How to Support a Family Member Who Has Anxiety or OCD

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Many adults and adolescents who attend treatment often experience further difficulties with managing their symptoms when they expect their family members to participate in their rituals. This often presents unique challenges for the OCD sufferer and family member. Many family members often report negative psychological effects in connection with participating in the rituals of a family member who may be experiencing difficulties with OCD. Difficulties may include increased conflict, relational strain, and compassion fatigue. Lebowitz and Halm’s argue that a distinction needs to be made between support and protection for family members who are supporting an OCD sufferer (Lebowitz & Haim 2013). This article explores the parallels between protecting and accommodating behaviours for a family member struggling with OCD or an anxiety disorder.  

Is Overprotection Bad?

As a parent, it is common for us to want to protect our children. Often this includes protecting our children from stimuli that they may not need protecting from such as clowns or the darkness. Lebowitz and Haim indicate “children often act less capable when in their parents’ presence because they are accustomed to using their parents as a proxy for their own undeveloped coping mechanisms. (Lebowitz & Haim 2013)” When a parent continues to promote this behaviour, the child may react to fear by seeking protection rather than confronting the situation. This could potentially interfere with the child developing distress tolerance skills and learning that the feared situation isn’t as fearful as they believe it to be. Given the liabilities that exist with protection, parents need to help their child by recognizing the task and supporting their abilities in challenging the feared situations (Lebowitz & Haim 2013)”). A child learns to become more capable in anxiety-provoking situations when parental protection is withdrawn and the child is forced to draw on their own inner strength (Lebowitz & Haim 2013). We also observe this type of behaviour in adult relationships. As we mature the people we may turn to most besides our parents are our spouses/partners. Often observed are OCD and anxiety sufferers requesting that their family members participate in activities to help them reduce their anxiety. For example, Jade experiences difficulties with contamination OCD and requests that her family members all wash their hands before handling the television remote. Often family members of OCD sufferers report increased conflict, compassion fatigue and negative psychological effects. This presents a conflict for the family member who is likely caught between continuing to protect the sufferer from their fears or asserting their needs in not participating in the rituals. For those willing to work on their anxieties, Lebowitz & Haim argue for moving from protection to support.

What is Support?

Providing support requires not overwhelming the child/family member, but helping them face situations that that will bring strength and growth. This requires acceptance in acknowledging that the situation will bring on some fear. Prudent to the process is also having confidence in and faith in their abilities to succeed.

Support requires:

Help your family member (the OCD sufferer) create suitable challenges for their OCD/Anxiety.

This may mean that you inquire what they are working on in therapy and help participate in creating an exposure hierarchy (a list of feared situations from 1 to 10). You may also want to help model the behaviour by participating in the exposure exercises with them. We certainly don’t want to overwhelm them. One of the purposes of completing an exposure is to help them build confidence in their abilities.

Help them make gradual changes

Recognizing where they are in their therapeutic journey is important in providing support. Some individuals may not be ready to participate in exposure while others are. This may mean that you provide support as best as you can by asking how you can help. You could read the assigned homework material with them (or on your own for further discussion at a later time) or provide them with the time to complete the assigned tasks (readings and exposure). Change takes time and having an understanding of this is important in the process. Set a day and time to discuss how you can help each week.

Supporting the person in feeling brave and confident

Imperative to the process is helping your family member (the OCD sufferer) build confidence in themselves to challenge their fears. Your words could influence how they see themselves and how they view the situation. Statements such as, ‘it’s not frightening,’ ‘they can’t handle stress,’ or ‘don’t be a wuss,’ may further dissuade your family member from challenging their fears (Lebowitz & Haim 2013). Instead, choose statements that acknowledge their emotions, but are supportive. For instance, ‘I see that you are scared, but I believe you can handle it,’ or ‘this is hard, but you can learn to manage with it.’  This may also require you to change your thought process around how you see the situation and their abilities to overcome their anxiety. Holding on to beliefs such as ‘they can’t handle the stress,’ or ‘anxiety may hurt them’ may only perpetuate their negative thoughts regarding the situation.

 

What is important to remember is that individual who experience difficulties with OCD and anxiety often discredits information that is against their beliefs and are more likely to accept information that supports their negative thinking. If you support or act in a way that further supports that they can’t handle the situation, it will only further reinforce that they aren’t capable.

Adopting a role as a coach may help provide the emotional support needed to challenge the difficult tasks of therapy. This may mean providing gentle reminders not to engage in rituals. Also, you could help ensure that the exposure is attempted, continued until sufficient anxiety is reduced, and that they are not engaging in any behaviours to reduce the anxiety (Abramowitz et al 2011). Use words to encourage the family member during the exposure, such as ‘you are doing a great job!.’ Do not provide reassurance that everything will be ok or distract the family member. Lastly, speak about the tasks beforehand and discuss potential obstacles that might get in the way of completing the task. If they get overwhelmed during an exposure take a break. Discuss how they would like to be supported, but do not provide reassurance. You could also speak about what went wrong and how they could continue with the exposures later on (Abramowitz, Deacon & Whiteside 2011). Abramowitz’s text, Exposure Therapy for Anxiety, indicates, “a partner should never encourage stopping exposures but at the same time must not force the patient to continue (Abramowitz, Deacon & Whiteside 2011).”

You may also want to inquire how best to support the relationship during the time your family member is attending therapy. Ensuring there is little familial conflict at this time could help as well.

What makes a good coach:

  • Supportive

  • Non-judgemental

  • Optimistic about treatment

  • Considerate

 Am I Accommodating the Behaviour?

Central to support is helping recognize what accommodations you have made for your family member that is functioning to maintain their anxiety. Lebowitz & state, “accommodation refers to any actions you may be doing, or even to things you are deliberately not doing, because of your [family member’s] anxiety disorder. Of course, helping a child to avoid things that are actually dangerous is not accommodation by rather healthy protection. If your child is 16, however, and fully capable of crossing alone but afraid to do so, then holding his or her hand would be accommodation (Lebowitz & Haim 2013).” Accommodation may also negatively influence the anxiety sufferer’s motivation to participate in exposure exercises as they may not see a good reason to change (Abramowitz, Deacon & Whiteside 2011). Research support that accommodation has been found to be related to a worsening of symptoms and poorer treatment outcomes in OCD treatment (Abramowitz, Deacon & Whiteside 2011).

Accommodations could look like (Lebowitz & Haim 2013):

  • Altering your schedule to accommodate your family member's anxiety

  • Buying special items so your family member can ‘feel’ safe

  • Participating in rituals with your family member

  • Providing reassurance in anxiety triggering situations

What we are requiring of you is to chart your accommodations. If you are unsure if you are accommodating or not you can use the survey method. This includes surveying 10 people and asking if they would respond similarly to the same situation. You could also ask yourself if you are acting the same way with other family members or if you would like to stop the behaviour (Lebowitz & Haim 2013).

On the chart simply label the accommodation and the date. Attempt to lessen your accommodation as they engage in therapy.

Get the buy-in of others

What is required for most people going through treatment is to have the buy-in of not just the immediate family members, but also other important individuals who could help round out their support network. You will also want to be aware of how others may be accommodating the anxiety as well. You can have them chart out their accommodations if necessary.

What else can I do?

  • Attend psychotherapy treatment with your family member to help better understand the cognitive model and how exposure therapy works.

  • Continue partner-assisted exposures

References:

Lebowitz, E. R., & Omer, H. (2013). Treating childhood and adolescent anxiety: A guide for caregivers. Chichester: John Wiley & Sons.

Abramowitz, J., Deacon, B., & Whiteside, S. (2011). Exposure Therapy for Anxiety. New York. Guilford Press.