how to be supportive for anxious daughter

September 11, 2008 8:42 AM

My daughter, who is at university, was just diagnosed with anxiety. What can I do to support her and better understand what she is going through? what about friends and professors?

I have no experience with this, so I'm not sure what my role is. I did not know, until she told us this, that she was struggling with anything. She was advised to go to therapy and take medication.

posted by anonymous to health & fitness (24 comments total)

Get a second opinion from someone who is wary of medication. This is essential.
posted by ewkpates at 9:14 AM on September 11, 2008

...or it could be legit. Geez.

Was she diagnosed with generalised anxiety disorder?

From Wikipedia, "Generalized anxiety disorder (GAD) is an anxiety disorder that is characterized by excessive, uncontrollable and often irrational worry about everyday things, which is disproportionate to the actual source of worry. This excessive worry often interferes with daily functioning, as individuals suffering GAD typically catastrophise, anticipate disaster, and are overly concerned about everyday matters such as health issues, money, family problems, friend problems or work difficulties."

I've had elements of this, ranging from panic at the start of a perfectly good relationship ("oh god, oh god, I should break up with him before we get hurt") to mundane anxieties ("I should take the stairs, because there's Something Bad in the elevator") to weird paranoias ("I think I'm chatting online with my friend, but what if it's really that guy I hate, spying on me and trying to trap me into saying something bad???").

Anti-depressants really helped me. All those strange thoughts just disappeared when I was on them. Books like Feeling Good are helpful. Just being able to talk about it and not being treated like a freak, that helps.

The worst thing you could do is downplay it and discourage her from seeking treatment. Another worst thing you could do is treat it like the end of the world and make it a Really Big Deal, and make her feel that she is making you worry and shouldn't have told you. Just keep on treating her like a normal person. Allow her to talk to you about it and do your best to learn about it.

She's at university, right? Lots of universities offer free counselling and are very flexible for students with various disorders when it comes to exams and such. Find out what sorts of things are available to her and encourage her to use them and not to feel guilty about it.
posted by heatherann at 9:15 AM on September 11, 2008 [3 favorites]

Encourage her to tackle anxiety from all routes. Medication, talk therapy, exercise, the right diet, and making a commitment to do things that make you happy or feel care free each day is important. But don't be overbearing. Perhaps ask her outright how much help she wants from you on this. You are a well-meaning parent but you could also be a source of her anxiety.
posted by metamush at 9:17 AM on September 11, 2008

Ask her how you can help, and let her know that you love and support her. Yes, you may want to be wary about the diagnosis, but at the same time, you don't want her to feel like she has to defend her feelings to her parent(s).
posted by epersonae at 9:19 AM on September 11, 2008

(after posting: what heatherann said.)
posted by epersonae at 9:20 AM on September 11, 2008

Both of those things that were prescribed sound like a good idea.

Anxiety is a really common issue among students, mostly because stress levels are ridiculously high.

If she has outside pressure about grades (ie: yourself), please stop. If she has outside pressure about money and how she's going to afford school, see what you can do to help. If she has outside pressure about her major and presumably her choices of employment post-grad, that's probably not going to help her either.

Add to the fact that her living situation with roommates is sometimes not ideal, there may be romantic conflicts, stress of work-study arrangements, not to mention the actual classwork and homework involved in getting a degree, attempting to box yourself into one major that -rule the rest of your life-... It becomes overwhelming in a hurry. College is a time where you learn lots of things, but perspective is not one of those things.

The university cannot really tell you anything about your daughter's treatment, and this is something that she's working on herself. Someone in her community is helping her, probably a combination of the Residence Life staff and the medical staff on campus. You're concerned for her, which is good. Continue to be concerned about her mental health, and try not to mention 'future plans', unless she brings them up. It tended to freak me out when I was a student, until I got out and realized that being an adult really means making it up as you go along.

Good luck!
posted by msamye at 9:23 AM on September 11, 2008 [1 favorite]

I'd get a second opinion on the medication as well. but other than that....it really depends on what symptoms you're talking about, if any. And I'm not sure that you have any "role" other than to be her mother.

Therapy will do a lot for her -- but it's something she'll need to do on her own. She may act cranky for a while, because therapy may stir up all sorts of "stuff" in her head that she just needs to process -- she may not quite be the same person you're used to while this is going on. But the rough part will be temporary -- it's just going to be a bit of a roller-coaster for her while she's finally letting herself feel some things that she hasn't been letting herself feel for a long time. Some of that could, yes, be about things that happened to her when she was a little girl, and some of those things could be things that you were involved in.

But it's important to understand that this doesn't mean her therapist is encouraging her to BLAME you for them. Therapy encourages you to go ahead and feel things, while channeling them properly (i.e., it IS possible to be angry at your parents for not getting you a pony, but at the same time accepting that you lived in an apartment so it wouldn't have worked anyway).

So what your "role" is is just to be there for her -- be patient with the roller-coaster she may be going through, be there to listen when she wants to talk, be calm if she lashes out because that might NOT be about you after all, be there to listen if she comes to you and says "...um...Mom, can we talk about something that happened when I was ten? Because I really want to just clear the air about it". Let her figure out what works for her. Wait for her to come to YOU to ask advice rather than trying to offer help.

Mind you, I'm saying all of these things with the assumption that what she has is mild anxiety. If it's a more serious case, to the extent that she's afraid to leave the house, that'd be something different, and only a doctor could advise you; but if it were THAT serious, I'd wager you'd have heard something was wrong before this. This sounds like more the kind of "anxiety" that just therapy could handle.

Good luck.
posted by EmpressCallipygos at 9:26 AM on September 11, 2008 [3 favorites]

I think you'll probably get a lot of responses to this one, since as you might know, this is probably one of the most common mental health problems that there is. A full blown panic attack is just horrible horrible, and anxiety is like being stuck on the verge of that without being able to get off, and just as bad in many ways. It can just feel like you're going mad and it will never end.

Depending on how bad it is, I would bet that she doesn't need medication, but a bit of therapy can help in terms of reassuring you that no amount of fear can cause you to have a heart attack or blackout etc. It's a normal physiological reaction that is getting triggered at an inappropriate time (i.e. when you are not trying to flee from lions).

I used to get anxiety attacks quite frequently when I was doing my phd, and I'd bet it's the school pressures that are causing your daughter's anxieties (so can be relieved by a change in situation). What helped for me were two quite simple pieces of advice: firstly to notice when your anxiety symptoms are starting, in a way like 'oh, there's that anxiety symptom' without either focusing on it, or trying to ignore it. This helps because it's often the fear of having an anxiety attack that intensifies the attack. So you just sort of notice it in an accepting, mildly curious, sort of humourous way.

The other bit of advice was the breathing method. You breathe through one nostil at a time by putting thumb and finger over both, then releasing one finger as you breathe out through one nostril (supposedly to the count of 10, but I could only ever manage 4), then closing both for another count, then releasing other nostril and breathe in for the count, hold both for a count repeating the cycle. This helps because it prevents hyperventilation that is what is mainly responsible for all the arousal symptoms, and gives you a fairly complex task to concentrate on.

Cognitive behaviour therapists then like to say that you shouldn't get so hung up about success and learn that even if you fail that everything is fine, but frankly I didn't agree. Value is added to my life by struggling to achieve something great, and I wasn't willing to give up my commitment to my goals. But hey, maybe your daughter could use some perspective on all the available options even if she flunks out of school.

In general I would describe anxiety attacks as an attention disorder. A friend of mine who does a lot of meditation described attention wonderfully as being like a fly buzzing around a room. It then occasionally gets stuck on something sticky and is buzzing to try and get free to no avail. The goal isthen to allow events to happen without allowing them to unduly grab your attention (unless you want them to). I think meditation could be a good long term strategy then, but its extremely difficult to control one's attention and so not so useful in the short term.

Finally there are a few central 'dimensions' to categorising anxiety/fear. The sense of things upcoming, the sense of weakness (inability to cope), possibly also the sense of constraint (but anxiety can also be drifting unsecured, so this is specific to each case). In this case, when you are talking someone down from an anxiety attack it's best to focus on things contrary to these aspects. So for example by talking about past events (looking at old photos helped for me) and preferably ones that empower in some way. Statements like 'oh I know this other guy who got anxiety attacks' are not helpful because they just intensify that others are weak too and the overall sense of weakness. Meanwhile, one could try to generally to increase one's sense of day to day wellbeing with activities that emphasise strength, slowness, gravitas etc, like I don't know, rowing on a lake or something. I really think it can be something silly and seemingly irrelevant like that. Our emotions normally feed on metaphorical associations.
posted by leibniz at 9:26 AM on September 11, 2008 [3 favorites]

I'd suggest taking her seriously and not dismiss it due to some misguided backlash against the old "female hysteria" diagnosis, or overinvestment in cynicism about the pharma industry.

I've seen acute panic attacks played out and I wouldn't wish them on anyone. I've seen how medication and therapy has helped someone with acute panic attacks, and I've seen how treating the low-level anxiety they've been living with for most of their life is rippling through their personality and attitude to the world. On the flip side, I'm pretty sure that someone close to me suffered from anxiety for most of their lives, until self-medication with alcohol killed them.

I'm as suspicious of the medical-industrial complex as any one, but some perspective is in order. An appropriate prescription for a psychological drugs can have huge quality of life benefits that far exceed those of similarly priced long-term recurring expenses, like a cell phone plan, an extended cable TV package, or a drinking habit, to give just a few examples.

Do take her seriously. Anxiety disorder often has a genetic component, so as you come to understand it better you may see aspects of it in your own experience, and that of people in your family. Take both the medication and the therapy seriously. The thing about anxiety is that it builds on itself. Going through an anxiety attack can make someone incredibly anxious when they feel like another one is coming on, and it can become self-fulfilling. Meds can help break that cycle, while therapy can help unwind the conditioning and develop effective coping mechanisms.

Good luck to both you and your daughter.
posted by Good Brain at 9:28 AM on September 11, 2008

I found the wiki articles were very helpful in understanding the disorder and treatments for my anxiety. Bringing her condition up to friends or professors shouldn't involve you, and will only become comfortable for her once she has a good understanding of the disorder and feels optomistic about techniques to deal with it.

You can minimize the anxiety you yourself cause her by surveying aspects of your relationship that cause disagreements, threats, or distance. Those cause stress and fear. Stop fights before they escalate, be loving and warm, and restate all the good things you feel towards her that you might think she can take for granted -- she might not, and think they're constantly in jeopardy. Make sure you're providing her with security that your love and support will always be there for her.

You haven't provided alot of detail here, but suppose that you and her disagree about money alot of the time: she has a hard time budgeting school/social expenses and you're upset that she's constantly asking for more money. Threatening to cut her off or hectoring her to find a job, while reasonable responses, might cause her much more anxiety than other responses. You could establish a payment schedule that you can live with which she can depend on (and knows will not be at risk despite any displeasure you might express). If she felt that many of the essentials she depends on you for were only contingent on your expectations (however reasonable), she might be inordinately fearful for her circumstances because of the disorder. So be calm and reassuring, and find ways to make her feel secure without being too indulgent in this example.
posted by cowbellemoo at 9:30 AM on September 11, 2008

I think it's important for you, and her, to understand that everyone in the world has some degree of anxiety. Anxiety is a normal part of the human experience. Sometimes counselors and drug companies talk about anxiety as if it's a rare disease, and I think that has the effect of making people who are having a hard time managing their anxiety in the first place just feel worse.

Therapy is good for just about everyone, and if her university offers it, she should take advantage. Medication might help too, but you and she should be aware that medications can have serious side effects. Antidepressants can even make anxiety worse at the beginning of a treatment for some people. And then there's the stigma and possible self-stigma of taking medication. She should weigh how much she is suffering and decide whether it's worth it to her.

If I were you, I'd encourage your daughter to get therapy, and to make healthy lifestyle choices (get enough sleep, try to keep regular hours, take a 'mental health day' when necessary, eat well, get moderate exercise, have a good friend network) for a while. If anxiety and/or excessive sadness are still a problem, THEN consider medication.
posted by toomuchkatherine at 9:32 AM on September 11, 2008 [1 favorite]

Oh and stop drinking coffee.
posted by leibniz at 9:32 AM on September 11, 2008

could be a quack insinuating archaic notions of female hysteria, or a con to get her a script for a lucrative lifelong prescription.

S/he could be, yes. But as someone who used to feel overwhelmed and sometimes nauseous knowing I had to work the next day (at a job I thoroughly enjoyed doing) or meet a friend for lunch later in the week, I reject the (perhaps unintentional or even imagined on my part) implication that anxiety is an imaginary diagnosis used by archaic doctors or people hoping for medical kickbacks.

Anxiety is interesting in that it's very hard for anyone to "see"—no one thought I had a problem with anxiety because I didn't "seem" anxious. In extreme cases it can certainly be visible (like if your daughter was terrified of leaving the house, or had panic attacks routinely), but a lot of times it can leave someone feeling anxious on the inside, but seeming normal on the outside. So the net result of your daughter's treatment may be that she seems exactly the same to you, but that she feels much better on the inside.

"Anxiety" is a broad term: there's Generalized anxiety disorder, social anxiety, and a whole host of other types, too. It might help if you (through a mod, seeing as you're anonymous) knew / were able to share more information on the diagnosis, but I think there's a lot of overlap with various anxiety disorders (though I'm not familiar with all of them).

FWIW, I think college is a common time for anxiety to really stand out, since it can be so much more stressing. I always felt a little bit anxious as a kid going to school or whatnot, but assumed it was normal, and it was never a big problem. Only as the stress in my life really increased did I come to realize that it was a problem, and only in college did it start to become exceptionally handicapping.

For me, the medication (Lexapro) has been very effective. I'm on a very small dose, which is enough to bring me to "normal" levels of anxiety. The goal isn't to "eliminate" anxiety, but to bring my anxiety levels closer to those of a "normal" person. I still feel really nervous in the job interviews I'm going through, but without the medication, I'd have been so anxious about interviews that I wouldn't have send job applications in anywhere. And anxiety isn't even rational: the big thing for me was social anxiety, where I'd be incredibly anxious about meeting with friends and family, and would often make up excuses to not "have to" go out to lunch with friends or the like. I enjoyed those things, and yet they brought me so much anxiety that I couldn't do them.

My family noticed that I seemed a little more uninhibited when I started the medication. Not in a bad/"drunken" way, but a little less "reserved" than I used to be. (Which is good, because I'm naturally a quiet, introverted person.) That was the only visible change, and I think it was because anxiety no longer kept me from functioning normally. Everything else that the medicine did was just making me feeling much better internally.

The only side-effect I have is drowsiness from the medicine, but I actually see it as a "bonus," as I take the medicine in the evening, turning the "drowsiness side-effect" into "doubles as a sleeping pill."

As far as how to offer support, it's hard to say. For me, I started laughing with joy driving home when I was diagnosed: the formal diagnosis and beginning of a treatment was a gigantic relief. It was a while before I actually felt reduced anxiety, but just knowing that it was on the mend helped to ease my anxiety a bit. I guess the best "support" would be understanding that she's probably much more anxious about things than is rational, so to try to avoid doing anything that would exasperate it. I liked specifics: "Can you come home some weekend in October?" would have me feeling quite anxious because I didn't know when it was or if it would conflict with existing plans, and I wouldn't want to plan anything for the month of October since I didn't know when I had to go home, but "Can you come home for the 18th and 19th" was a huge improvement. This, of course, is blindly assuming that your daughter has the same sort of anxiety I do (part social anxiety, part generalized anxiety), and that she handles it in the same way.

Personally, I never went for therapy, as the medication was enough to get me "feeling normal." If I could do it over, I'd take advantage of the fact that my college had several full-time therapists available to meet with students for free. (Licensed therapists/psychologists, not "Professors and nurses moonlighting as guidance counselors.") Part of the problem is that there's still a huge social stigma attached to getting "mental help," so somewhere like a college campus where I knew everybody, I wouldn't want to be caught dead going. (Even though it was discretely located in an administrative building with lots of offices that I found myself visiting weekly anyway.)

Sorry if this is rambly, but I hope it helps!
posted by fogster at 9:56 AM on September 11, 2008 [3 favorites]

I would talk to her about to what extent anxiety may have disrupted her schoolwork. If she's having trouble getting to classes, definitely encourage her to talk to disability services at her school. She may be able to take tests separately from other students, or have other accommodations made to her anxiety. She should not just stop going to class--as an instructor, I've encountered students with anxiety disorders who would completely stop doing their work or showing up because of their anxiety, and without advice from Disability Services, legally, I was obligated to hold them to identical standards to the rest of my students (IE, fail them).
posted by PhoBWanKenobi at 9:56 AM on September 11, 2008

Everyone in this thread has really good advice, but I want to add that you might encourage her to get regular exercise, especially yoga. I am a big fan of vinyasa-style yoga, which incorporates a lot of linking breath with movement and is an amazing form of exercise and great therapy and relaxation. Depending on her schedule, you might try buying her a series of classes at a local studio or, given that she's at university, see if they have not-for-credit classes (these are usually dirt-cheap but still have good instructors). Alternately, buying her a few dvds and a yoga mat might be nice. If she has no experience, though, I do recommend taking at least a few classes with a teacher present to give her corrections and make sure she's moving through the poses properly.

You could also see about getting her some massage therapy. Anxiety can manifest itself physically (kinked muscles, etc.) and massage can be a great way to relieve some of that.

These suggestions should be taken with a grain of salt, however. If one of the sources of your daughter's anxiety is feeling overscheduled and overwhelmed, then having her parents suggest something that will take up EVEN MORE of her already scarce time might not go over well. Or, if she's feeling dependent and trapped (professors telling her what to do, parents telling her what to do, everyone having expectations of her that she's struggling to live up to, she's financially dependent, etc.), this could also be a minefield.

Most important: Listen to her.
posted by fuzzbean at 9:57 AM on September 11, 2008

"I think it's important for you, and her, to understand that everyone in the world has some degree of anxiety. Anxiety is a normal part of the human experience."

I think of anxiety kind of like pain: it's something everyone will feel here and there, sometimes fairly often. But if it's intense and you feel it 24/7, it's not normal, and you'd do well to consult a doctor about managing it. The goal is never to eliminate pain or anxiety, just to bring it down to normal levels.

"Oh and stop drinking coffee."

Definitely. I used to be a soda addict. (Sometimes downing half a dozen 20 ounce bottles in an afternoon.) Abstaining from caffeine didn't cure my anxiety, and drinking lots of caffeine didn't cause it, but cutting back on it sure did help.

I'd get a second opinion on the medication as well.

Given the fact that you're asking about your daughter, versus for yourself, I don't know about this bit of advice... The last thing she needs right now is you probing into what medication she's taking, or suggesting that it might have horrible side effects. I don't know what she's been prescribed; some antidepressants can have strong side effects, but I'd like to think that her doctor wouldn't have prescribed a high dose of an intense antidepressant to cure mild anxiety.
posted by fogster at 10:19 AM on September 11, 2008

Be understanding if she needs to take a semester off of school to get herself back from the brink.

She likely didn't want you to worry about her, and so didn't confide in you, but that could easily have had the end result of making her anxiety worse, and causing her to get help only when it got pretty bad.

So, do anything you can to relieve the pressure she feels (and I am not at all implying, by the way, that you are applying pressure to her, she's just in a situation that is a potential pressure cooker, being at university).
posted by misha at 10:49 AM on September 11, 2008

I'm anti-meds except as a last resort. Has she already made sure she's eating right? And most importantly (for myself anyway) sleeping enough?

These are hard to do because being stressed, badly fed, and underslept are usually things to be proud of when you're in college.
posted by small_ruminant at 11:02 AM on September 11, 2008

I dunno. "Anxiety" seems to people who don't have it to be a vague, meaningless issue. I can verify that to those who have it, it SEEMS like the end of the world when you have an attack or even a "high tide" as it ebbs and flows.

One of the big things that you should be aware of as a parent that if left untreated, anxiety will get worse. much worse. One of the ways that anxiety manifests is an inability to do something to make it "better". It's like sitting at a dinner table, hungry, with a plate of food in front of you and utensils at hand, and not being able to muster the will to move the food from the plate to your mouth. You know you'll feel better the instant you put the food in, but you just can't DO it!

In many cases, generalized anxiety can be due to an imbalance in brain chemistry that was masked by the support she got from you and others at home. Medication is not out of the question to help correct it, especially if she is having panic attacks or any other serious symptoms like heart palpitations. She needs to see a Psychiatrist for this kind of medication ... don't just let her go to a GP or let a psychologist work with it.

With that in mind ... the school will have lots of support for this, including free counselors. You should find out from your daughter if she wants you to be involved. It's her decision. If she does, ask her what she's feeling anxious about and help her do it. When I started having problems my mom showed up for a week and helped me "catch up with life" and organize/clean my house, which helped me focus on the other issues.
posted by SpecialK at 11:12 AM on September 11, 2008

There's a lot of advice in this thread (take medication, don't take medication, exercise, stop drinking caffine, change diet, address underlying problems causing anxiety). Some of this is good advice, but it is all advice for your daughter. There is a good chance that if you, as her mother, tell her to do any or all of these things or otherwise try to manage her illness for her, you will do more harm than good. As long as your daughter is receiving medical care and is satisfied by it, I would defer to her and the medical professionals she has selected. If she is not satisfied by the medical care she has selected, help her get the right doctors.
posted by A Long and Troublesome Lameness at 11:15 AM on September 11, 2008 [3 favorites]

As someone who was in your daughter's shoes and sometimes still is, I would say your role is to be understanding and to not judge. My parents treated me very harshly when I told them and still do to this day when it comes up. On the other side, when I came home for the holidays my mom's best friend took me aside in her study, gave me a giant hug and told me she was there for me if I ever needed someone to talk to. That was exactly what I needed.

From a treatment perspective, therapy and medication worked wonders. Good luck to you and your daughter.
posted by ml98tu at 11:17 AM on September 11, 2008

Anxiety is very treatable, so you could support her in finding a therapist who knows what he or she is doing. Many people find that cognitive behavioral therapy is very effective relatively quickly for people with anxiety.

Medications can be very helpful, but in my opinion they should primarily be used as an adjunct, to help her with the therapy work if she gets overwhelmed. Far too many primary care docs will just dispense anti-anxiety pills to which patients get addicted.

Don't be surprised if, in the assessment phase of therapy, other diagnoses come along - depression often co-occurs with anxiety, as do eating disorders, especially among young women. All these things are treatable.

Let your daughter know that her wellbeing is *everyone's* first priority, so she should do whatever she needs to to solve this problem. Let her know that you have confidence that she'll be able to work through these challenges, as she has worked through other challenges in her life.
posted by jasper411 at 12:04 PM on September 11, 2008

My two cents as a lifelong sufferer of GAD:

She could have situational anxiety, where she's under extreme stress at school, but once she's over that she'll be "normal." Or she could have general anxiety, which manifests under all sorts of stressors, and she's just now had it diagnosed.

Either way, therapy, exercise, and medication can help a lot. (BTW many people taper off medication once a certain situation becomes resolved.)

As her mom, IMHO, just be understanding and accepting. Let her work it out. If she asks for advice, give it. Gently. For me at least, when you feel like you're crawling out of your skin, even with supportive people are around it's something you kind of have to work out for yourself. The sweetest suggestions from a loved one can just (albeit irrationally) add to the misery.

After trying everything else I could think of, I finally resorted to psychiatry and medication. It is the only thing that has worked for me.

Best of luck.
posted by blahtsk at 1:17 PM on September 11, 2008

Aside from everything else above:

Be calm. Having multiple people freak out over your anxiety just makes it worse. What helps for me is to be around a calm, collected person who will be able to talk me through breathing, relaxing, resting. I forget all that when I'm anxious/depressed, but having a calm voice gently reminding me works wonders.
posted by divabat at 4:55 PM on September 11, 2008