Loving Someone with Anxiety

by Kate N Thieda

  Turn your focus to the back and top of your head, noticing sensations, then inhaling and exhaling through the back and top of your head and releasing any tension as you exhale.

  Breathe in and out slowly three times, feeling the breath come in through the soles of your feet and then flow through your body and out the top of your head.

  Slowly open your eyes if they were closed and stretch your body.

  Helping Your Partner Practice Alternative Thoughts

  Jon Kabat-Zinn, widely renowned for promoting mindfulness in Western cultures, tells an interesting story about how monkeys are caught in India: “Hunters will cut a hole in a coconut that is just big enough for a monkey to put its hand through. Then they will drill two smaller holes in the other end, pass a wire through, and secure the coconut to the base of the tree. Then they put a banana inside the coconut and hide. The monkey comes down, puts his hand in and takes hold of the banana. The hole is crafted so that the open hand can go in but the fist cannot get out. All the monkey has to do to be free is let go of the banana. But it seems most monkeys don’t let go” (1990, 39).

  Jon Kabat-Zinn uses this example to illustrate how our minds work: we get so caught up in a particular thought or emotion that we can’t let go, even though letting go would free us of the anxiety and stress.

  Your partner probably has many automatic thoughts that go through his brain regularly and cause anxiety. When you notice that your partner seems anxious, you can ask him what he’s thinking about and then help him to redirect his thoughts. Have your partner either verbalize his anxious thoughts or write them down. Next, help him come up with alternative thoughts he can tell himself instead. For example, if he’s thinking, I’m so anxious that I’m going to panic when I go out in public, you might generate alternative thoughts such as I have succeeded in overcoming this situation before, and I can do it again or I have the skills to not let this anxiety get the best of me.

  Think of yourself as a coach, and gently encourage your partner to repeat the positive thoughts to himself both before and during the stressful situation. You can also ask your partner the following questions:

  What is the evidence that what you’re anxious about will actually happen?

  On a scale of 0 to 10, how strongly do you believe what you’re thinking about will happen?

  Are your thoughts taking the whole picture into account? Is there anything you might be missing?

  How does thinking this way help you? Can you let it go?

  How can we work together to make this less anxiety provoking?

  Supporting Your Partner in Practicing Affirmations

  Another way to shift thinking from anxiety to confidence is by repeating affirmations. Your partner developed a pattern of anxious thinking after having certain unhelpful thoughts repeatedly. It will take the same kind of repetition, or practice, to replace them with thoughts that are supportive and affirming. Ideally, your partner would develop a list of affirmations and then decide on two or three to work with at a time. Affirmations should be short, use positive words, and be stated in the present tense. Here are some examples of affirmations:

  I can learn to cope with this anxiety.

  I’m learning to let go of my fears.

  When I’m feeling anxious, I can make decisions about moving toward calm.

  I’m able to let go of worry thoughts.

  I’m gaining confidence in myself.

  You can help your partner practice affirmations by taking turns stating them. First say the affirmation to your partner, stating it in the second person; for example, “You’re learning to overcome your anxiety.” Your partner should respond, “Yes, I am.” Repeat this, you stating the affirmation and your partner replying with “Yes, I am,” until you feel your partner truly believes what he’s saying. Then switch roles, with your partner saying to you, “I’m learning to overcome my anxiety,” and you replying, “Yes, you are,” until you’re convinced that your partner believes what he’s saying.

  Abdominal Breathing

  Since our breath is automatic, we generally don’t give it much thought unless we’re struggling to breathe for some reason. However, paying attention to the breath is important, especially for people who have anxiety. When we’re stressed, our breath becomes shallower and we tend to breathe from the chest. This way of breathing can heighten anxiety symptoms. It can also lead to hyperventilation, which can feel very similar to a panic attack.

  Breathing from the abdominal area, on the other hand, increases the amount of oxygen available to the brain and muscles, stimulates the parasympathetic nervous system (which calms us from a state of arousal), improves concentration, and can help us relax (Bourne 2005). Devoting just a bit of time to focusing on the breath and breathing from the abdomen can be enormously beneficial. Here are some instructions on exactly how to go about it:

  While sitting or lying comfortably, place one hand on your chest and one hand on your abdomen. Breathing normally, notice which hand rises when you breathe in.

  On your next inhalation, breathe deeply so that the hand on your abdomen rises. Inhale through your nose for a count of four, counting the numbers to yourself slowly as you inhale: “One… two… three… four.”

  After inhaling, pause for a count of four.

  Exhale slowly, through either your nose or your mouth, for a count of at least five.

  After exhaling fully, take two breaths as you would normally.

  Repeat steps two through five. Continue this cycle for three to five minutes.

  Practiced on a daily basis, this technique will promote calm and help retrain breathing patterns. It’s also helpful in a crisis; if your partner feels anxiety and panic rising, abdominal breathing will redirect his focus from his anxious thoughts to his breath, and when done correctly, it creates a calming sensation.

  Progressive Muscle Relaxation

  Does your partner often complain that he feels tense or uptight, or that he can’t relax? This is common among people with anxiety, who often experience chronic tightness in the chest, neck, back, and shoulders. Progressive muscle relaxation (PMR) can help. PMR is a process of tightening and releasing different muscle groups throughout the body. You tense each group tightly and hold the tension for a few seconds, and then suddenly release, allowing the feeling of relaxation to spread through the muscle group. By systematically working your way through all of the major muscle groups, you can help your entire body relax and release any pent-up tension.

  When practiced regularly, PMR is an effective technique for reducing the muscle tension often associated with stress and anxiety. It can also help with stress or tension headaches, migraines, backaches, and jaw tightness. If your partner practices PMR daily for at least twenty minutes each time, he’s likely to feel an increased sense of relaxation that lasts long after the practice is over.

  Before I explain the specifics of PMR, here are some general guidelines:

  Allow at least twenty minutes to do this exercise. Find a quiet place to relax that is free of distractions and interruptions. It may be helpful to establish a routine in which you practice PMR at the same time each day.

  Find a comfortable position that includes having your head supported. If you’re feeling sleepy, sitting up rather than lying down can help prevent falling asleep. If you lie down, having a pillow under your knees can provide support.

  Loosen any tight clothing and remove your watch, jewelry, shoes, glasses, and so on.

  Adopt the mind-set that whatever happens, happens, and that you aren’t going to worry about anything during this time. Don’t try to force yourself to relax or not worry. Just do your best to accept your experience and let go.

  If you have any muscle areas that have been injured or feel painful when tensed, feel free to omit those areas from this exercise.

  Until you get familiar with this exercise, it may be helpful to have someone read the following script to you as you practice or to record it and listen as you practice. The following exercise
is adapted from The Anxiety and Phobia Workbook (Bourne 2005):

  Begin by taking three full abdominal breaths, exhaling slowly and fully each time. During each exhalation, imagine tension being released from your body.

  Clench your fists, holding them squeezed tight for seven to ten seconds. Then release and relax for fifteen to twenty seconds. Notice the difference in sensations between tension and relaxation. As you proceed through all of the following muscle groups, continue to use these same time intervals and to focus on the difference in sensations.

  Tighten your biceps by bending your elbows and bringing your hands toward your shoulders. Hold for seven to ten seconds, then release for fifteen to twenty seconds and notice the difference in sensations.

  Tighten your triceps by straightening your arms and locking your elbows. Hold for seven to ten seconds, then release.

  Tense the muscles in your forehead by raising your eyebrows as high as possible. Hold for seven to ten seconds, then release.

  Tense the muscles around your eyes by clenching your eyelids tightly shut. Hold for seven to ten seconds, then release.

  Tighten your jaw by opening your mouth wide enough that the muscles around your jaw are stretched. Hold for seven to ten seconds, then release.

  Tighten the muscles of your neck by tilting your head back, as though looking at the ceiling if you’re sitting or at the wall behind you if you’re lying down. Hold for seven to ten seconds, then release. (You may want to repeat this step, as the neck can be extra tight.)

  Take a few abdominal breaths and focus on relaxing your neck and letting your head sink into whatever it’s resting on.

  Tighten your shoulders by raising them up toward your ears. Hold for seven to ten seconds, then release.

  Tighten your shoulder blades by pushing them back toward your spine. Hold for seven to ten seconds, then release. (You may want to repeat this step as well, since the shoulders are another area where people often hold tension.)

  Tighten your chest muscles by taking a full breath into your chest and expanding it. Hold for seven to ten seconds, then release.

  Tighten your stomach muscles by sucking in your stomach. Hold for seven to ten seconds, then release.

  Tighten your lower back by arching it. Hold for seven to ten seconds, then release. (Omit this step if you have low back pain.)

  Tighten your buttocks by squeezing them together. Hold for seven to ten seconds, then release.

  Tighten your thigh muscles. Hold for seven to ten seconds, then release.

  Tighten your calf muscles by flexing your feet so your toes point up toward your body. Hold for seven to ten seconds, then release.

  Tighten your feet by curling your toes down. Hold for seven to ten seconds, then release.

  Scan your body for any remaining tension. Repeat the appropriate step to release any tension.

  Imagine a wave of relaxation spreading through your body, starting from your head and moving through every muscle in your body.

  Slowly open your eyes and return your attention to the world around you.

  Visualization

  Visualization is a good way for anyone to de-stress and relax. For your partner, it can also allow him to mentally remove himself from an anxious situation and become calm without striving to overcome the anxiety. With visualization, all he’s trying to do is turn off the anxious thoughts so he can refocus on what’s important and envision success.

  Professional athletes use visualization to prepare for an event, imagining themselves crossing the finish line of the track and seeing a new personal record on the time clock; seeing the ball leave the pitcher’s hand and then seeing themselves swinging the bat and watching the ball sail over the fence; or mentally practicing free throws, imagining bouncing the ball on the court and the movement to release the ball, and seeing it sink through the net. Here are some instructions for doing a visualization using the senses of smell, hearing, touch, and sight:

  Make yourself comfortable in a place where you can relax without interruptions.

  Visualize yourself in a peaceful scene that you can vividly see in your mind—a place that feels safe and calming to you. It can be a real place or somewhere imagined. Some suggestions are a meadow, a beach, a forest, or a garden, but pick whatever works for you.

  Close your eyes and imagine yourself in this safe, calming place. Since this place is in your mind, it’s easily accessible twenty-four hours a day, seven days a week.

  Imagine the smells of the place. What scents are associated with it? Flowers? Suntan lotion? Damp leaves? Fresh air? Grass?

  Imagine the sounds of the place. Are there waves crashing or birds singing? Are leaves rustling? Can you hear insects buzzing, or is it just quiet?

  Imagine what being in that place feels like. Is there warm sun on your face? Is a breeze blowing? Is it misty or damp? Is it cool, comfortable, or warm?

  Explore the place visually. How many different colors can you see? What are the shapes around you? Is it bright or dim? Are there shadows? Can you see the sky? Are there clouds? What do they look like? Are there plants or creatures around?

  When you feel relaxed, slowly open your eyes and gently bring yourself back to your surroundings. Remember that you can visit this special place any time you need a break.

  What’s Next?

  All of the techniques in this chapter can be helpful for both you and your partner. In addition to helping relieve your partner’s anxiety in the moment, they can help reduce anxiety levels in the long term and will promote calm and relaxation. Figuring out which work for each of you and practicing those techniques regularly will create an excellent foundation for the approaches you’ll learn in the next chapter—techniques targeted to different types of anxiety.

  Chapter 6

  Responding to Specific Types of Anxiety

  As you know from reading previous chapters, anxiety can manifest in many ways, running the gamut from low-level “everyday” anxiety to full-blown panic attacks and all-consuming anxiety that prevents people from living fulfilling, productive lives. Because of this, and because the experience of anxiety is so individualized, there isn’t a one-size-fits-all approach to neutralizing anxiety, though the techniques in chapter 5 will certainly be helpful for anyone who struggles with anxiety.

  Fortunately, there are numerous interventions that can be very helpful for specific anxiety disorders and different types of anxiety, and I’ll outline some of the most effective approaches in this chapter.

  I’ll begin by explaining how you can assess what’s happening with your partner during acute anxiety, meaning anxiety that arises suddenly. In this situation, a quick intervention can often resolve the problem. Next I’ll explain how to address chronic anxiety using exposure therapy, a highly effective method for helping people overcome their fear of specific objects or situations. Then I’ll discuss strategies specific to each of the six anxiety disorders and that include case examples to illustrate how couples have used those approaches in their relationship.

  As you read through this chapter, continue to practice the techniques in chapter 5. Then, after trying the techniques in this chapter that are appropriate to your partner’s anxiety, you’ll have a good idea of what works and what doesn’t. This will be invaluable information in creating a plan for how you can respond effectively when anxiety strikes.

  Addressing Acute Anxiety: CARE

  When anxiety strikes suddenly, perhaps out of the blue, you need to approach the situation like a first responder at an accident scene, rapidly assessing what’s happening with your partner and deciding on a course of action. Here’s an acronym that can help you remember what to do in an acute anxiety situation—CARE:

  C: Be calm and compassionate. Above all else, and no matter what happens, remain calm and be compassionate. This will allow you to provide appropriate support if necessary, and if desired by your partner. If you get angry, frustrated, or anxious, that won’t improve the situation. Just remember that accommodating your partner
’s anxiety isn’t a compassionate move, even if it seems like it in the moment. Her anxiety won’t improve in the long run if you simply step in and make an accommodation.

  A: Assess your partner’s symptoms. How do you know your partner is experiencing anxiety? What signs, symptoms, and signals is she showing? Because the severity of anxiety can range so widely, you should choose an intervention appropriate to what your partner is feeling. Some forms of anxiety require more deliberate interventions than others. (You’ll learn more about this as you read through this chapter.)

  R: Reinforce and remind. Your partner is probably already trying to reduce her anxiety on her own. If so, give positive reinforcement about what she’s tried. If she hasn’t tried anything yet and seems to be unable or unwilling to help herself, remind her of techniques that have been effective in reducing her anxiety. (In addition to those you learned in chapter 5, you’ll learn more in this chapter.) When your partner tries one or more of the suggested techniques, praise her and use your empathy skills to express your understanding of how difficult it must have been to handle this challenge.

  E: Evaluate. After some time has passed (how much time depends on the severity of the anxiety), evaluate the situation. Is your partner’s anxiety level improving? If yes, let things be and continue to offer support and encouragement. If your partner’s anxiety level isn’t decreasing, start over again: Make sure you’re acting in a calm and compassionate manner, and then repeat the steps of assessing, reinforcing and reminding, and evaluating.

  Addressing Chronic Anxiety: Exposure Therapy

  The CARE approach is very effective in acute anxiety situations when your partner needs a quick intervention to help neutralize her feelings and allow her to return to a calmer state. For long-term, chronic anxiety, many people consider exposure therapy to be the gold standard of treatment. It’s used by mental health professionals to treat many types of anxiety. Depending on the severity of your partner’s anxiety and your comfort level with being a support person, exposure therapy may be something you and your partner want to try on your own, although it’s generally best to use this technique under the guidance of a trained professional. As the name indicates, during exposure therapy, your partner will be exposed to situations that generate anxiety in order to help her learn that she can actually tolerate the anxiety and even reduce it so that the feared situation becomes manageable, and eventually perhaps neutral or even enjoyable.