The challenge with Generalized Anxiety Disorders and relationships is that deep anxiety is one of the most prevalent mental health problems affecting Americans today.
How big a problem is it? Consider this.
Anxiety is the 5th most common medical complaint that patients bring up with their primary care physicians (O’Brien & Last, 1984).
We all have a pretty stupid nervous system. It’s designed to work in concert with our brains to keep us safe…not to make us happy.
Because anxiety disorders are so common, their impact on marriage and relationships has been a subject of interest to researchers.
Perhaps one of the first comprehensive reviews of the data was conducted by Mark Whisman in 1999. Dr. Whisman found a significant association between spouses who reported both anxiety disorders and a lack of marital satisfaction.
However, Whisman’s research also showed that some marriages continue to work well despite the fact that one spouse has an anxiety disorder. It’s important for therapists who are working with such a couple to carefully assess how anxiety disorders affect both marital and individual functioning. This is very much a “your mileage may vary” situation.
This chicken and egg question has been the key area of interest for researchers. How can we develop interventions for couples that address the extent to which relationship dynamics impact anxiety and vice versa?
Both the anxiety disorder and marriage are being impacted at the same time. How do we unpack how the quality of a couple’s relationship when both the anxiety disorder and the marriage are being impacted simultaneously?
We look at the couple’s baseline marital satisfaction first.
We know that married patients with Generalized Anxiety Disorder (GAD) tend to respond better to treatment than single people with GAD. However, an increase in marital tension is correlated with a poorer treatment outcome.
Even looking at married couples at the start of treatment points at the same correlation. Spouses who report a higher level of marital satisfaction at the start of treatment have a predictably better outcome (Daiuto, Baucom, Epstein, & Dutton, 1998).
In other words, the more stressed your marriage, the worse your anxiety. The research parallels what we’ve already learned about marital satisfaction and depression.
It also mirrors what we know about physical health issues and marital stress. Whether we’re talking about physical or mental health, a strong intimate bond heals, and an unhappy relationship makes any kind of illness worse. A good marriage is protective of mental and physical health (Barnett, 1988).
Commonly found mental health challenges such as anxiety and depression have been found to be more prevalent in spouses who are enduring unhappy marriages (Whisman & Uebelacker, 2003). The bottom line is that partners who are in troubled relationships are 3 times as likely to suffer from mood disorders such as anxiety and depression. Researcher Talia Zaider summed it up well:
Anxiety disorders are chronic and unremitting. Those in long-term intimate relationships with adults suffering from anxiety disorders face the prospect of managing the affective (emotional) and behavioral consequences with little substantial relief. The difference between couples who maintain a positive sentiment regarding their relationship and those who do not may lie in the particulars of how anxiety is metabolized form day to day. Talia Zaider (2010).
The clinical problem is that mental health disorders such as anxiety are both cause and a consequence of marriage problems.
What all-purpose therapists often miss is that it’s the bi-directionality between the two that matters.
In other words, good, science-based couples therapy does more than improve the relationship. Research tells us that improving marital satisfaction can alleviate up to 30% of cases of major depression.
Good couples therapy improves both depression and anxiety because a healthy intimate bond protects mental health.
At the end of the day, most anxiety disorders are more about what you’re avoiding than what you’re seeking.
The non-anxious partner often accommodates the anxiety disorder by performing tasks and assuming duties that would spike anxiety in their afflicted spouse.
Studies have shown that anywhere from 40-88% of non-anxious spouses and family members modify their daily routine to accommodate their partner’s anxiety disorder.
Unfortunately, this accommodation often results in a decline in marital satisfaction. The helpful spouse sees no change in the anxiety and often becomes resentful. The same toxic compensatory dynamic is found in the partners of spouses who are battling severe depression.
Generalized Anxiety Disorder (GAD) is pretty hard to ignore.
Spouses with GAD may experience tense muscles, irritability, insomnia, fatigue, and other physical health problems. GAD tens to be a chronic condition.
It impacts between 4 and 7 percent of the United States adult population. And it is associated with a higher risk of developing depression, other specific forms of anxiety (such as social anxiety) as well as other mental health challenges.
GAD has a huge impact on individuals, so it is no surprise that research also indicates that the impact on intimate relationships is also significant.
Ironically relationships tend to be a focus for those suffering from GAD, which installs a perfect negative feedback loop.
Relationship worries themselves take a toll on relationships, which makes managing them even harder as anxiety spikes upward.
We know that GAD is a relational stressor. Anxiety is a distorting filter. Spouses with anxiety may view the intentions of their partners with greater skepticism and wariness.
They also tend to be prickly pears, more likely to feel slighted by their spouse and may respond with passive-aggressive stances.
Spouse with GAD may tend to be either overly passive or critical. These patterns of communication can happen automatically without conscious awareness.
They also struggle with divided attention, part of them focuses keenly on the relationship, while another part of them manufacturers anxiety. In other words, true presence for those afflicted with GAD is hard to sustain.
Anxiety is an overlearned association between an avoidance behavior and a subjective feeling of anxiety. A spouse with anxiety overestimates the probability of a dreaded experience and then seeks to reduce the feeling by engaging in avoidance behaviors.
The problem is, we can get used to anxiety as an almost perpetual state of being.
It can be puzzling, painful, and lonely to be,(or have) an intimate partner with GAD. Here are some ideas on how to deal with it.
Mindfulness is the basic human ability to be fully aware and present to what’s happening right now. It means being aware of where you are and what you’re doing, and not overly reactive or overwhelmed by the experience.
In other words, it’s the exact opposite of anxiety, which tends to focus more on the past or the future, while discounting the present moment.
While mindfulness is something we all naturally possess to varying degrees, it’s more readily available to us when we practice it every day.
Bring awareness to what you’re directly experiencing via your senses in the present moment. Whenever you direct your attention to your thoughts and emotions, you’re being mindful. And there’s growing research showing that as you train yourself to become more mindful, you’re actually transforming the physical structure of your brain.
Cultivate an observing self. Work to externalize your anxiety through mindfulness. The problem with anxiety is that kidnaps you completely out of the present and dumps you mentally into either an unpleasant past or an apprehensive future.
Externalize your anxiety. Recognize your anxiety as a troubled old friend paying you an unexpected visit. With consistent effort, you can learn not to become anxious… by just visiting with your anxiety as if they were a drunk friend at a bar with you.
Accept the fact that your anxiety distorts your perception. Focus on understanding what your spouse has to say, and make sure that you understand them accurately before responding. This discipline will help you improve communication with your spouse.
Slowing down is important. Anxiety, like depression, not only directly distorts communication, it compounds relational distress by increasing negative feelings between both spouses. Technology now offers us amazing tools that can treat anxiety by teaching our minds how to slow down.
Research on depression tells us that living with a depressed spouse increases your own vulnerability to becoming depressed (Coyne et al., 1987). However, it is also true that living with an anxious spouse may increase the stress and tension for the non-anxious partner.
Another toxic pattern in couples battling depression and/or anxiety is that as the healthier spouse compensates for their partner, they begin to perceive their partner as a fragile emotional invalid.
Anxious spouses can also foster an “emotional contagion.” The more they focus on their anxiety, the more apprehensive, resentful and reactive their partner becomes. Their partner’s anxiety crowds out any bandwidth they might enjoy for having their own relational needs met.
Anxiety crowds out the good that may be otherwise obvious in the present moment.
Cognitive restructuring and relaxation training can help you manage your body-based behaviors and sensations (DeRubeis & Borkovec, 1973).
Cognitive restructuring is particularly effective because it confronts the anxiety feedback loop between Generalized Anxiety Disorders and relationships.
Anxiety tells you that something bad is likely to happen, and you won’t be able to deal with it.
Cognitive restructuring teaches you to interrupt and challenge this pattern and replace it with more careful considerations about other possible outcomes.
The goal is to weaken the vicious cycle of automatic anxious thoughts and feelings (Beck & Emery, 1985).
One of these replacement patterns is gratitude. Cultivating a sense of gratitude can redirect your attention to the more positive and hopeful aspects of your relationship. Fear and worry become habitual states that blind us to the good that surrounds us.
One of the ways you can do this is to notice the little things your partner does on a daily basis… and express gratitude.
What kind of partner do you want to be? How do you want to behave in your relationship? What small steps can you take to move in that direction right now?
These actions don’t have to be hard. Breathe. Stifle that anxious comment. Notice. Take a time out when it’s warranted. Look for something to be thankful for. GAD responds to treatment. Get help. At the end of the day, your anxiety is something that you are responsible for bringing under your conscious control.
Generalized Anxiety Disorder and Relationships…Start With Good Science-Based Couples Therapy
Here’s some good news. Baucom et al. (1998) found that couples therapy is the most effective way to start treating generalized anxiety.
Good couples therapy will reduce stress levels, and lay the necessary foundation for individual therapy to treat anxiety. Research suggests that a stronger, healthier marriage is a vital part of treating any and all anxiety disorders.
Generalized Anxiety Disorders and relationships improve when couples acquire better communication skills (Arnow, et al., 1985). Research says that for married or clients in committed relationships, couples therapy is often the first thing you should do to treat a Generalized Anxiety Disorder or any other anxiety disorder.
Arnow, b. A., Taylor, C.B., Agras, W.S., & Telch. M. J. (1985) enhancing agoraphobia treatment by changing couple communication patterns. Behavior Therapy, 16, 452-467.
Baucom, D. A., Shoham, V., Mueser, K.T., Daito, A.D., & Stickle, T.R. (1998) Empirically supported couples and family interventions for marital distress and adult mental health problems. Journal of Consulting and Clinical Psychology, 66 53-88.
Whisman, M.A. (1999) Marital dissatisfaction and psychiatric disorders: Results from the National Comorbidity Survey. Journal of Abnormal Psychology 108 (4), 701-706.
Daniel is a Marriage and Family Therapist. He currently sees couples at Couples Therapy Inc. in Boston, Massachusetts, three seasons in Cummington (at the foothills of the Berkshires...) and in Miami during joint retreats with his wife, Dr. Kathy McMahon. He uses EFT, Gottman Method, Solution-focused and the Developmental Model in his approaches.