How to help someone you love with anxiety — without burning out

“Are you sure you locked it?”

That’s the third time this evening. The first time he answered patiently, the second time a little less so; the third time he gets up, goes to the door, presses the handle and comes back. “Locked.” She breathes out and settles for a few minutes. He sits back down on the sofa and feels both useful and completely drained. Tomorrow it will be the same. And the day after. He loves her and wants to help her. He just no longer knows whether what he is doing really helps.

This post is for people who live alongside someone with anxiety — partners, parents of adult children, friends, adult children of anxious parents. It is for you if you have learned to read their face, if you answer the same questions, take over the calls they can’t manage, and sometimes wonder in the evening how much longer you can keep going. I will write about what to say and what not to, about the difference between reassurance and support, about how loving accommodation quietly keeps anxiety alive — and about how to stay by someone’s side without burning out.

Anxiety never lives alone

Anxiety disorders are the most common mental health conditions. In a large American study published in 2005 by Ronald Kessler and his colleagues, 28.8 per cent of adults had had an anxiety disorder at some point in their lives — more than one in four. If you add everyone whose anxiety doesn’t reach the threshold for a diagnosis, it is almost impossible that nobody in your circle is affected.

Because anxiety is so common, it is often seen as something private that happens inside one person’s head. But in relational family therapy, in which I am training, we look at it differently. Anxiety lives in relationships. A person with anxiety turns to others for safety, the others respond, and those responses either calm the anxiety or — often unintentionally — entrench it. Over time a family, a couple or a friendship reshapes itself around anxiety: where you go and where you don’t, who rings the doctor, who drives on the motorway, what isn’t talked about at home.

That isn’t a reproach. Loved ones adapt to anxiety because they care about the person. But that is exactly why it helps to know which responses really help and which only bring momentary relief. I described what happens in the body during anxiety in more detail in What happens in the brain during anxiety — it is a good starting point for loved ones, because it shows that this is an alarm, not a choice.

Reassurance isn’t the same as support

The most common response from loved ones is reassurance: “Don’t worry, it’ll be fine.” “It’s nothing.” “The doctor said you’re healthy.” That is human, and at certain moments it is right. The trouble starts when reassurance becomes the only way a couple or family deals with anxiety.

Anxiety researchers have long described a pattern they call excessive reassurance seeking. The anxious person asks, gets an answer, feels relief for a short while — and soon asks again, because the doubt returns. Each answer quietens the anxiety for a moment, but at the same time teaches it that nothing works without outside confirmation. Over time the questions become more frequent and the answers have to be ever more convincing.

Support is something else. It doesn’t promise that nothing will happen. It acknowledges that the fear is real and at the same time expresses confidence that the person can bear it. The difference is small in words and large in effect.

Accommodation that keeps anxiety going

Beyond reassurance there is a broader pattern, best researched by the American psychologist Eli Lebowitz. It is called family accommodation: all the changes loved ones make to their own behaviour to spare an anxious person fear. A parent sleeps beside a child who is afraid of the dark. A partner always drives because she is afraid of the motorway. A sister rings the benefits office for her brother because he can’t face the phone. The family doesn’t go to the seaside because Mum is afraid of flying.

Lebowitz and his colleagues found that almost every family of an anxious child accommodates — and that more accommodation is linked to stronger symptoms. The mechanism is the same as with avoidance: when someone else removes the situation a person fears, they never experience surviving it. The fear stays untested and therefore untouched. I write about why avoidance helps today and harms tomorrow in Anxiety and avoidance.

This work gave rise to the SPACE programme, in which the therapist works only with the parents, not with the child. Parents learn two things: to express support and gradually to reduce accommodation. In a study published in 2020 this approach was as effective for childhood anxiety as cognitive behavioural therapy delivered directly to the child. That is an important message for adults too: the person close to you holds more in their hands than they think — not because they are to blame, but because they are part of the system in which the anxiety lives.

What to say and what not to

There are no magic sentences. But there are a few patterns that almost always make things worse, and a few that almost always help.

What it’s better not to say:

• “It’s nothing.” For someone in the grip of anxiety it is something — their body is screaming that they are in danger. This sentence leaves them alone.
• “Just relax.” If they could, they would. I wrote about why well-meant advice doesn’t help in “Just snap out of it”: why advice from loved ones does not help — it is about depression, but the same applies.
• “You’re overreacting again.” Perhaps that’s true, but in a moment of anxiety this sentence adds shame and doesn’t reduce the anxiety.
• “I promise nothing will happen.” You can’t promise that. And the anxiety knows it.

What often helps:

• “I can see this is hard for you.” Being recognised is the first step towards calming down.
• “Fear is unpleasant, but it isn’t dangerous. I’ll stay with you until it eases.”
• “I trust you can do this.” Support without taking over.
• “What helps you most right now — me being quietly beside you, or us talking?”
• During a panic attack: slow breathing together. What really works here is described in Breathing during panic: what actually helps.

Co-regulation: your calm is more than words

We don’t calm down only on our own. A nervous system also settles alongside another nervous system — this is called co-regulation. A child calms in the arms of a parent who is calm themselves. As adults we are more discreet about it, but the mechanism remains.

In a well-known 2006 study, the American psychologist James Coan and his colleagues showed that in women waiting for a mild electric shock, the brain’s response to threat decreased when they held their husband’s hand — and most of all in those who reported the most satisfying marriages. Holding a stranger’s hand helped less.

What does this mean for you? That your calm is sometimes more important than what you say. A slow voice, a relaxed posture, not rushing and not getting frightened along with them. And the other way round: if you are tense, tired and at the end of your patience yourself, your words won’t sound soothing, even if they are the right ones. That is why looking after yourself isn’t selfish — it is a precondition for being able to help at all.

How it might sound

Let’s go back to the couple from the beginning. A different evening might go like this (a composite, not a real person):

“Are you sure you locked it?”
“I am. You saw me locking it.”
“Yes, but … could you check once more?”
“I can see it’s got hold of you again. I’m not going to check again. Not because I don’t care — but because we agreed we wouldn’t give the anxiety everything any more.”
“But what if …”
“I know. Let’s sit together for a few minutes. Let’s wait for it to ease.”
Ten minutes later: “It’s a bit better. I’m still scared, but it’s better.”

It matters that a conversation like this doesn’t come as a surprise. If a loved one suddenly stops answering without any agreement, the anxious person will feel abandoned. Changes in accommodation are made together, announced in advance and gradually — ideally with a therapist’s support.

Exercise: from accommodation to support

You can start this exercise today. Do it on your own first, and then — if possible — together with the person you care about.

1. Write down everything you do because of their anxiety. You answer the same questions, drive instead of them, make calls for them, avoid certain things. Write it all down, even the small things.
2. For each item, rate from 1 to 10 how much it weighs on you and how much you think it shields them from the chance to discover for themselves that they can cope.
3. Choose just one item that isn’t the hardest. Don’t start with the biggest fear.
4. Tell them what you are going to change, and why. For example: “I’ve noticed that answering the same question doesn’t help you. From tomorrow I’ll answer once, and then stay with you until the fear eases.”
5. Stick to the agreement and be kind. At first the anxiety will be stronger; that’s to be expected. After a few weeks, look back and see what has changed — for them and for you.

Looking after yourself, and boundaries

Living alongside someone with anxiety is tiring. Loved ones often don’t notice how much they have adapted until they are exhausted. They become irritable, sad, resentful — and then feel guilty for resenting someone who is suffering. That isn’t a flaw of character. It is a sign that you have carried more than can be carried for a long time.

This is where boundaries help. A boundary isn’t a punishment or a withdrawal of love. It is a clear agreement about what you can and can’t do: “I can ring you once during work, but not every hour.” “On Sunday I’m going to see friends, even if you stay at home.” When you set boundaries calmly and in advance, they help you both — you so that you don’t burn out, and them so that the anxiety doesn’t take up all the space in the relationship.

Keep your own resources: friends you see on your own, an activity that is just yours, sleep you protect. If you notice your patience running out, that you are withdrawing, or that your chest tightens at the thought of going home, take it seriously. I describe a similar dynamic with depression in How to support someone with depression without burning yourself out, and everything written there about looking after yourself applies here as well.

When to encourage professional help

A loved one can’t and shouldn’t be a therapist. But they can be the one who opens the door. It is time to gently encourage professional help when:

• the anxiety has lasted for months and is spreading to more and more areas — work, socialising, driving, health;
• the person avoids more and more things and their world is getting smaller;
• panic attacks, sleeplessness or physical symptoms a doctor hasn’t explained are appearing;
• they increasingly reach for alcohol, unsupervised sedatives or other substances to calm down;
• you can’t cope any more yourself and your exhaustion can no longer be hidden.

It helps not to raise this in a moment of anxiety, but at a calm time. And to talk about yourself rather than about them: “I love you and I can see how much the anxiety takes from you. It’s hard for me too. I think it would help us both to talk to a professional about it.” With long-lasting, wide-ranging worry, it is also worth knowing what generalised anxiety disorder looks like. A first step can be a visit to the GP, who can rule out physical causes and refer on. With anxiety in a couple or family it often makes sense to come to therapy together — because the accommodation pattern is easiest to change where it began.

If thoughts of suicide or self-harm appear, don’t wait: call the crisis line Klic v duševni stiski on 01 520 99 00 in Slovenia (7 pm to 7 am), the Samaritan helpline on 116 123 in Slovenia (24 hours) or, in immediate danger, 112.

Where this approach doesn’t apply

This whole post says that loved ones who accommodate too much unintentionally keep anxiety going. That holds for many everyday situations — but not for all of them.

In acute distress, calm first. During a severe panic attack or after a shocking event, it is not the time to reduce accommodation. Then it is right simply to be with the person, to soothe them and help them return to their window of tolerance. Work on patterns comes later, at a calm time.

Some fears are justified. If a person has experienced violence, lives in insecure circumstances, or the danger is real, their fear isn’t “just anxiety”. Asking them to face a situation that genuinely threatens them would be harmful.

Anxiety is no excuse for control. If a partner, because of “anxiety”, demands that you report where you are, checks your phone, forbids you from seeing people or threatens you when you don’t comply, it is no longer just anxiety — it may be control with elements of abuse. Then it isn’t your job to accommodate better. Help is also available on the SOS helpline for women and children affected by violence on 080 11 55 in Slovenia. I describe a similar line between support and enabling in When your partner is addicted: where support ends and enabling begins.

You aren’t responsible for their recovery. You can offer support, set boundaries and encourage them to get help. But you can’t go to therapy for them or face their fear in their place. If, despite everything, they don’t want change, your task is to look after yourself.

What to remember

• Anxiety lives in relationships — loved ones can calm it with their responses, or unintentionally entrench it.
• Reassurance brings quick relief but, repeated, feeds anxiety. Support acknowledges the fear and expresses confidence that the person can bear it.
• Accommodation (taking over, avoiding on their behalf) keeps the fear untested. It is reduced together, announced in advance and gradually.
• Your calm is part of the help — co-regulation only works if you aren’t exhausted yourself. Boundaries protect you both.
• When anxiety spreads, when the person’s world shrinks or when you can’t cope any more, it is time for professional help — often together.