Emma treats those with anxiety, using a variety of techniques including mindfulness and grounding.

How can I support someone with anxiety?

Emma treats those with anxiety, using a variety of techniques including mindfulness and grounding.

Why is it difficult to support someone with anxiety ?

If you have not experienced the debilitating effect of anxiety, it can be very difficult to offer empathy or understanding to someone who has. I have written this blog to help you understand how to empathise and support a loved one with anxiety.

Some people struggle to understand anxiety and how it can be so crippling. A few individuals are dismissive of anxiety and minimalize it. This attitude is not helpful because it undermines the impact of poor mental health on society. This also implies someone suffering anxiety is somehow responsible or inadequate for not being able to manage the complexities of their experience.

An ‘anxiety attack’ is not something we can stop using rational discussion. Anxiety is a response triggered in the brain which interpretates information it receives externally and internally. Once our nervous system has been activated a cascade of physiological changes occur or are primed for action. Telling someone to stop this cascade is like asking someone to decrease their heart rate when they start to exercise. Offering support to someone with anxiety is more about being with them rather than talking at them.

The information that triggers the anxiety response comes from many sources. How individuals might interpret that information is based on genetics, up-bringing, social positioning, past experience, awareness, and education. If you have not been in that person’s shoes you are not in a position to judge their anxiety.

A simple guide to anxiety

  • Anxiety is a response to danger (real, perceived or imaginary)
  • An individual cannot stop being anxious because you tell them to
  • Anxiety may be irrational
  • Anxiety can start slowly or quickly
  • Anxiety is a physiological response, the further it has progressed the less easy it is to modify
  • Someone whose anxiety builds slowly can be helped to prevent it escalating.
  • Anxiety is often a result of a pattern of sustained thoughts and actions that have occurred over years
  • Long term treatment addresses the habitual process that has caused the anxiety
  • A panic attack is an extreme form of anxiety

If you want to read a little more about anxiety visit Thoughts and Anxiety -Using Psychotherapy and Mindfulness to alleviate fretful thinking

How to support someone with anxiety

  • When they are very anxious or panicking-
    • Keep calm. Calmness is contagious, this is recognised when a baby is immediately calmed by the soothing voice of their mother. If you can get grounded and your breathing and heart rate is stable this confers calmness to others
    • Draw their attention, not necessarily just words but eye contact and if appropriate hand holding.
    • Encourage them to look at you
    • Consciously slow your breath and invite them to slow their breathe with yours.
    • Talk slowly and with purpose
    • Continue to encourage eye contact.
    • Suggest they place their feet firmly on the ground
    • To bring them back to the reality of the present moment encourage them to pay attention to things they can sense, ask them what colour clothing you have, or whether they can feel the ground, or air on their face.
    • You will begin to see their posture relax and them becoming calmer, this is when you can talk. Start with reassurance, ‘you are safe’, ‘I’m here’ ‘do you need anything?’
    • Only when they are back in a safe environment and recognise what happened can you ask them about what they were anxious about.
  • When they are generally anxious (and tearful)

Those suffering Generalised Anxiety Disorder (GAD) may have varying degrees of anxiety most of the time. Here are some ideas for you to try when they are at their low point.

    • If you know what makes your loved one happy and relaxed try to encourage them to do these things.
    • Gentle, regular and frequent encouragement is important.
    • It can be disheartening for your attempts to engage to be constantly turned down, but don’t give up.
    • Those with GAD can be anxious in large groups, or busy settings. Be prepared to invite yourself in for a coffee, or take them for a short walk.
    • Build on these activities. If you have a friendship group or close relatives you might want to set up a support hub where each takes a responsibility  for a daily connection with your loved one.
    • Someone with GAD gets safety and stability from knowing friends and family are consistent and reliable. Don’t over promise.
  • How does employment help someone with anxiety?
    •  Work can be a cause of stress but it can also provide a normal and familiar environment which is calming for the nervous system.
    • Generally some time off work after a long period of anxiety will help your loved one recover.
    • Mental exhaustion may not be very visible but your loved one may show symptoms of not being able to concentrate, or make decisions, feeling tired but not able to sleep, being edgy but not able to settle to do something.
    • Someone at work with mental exhaustion can feel very inadequate, unfulfilled, disillusioned and have steadily decreasing self belief. All these will make anxiety worse and potentially turn to depression.
    • If you suspect work is part of the problem discuss this with them.
    • Accepting the impact of GAD on life choices is hard, but small changes such as reduced working hours, change of locality, change in job role can be really beneficial. Try talking this through with them.
  • How to help your loved one manage their Generalized Anxiety Disorder

GAD as with most anxiety, can be well manged, I find people can return to a life with normal levels of anxiety with psychotherapy and/or appropriate medication, however in times of difficulty it can return.

Counselling and psychotherapy can help by providing a safe space to understand anxiety at a physiological level and an experiential level. A good therapist will enable a person with anxiety to understand when their thoughts and beliefs contribute to anxiety and help them to have a different relationship to thoughts. You might be able to do this too, but because there is an emotional attachment between you and your loved one it can be a lot harder and create frustration and animosity which is then counterproductive.

Hints-

 

 

    • Encourage your loved one to seek outside support Counselling for anxiety.
    •  Have your own support network away from your loved one. It can be hard to continually be supportive and patient.
    • Learn to recognise what is a thought and what is reality. This is important to enable you to stop engaging with their anxious thoughts.
    • Do some research to help understand more about anxiety.
    • Healing from anxiety involves changing neuropathways in the brain, it therefore can take time. The longer the anxiety has been going on the longer the healing.
    • To repeat myself, being calm during a crisis is one of the most helpful things you can be. Calmness is contagious.

In summary

Anxiety can happen to anyone, some people, possibly due to their experiences, genetics and their childhood are more likely than others to suffer.

Anxiety is the body’s way of saying ‘I sense danger and I need to be ultra-vigilant’.

Feelings of anxiety may not be justified, as there is no danger, but an anxious person cannot always hear that truth, so it is not helpful to repeat ‘Don’t worry everything is fine’.

If you can be calm, patient, consistent, reliable and show empathy you are giving them safety to experience their environment as safe too.

Resources

Book Review: A Mindfulness Guide for the Frazzled by Ruby Wax

Thoughts and Anxiety -Using Psychotherapy and Mindfulness to alleviate fretful thinking

Counselling can be for anyone.

Christmas Stress-How to change your mindset using Mindfulness

Christmas Stress – How to change your mindset at Christmas

Christmas and Mindfulness
Anyone hosting Christmas will be aware of all the jobs that need to be done, the presents and party clothes to buy, food to be ordered, the list can go on. For those having Christmas alone, or if this year is the first without a loved one, the festivities provide a complex set of emotions which can be difficult to bare.

It may be that you have a silent dread of Christmas. However, Christmas is going to happen.

What follows are a few ideas about how changing your mindset may help.

Many of the reasons why stress builds up prior to Christmas is to do with thoughts and behaviours, habits and expectations.

For example;

  1. The emphasis placed on family traditions
  2. You may be concerned about how much work needs to be done to make the day successful
  3. Present buying; how much to spend, what to buy
  4. The day being a reminder of those we have lost

You may be able to relate to these. Mindfulness encourages a different approach and awareness to the meanings we give to things such as traditions and expectations.

Mindfulness allows us to treat the current moment as all there is.  It helps us see how much meaning we attach to the past at the expense of the present.

  1. The emphasis placed on family traditions

It can be difficult to change habits, certainly if we frame them as ‘family traditions’. I wonder if when your ‘family tradition’ happened for the first time the intention was for it to go on past its sell by date?

Interestingly we are aware in other circumstances, such as holidays, that when we try to repeat the experience it causes greater disappointment. Can this be applied to Christmas?

Traditions may include when to put the decorations up, real tree or artificial, Christmas day menu, the family members invited, the timing of present opening, television and what film to watch.

Before planning gets well under way why not ask yourself and your family, whether  these traditions important and why. Do they create a good experience?

You may find you can drop one or two and everyone has a sense of relief.

  1. The concern about how much work needs to be done for the day to be successful

There is as much work as you want. Is it true that the more work you put in, the happier everyone is? Or is this about you, and how others might perceive you?

Thoughts can creep into our head and be believed. At Christmas there might be a little bit more organising and planning but it happens every year and we do it every year. It is often worth noticing the thoughts we have, and reminding ourselves they are thoughts. There might be the thought, ‘I won’t get it done in time’ or ‘what if the turkey is under cooked ?’ Notice what happens to your stress levels when you have these thoughts. Are they appropriate, what is the worst that can happen? Thoughts are not facts, mindfulness enables us to notice a thought and not react to it.

Take a mindful moment. Take a deep in-breath and a slower out breath, counting to five. Repeat once or twice more.

  1. Present buying; how much to spend, what to buy

Why are you buying presents, who for and at what cost?

Present buying is a reflection of who you are and your relationship with the recipient, as well as your personal beliefs about Christmas.

There are many ways in which we get distracted from this, especially adverts and consumerism and ‘family traditions’. The shops become full of ‘gift ideas’. Spend a little time reflecting on why you want to give as a gift. There is some truth in the statement ‘it is the thought that counts’. A mindful approach focuses your mind on the reality of Christmas, encourages you to stick to intentions meaning it is less likely you buy things spontaneously.

You may also reflect on what does receiving a gift mean to you, and is this truth based on reality. A common belief is that a person close to you will instinctively know what you want. Unfortunately, life isn’t this simple, either tell them or be prepared for anything. People are not mind readers.

  1. The day is a reminder of those we have lost

Anniversaries are reminders. Allowing a time in the day to acknowledge absent friends and family can be useful. You and other friends and family also represent a little of that missing person, a shared joke, or shared gene, this too can be honoured. They have not gone completely.

Mindfulness encourages us to stay in the here and now, it is this moment that is important, comparisons often bring dissatisfaction. Each Christmas will be different, enjoying it for what it is can be more rewarding than not liking it for what it isn’t.

Mindfulness at Christmas

Mindfulness involves a regular commitment to paying attention to the present moment. Christmas often draws us into the past, the past has gone, enjoy the ‘now’ as this too will soon be gone.

You might be interested in

Thoughts and Anxiety-Using psychotherapy to alleviate stress

Mindfulness meditation for novices-Part 3

If Christmas does provide a challenge getting some counselling support may just help build up resilience.

Emma Dunn Counselling and psychotherapy

Thoughts and Anxiety -Using Psychotherapy and Mindfulness to alleviate fretful thinking

Thoughts and Anxiety

Anxiety often manifests itself as poor eating, irritability due to poor sleep, and an inability to concentrate. First line treatment addresses these manifestations. Anxious people are encouraged to exercise to become physically tired; eat regular meals and to make lists  to feel less over- whelmed. These are useful for symptom alleviation but without identifying the cause there is potential for anxiety to continue. The link between thoughts and anxiety is not being addressed in these treatment. It is understanding the cause that will ultimately decrease the symptoms of anxiety.

Anxiety might be interpreted as a reaction to a real situation. Do you believe anxiety is a reaction to a real situation?

Have you ever considered your thoughts and anxiety as one problem?

The Neuroscience of Anxiety

Emma Dunn Counselling and Psychotherapy

Summary of the brains response to a threat

The stress response is the same whether there is a real threat to our physical safety or a perceived one. An area in our brain called the amygdala is the warning bell that makes us physically alert through a cascade of hormone and nervous reactions. One of the hormones released is cortisol, which further alarms the amygdala so it becomes even more alert to negative stimuli. Meanwhile, another area of the brain, the hippocampus, becomes less responsive. The hippocampus normally provides a control over the amygdala such that positive experiences are noticed as well as the negative ones and we can weigh up rationally what is the best action to take. The more often we are stimulated by anxious reactive thoughts the more readily we get to a state of alertness and vigilance, and less able to keep calm and rational. We attune into (implicit) memories that are not quite clear ‘the sense of something bad going to happen’; thoughts and reality become inseparable, we become less able to access reality, which might appropriately be remembered as as ‘when such and such happened, I was concerned but it all worked out in the end’.

Thoughts

Thoughts and Mindfulness

In the context of Mindfulness there are 3 types of thinking

  • Active-Useful, essential for planning, doing, reaching our goals
  • Flow-thoughts occur but are not judged, they pass by.
  • Fixed-unhelpful patterns of thinking, not usually based on reality.

Mindfulness aims to help us move away from fixed thinking to flow thinking and active thinking.

It is useful to remember that

  1. Thoughts are not facts
  2. We are not our thoughts

We are then in a better position not to let thoughts and anxiety dominate our thinking and behaviour.

A useful way to notice whether a thought is an unhelpful one is whether it creates an emotion, or whether it is helping or not, that is enabling you to do a task or stopping you from doing a task by relating to the past or the future, rather than the present.

Psychotherapy and Thought

Psychotherapy is about understand the workings of the mind, and bringing it into awareness. It is about recognising behaviours that are based on past experiences, and understanding that we do not need to repeat behaviours and thoughts, especially those that cause unhappiness.

The implicit memories that were mentioned earlier, it is these that psychotherapy can help unravel and challenge.
An example
As we grow up we often maintain the beliefs, behaviours and thinking patterns that were familiar to us as children, when they are out of awareness, as adults they can prove to be unhelpful. An innocuous example might be that as a child ‘greediness’ was discouraged. So little Billy, to please his mum would take the smallest bun when offered a plate of cakes. As an adult Billy’s wife offers him a plate of buns, obligingly he takes the smallest, not wanting to be disliked for being greedy, Billy’s wife is upset thinking Billy does not like her cooking. There is something in Billy’s wife’s belief, behaviours and thinking that feels rejected if someone doesn’t accept what she offers.

These actions can be so ingrained that we believe them. Billy believes he is greedy if he takes a big bun and his wife believes she is rejected because he didn’t take the biggest one. These are fixed thoughts. The reality of the situation has not been made explicit, spoken about. In a state of anxiety further implicit memories may be stored (remember these are not based on reality). Billy’s implicit memory might be is that he upsets his wife by eating buns, his wife’s that Billy doesn’t like her cooking. A tiny event reaffirming a whole set of thinking and anxiety based on past experiences not relevant in the present.

Through psychotherapy Billy will gain an understanding that perceptions of greediness are individual. He will identify with his own physiological experience about what it is for him to be greedy, or even whether greediness is an unhelpful experience that represents for him an interpretation of poor self-worth (i.e. he doesn’t deserve a big cake because his mother will not love him, and as an adult, his wife will not love him if he has it) He will become aware through dialogue that explaining why he makes certain choices can avoid future misunderstandings, and stop the perpetuation of irrational decision making. He will learn that other people, including his wife, experience his behaviours in their own way, not necessarily how they were intended.

Psychotherapy and Mindfulness

Thoughts and anxiety can be inseparable. Through Mindfulness practice there can be an awareness of our thinking, noticing spiralling sequential thinking sometimes pulls us away from reality into a repetitive story of stress, and worry; Mindful practice enables us to begin to slow down fixed thinking, replacing it with flowing thoughts.

Psychotherapy acts as an adjunct helping us to notice actions and behaviours that are based on habit, or implicit memories, and previously out of our awareness. It therefore helps us to modify our behaviour and take greater control, strengthening explicit memory formation and the role of the hippocampus, enabling rationality informed by experience.

Thoughts and anxiety lose their grip on each other. Thoughts become focused based on reality, and our physical arousal is appropriate based on actual threat or excitement.

We learn to make our thoughts explicit to help identify reality from ‘make believe’. Relationships improve and anxiety decreases.

Further information about mindfulness can be found below.

If you think counselling can help you please look at my website Insightfulness or visit Counselling Directory or British Association for Counselling and Psychotherapy where you might find some helpful resources.

Resources

Books

The practical neuroscience of Buddha’s Brain. By Rick Hanson, with Richard Mendius

Mindfulness; a practical guide to finding peace in a frantic world. By Mark Williams and Danny Penman

Web Sites

The Mindfulness Project

Oxford Mindfulness Centre

Counselling Directory

British Association for Counselling and Psychotherapy