do so.
Professional coaches have emerged in large numbers over the past decade. These people vary widely in their training and experience. You may want to use one of these folks to help carry out an exposure plan, but you don't want one of these people to diagnose an anxiety disorder or design a treatment plan from beginning to end. The only exception to this rule of thumb is a coach who also happens to be a licensed mental-health professional.
Coaching the right way
So exactly how does a coach help a loved one who has problems with anxiety? In most cases, coaches help the one they care about carry out exposure tasks. In other cases, coaches simply provide encouragement and support on the sidelines. Our discussion here focuses on the former role.
Generally, your participation in coaching would first come as a suggestion from the therapist working with your loved one. However, you may bring up the possibility yourself. In either case, you only want to serve as a coach if your partner clearly expresses an interest in and a desire for your assistance.
Coaching won't work if your partner doesn't feel ready to tackle her anxiety. Coaching also won't work if your loved one doesn't want your involvement. In fact, the effort could easily harm your relationship if you push your help too hard.
Not everyone is cut out to be a coach. Coaching requires significant patience, compassion, and time. If you don't have those things in abundance, don't agree to be a coach. Perhaps you can help your loved one in other ways, such as by taking on a few extra household tasks or simply by being an interested, supportive bystander.
Assuming you choose to accept the position, coaching requires you to take the following actions to be the best coach you can be:
Define your role: Come to a clear understanding of how much and what type of input your loved one and her therapist want. Do they want you to be involved in the planning? How so? Ask whether they want you to simply observe the exposure activities or actively encourage carrying out the tasks involved with exposure. Make sure they're specific about what they want you to do. For example, ask whether you should stand next to your partner, hold a hand, or stand a few feet away during exposure tasks.
Encourage while keeping emotions in check: Because you care so much, it's really easy to let your emotions guide your behavior while you coach. You want to encourage, but do so gently and calmly. Be careful not to
• Push too hard. If your partner says "enough," it's enough.
• Become too enthusiastic about progress. Your partner may feel it as pressure.
• Get angry or argue. Remember to accept whatever your partner is able to do.
• Become tearful or discouraged.
• Feel overly involved with the process.
• Start losing sleep.
If the coaching process causes you to become overly emotional or upset, back off. You may not be the right person for this job. That doesn't mean you don't care; in fact, you may simply care too much to be a good coach.
Avoid excessive responsibility: Your loved one must develop an exposure plan, usually in concert with a therapist. You may help the one you care about develop a few details of the plan, but don't take on the full responsibility for designing an exposure hierarchy. People who have problems with anxiety frequently feel insecure and ask for excessive help and reassurance. Don't be pulled in by your loved one's insecurity.
Stick with the plan: Resist the temptation to improvise. After a plan is in place, stick to it. If changes need to be made, consult with your loved one or have her discuss it with her therapist. Don't throw in surprises.
Remain positive: Coaches need to avoid criticism and judgment. Your loved one won't be spurred on by negative comments from you. People work hard for praise and become immobilized and defensive in response to criticism. Avoid saying anything like, "You should be able to do this," or, "You aren't working hard enough."
Maintain realistic expectations: After the plan is in place, expect your partner to have ups and downs. Some days go better than others. Small steps eventually go a long way. But you must always remember that determining how the plan plays itself out isn't up to you.
Execute the game plan: After an exposure plan has been developed, the next step is to begin with relatively easy tasks. A good coach provides support and feedback. In addition, the coach can model, reward, and focus attention. Here are a few additional tips:
• Before asking your loved one to carry out a step, see whether she wants you to model the task first. If you model, showing a small amount of anxiety yourself is fine if you feel it.
• Practice going through the steps with imagery first. In other words, describe the scene in detail and have your loved one imagine it first. Don't carry it out in real life until your partner feels more comfortable with the imagery. You can consult Chapter 8 for details about using your imagination through exposure as well.
• Set up some rewards for success at a few intervals along the hierarchy. Do something you can enjoy together. You can also give some honest praise for success; just be sure not to sound patronizing or condescending.
• If the person you care about appears anxious at any step but not overwhelmed, encourage staying with that step until the anxiety comes down 50 percent. Obviously, don't absolutely insist, just encourage. Remind your partner that anxiety comes down with enough time.
Looking at a coach in action
Coaching someone you care about can seem overwhelming. The following example about Doug and Rosie helps you see how one couple worked through a mild case of anxiety with the help of a good game plan.
Doug and Rosie have dated for over a year. In all that time, they've never gone to a movie together because Rosie wrestles with a mild case of agoraphobia. Although she's able to go most places and do what she needs to in life, she dreads going anywhere that makes her feel trapped, especially movie theaters. She fantasizes that she'll need to get out, but she won't find her way to an exit because of the crowd and the darkness. She imagines that she would trip over people, fall on her face, and desperately crawl through the darkened theater.
Doug realizes that Rosie makes one excuse after another to avoid going to movies, even though she enjoys watching them on television. Gently, he asks Rosie, "Some things make me a little anxious — heavy traffic or big crowds — what makes you anxious?" Rosie confesses that crowded movie theaters make her feel closed in and trapped.
Several days later, Doug sees a copy of Overcoming Anxiety For Dummies in a bookstore and buys it with Rosie in mind. He starts reading, paying particular attention to Chapter 8 about exposure. Doug and Rosie have a productive discussion about her concerns and decide to face them. Doug volunteers to coach.
First, together they devise a staircase of fear, which breaks down the feared situation into small steps. (See more on the staircase of fear in Chapter 8.) Rosie's staircase of fear consists of the 12 steps shown in Figure 18-1.
Figure 18-1: Rosie's staircase of fear.
Doug plays a role in most of Rosie's tasks. He helps her write a script for the imagined scenes. He reads the script out loud to Rosie while she closes her eyes and tries to picture the experiences. She rates her level of anxiety, and during the first few steps, he stays with her until her anxiety goes down.
Not only does he accompany her to the movies, but he also celebrates her successes and encourages her when she starts to falter. He holds her hand on the easier items and gives less support toward the end. Gradually, Rosie feels less anxiety when watching movies with Doug.
It takes attending a number of movies with Doug before she agrees to the final tasks of going by herself. In fact, they begin enjoying their nights at the
movies and find that they both love talking about their experiences afterwards over coffee and dessert. Although Rosie balks at going to the theater by herself, her comfort level has increased over the last few months.
Rosie and Doug drive to the theater together on her last two items, but he chooses a movie playing on a different screen. Although Rosie feels frightened, she sticks it out. She feels good about her accomplishment, and the two of them become closer.
Rosie's fear of the movies had not yet reached the level of severely interfering with her life. Therefore, it was a good choice for a relatively simple exposure plan. Had Rosie not dealt with her fear in this early stage, it would likely have spread from fear of movies to fear of other crowded places.
Most people with fears, obsessions, or compulsions need to develop a plan with the help of a therapist. However, the example of Rosie and Doug can serve as an illustration of how a simple plan can be carried out without a therapist.
Teaming Up against Anxiety
One way you can help your partner overcome anxiety is to collaborate on ways to decrease stress in both your lives. With a little ingenuity, you can explore a variety of solutions that are likely to feel good to you even if you personally don't suffer from anxiety at all. For example:
Take a stress management class at a local center for adult continuing education. These classes help people make lifestyle changes and set goals. Many of the ideas make life more fun and interesting in addition to reducing stress.
Take regular walks with your partner. It's a great way to reduce stress, but even if you don't have much stress, strolling under the sky together is a wonderful time to talk and is great for your health.
Take a yoga, Pilates, or tai chi class together. Again, even if you don't have anxiety, these classes are terrific for balance, muscle strength, flexibility, and overall health.
Explore spirituality together. You may choose to attend a church, a synagogue, or a mosque, or scope out a less traditional method of communing with a higher power, such as immersing yourselves in nature. Thinking about things bigger than yourselves or the mundane events of the world provides a peaceful perspective.
Look for creative ways to simplify your joint lives. Consider looking for help with household chores if you both work. Carefully analyze the way that you spend time. Make sure that your time reflects your priorities. See Chapter 10 for more ideas.
Do something good. Consider jointly volunteering for a worthwhile cause or charity. Many people feel that such work enhances the meaning and purpose of their lives. Look at animal shelters, food banks, hospitals, and schools as possibilities. Even an hour every other week can make a positive difference.
Get away. Take a vacation. You don't have to spend much money. And if you don't have the time for a long vacation, go away for an occasional evening at a local hotel. Getting away from texting, telephones, e-mails, doorbells, and other endless tasks and demands, even for a night, can help rejuvenate both of you.
Accepting Anxiety with Love
It may seem rather counterintuitive, but accepting your loved one's battle with anxiety is one of the most useful attitudes that you can take. Acceptance paradoxically forms the foundation for change. In other words, whenever you discuss your loved one's anxiety or engage in any effort to help, you need to appreciate and love all your partner's strengths and weaknesses.
You fell in love with the whole package — not just the good stuff. After all, you're not perfect, nor is your loved one. You wouldn't want perfection if you had it. If perfect people even existed, we can only imagine that they would be quite boring. Besides, studies show that people who try to be perfect more often become depressed, anxious, and distressed.
Therefore, rather than expecting perfection, accept your loved one as is. You need to accept and embrace both the possibility of productive change as well as the chance that your partner may remain stuck. Accepting your partner is especially important when your efforts to help
Result in an argument
Seem ineffective
Aren't well-received by your partner
Seem merely to increase your partner's anxiety even after multiple exposure trials
What does acceptance do? More than you may think. Acceptance allows you and your loved one to join together and grow closer, because acceptance avoids putting pressure on the one you care about. Intense expectations only serve to increase anxiety and resistance to change.
Acceptance conveys the message that you will love your partner no matter what. You'll care whether your partner stays the same or succeeds in making changes. This message frees your loved one to
Take risks
Make mistakes
Feel vulnerable
Feel loved
Change requires risk-taking, vulnerability, and mistakes. When people feel that they can safely goof up, look silly, cry, or fail miserably, they can take those risks. Think about it. When do you take risks or try new things? Probably not around an especially critical audience.
Giving up anxiety and fear takes tremendous courage in order to face the risks involved. Letting go of your need to see your partner change helps bolster the courage needed. Letting go of your need includes giving up your ego. In other words, this is not about you.
When you take on the role of a helper, it doesn't mean that your worth is at stake. Of course, you want to do the best you can, but you can't force others to change. Your loved one ultimately must own the responsibility.
Chapter 19: Recognizing Anxiety in Kids
In This Chapter
Seeing what's making kids so scared
Knowing when to worry about your kids' anxiety
Recognizing the usual anxieties of childhood
Looking at the most common anxiety disorders among kids
Many adults can recall childhood as being a time of freedom, exploration, and fun. Not too many years ago, kids rode bikes in the street and played outside until dark. Kids walked to school — with other kids.
Now, anxious parents wait with their children at bus stops until they're safely loaded. Parents rarely allow kids to leave the home without adult supervision. Parents worry about predators, kidnappers, and violence. They feel understandably protective. However, anxiety spreads from parents to their children. No wonder so many children experience anxiety.
Some anxiety is typical at certain ages. In this chapter, you discover the difference between normal and problematic anxiety in kids. We explain that some childhood fears are completely normal, while others require intervention. Then we take a look at the symptoms of anxiety disorders in children. (We devote Chapter 20 to ways you can ease your child's anxiety. If you're concerned about a particular child, we urge you to seek professional diagnosis and treatment.)
Separating Normal from Abnormal
Childhood anxiety has grown to epidemic proportions during the past 40 to 50 years. Numerous studies confirm this alarming development, but one in particular is a shocker. Psychologist Jean Twenge compared symptoms of anxiety in today's kids with symptoms in seriously disturbed kids receiving hospital treatment in 1957. She reported in the Journal of Personality and Social Psychology (December 2000) that boys and girls today report a greater number of anxiety symptoms than psychiatric inpatient children in 1957.
Should these findings cause alarm? We think so. The statistics are bad enough in their own right, but when you consider the fact that anxiety disorders often precede the development of depression later on, it raises concerns that the consequences of childhood anxiety could worsen in the years to come.
So what's going on? Why do our children experience emotional turmoil? Of course, we all know the complexities and tensions of the world today — longer work hours, rapidly developing technologies, violence on television, and even terrorism. We also suspect that certain types of parenting hold partial responsibility, as we discuss in Chapter 20.
For the moment, what you as a parent need to know is how to distinguish the normal anxieties of childho
od from abnormal suffering. Realize that the vast majority of kids feel anxious at various times to one degree or another. After all, one of the primary tasks of childhood is to figure out how to overcome the fears that life creates for everyone. Successful resolution of those fears usually results in good emotional adjustment. You just need to know whether your children's fears represent normal development or a more sinister frame of mind that requires help. Look at Table 19-1 to get an idea of the anxiety that you can expect your children to experience at one time or another during their youth.
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