IV. What choices do I have to include social support in my anxiety treatment exercises?

If you are a friend, family member or partner caring or helping someone with anxiety, there are steps you can take to be even more supportive for your loved one while still having time for yourself and receiving support as well.

Preparing Yourself for Social Support by Being Open

In seeking or giving social support, the more open a person is, the more interaction there is, and the more likely are the benefits. To help you understand and realise what it means to be open and how to better achieve openness with another person, you should take note of the following:

1. Support gained through social interaction is your main goal.
2. Patience and a non-judgemental attitude are essential to developing an open relationship.
3. Focusing on the now, as opposed to the past or projected future experiences, is vital to having efficient social interaction to facilitate support.
4. Keep in mind the ultimate goal of your social supportive interaction (to provide or receive social support) so as to give purpose and meaning to your personal needs as well as having a clearer understanding of another person’s needs.
5. Know that you have a choice in what to believe and what not to believe. It will help you to maintain control over the outcome of your interaction.
6. You can obtain more beneficial results through practice and positive attitude.

General Social Support

The research defines support as ‘verbal or nonverbal communication that reduces uncertainty about a situation, oneself or others or a relationship, and enhances the perception of control over one’s life [2, 16].’ Having social support not only can help you understand your experiences and how they may be a source of anxiety or worry, but will also help you cope with those anxieties when they arise.

There are three types of social support that all people need, regardless of their experience with anxiety.

• Emotional support: involves receiving empathy and compassion when we are stressed, anxious or excited.
• Informational support: means having people to help guide or mentor you when you have anxiety, how to cope with anxiety, and how to gain relief from anxiety.
• Tangible support: is having someone extend you a helping hand when you need it.

If you have these three kinds of support, then you have a way to get general social support. General support means daily social support for everyday stressors or events, so that you can “vent” or get them out and deal with them while they are small concerns before they become larger issues that lead to anxiety. For example:

• On one day you may be worried about whether you have enough money to pay a small phone bill – then the phone bill turns into worrying about an affordable lifestyle.
• On the following day, you may have to get your car repaired, but do not know of a good mechanic – the car repairs turns into a fear that the car may break down on the motorway.
• On another day, you may be worried about an exam or a deadline at work – the deadline turns into anxiety that the project may not come out right and on time.

Having someone to talk to on a daily basis makes it easier to deal with these small stressors.

Self-help or Support Groups

You may feel you do not have enough support in your life or that the people around you are not necessarily the best to turn to for certain issues, there are always self-help and support groups out there. These groups are focused on specific issues or concerns. If you are dealing with anxiety, you either find support groups that help you deal with it in general terms, or find ones that deal specifically with anxiety disorder. Support groups allow you not only to share experiences and receive information about anxiety, but to interact with like-minded people who can relate to your experiences. Self-help and support groups can give you the emotional and informational support you need, and more so if you become friends with them.

Counsellors or Therapists

Counsellors, therapists, and other psychological professionals have specialised training to help you meet your anxiety reduction goals. They can be a source of informational and emotional support. The support you receive can be geared towards specific anxiety disorders or symptoms, trauma or life-changing events, or relationships related to your anxiety concerns. Psychological professionals can act as a guide or a coach to help you fully examine and deal with your anxiety.

If you are experiencing social anxiety disorder, phobia or panic disorder that prevent you from developing your social network, there are counsellors and therapists who can work with you using Cognitive and Behavioural Therapies to lower the symptoms of these disorders first. If social support and/or other therapies are not effective, then a psychiatrist may be able to combine treatment with medication and devise an effective regimen for you.

How to Develop Your Social Support Network

There are a number of small steps you can take to develop your network and gain the emotional, informational and tangible support you need to get through stressful and exciting times that can lead to anxiety. Below are some key steps you can take to build a supportive network:

Since research has shown that having diverse connections can help buffer stress and anxiety in different parts of your life, you should take an active role in developing your network as this leads to more social connections. You can do this:

• by answering calls；
• replying to emails；
• accepting invitations to go out；
• calling on the phone to simply say “hello” [9,16].
• Seeking out social groups that share your interests
• Joining a local club for sports activities
• Taking art classes if you enjoy painting or drawing
• Volunteering at a local charity organization
• Searching online to people with like-minded interests.

We quite often feel anxiety from the possibility of being rejected or judged if we make known our needs and desires for support. Being able to ask for help properly and without fear is called assertiveness. Being assertive helps you:

• to say “no” when others ask for something that may make you feel anxious or guilty.
• to say “no” can clear the air, but you must also be respectful.
• to say “yes” to certain things while still keeping your emotional boundaries safe.
• to reduce anxiety and bring the right people who are happy to support you into your life.

Here are a few pointers to bear in mind when being assertive with others and in turn reduce anxiety:

• First, know your rights.
• You have the right to feel healthy and be in a healthy environment. This may mean there are physically or emotionally unhealthy people or places around you. You can use your assertiveness to change this situation.
• You have the right to say “I don’t know” or “no”, change your mind, without having to give any reasons or excuses, and without feeling guilty for doing so.
• You also have the right to give excuses for your behaviour and deal with the consequences of doing this.

After learning the rights you have when dealing with people, you can then work to change how you communicate with them. Know what non-assertive communication sounds like.
Non-assertive communication is passive, is critical of the other person, does not ask for clear action or seek a solution, and does not deal with the situation that is causing anxiety. Here are some examples:

• “You never do….”
• “You should have…”
• “You never let me…”

If you use these types of statements, or hear them from a person that you turn to for support, you risk being manipulative, passive, and creating more anxiety and worry for yourself.

Use assertive communication to show respect to yourself and the other person, and bring other assertive people into your life that are also respectful of your needs.

Being assertive is not being rude, it is just letting the other person know that you have your own opinions and a mind of your own. Respectful of each other’s boundaries can offer a healthy solution if there is a problem. By communicating assertively, you will also attract others who are similarly clear and direct-thinking, and not creating situations that can cause anxiety.

Here are some tips for communicating assertively:

• Use “I” statements. You may feel uneasy at first, but using “I" statements to express your needs and concerns without having to single out the other person by using “you” too often. You can change statements to an “I” statement. You may feel uncomfortable but bear in mind that you can have your needs met: “I enjoy listening to your story. I feel worried about something and would appreciate you listening to me.”
• Make direct requests: make clear requests of your needs to show you are respectful of someone else’s time and consideration: “I would like to go and see this movie with you.”
• Refuse requests if you do not feel comfortable or appropriate. Someone may ask you to do something you feel is not right to do, if that is the case, you must listen to your feelings, evaluate the situation, and not the person. It should then be easy for you to make a clear decision. You do not have to give any excuse, apology, or reason. For example, if someone asks you to dinner at a place you do not like, say so: I don’t want to go to dinner there as I don’t like their food. Perhaps we can find another place we both like?”

You can also follow up with a direct request in order to create a situation that benefits both you and the other person: “Why don’t we talk about other places and find a place we can both enjoy”.

Many would agree that there is a fine line between being assertive and being aggressive. Much depends on respect. If you can show respect to the other person and their wishes, the way you make eye contact, the tone of your voice, and the right word choice, you will more than likely be perceived as having an assertive and not an aggressive behaviour. In order to avoid aggressiveness, you must remember to ask yourself before engaging someone in conversation: “Am I standing up for myself or am I just being rude?”

By using assertive communication, you can weed out people and situations that may bring your anxiety, and bring in people who can communicate in the same way as you, who can consider your requests reasonably without taking offence, and who can let you know clearly whether or not they can be supportive to you.

Empathy and reciprocation are social skills that can involve you being there for others. Empathy means you can accurately perceive the feelings of those around you. You may wonder how this can lower your anxiety, but being able to reflect and understand other people’s feeling and what they say can minimise confusion and the stress that comes with miscommunication. 

If you do not think you can become a more empathetic person, there are different options you can try:

• When you are unsure of what someone is telling you, try rephrasing it in your own words. You can even ask “did you mean….?” and then put your interpretation of what is said. Instead of becoming frustrated and worried that you do not understand, give the other person the opportunity to agree with you, and define exactly what the person is thinking or feeling. You will then feel less confused and worried about talking with someone when you try to be empathetic first, and this can then open the door for the empathy to be reciprocated.
• Reciprocation is similar to empathy, but it involves you returning the favour and helping others who have helped you. Your social support network grows and becomes more stable when you give what you receive, and also accept help from people whom you have helped or offered to help. By reciprocating, you show that you are trustworthy and respectable, and deserve the same level of support when you ask for it from your network. At the same time, keep in mind that support goes both ways. You would not appreciate it if people kept asking for your help without returning it, so you cannot keep helping people who do not help you. By always taking help and not reciprocating, you may become dependent on others when you are in need and may not learn how to help yourself when you are alone and may be feeling anxious, scared, or worried. Always giving and not receiving can also be stressful to both the mind and the body.  

Cognitive Behavioural Training for Shyness, Social Anxiety Disorder and Social Phobia

Even with all the choices in developing your social network of support, you may still feel too shy or worried about being judged and embarrassing yourself when you try these different exercises. If you feel this way, you should consider Cognitive Behavioural Therapy to help you address your fears and worry about dealing with people. You can also see our lessons on Cognitive and Behavioural approaches to anxiety for more help.

Ways to Support People Who Have Anxiety

If you are trying to help someone who has an anxiety disorder, or believe a friend, a family member, or partner may be suffering from anxiety, there are ways you can be part of their social support network. As you take this major, empathetic step, you may feel frustrated at times with this difficult process. You too, will also need emotional, informational and tangible support as a carer to someone with anxiety. The following are tips you can use to be as supportive as possible while still leaving enough time for your own network.

• Understand the warning signs of more serious anxiety:

A loved one or someone close may be expressing irrational feelings and thoughts that are bigger than everyday stresses or worries.

• They may become withdrawn and isolate themselves.
• They may be angrier than what the situation is called for, or are always worried, tense, or anxious.
• They may constantly complain about an upset stomach or a higher heart rate even when relaxed.
• With Panic Disorder, they may appear to be having a heart attack, hyperventilating, having a pounding heart, or feeling dizzy and may even faint.
• With Obsessive Compulsive disorder, they may be excessively meticulous about keeping things in order or having repeated behaviours like hand washing or checking items for fear they are lost.
• They may also hoard items in storage spaces and be unable to throw things away.
• With Anxiety Disorder, they may be absent too often from work or school because they ‘just didn’t feel like they could manage to complete work that day’.
• They may let errands, such as grocery shopping pile up because, ‘it just makes them too nervous to be around other people out there’.

All of these feelings and behaviours may seem normal if only on an occasional basis, but if they occur frequently, and disrupt one’s ability to work, maintain relationships, or keep one from caring for themselves, then the person may be experiencing an anxiety disorder or extreme levels of anxiety.

• Acceptance:

Accept that your friend or family member is experiencing anxiety, or may have an anxiety disorder. Remember that this is not a sign that they are weak or will always be weak or cannot be cured with proper treatment. Accept also that you may not be able to fully understand their personal experience with the disorder without having experienced it yourself. Although you would wish to paint your loved ones in the best light, you must accept that they have a problem, and be supportive in their time of need.

• Learn about anxiety and anxiety disorders:

You can turn to the same sources of informational support as your loved one, including therapists, psychologists, or psychiatrists as and when needed. There are also many resources on the web and books to help you learn more about anxiety disorders and its physiological and psychological impact. There is also information on therapies and medications that may help improve your loved one’s anxiety symptoms, whether or not they may need treatment or hospitalization. There are also support groups that can provide you with training and ways to help you cope with your loved one.

• Coping with symptoms as a friend or family member:

As a family member, friend or partner, you can play an important role in your loved one’s day-to-day efforts to relieve anxiety. Although it is not intentional, you may be accidentally contributing to their anxiety symptoms. Remember, it is no one’s fault, and there are ways that you can help them cope.

• Stay hopeful:

Supporters who are both confident and optimistic about their own outcome will be more patient and have more positive temperaments when using different therapies to help anxiety sufferers. Staying confident and optimistic has benefits for both parties. Thinking optimistically and always looking ahead positively can help to calm turbulent feelings of anxiety and achieve goals more easily.

• Set step-by-step goals for friend or family member:

Don’t set goals too high to “cure” your loved one’s anxiety. Instead, set smaller, reachable goals that will lead to long-term change. It may start as something as small as visiting a therapist regularly, taking medications at the correct times, or practicing Cognitive Behavioural lessons each week. Either way, you are helping them to get one step closer to recovery.

• Patience vs Pushing:

Keep in mind that the treatment for anxiety is hard work for your loved one. You may want to do everything you can to make sure they get better as quickly as possible and that their pain is relieved, but pushing too fast too soon may send them to another anxiety episode or feelings of failure. The route to recovery when dealing with anxiety is certainly not to induce more anxiety upon your loved one. 

• Do not over help:

Supporting is to help someone face difficulty. Overdoing help on the other hand is to allow someone else to do something when it can quite easily be done by him or herself. Although you want to be supportive and help them get through the situations and events that give your loved ones anxiety, they may also become overly dependent on you and never learn to ease anxiety on their own. For example, if your brother or sister can only sit in a crowded restaurant if you are with them, they may think that the solution is you, and not what they have learned on their own to treat anxiety.

• Recognise accomplishments:

Give your loved ones positive feedback as they achieve the step-by-step goals set out for them to reduce anxiety. This will encourage them to keep going with the process. For example, when your loved one has finally conquered the fear of dining in a crowded restaurant on his own, congratulate him, and let him know your interest in his progress.

• Establishing a network of like-minded carers and support:
  

  It is just as important that you have a network of support to help you cope with your role as a carer. There are many support groups designed to provide you with emotional and informational support, counselling, as well as learning support tools from a resourceful network of like-minded people with similar experiences.

• Taking time away:
  

  You may find the work of being a carer stressful on your mind and body. Remember you have your own life that also needs looking after. As a carer, you should take time off to re-invigorate yourself and enhance your wellbeing. We all know what it is like to be worn thin and burnt out, and we all know the outcome from these types of conditions. The fact is, being irritable, tired, and unsociable cannot be beneficial to either the carer or the person being cared for. Unwind, recharge your batteries, take a break. It will help not only you as the carer but also the loved one you are caring for to feel less stressed out.

Can I incorporate social support with other treatments to help with my anxiety?

Social support should be part of a total effort to lower anxiety. As you have seen in this lesson, there are many ways how stress and anxiety can affect the body in the short and the long-term, mentally and physically. The scientifically-supported benefits of social support can improve physical and psychological wellbeing so that you can take advantage of other anxiety treatments. When building a social network as part of your treatment plan for anxiety, you should keep the following in mind:

• Partner or work with therapeutic professionals and if medication is necessary, work with a qualified psychiatrist
• Map out a treatment plan with your therapist
• Regularly review your plan for progress and results

It is vital that you reach out to others for assistance and maximize your efforts in reducing anxiety in your life.

Although you can do these exercises on your own, it would improve your chances to reduce anxiety if you were to work with a network of support. These treatments are enhanced when done with partners, classes, or groups:

• Physical Exercise
• Cognitive Therapies
• Behavioural Therapies
• Nutrition planning and changes

If you experience social phobia or anxiety, Cognitive and Behavioural treatments may help address the underlying fears, thoughts and activities that keep you from being around people in the first instant. You will learn the tools to calm social fears so that you can later take advantage of the benefits of social support.

Building a social support network will benefit other exercises and treatments you use to treat anxiety. You may also find that the strategies presented in this lesson are all you need for your level of anxiety. If you find that having a supportive network has helped you to find relief from stress and anxiety, you can always use these exercises to build and maintain friendships and connections.