I’ve lost count of the number of questions I’ve been asked about anxiety. Some I can answer and some are less easy. “Why me? Is this payback for something I did in a previous life?” I’m stumped when it comes to questions about reincarnation, but everything I do know points to this question as one of sheer exasperation. Other times, the questions come from a partner or the family. “We’ve done everything we can think of to support him/her, but nothing seems to help."
Yes, it’s frustrating, and sometimes for families it can be even more alarming to learn that what they have always regarded as help and support is actually colluding with the very process that maintains anxiety. To fully understand how and why this might be happening, it can be helpful to revisit how anxiety develops and the things that cause it to persist.
What makes us vulnerable to anxiety?
Perhaps it helps to know there is often no single cause for anxiety. We need to remember there is some evidence that anxiety runs in families. This points toward a genetic component, although growing up in an environment of anxiety may itself lead to anxiety. Being raised in a difficult, demanding or insecure environment is also stressful. It leads to beliefs that the world is a dangerous place.
Life events are hugely varied but vulnerability to anxiety can be triggered from quite a young age. Bullying, poverty, living with a chronic illness, lack of work opportunities: these are just a handful of examples that can lead to interpreting things in an anxious way.
Put these things together and we have the basis for anxiety, but we also know that anxiety feeds from within a vicious cycle of the way we think, feel, and behave. The role of therapy starts with making people aware of this pattern before using techniques to try and make things easier or better.
Some of the most challenging times I’ve encountered involved working with families. Many were hugely supportive, keen to learn, and willing to apply new ideas in order to help a family member manage their anxiety. With others it was less easy. They were often torn between acting on the advice they were given and succumbing to old ways of behaving. Reasons were varied. Sometimes it was out of stubbornness (I think I know my relative better than you) and sometimes it was out of misplaced loyalty and love.
Here’s an example:
Tom had OCD. He had been hospitalized on a couple of occasions and now lived with his elderly parents. Tom was terrified of germs. He refused to leave the house without wearing a facemask and he would avoid walking in certain areas he considered especially dirty. At home he required his parents to disinfect sinks, toilets, door handles, and floors several times a day. He demanded a fresh towel after every hand wash (a frequent activity). Tom also sought frequent reassurances that his demands were not causing unnecessary distress. Yet, if challenged over his demands he would become visibly upset and even more anxious. Little wonder his parents often succumbed to his demands in order to claim a few moments of peace and quiet, but in doing so they also reinforced Tom’s OCD.
Reassurance appears to work because, in the short term at least, it leads to a reduction in anxiety. The problem is that it never leads to a resolution. The cycle of anxiety continues and may even worsen. Tom’s case may seem extreme but it serves as an example of how easy it is to maintain anxiety in someone else. It is natural to want to help a loved one who is suffering, so finding the dividing line between what is and isn’t helpful can be difficult. Giving reassurance to someone seeking it is also perfectly natural, but when the same or similar question is asked over and over, it shows the sufferer no longer trusts their own judgement and looks to others, instead.
When we do things for other people because their anxiety prevents it (e.g., shopping, making phone calls, posting letters) we help to validate the fact that their fears are real and that help is needed. Yet refusing to help or reassure can be just as unhelpful and unsupportive. Finding the balance and learning how best to give support is the answer.
Setting limits isn’t always easy within a family structure. Sometimes people have different ideas about what is or isn’t acceptable. This is where therapy can help. A therapist can help point out what works and what doesn’t, without apportioning blame. But getting a family member to seek help for anxiety is a big step that may require a combination of persistence and encouragement.
However, only by breaking into the cycle that maintains anxiety is recovery likely, so a little tough love may be something the family needs to consider in order to get the ball rolling.
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Jerry Kennard, Ph.D., is a chartered psychologist and associate fellow of the British Psychological Society. Jerry’s clinical background is in mental health and, most recently, higher education. He is the author of various self-help books and is co-founder of positivityguides.net.