13 Things People With Anxiety Want You to Know
For starters, we can’t just stop worrying.
“People think of anxiety as a character in a Woody Allen film,” says Jamie Howard, Ph.D., a clinical psychologist in the Anxiety and Mood Disorders Center at the Child Mind Institute in New York City. “People who have it are kind of neurotic. They’re being silly, and they should just knock it off.” While this portrayal may be funny in a movie, it’s anything but for those who are coping with the disorder. And that’s a big number: Anxiety disorders are the most common mental illness in the United States, affecting 18 percent of adults, according to the National Institute of Mental Health. Here are a few things those 40 million people would really like you to know.
It’s a common view that people with an anxiety disorder want to worry. Not so, says Howard: “They would like to be more carefree.” But they can’t because a biological misfiring in their brain that causes them to feel threatened even when they’re safe. “They believe that what they’re worrying about is a legitimate threat,” she says. “They believe it’s in their best interest to worry about it.”
“When you have an anxiety disorder, your whole fight-or-flight response takes off,” Howard says. “Your brain interprets a situation as threatening and sends a signal to your body to deal with it.” Your body in turn has a strong physical reaction: a rapid heartbeat, shallow breathing, sweating, and trembling. “It’s very difficult to feel that much distress and be that alarmed by so many small things in your world,” she says.
Given how the body reacts, the person with anxiety feels a strong physical urge to avoid the situation causing the problem. So whether it’s choosing a piece of furniture for the living room or finishing a paper for a college class, people with anxiety become paralyzed by it. What’s difficult but doable for most people is nearly impossible for them.
“The inability to get things done may look like procrastination or laziness,” says Howard, “but it’s not as simple as that.” Underneath is fear: “Very bright students don’t turn in a paper because they’re worried someone won’t think it’s good. They’re not in danger, but their body perceives the situation as such a big threat that they avoid it.” They wind up hurting themselves, she says: “They wish they could turn that paper in.”
Not being able to do seemingly simple things isn’t much of a confidence booster. The thought that “I can’t do that” is ever present—and makes people with anxiety want to avoid situations that make them feel even more like failures. So smart kids will end up failing classes or smart adults will have trouble at work because they can’t meet deadlines.
Anxiety affects people’s social lives too. Many people with anxiety won’t go out with their friends, for example, because being in a large crowd or drinking alcohol triggers an out-of-control feeling. “So they get labeled as someone who isn’t fun,” says Howard. “But it’s not true. They would love to be able to go out, but they feel scared.” Their friends take it personally, but it’s not personal. It’s a perception of threat. “They lose friends because they never accept invitations.”
Some supportive things to say: “You seem really anxious. That must be horrible. Is there anything I can do to help?”
Say you’re having a party and you want to invite 10 people, and you know your friend with anxiety won’t come if you have more than three. Don’t cut down your guest list. “Go ahead and have the party and tell your friend you hope she can be there,” Howard says. It may sound cruel, but it’s actually kind. “Avoidance is what maintains the anxiety," she says. So if you’re helping your friend sidestep a situation that makes her uncomfortable, you’re not doing her any favors. A more supportive approach: “See your friend separately in a smaller group, but keep inviting her to the larger party. If she’s receiving good treatment, she’ll be coached to face her fears.”
People with anxiety disorders are actually coping with a lot more than the average person. They get criticized (“You mean you can’t just pick out a sofa?”), but the person who says that can pick out a sofa without any physical reaction. “If you don’t put yourself in other people’s shoes, you think they’re being dramatic and making life more difficult than it needs to be,” says Howard.
You can’t make people with anxiety more functional and less anxious. Likewise, pep talks trying to force people to do things they don’t want to do aren’t going to work. “It feels invalidating because it’s usually coming from someone who doesn’t grasp how challenging it is for people to do that they’re being asked to do,” says Howard.
Anxiety disorders are very treatable with cognitive behavioral therapy, sometimes accompanied by medication (for moderate to severe cases).
Treatment takes a minimum of 12 weeks. “Many people will see some improvement in that time, and for some people you’ll see it quickly if it’s a simple, straightforward case of anxiety,” says Howard. “But more severe cases will take longer and the improvement will be smaller.” Either way, they don’t get better overnight.