How online interventions help couples experiencing generalized anxiety disorder

Generalized anxiety disorder: An overview

While some anxiety is normal from time to time, overwhelming or notable anxiety that interferes with day-to-day life usually indicates something deeper. Generalized anxiety disorder (GAD) is among the most common mental disorders in the United States. The National Institute of Mental Health estimates that in the U.S., 2.7% of adults have had GAD in the last year, with roughly 5.7% of U.S. adults experiencing it at some point in their lives. Lifetime prevalence is 7.7% for women and 4.6% for men. People who experience GAD typically have feelings of excessive anxiety that occur on the majority of days for at least six months.

Common signs and symptoms a person with anxiety may notice include:

• A sense of nervousness or of being on edge

• Trouble sleeping and fatigue

• Weakness or a tired feeling

• Loss of interest in socialization

• A sense of impending danger or feelings of panic

• Increased heart rate

• Withdrawal from friends and loved ones

GAD can aggravate physical health conditions, such as headaches, chronic pain, insomnia, and digestive problems. Medical advice and treatment is sometimes necessary when anxiety interferes with the ability to function from day-to-day functioning. It may also be necessary if anxiety leads to depression or causes suicidal thoughts.

If you are experiencing suicidal thoughts or urges, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 988 to talk to someone over SMS. Support is available 24/7.

Online intervention for couples affected by generalized anxiety disorder

OurRelationship.com: A GAD intervention for couples

The process used in the OurRelationship.com program was designed with the intent of supporting both individuals in a relationship affected by anxiety: both the partner experiencing anxiety and the partner impacted by the other's anxiety. It is designed to help people with anxiety be mindful and accept their anxiety, and to help both individuals in a relationship be mindful of their behaviors and accept the other's emotions and experiences.

Below is a summary of a research study examining OurRelationship.com. After following the progress of several couples who completed the program, investigators opted to present a case study of a fictional couple representing the composite experience of the couples to preserve secrecy.

Participants

Elizabeth and Trevor are presented as a composite couple representative of study participants. They are both in their mid-twenties and have been dating for three years. They began by completing an online screening that included the Overall Anxiety Severity and Impairment Scale (OASIS), which is used to define whether individuals do or do not have an anxiety disorder. Elizabeth scored above the cutoff needed to continue and completed the Anxiety Disorders Interview Schedule (ADIS-IV-L). Her score on this assessment indicated fairly severe GAD.

Both Elizabeth and Trevor also completed the Couples Satisfaction Inventory, and each of their scores indicated mild distress. With the relationship distress, Elizabeth's anxiety qualified the couple for the Our Relationship program.

At the start of the program, Elizabeth divulged how the challenges relating to GAD impacted their relationship and caused her to have doubts about the future of their relationship. Although Trevor did not communicate the same concerns, Elizabeth's anxiety about the relationship did cause him to feel hurt.

The intervention

The development of the OurRelationship.com program was guided by principles from Integrative Behavioral Couple Therapy (IBCT), which encourages couples to learn how to accept different personalities and develop more empathetic communication skills. In clinical trials, it's been shown to be more effective than traditional couples therapy at two-year follow-ups.

OurRelationship.com consists of eight hours of content that includes videos, interactive couple's activities, psychoeducation from relationship experts, and tailored feedback based on the information that couples have. Like IBCT, it tends to focus on helping couples examine and accept their differences, learn conflict resolution techniques, practice empathy with one another, and be mindful about utilizing what they learn in interactions. For that to happen, couples will usually have to go through all three phases of the program. Theses phases include:

Observe: Couples complete an orientation and an assessment battery. They also identify one or two core issues to focus on and receive feedback about their relationship.

Understand: In this phase, couples learn about DEEP understanding, which focuses on how natural differences or contempt are the source of relationship distress, how Emotional sensitivities can make it hard to manage the differences, how External stressors make certain difficulties worse, and how unhealthy Patterns of communication can further exacerbate problems or the level of desire partners have for one another.

After couples learn more about DEEP understanding, they spend some time discussing the topic and its relation to their relationship.

Respond: Couples learn how to discern what aspects of their relationship need to be changed and what aspects should be accepted as they are. They also work together to create plans for handling stress, improving self-care, and building their relationship through positive activities. Finally, they discuss how to improve their communication and truly hear one another when they express their concerns.

Results

For Elizabeth and Trevor, the intervention helped them become more accepting of their anxiety and open about their feelings in general. According to measurements of the GAD-7 scale performed at the beginning, middle, and end of the program, Elizabeth's anxiety decreased significantly. While she scored 16 at the beginning (above the clinical cutoff score of 10), her score had declined to 6 at the mid-treatment assessment and ended up at 7 at the post-treatment assessment.

Both partners also saw an increase in their score on the relationship distress measure. Elizabeth's grew from 42 to 62 to 73 throughout treatment, while Trevor's progressed from 47 to 64 to 74. These scores indicate that relationship satisfaction increased significantly for Elizabeth and Trevor.

Assessments were also used to measure the way partners with and without GAD perceived one another. Elizabeth completed the Perceived Criticism Measure-Type to rate Trevor's criticism of her. Before beginning the intervention, she responded that during a disagreement he would tend to criticize her in a "helpful, constructive way" at level 3 out of 7 and in a "harsh, hurtful way" at 2 out of 7. By the end of the program, these scores evolved so that she felt he criticized her in a "helpful, constructive way" at 5 out of 7 and in a "harsh, hurtful way" at 0 out of 7.

Trevor completed the Family Accommodation Questionnaire-Modified to measure how he felt he accommodated Elizabeth's symptoms. Before the intervention, his score was 13. After completing the program, it declined to a 10, demonstrating that he didn't feel he was accommodating Elizabeth's anxiety as much as he needed to in the past. This isn't to say that he cared about her less, but that anxiety didn't play as big of a negative role in their relationship as it once had.

In summary

The case study presented above represents a composite couple, Elizabeth and Trevor, created from the experiences of several couples who completed the OurRelationship.com GAD program. This intervention helped them decide on new patterns of interaction that were more effective in responding to Elizabeth's anxiety.

The two learned better ways to handle anxiety, and post-assessments revealed that Trevor's harsh criticisms and accommodations of Elizabeth's anxiety decreased, indicating that anxiety held less influence in their relationship than it did before the study. Relationship satisfaction also increased significantly for both partners.

Additional research regarding Ourrelationship.com

In another study of OurRelationship.com, 300 heterosexual couples were randomly assigned to two groups. The intervention group began the program immediately, and the control group was placed on a waiting list for two months. After two months, the intervention group experienced significant improvements in relationship satisfaction and quality of life compared to the waitlist control group, with 97% responding that they would recommend it to a friend. In addition, participants saw significant improvements in depression and anxiety symptoms.

Although research regarding OurRelationship.com has been positive, only a few studies have been performed. Future research should continue to assess the efficacy of the program and any others that are similar.

Mental illness and health can play a significant role in relationship quality, and anxiety isn't the only condition that has an impact. Depression, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and addictions can also cause distress. Research could look at a modified OurRelationship.com program that addresses these different conditions or other interventions designed to help couples.

Managing generalized anxiety order

If moderate to severe anxiety interferes with your life,  there are strategies you can implement to try to reduce the symptoms. The following are just a few:

Engage in daily physical activity

You might try practicing various exercises to reduce stress and help both your body and mind be more at peace.

Strive for adequate sleep

Anxiety and sleep disturbances often go hand-in-hand. You can practice good sleep hygiene habits, such as following a regular sleep schedule, to limit the chances of losing sleep.

Limit nicotine and caffeine

Caffeine and nicotine can contribute to anxiety, especially by increasing the physiological arousal connected to anxiety. The misuse of these substances can also lead a person to form a type of substance use disorder (sometimes incorrectly referred to as “substance abuse.”) This may further negatively impact their feelings relating to anxiety.

If you are struggling with substance use, contact the SAMHSA National Helpline at (800) 662-4357 to receive support and resources. Support is available 24/7.

Accept worry

An article from Harvard Health Publishing recommends shifting your mindset regarding worry. Instead of allowing yourself to fall into a negative spiral, you can work on recognizing how worry is interfering with your life and practice swapping out concerns for more constructive, helpful thoughts. You can also discuss common concerns like commitment or infidelity with your partner, as long as you keep the conversations constructive and free from unnecessary blame.

Talking to a therapist about anxiety

If you’re experiencing anxiety, you might benefit from talking to a licensed therapist. If anxiety makes it difficult to leave the house at times, or the distance between you and the nearest provider is too great, you might consider trying online therapy, which studies have shown to be just as effective as in-office therapy. With BetterHelp, you can connect with a licensed therapist via phone or video chat from the comfort of your home or anywhere with an internet connection. If you experience anxiety in between sessions, you can contact your therapist 24/7 via in-app messaging, and they’ll respond as soon as they can.