Loving Someone with Anxiety

by Kate N Thieda

  If your partner does come back with examples of feeling rejected, this also provides data that she and her therapist can examine to evaluate whether she genuinely was rejected or simply perceived that she was. If it appears that she was rejected, they can work on social skills that will help her avoid being rejected in the future. If it appears that she wasn’t, the therapist can help your partner try to figure out what actually did happen so she might better interpret the behavior of others and consider whether there might be other reasons why she feels rejected.

  If your partner has social phobia, it will be very helpful if you encourage her to test her hypotheses instead of avoiding social situations. Help her see that, no matter what the outcome, she won’t be a “loser” because she’ll be gathering information that can lead to positive changes. If she finds that her fears didn’t materialize, that’s good information; then she can start examining why she predicts negative outcomes that don’t actually happen. If the feared situation did occur, you can work together to examine what happened and come up with a plan to prevent it from occurring again or devise a plan to help your partner better cope if the situation does arise in the future.

  Case Example: Jon and Judy

  Jon, who is fifty-five, has been a hospital administrator at a large academic institution for over twenty years. He’s recently transitioned into a new role and is losing sleep at night because of his anxiety. His partner, Judy, who is forty-eight, also works at the hospital as an administrator, but in a different department. Although Jon is well educated, has been successful throughout his career, and has won awards for his service and leadership, he still worries that eventually his supervisors will decide he’s incompetent and incapable of doing his job. Whenever he has to chair a meeting, he prepares for days in advance and tosses and turns all night in nervous anticipation of something going wrong, such as not being prepared to answer a question or being challenged by a coworker. After the meeting, he agonizes over perceived mistakes, even if everything went smoothly. When he has to meet with the board of trustees to report on activities in his department, he sometimes works himself into such a frenzy over his fears of what could go wrong that he vomits before or after the meeting.

  Although Judy is very proud to have a partner in such an important role and often hears praise from others about the terrific job Jon does, she knows that his anxiety is taking a toll on his physical and mental health. It’s also interfering with their time as a couple because Jon often works late into the evening and on weekends in an effort to ensure everything is perfect.

  Recently, Jon and Judy have decided to make some changes to help Jon stop the obsessive worries that are leading to his social phobia. First, Jon has learned that physical exercise is a good outlet for his worry, so he’s started going for a thirty-minute run most mornings. Some evenings he and Judy take a walk together to unwind from the stresses of the day. When Jon feels his anxiety increasing at work, he sometimes takes a fifteen-minute break to get outside in the fresh air. Other times he walks over to Judy’s office to surprise her, which she always appreciates, and the distraction of doing something that’s nice for both of them helps Jon refocus his thoughts.

  When he starts to feel incompetent, Jon looks at the awards hanging on his office walls and reminds himself that he is truly worthy of holding his new job. He also writes out a to-do list, which helps him organize his thoughts and feel more in control of what needs to be accomplished. He shares his lists with Judy, and she gives him positive feedback about what he’s completed.

  As for Judy, she plans fun activities for the evenings and weekends to give Jon incentive to get home to participate, and also to provide a pleasurable distraction that helps take his mind off work. In addition, Judy encourages Jon to challenge his thoughts about failure and incompetence and reminds him to conduct experiments to determine whether his fears are valid. When Jon returns home with his data, Judy uses validation to empathize with Jon’s feelings and gently challenges him to find alternative ways to interpret the events. Jon’s anxiety about his work performance has improved greatly, and going to work has become fun for him again. Both Jon and Judy have noticed that their relationship has improved because of the time they’re spending together doing fun activities, without work worries interfering.

  Post-Traumatic Stress Disorder

  If your partner has experienced a trauma that resulted in the development of PTSD, every facet of your relationship may be affected. Triggers that remind your partner of the event can happen spontaneously, catching both of you off guard, or routinely, which may call for changes in your partner’s routine or your shared living situation. If your partner enters a dissociative state when remembering the trauma—meaning she becomes disconnected from what’s happening in the environment around her—she may not recognize you as who you are or may become unresponsive to you. In addition, if the traumatic event occurred after the two of you became a couple, your partner’s behaviors may change in unpredictable and frightening ways. All of these situations require special attention in order to relieve your partner’s distress, and to keep you safe as well.

  Try to remember that when your partner’s PTSD is triggered, her actions and reactions don’t necessarily reflect how she truly feels about you or the relationship. For example, people with PTSD often experience emotional numbing and struggle to feel positive emotions, including happiness and love. It isn’t that your partner doesn’t love you; rather, she might not be capable of expressing her emotions as you might expect, such as by hugging or kissing you or wanting to have sex. Another issue is that your partner may be concerned that if she interacts with others, her upsetting thoughts and feelings may come out and make others feel uncomfortable. Using the communication skills of validation and empathy is extremely important in helping your partner feel safe and understood.

  If your partner’s PTSD is triggered by places, events, sights, sounds, smells, or other specific experiences, this is one exception to the rule of not accommodating for anxiety. With professional treatment, your partner may become less sensitive to triggers and learn coping skills. But if you know, for example, that driving past the place where an assault occurred or watching news stories about war is going to upset your partner, then don’t do it. In time, your partner may become less sensitive to these triggers, but only with the help of professional treatment.

  Case Example: Jody and Gary

  On a rainy night about a month ago, Jody, age thirty-three, was involved in a head-on collision while driving home from work. Both cars were totaled, and Jody had to be extricated from her car by emergency workers. The other driver, who was at fault, was hospitalized with his injuries. Jody suffered a broken wrist and a concussion from the airbags, as well as multiple cuts and bruises. When her husband Gary, age thirty-seven, arrived at the emergency room, Jody was hysterical. She knew the accident wasn’t her fault and that both she and the other driver would be okay, but she told Gary that she never wanted to drive again.

  Gary tried to calm her down, reassuring her that they would get her a new car—whatever she wanted that would make her feel safe—and that in a few days she would feel better. But Jody is still having nightmares about the accident and refuses to go shopping for a new car. She insists that Gary drive her to work, and not along the route she was traveling on the night of the accident, even though the alternative takes fifteen minutes longer. And even though her bruises are gone, her concussion is resolved, and her wrist is healing, she isn’t interested in going out socially, either with Gary or with friends. To Jody, it seems like no one can understand what she went through, and she always feels as if she’s about to start crying.

  Gary began to suspect that Jody may have PTSD, so he educated himself about how he might be helpful. He learned that patience, encouragement, and understanding are the keys to being supportive when a partner has PTSD, and that it takes time to resolve the psychological damage that was done. He’s been accommodating Jody’s request to be driven everywhere,
despite his concern that the longer he does this, the harder it will be for Jody to get behind the wheel again. He’s also been gently encouraging Jody to take his car to run errands and remaining patient when she refuses. Gary hopes that his gentle nudging will eventually result in Jody deciding that it’s safe to drive again. When Jody wakes up from a nightmare, Gary offers reassurances that she’s safe and that it was just a dream, and he listens if Jody wants to share what she was dreaming about, but often she just wants to be held for a few minutes before falling back to sleep. Gary has also suggested that Jody go out with friends or, if going out in public feels like too much, that they could host friends at their house. In addition, he’s been encouraging Jody to seek professional help from a therapist who specializes in PTSD. He helped her find a therapist and set up an initial meeting and plans to attend Jody’s first session so that he can learn more about how he can help.

  Specific Phobias

  If your partner has a specific phobia, the most effective way she can overcome it is to face it, despite how impossible that may feel to her and how difficult it may be for you as the supportive partner. You’ve probably witnessed how your partner reacts in situations that trigger the phobia, and if so, you undoubtedly want to avoid that ever happening again! However, treatment consisting of exposure to triggers, if planned carefully and executed correctly, can make the unthinkable possible. Earlier in this chapter I discussed exposure therapy and how to work through a hierarchy of feared situations, and that is often exactly how phobias are treated: by creating a plan in which your partner faces increasingly intense stimuli, in a safe environment, and learns to regulate her anxiety symptoms in the process.

  For some fears, such as fear of heights, bridges, or dogs, it’s possible to engage in real-life exposures, actually confronting the feared object or situation. But for others, such as a fear of flying or fear of contracting a disease, that may be impractical because of time, expense, or logistics. Imagery desensitization works in much the same way as exposure therapy: Your partner would create a hierarchy that starts with a nonthreatening scenario related to her phobia and proceed stepwise through increasingly difficult scenarios. Here’s an example of how a hierarchy might look for someone who has a fear of flying:

  Arriving at the airport on the day of the flight

  Checking baggage

  Passing through security

  Waiting at the gate

  Boarding the plane

  Finding her seat

  Strapping on her seatbelt

  Listening to the safety instructions

  Hearing the departure announcements, including that the doors are being secured for takeoff

  Taxiing on the runway

  Accelerating on the runway for takeoff

  Feeling the plane lift off the ground

  Experiencing turbulence in the air

  Feeling the sensation of descending

  Feeling the bump of landing and the vibration of the plane during braking

  After creating the hierarchy, your partner would envision the scenes sequentially, working her way up the hierarchy, using the following basic steps for imagery desensitization, adapted from The Anxiety and Phobia Workbook (Bourne 2005):

  Take a few minutes to get relaxed, using any technique that helps achieve that state, such as abdominal breathing, mindful breathing, or a quick body scan.

  Visualize yourself in a peaceful scene that you can vividly see in your mind. It can be indoors, such as relaxing by a fire, or outdoors, maybe at the beach or in the woods. It can also be a place that’s entirely in your imagination. Spend about one minute visualizing this peaceful scene.

  Move to the first scene of your phobia hierarchy. Stay with this image for thirty seconds to a minute, picturing it in as much detail as possible, as if you were actually there. Imagine yourself acting calm and confident in the scene. If you feel anxious, practice abdominal breathing and try to stay with the anxiety for an additional thirty to sixty seconds. When you feel little to no anxiety, visualize the next scene in the hierarchy.

  When you reach a level of your hierarchy where your anxiety is above a 5 on a scale of 0 to 10, stay with the scene for about one minute, then retreat to the peaceful scene and spend about one minute there to relax again. Then repeat the visualization from the hierarchy scene you left. Continue this cycle of visualizing the phobia scene for one minute, then relaxing with the peaceful scene for one minute, until the phobia scene provokes minimal anxiety.

  If you feel your anxiety level rising above a 7, only stay with the phobia scene for about ten seconds before retreating to the peaceful scene, then stay in the peaceful scene until you feel completely relaxed again. If a particular step in the hierarchy remains difficult to tolerate after many attempts, add an intermediate step that’s more challenging than the previous level but not as difficult as the step you’ve been working on.

  Continue working through your hierarchy until you can visualize the most challenging item with minimal anxiety.

  Practice imagery desensitization for fifteen to twenty minutes daily, beginning each new session with the scene one step below where you stopped before—in other words, the last scene you successfully negotiated.

  Case Example: Lisa and Jennifer

  Lisa and Jennifer, both twenty-five, are preparing to celebrate their three-year anniversary and have decided to take a trip to New Orleans for Mardi Gras. Unfortunately, Lisa has a fear of being in crowds. Her chest tightens, her breathing gets shallow, she feels dizzy, and she feels she must leave the situation, even if it means running away, which draws attention. They know attending the Mardi Gras festivities will mean being in crowds, so they’ve decided to start working on Lisa’s fears at home so that they can enjoy New Orleans and the Mardi Gras celebration to the fullest.

  Working together, they created a hierarchy of exposures to help reduce Lisa’s anxiety about being in crowds. Since they would be together during their trip, they also discussed how Jennifer could be helpful, such as distracting Lisa by pointing out things to look at, encouraging Lisa to stay in challenging situations a few moments longer if she starts feeling anxious, and holding hands when it seems they might get separated in a crowd.

  To practice exposure prior to their trip, they started by going to a shopping mall on a weekday, when there weren’t many people around. They stayed in close proximity, but Lisa had to be on her own for five minutes. Next they went to a department store in the evening, which was a bit more crowded than the mall had been. They stayed in the same department but got a little further from each other and weren’t always able to make eye contact, again, for just five minutes. The next step was for Jennifer to return to the car while Lisa walked around the department store on her own for ten minutes. Whenever Lisa felt anxious, she focused her attention on the products in the store and took several deep breaths. They repeated this exposure a few times during the week and then went back to the mall on a weekend when it was a lot more crowded. Once Lisa felt comfortable being in the crowded mall on her own for twenty minutes at a time, they worked toward a more challenging situation to prepare for a different type of crowd: an outdoor rock concert.

  First they went to a show at a small music venue that seated about one hundred people and remained together the entire time. Next they went to a show at the same venue, but Jennifer left Lisa alone for five minutes. Next they attended a concert in a hall that seated two thousand people. Jennifer waited outside while Lisa went in alone to find their seats and then followed her in about ten minutes later. Finally, Lisa attended a show at the same two-thousand-seat venue alone. After that success, they were able to attend an outdoor rock concert together, and Lisa was able to tolerate staying in their seats alone when Jennifer went to get food or use the restroom. When it was time for their trip to New Orleans, they had practiced enough exposures that even though Lisa was overwhelmed by the crowds at times, she never felt so fearful that they needed to retreat to their hotel or leave the city altogether. They enjoy
ed their anniversary trip immensely.

  Making a Plan for Relieving Your Partner’s Anxiety

  Now that you’ve learned a variety of techniques that can help reduce anxiety, you can create a plan for how to help your partner by making lists of what’s effective and what isn’t when your partner is experiencing anxiety. This way, not only will you know what to do to help your partner, you’ll also have a reminder about what doesn’t work. As I’ve emphasized, partners of people with anxiety generally mean well, but their attempts to be helpful and supportive can inadvertently make things worse. By talking this out with your partner when she’s in a calm and receptive frame of mind, you’ll both be on the same page about what you can do that’s genuinely helpful when anxiety strikes.

  You may find that you and your partner disagree about what belongs on the list of what’s helpful. As discussed in chapter 3, accommodation behaviors feel very helpful to your partner, but they keep her from overcoming her anxiety, and they keep you trapped in the role of being the rescuer, which isn’t healthy for either of you in the long run. You may have to explain this to your partner or, if she’s aware of the problems with accommodation behaviors, remind her why they aren’t actually helpful.