Supporting A Person With an Anxiety Disorder

As you have read under General Description of Anxiety and Panic Attacks, being a support person is something which you cannot take lightly. The ill person has turned to you to be his or her life-line in returning to a "normal" world. Love and sincerity play an essential role, but in addition, you must understand what you are doing and why. If, therefore, you have not yet read the descriptions of a panic attack and agoraphobia found on this site, do so soon.

Remember, there are various schools of thought on being a support person. I am giving you what I have heard and found to be most helpful to the people with whom I have worked among on being a support person.

To help you understand why I like this approach, I am going to give you a brief true story of a person I will call Anne.

Anne developed panic attacks about 12 years ago, before panic attacks were more widely known and a variety of treatments became available.

For several years, she looked for a diagnosis and effective help. Eventually both were forthcoming but in the interim she developed severe depression and agoraphobia to the point where she could not leave the house without tranquilizers and a caregiver. Even then, there were times she had to come home without accomplishing her goal, and the failure led to greater depression and more anxiety.

About three years ago, came a change in her thought patterns. Anne realized that by setting a specific location or a specific accomplishment as a goal, she was constantly setting herself up for possible failure. There is a world of difference between "I am going for a walk" and "I am going to try to go to the store."

In the first, the goal is to go for a walk. It may be to the property line or 12 blocks and back; Anne does as much as she feels comfortable doing. In the second case, Anne has to make it to the store or she will have failed. The same is true of any such project. Why make a big thing out of trying to drive to the store when you can be more relaxed just going for a drive and doing whatever you feel comfortable doing? Turn right. Turn left. Come home. Keep going. It doesn't matter. Allowing yourself freedom of choice without feeling pressured or guilty is the key.

After a few weeks, Anne found she was driving greater distances and eventually could set off for a specific location, knowing she had been there before while on her no-pressure drives. She can now drive virtually anywhere. Stoplights and inner lanes are still a bit of a problem, but not enough to force her to use alternate routes.

A number of authors have come to see the effectiveness of this strategy and have referred to it as "giving yourself permission."

Before getting into specific suggestions, there are few points to keep in mind:

1. At all times, be supportive but not condescending.
2. Remember, you are not responsible for your companion's recovery. You are doing what you can but the majority of the healing must come from within.
3. Don't blame yourself if the person has a panic attack or is unable to complete the outing. It's not your fault.
4. Don't feel there is something you must be able to do help the person get over a panic attack. There is little you can do. If at home, the person may want to be held or just left alone. If you are out, he or she may want to just sit for a few minutes or return home.
5. The person you are with is in charge; he or she calls the shots. If she or he wants to abort the outing, abort; to go somewhere other than where you planned, go there. That person, not you, knows what feels most comfortable.
6. After a few outings, try to have someone else come along so that the person you are supporting can begin to feel comfortable with the other person. Eventually, you don't have to be present all the time.
7. Don't wear yourself out. For your own health, there may be times you have to say "no" to a request.
8. You may not understand panic attacks, but never tell the person that it's all in her or his head, that he or she could go out if she or he really wanted to. PA's and anxiety don't work that way.
9. Don't call outings "practices"; "practice" seems not to expect less than success. Since there is no specific goal, how can one fail? Every outing is successful if looked at correctly.
10. As part of your support role you may have to remind the person that backsliding is normal, assure them that they are sane and that they are not having a heart attack or other physical trauma.
11. Don't be upset if you get snapped at occasionally. The person may be very up-tight.

Practical guidelines for going out together:

1. Don't make a big deal of it. The person is probably anxious, and to plan as though you were preparing an invasion will make him or her more anxious. How much planning and structure is required varies from person-to-person and will probably change over time.
2. If you are not familiar with the place you plan to go to, go ahead of time to case it out. See which areas will seem confined, find the exits, ask about times when it is not too crowded. Know where the stairs are located in case escalators or elevators are a problem. Being able to tell the person you know the area may make her or him feel less anxious.
3. If the person wants you to stay with them do so--like glue. It's not his or her job to keep an eye on you. It's your job to keep your eye on her or him.
4. If your companion wants to hold your hand or suggests you stay a few feet back from them, do what she or he requests.
5. Always have an agreed upon central place picked out at which to meet in case you accidentally become separated. Once it is obvious you have lost the person go directly to that spot. Do not waste more time looking. He or she will feel more comfortable if she or he knows you will be there.
6. If the person wants to leave you for a while, set a definite time and place where you will meet. Don't be late. It is better to be early in case he or she arrives early.
7. The only responsibility with which to charge your companion is to let you know if she or he feels overly anxious or panicky. Frequently you can't tell from just looking at him or her.
8. If the person indicates that she or he is becoming anxious ask them what they would like to do--take a few deep breaths? sit down? go to a restaurant? leave the building? return to the car? A break may be all that is needed for his or her anxiety to diminish. She or he may want to go home or return to the place you have left. That is up to him or her. Ask the question but don't push.
9. If your companion has an unmanageable panic attack lead her or him from the area to a place where he or she feels safer. Don't forget to see that there are not inadvertently unpaid for items in her or his hands. They probably won't be thinking of them.
10. Don't add stress by giving the impression that there is something YOU must absolutely accomplish before returning home. The free permission to return home at any time is now gone.

Going out alone:

Driving is a problem for many. Again, remember that there is no need for failure if no specific goal is set. The person should just follow what that little voice inside says it is O.K. to do. Here's a method many have found helpful--there is no set time. It may take days or months or longer to work through the sequence. There is no time limit.

1. Go with the person; either of you driving. He or she may want you help locate turn-around points or pull-off places. Your companion just needs to know he or she is not trapped on the road.
2. When the person is ready he or she can drive alone with you following close behind. Make certain she or he can see you in the rear-view mirror at all times.
3. When the person is ready he or she drives down the road with you following, but just out of sight.
4. If the person wants to drive on her or his own try to borrow a cellular phone so that he or she can be in contact with you. The person may ask for you to come and lead them home or just to give them some reassurance. If you are using a phone keep the line clear. The person needs to know she or he can reach you at any moment.

Other Situations:

The ill person may need you when visiting doctors or dentists. Understanding medical people usually don't object, especially when they realise they may have to deal with a panic attack if you aren't there. Your sense of humor may help in unusual situations and you may be able to joke your companions along; or the person may feel more comfortable just telling you to shut up.

Some techniques I have used: making certain we took the right cassettes to the dentist for the person to listen too while having work done; suggesting to the dentist that a rubber dam may not be the best idea; holding hands while your companion is in the dentist's chair; making certain that everything the doctor or dentist does is explained as it is being done; holding hands with your companion during a biopsy under a local anaesthetic; discreetly looking the other way while holding a hand during a mammogram; climbing inside the far end of a CAT scanner to describe the tunnel to the person before he or she is moved in; sitting in post-op so your companion has a familiar face to wake up to. You never know what is next. I have learned a great deal just by watching what's going on and the person's reactions.

Finally, don't let yourself start to suffer. If you find the stress of looking after a loved one is wearing you down, get medical advice. Also, being able to be a support person is not for everyone. There is no shame, nor lack of caring, in not being able to do it. You have your own health to consider as well.