It seems like everyone has anxiety right now. When should I get help?

If I had a quarter for all the moments I’ve heard the phrase “ unprecedented times” in the past six months I’d probably be able to buy myself a full body Swedish massage (which would be very helpful, considering the subject matter being discussed at the moment). The point is, we are all uncertain, fearful, and worried. Anxiety right now is normal. It’s common. But when does it cross the line into something like a disorder?

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM–5), the official criteria for Generalized Anxiety Disorder (GAD) are:

1) Excessive worry and anxiety about a variety of topics. Anxiety occurs more days than not for at least six months.

2) The worry is very difficult to control. The worry can easy shift from one topic to another.

3) The worry and anxiety also include at least three of the following physical and cognitive symptoms:

• Restlessness or agitation

• Fatigue

• Difficulty with concentration or feeling like the mind goes “blank”

• Irritability (directed inwards towards self or outwards towards others)

• Muscle aches and soreness

• Difficulty sleeping (trouble falling or staying asleep, unsatisfying sleep, restlessness)

The good news is that there are many resources available for those struggling with anxiety. Learning and utilizing simple mindfulness techniques (deep breathing, journaling, progressive muscle relaxation), establishing a good self care routine (ie consistent exercise, good sleep hygiene, nutritious diet), and building a support network (ie trusted friends, family members, therapists, support group) can help. For some people, medication is the best option and can provide immediate relief for the most distressing symptoms. Please don’t hesitate to reach out to a health professional if you need help. No one should go through this alone.

Couples Therapy: Why Individual Sessions Matter

While it may seem counterintuitive, individual sessions are an important part of couples therapy work. However, it can be stressful to think of a partner disclosing personal and/or incriminating information to the therapist without a chance to defend ourselves.

It’s important to note that these are not “private” sessions; that is, the information discussed is not considered “off limits” to the other partner. The therapist should always set this expectation at the outset of each individual session. The creation of secrets would form a new alliance between the therapist and the partner who disclosed the secret. This would be harmful to the trust built between the therapist and couple as a whole. If information is disclosed during an individual session that is important to share with a partner, the therapist will act in a collaborative fashion to support the partner around sharing the secret.

Why it helps

Individuals act differently when they are on their own versus when they are with their partner. This is a fact of human nature; we modify our behavior according to specific situation and surrounding persons(s). When the therapist has a chance to observe a partner one-on-one, the therapist gets a clearer sense of their wants and needs. A therapist gets a chance to find out how they soothe themselves when the partner is not available. A partner can speak freely and openly about concerns and fears in the relationship without directly needing to address their partner. The therapist can screen for emotional or physical abuse that a partner might not feel comfortable sharing in a couples session. A therapist can discuss experiences and expectations tied to family of origin. It is also important to gather information about mental health concerns and/or addictive behaviors that a partner may be experiencing in addition to relational stress.

© 2017, L. L. Brubacher, Stepping into emotionally focused couple therapy: Key ingredients of change

Coregulation for Couples

We typically think of communication in term of the words we use; the verbal communication we take part in. However, there is powerful communication happening at a much deeper level. This is the communication that takes place between nervous systems. One of the leading researchers on this topic is Dr. Stephen Porges, originator of Polyvagal Theory.

Think of the last time you were in an argument with your partner. Can you remember how fast your heart was beating? Was the hair standing up on the back of your neck? Did you have trouble swallowing? Were your palms sweaty? We often don’t notice what’s happening in our bodies because we’re used to intellectualizing our emotions — that is, developing arguments, complaints, and assessments. But listening to our nervous systems, and learning how to soothe ourselves and our partner, can bring about a deeper connection, a sense of safety. Not to mention lead to much more productive arguing.

The “fight-or-flight” mode, sometimes called “primal panic”, is hardwired into our nervous systems. This powerful system was developed thousands of years ago as a survival strategy in order to to detect threats in the environment. When activated, this survival-based system will always win out over rational, higher-order thought. If a bear was attacking you, it would take too long for your nervous system to send the message all the way up to your prefrontal cortex so that you could have a conscious thought: “I am in danger. I need to run away.” Instead, your nervous system would take over and your body would react without you making the call.

Something similar happens to our nervous systems when we feel threatened by those we depend on for love and safety. Our amygdala (often referred to as the brain’s alarm system) sends out warning signals when we perceive our partner might physically or emotionally hurt/abandon us. Here is where the difficulty often lies — even if intellectually and rationally we know we are not truly in danger, our bodies react anyways. We become anxious and might experience muscle tension, shortness of breath, or a rapid heartbeat. Our bodies are telling us that danger is near and we need to protect ourselves.

Knowing this information can help us to understand the difference between a productive argument and a harmful fight. We must monitor our own bodies first in order to have the power to understand when either bodies might be slipping into “fight or flight” mode. When either or both people are experiencing a threat, the first order of business is coregluation. No problem will be solved under threatening conditions.

Here are some options for coregulation:

1) Hug for 20 seconds. Research shows that our bodies release the most oxytocin (the bonding hormone) after hugging for approximately 20 seconds. The release of oxytocin has been shown to lower your blood pressure, slow your heart rate, and improve your mood. Gentle, soothing touch sends the nervous system messages of safety and connection.

2) Give a brief massage: soothing touch sends the message to our nervous systems that we are safe and cared for. These types of messages will gradually ease the nervous system out of “primal panic” mode.

3) Start speaking slowly and softly during escalated moments. The nervous system will detect this shift which will gradually send a message that the threat has passed.

4) Soften your expression. The nervous system is primed for detecting threats based on the expression on a face. Consciously relax your face. This will send messages to the other nervous system that it is okay to relax and calm down.

5) Maintain consistent eye contact. This simple practice sends the nervous system messages of safety and connection.

Learn more:

Beginners Guide to Polyvagal Theory

Grewen KM, Anderson BJ, Girdler SS, Light KC. Warm partner contact is related to lower cardiovascular reactivity. Behav Med. 2003;29(3):123-130. doi:10.1080/08964280309596065

Grewen KM, Girdler SS, Light KC. Relationship quality: effects on ambulatory blood pressure and negative affect in a biracial sample of men and women. Blood Press Monit. 2005;10(3):117-124. doi:10.1097/00126097-200506000-00002

Relationship in a rut? Try a gratitude journal

When annoyed and/or angry at a partner, gratitude is the last thing from our minds. We want our partner to acknowledge wrongdoing and apologize for it. And, if we’re honest, we want them to change. For good. It is healthy to work towards greater understanding and it is important to share when you’re hurt with your partner.

But….

We can get trapped in negative feedback loops, which are negative thinking patterns that continue to feed off of each other. For example, if I am annoyed that my partner forgot to unload the dishwasher it is easy for me to continue to remember all the other times they forgot to unload the dishwasher and, come to think of it, all the other important things they tend to forget in general. Before I realize it, I am more angry than I was to begin with because my critical negative thoughts have snowballed into a furious avalanche.

These negative thinking patterns can continue even when couples are not actively engaged in conflict. Think of it as a “default setting” — the way we see our partners, or the “glasses” we choose to wear — can dramatically affect our relationship.

If we are consistently bothered by our partners, we are unlikely to give them the benefit of the doubt when things go wrong. We are unlikely to move towards our partner with an attitude of respect and curiosity. We are more likely to presume guilt until proving innocence.

To challenge a negative “default setting” we need to change our perspective. Instead of allowing our thoughts to criticize and see our partners faults, we can choose to focus on the things we love about our partner. It will feel strange at first, especially if our “default setting” typically slants negative. But as we practice seeing the positive we will find it gets easier and easier. And, over time, we can change our “default setting” from critical to grateful.

Give it a Try

(try this for 15 min/day 1x/ week for two weeks)

Write down up to five things about your partner for which you feel grateful. It’s important to actually write this stuff down as the process of writing helps to deepen the emotional experience. It could be a small gesture (“The way he remembered to set up the coffee so it would be ready in the morning.”) or a more significant example (“She took care of me for a month when I recovered from surgery.”).

As you write, here are a few tips:

1. Be as specific as possible—specificity is an important part of fostering gratitude. “I’m grateful that my partner made soup for me while I was sick” will be more effective than “I’m grateful for my partner.”

2. Details details details. Elaborating in detail about your partner for which you’re grateful carries more benefits than a more superficial list.

3. Think subtraction, not just addition. Consider what your life would be like without your partner. Be grateful for the potential negative outcomes you avoided and the challenges you would face alone.

4. See good things as “gifts.” This kind of thinking deepens a sense of gratitude.

5. Savor surprises. Try to record events that were unexpected or surprising, as these tend to elicit stronger levels of gratitude.

This post is adapted from Greater Good in Action , a site launched by UC Berkley’s Greater Good Science Center in collaboration with Hope Lab.

Tips for Overwhelmed Couples

You are not alone. People are struggling. Kids are at home much more than normal. Maybe they’re even home all the time. If you are still working, work is stressful. If you are not working or lost your job, lack of work is stressful. Each time you turn on the news you are reminded of the frightening and chaotic world we live in. So. How do you manage.

1) Take a breath. We are in this for the long haul. Take a deep breath. Also encourage your partner to slow down and breathe.

2) Take a break from the news. Limit exposure to once a day at the most. People used to survive with just one half hour of nightly news. If possible, take a longer break - maybe a few days or a week.

3) Be gentle with each other. Maybe the kids haven’t had vegetables or you haven’t showered in a few days. Maybe the house is cluttered and the mail is unorganized. It’s okay. These are strange times. This is not business as usual.

4) Get outside. Fresh air and a change of scenery is still available even if your local libraries and favorite restaurants are not.

5) Move. Run. Go for a walk. Do yoga. Whatever makes your heart pump a bit faster. You will feel better and your mood will improve.

6) Change out of your pajamas. Doing your best to stick to routines creates a sense of safety and security for you and your family.

7) Accept sadness from yourself and your partner. While it might seem like the right thing to “think positive thoughts”, research shows that avoiding thinking or talking about sadness can negatively impact physical and mental health. Give each other permission to grieve and be “not okay” at times.

8) Reach out. Find ways to continue to connect with friends and family in socially distant ways. Zoom hangouts, outdoor picnics and walks, or phone calls can increase our sense of connection with others. Seek out help from a professional if needed.