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Hey there everybody, and welcome to this video on being in a relationship with someone who has generalized anxiety. I'm your host, Dr. Dawn-Elise Snipes. Before we get started, do me a favor and click that subscribe button and also click the bell so you're notified every time we put out a new video.
In this video, we're going to explore the symptoms of anxiety—the ones that are in the DSM as well as ones that are there and very common but may not be in the DSM. We'll identify strategies to support the person in coping with their symptoms. We'll also explore how their symptoms impact you and strategies for your self-care.
The mnemonic I created for generalized anxiety is WISER. Pace. People with generalized anxiety often feel revved up and like there's a lot of pressure, and they worry a lot. So helping them slow down, helping them take a breath and get into their wise mind can help them cope with their anxiety.
So the symptoms of a person with generalized anxiety include worry about a variety of things most of the time that is difficult to control, irritability, sleep changes. Now, if somebody has had generalized anxiety for a while—because this can go on for years—you may not notice the sleep changes because ever since you've known them, they may have had poor sleep. So really what we're looking at is poor sleep, exhaustion, and low motivation, restlessness, potentially panic attacks that include increased heart rate, trembling, sweating, aches, and increased pain, difficulty with concentration, and eating changes.
So let's talk about these in general. If you're supporting someone with generalized anxiety, whether it's a child or a loved one, it's important to recognize that their feelings are very real. Their anxiety is often based—the things they worry about is often based on prior learning experiences. So for them, what they're worried about seems very problematic at that point in time. Now, you may have a different perspective, and that's wonderful if you do, but it's important not to invalidate their symptoms. It's also important to recognize that just because they're anxious doesn't mean that you need to be anxious. So setting those good emotional boundaries will be really important.
When we talk about worry and some of these other things, we also need to identify for the person with generalized anxiety disorder what triggers their worry. What things do they worry about? And with generalized anxiety, as I mentioned, a lot of times they worry about a lot of things. They worry about the world; they worry about their safety; they worry about their finances; they worry—they have a lot of things that they worry about. If they can't control it, they often worry about it. And it's important to recognize that sometimes worry is a reaction to having been disempowered, having been traumatized in the past, and now they keep their fight-or-flight response kind of engaged. Because remember, worry is part of that fight-or-flight response. When you worry, it is the anxiety part of anger or anxiety. So the person will have different worry triggers, and it's important to identify what those triggers are for that person and maybe encourage them to try to figure out, you know, "What is this related to? Is this related to something in the present, in this context, at this time? Is it something I need to be concerned about, or is it something that happened in the past that I'm being reminded of? So now I'm reacting in the present off of a feeling, not off of facts, or am I worried about something that may or may not happen in the future based on prior experiences or based on what I want to happen?" So there are a lot of different triggers.
It's also important to help them identify their vulnerabilities. If they tend to worry more—which a lot of people do—when they don't get adequate sleep, we know that it's more difficult to control intrusive thoughts and what we call "monkey mind" when people are sleep-deprived. And we know that people with anxiety typically don't sleep well. So it is a self-perpetuating cycle. Helping them recognize things that may increase their worry—whether it is people, places, things, settings—and and those those vulnerabilities—do they tend to worry more when they are in getting ready to go into certain settings? So if they're in public places, for example, do they worry more than if they're at home? It doesn't mean that we're going to say, "Well, just stay home." No, it means recognizing that the person tends to be more anxious and tends to be triggered easier in certain settings and being prepared for that. I do have a video on the YouTube channel on creating a distress tolerance toolbox, and I encourage you to check that out.
Now, irritability. I mentioned that worry is part of the fight-or-flight response; it's the anxiety part. Irritability is the anger part, and sometimes it may come out as lashing out or being snippy. Sometimes it may come out as being just unhappy and and sort of irritable. And it's important to recognize that many times that's not because of you; many times it's because they are feeling unsafe and disempowered in their life. They're having difficulty controlling some of those intrusive thoughts, which can get really frustrating and annoying. So it's important to figure out what's that irritability about for your own um mental awareness as well as encourage them to recognize their irritability. When they start getting irritable, note it. Recognize, "Okay, Jane's irritable today, or Tom's irritable today. What is it that might help them feel calmer, feel more safer and more empowered?" Because when we turn down that HPA axis, when people feel safe and empowered, they tend to feel less anxious and less irritable.
Changes or poor sleep is another issue, and it's really important to evaluate sleep hygiene, and this can be something you do together. It may be that you have poor sleep hygiene, so you are waking up your your partner throughout the night, or it could be that they have poor sleep hygiene, or maybe you sleep with a cat or a dog in the room that wakes you up. But it's important—again, videos on the YouTube channel—not going to go deep into sleep hygiene right now, but it's important to address issues that are contributing to poor sleep for both of you. It's also important to help the person—a lot of times people with anxiety, when they lay down to go to sleep, when they try to get quiet, when they're not being distracted, that's when they start being flooded with all these worry thoughts. Some of them may be able to be tamed by just writing them down. They're worried they're going to forget something tomorrow; they're worried about whatever. Others may be more difficult, and there are strategies such as guided imagery that can be helpful for helping somebody tamp down those flooding thoughts when they're going to sleep so they can relax more. If the person is continuing to have difficulty going to sleep, staying asleep, getting good rest, consulting with a physician, a sleep doctor who can assess for any particular sleep disorders and make more specific recommendations can be really helpful.
Unfortunately or fortunately, depending on how you look at it, sleep deprivation or lack of good quality sleep is an underlying cause for a lot of mood issues, inflammation issues, other things. Because when we're sleep-deprived, it triggers our HPA axis. Our body says, "Hey, we don't have enough energy right now; that means we're vulnerable to threats that are coming along, so I'll just, you know, give you a little extra energy. I'm going to ramp up that fight-or-flight response so you were not caught unaware," which means that the person already has their anxiety sort of primed.
Exhaustion and low motivation can be a consequence of ongoing worry. When you have that HPA access, that stress response system, in the on position for a long time, your brain starts to say, "You know what? We don't have the energy; we can't pay attention to all these stressors, all these things," so it turns down its sensitivity, if you will, so it only actually gets triggered by major stressors. So a person with anxiety may actually also have depression; they may be flat a lot of the time, and then when they do get triggered, they go into frantic mode. If there's no middle ground. Another cause of exhaustion is just poor sleep. If they're not getting good sleep, then they are not getting rest and rest, restorative time for their body, and that can contribute to exhaustion. Most of us know when we've gone through a period where we've been sleep-deprived, we start to get run down; we start to get exhausted. Worrying takes a lot of energy. When we worry, it's not generally—it's not just in our mind; it is in our mind; it's in our gut; it's in our muscles. We have muscle tension; we tend to startle more easily. That's freaking exhausting. Recognizing that and being compassionate with that with the person is going to be important and recognizing that as they get tired, as they get worn down, as they're worried, their motivation, their dopamine levels and other neurotransmitters are going going to change, so their motivation is going to often decrease.
And restlessness. A lot of people with anxiety have difficulty sitting still; they're restless; they're fidgety. Part of that could be if they're not moving, then they start thinking, and they start worrying. Part of it could be that stress response being activated means that they've got cortisol and adrenaline kind of coursing through their veins, so it's difficult to sit still. So again, for all of these, recognizing kind of why it's important, where it's coming from, but then starting to talk to the person, especially if you can do it when they're not in a in an episode, but definitely don't do it when they are really, really anxious. If you can wait till a time when they are calm for them, discussing these signs and symptoms, discussing the triggers, helping them identify vulnerabilities and identifying what solutions have worked for them in the past and start making a plan that when that way when they get triggered, when they start to get anxious, when they start to spiral or ramp up, whatever they call it, then you have a toolbox. You know what works, and you're not just kind of trying different things hoping something works. You know what works for them.
Panic is another symptom for many people with anxiety. It doesn't mean they're always going to be panicked, but they can have episodes where they go into a full-fledged panic attack. Their heart rates, you know, really fast; they're trembling; they're sweating. It's important again to recognize if there are particular things that trigger this in the person that you're in a relationship with. For some people, if they have POTS, for example, which is postural orthostatic tachycardia syndrome, when they get up, their heart rate goes up, and they can also have periods where their heart rate goes way down and then bounces back up. So if they have that, that might contribute to persistent anxiety symptoms because they don't know when it's going to happen. For other people, when their blood sugar gets out of whack, they may start—especially if it gets really low, if they get hypoglycemic—they may start getting really trembly, and that can be interpreted as anxiety. Somebody who has generalized anxiety, when they feel anxiety, often start assuming there's something to be anxious about, so they can ramp themselves up into a full-blown anxiety or panic attack. It's important to acknowledge what's going on with them. If they're having a panic attack, it's super helpful to have a toolbox, to identify what tools help you. "What can I do to best support you and help you feel safe until that panic subsides?" And usually it's only 10 or 15 minutes, but it's important to let them know that you're there and you can be supportive.
Aches and increased pain—and these are not necessarily the same thing. As I mentioned, when that fight-or-flight response is enacted, we tend to be uh more tense; we tend to have more muscle tension. Most of us know if we've been anxious over something—you know, maybe a promotion or a project that was due—you may have more muscle tension. Well, a person with generalized anxiety may feel that way pretty much all the time. So those aches can be frustrating. Those aches from muscle tension, especially in their neck and shoulders and upper back, can also contribute to poor sleep. Additionally, the HPA axis activation, the sleep changes, the restlessness, and and potentially ongoing tension in their body can contribute to changes in neurotransmitter systems—serotonin, endorphins, dopamine—all of these things are important for pain management. When we're stressed out, when that HPA axis is activated, we tend to also start to see systemic inflammation. If that goes on for too long, so a lot of people with generalized anxiety also have systemic inflammation.
Concentration difficulties. This can be really frustrating for the person with anxiety because they want to remember; they want to do what they need to do, but they have so many intrusive thoughts just plugging into their mind, and the lack of quality sleep prevents good concentration. When the HPA axis is activated, when that stress response is activated, they're in fight-or-flight mode, not "concentrate on doing the bills" mode. So concentration can be very difficult, and it's important to work with them to identify what helps them, especially when they're having difficulty concentrating. Making lists, for example, can be helpful. Setting push notifications can be helpful. Chunking stuff so they're only having to focus for 10 or 15 or 20 minutes at a time can be helpful, and paying attention to their best times of day can also be helpful. If it's a morning person, they may be able to concentrate better the first three or four hours of the day. If it's an evening person, obviously they may do better the last three or four hours of their day.
And eating changes and GI distress. We know now that stress and activation of that HPA axis actually changes the gut microbiome; it changes the factory that breaks down the food and then makes the neurotransmitters necessary for survival. When we're stressed, basically the brain is sending different orders down there. It says, "We don't need all that relaxation stuff to be made; we need the fight-or-flight stuff to be made, so why don't you ramp up production of that?" So that does lead to a change in the gut microbiome; it also may lead to an upset stomach. When we're in fight or flight, our body is not in rest or digest; our body says, "We need to get that food out of there; we can't focus on that right now; we need to worry about getting away from whatever the threat is." So a lot of people start to get an upset stomach; the pH of the stuff in their stomach may change a little bit, but we do see again increases in inflammation that often show up first in the gut—through peptic ulcers, through gastric ulcers, through just other symptoms of GI distress. So it's important to recognize the connection between all of these things and anxiety.
If your loved one has anxiety, there—they may not have the energy or the motivation to do things because they're tired, because their stomach hurts, because whatever, and that can be really frustrating for them, and it can be really frustrating for you. It's important for you to recognize how each one of these symptoms impacts you. When your loved one is worrying a lot or very, very irritable, how does that impact you? What can you do, based on the toolbox that they've helped you identify, to support them, but what do you also need to do in order to support your own mental health? It can be exhausting being around someone who is worried all the time. It doesn't mean you don't love them, but being able to set those cognitive and emotional boundaries and say, "You know, I love you, and I need to take a breather; I need to go recharge," is really, really important.
It's important to identify frustrations, for example, if you can't do the things with your loved one that you want to do, or it's kind of hit or miss—sometimes you can follow through with plans, and other times their anxiety ramps up. Okay, recognizing that and understanding your feelings when that happens is going to be really important. Because if even if you say, "Okay, it's fine, whatever," if they hear the tone in your voice, if they recognize that you're angry, that will probably increase their anxiety. It doesn't mean that you can't be angry, but recognizing when you have that anger and acknowledging it—be authentic—"I'm really disappointed; however, I understand what's going on; I understand that this is difficult for you"—and then arriving at a compromise. Sometimes you may switch plans a little bit and figure out, "Okay, if I if we can't do this, maybe we can't go to this concert; maybe we could go to a movie, or maybe we could do something else." So we're still doing—spending quality time together, for example, but it's in a setting that in which you feel less vulnerable; it's in a setting that is less likely to trigger anxiety for you.
So just kind of to sum up: identifying the triggers and vulnerabilities for each of these symptoms for your loved one and solutions that work for them, but also recognizing each of these symptoms and the impact it has on you—on your sense of frustration, on your sense of connection with them, and maybe even on your sense of acceptance—recognizing that they may not be able to do the things they want to do; it doesn't mean they don't want to, but they're just not able to because of their anxiety. If the anxiety is really bad—um, whatever that means for them—making sure to encourage them to reach out. There are a lot of counseling services they can do virtually or face to face in order to help them get some tools to start addressing the anxiety.
Help us continue to make practical mental health tools available to everyone. You can join the channel at docsnipes.com/YouTube. You can donate at docsnipes.com/donate, and definitely like, subscribe, comment, and share. Every person's anxiety may look a little bit different; there is no one-size-fits-all way of supporting someone with anxiety. It's important to understand their vulnerabilities, their triggers, and interventions that are effective for them. What has worked in the past, or what do you think might work? What are you willing to try? When somebody is in an anxious state or in their having an anxiety attack, they're not going to often be able to clearly think of a lot of their options. Encouraging them to keep a list of their options available, encouraging them to call you or reach out to you can also be a step, and then you can walk them through and say, "Well, have you tried this? Or what do you think would work right now? What's triggering your anxiety, and is it a threat in this moment, in this setting?" It may be helpful to encourage your loved one to start practicing mindful awareness of vulnerabilities and triggers. When they get up, at lunch, at dinner, before bed, checking in with themselves and saying, "What vulnerabilities do I have right now? Are there any triggers in my environment that I need to address? And what is it that I need to feel safe and empowered?"
Self-care is also vital to help you, the loved one, the caregiver, cope with the vicarious distress, because it's hard to see our loved ones struggling with anxiety, and we can't fix it for them. They have to feel safe and empowered to fix it themselves, and it can also be difficult to cope with our own feelings of frustration and helplessness, because their anxiety not only disrupts their life; it disrupts your life too. So it's important to recognize that and deal with your own frustrations in order to not set up blocks between you and that person. Additional videos that might be helpful include my videos on anxiety causes and treatments. You can find that at docsnipes.com/anxietylist. I also have two other videos: one's called "Caring for Caregivers," and one's called "Burnout Prevention," that can be helpful for someone who is in a relationship with someone who has a mental health or addictive or even chronic health issue.