Helping adult dd with anxiety

[longtompot]

My 21 year old yd has anxiety and has frequent panic attacks. She has had these for a long time, and despite cbt and camhs, she is no better than she was at the beginning. She cannot use a phone, especially to call her gp for example, which she needs to be able to do for her various health conditions.
Does anyone have anything they can suggest for us to try and help her with her anxiety and to be able to do things for herself? We won't be around forever, and our fear is she will just stop after we are no longer about.

Things I’d consider are:

getting her a pet - a small dog or a cat make a fantastic companion and there are some great studies eg showing how spending time with a dog helps calm both the owner and the animal. She may find it easier to handle calling a vet, practising contact with “medical people” without focusing on her own problems which might be triggering her

making sure she isn’t deficient in vitamins or minerals. Can affect mood.

encouraging her to take up yoga or something similar, and get in a very calm place before she is going to make a call.

With panic attacks as I’m sure you know, the thing that makes you most anxious is knowing you are going to panic and knowing how horrible that feeling is, so you do anything to avoid it, even if it’s quite irrational (like ignoring your medical needs). Avoidant and escapist behaviour doesn’t help in the long run, and it is very habit-forming, but if she is having panic attacks then she is in a really bad place. How is she with phone calls generally - is it only the GP that causes the anxiety? Does she live with you? If yes, then I would suggest that you involve her in lots of “official” calls - phoning up to check opening times of a shop, order a new bank card, making an enquiry about holiday insurance cover. You should do the GP calls for her for now, but she should stay in the room while you do the speaking with the call on loudspeaker. Schedule the calls so she knows when it will happen and she cannot avoid it. Get her in a calm place for the call - maybe right after a yoga or meditation. After a few times with you in charge, she should dial the number then immediately you take over the speaking. And next time she should dial and then pick the options on the answer service, then you take over. When she’s ready to try the call herself, make sure she has a basic script in her head of what she will say when she starts the phone conversation- she can practise this out loud with you.

Build her up slowly in other words, you want her to feel she can cope with whatever the call throws at her, so give her some stock phrases to use, for example “thanks for that information but I need to think about it so I will hang up the call now and call back another time.”

This isn’t babying her, it’s training her, helping her form new habits and push through/ handle the discomfort she feels in certain situations. You can acknowledge that she will feel some discomfort and fear but that exposure to that fear will gradually help it reduce. Like sitting in the sun - you don’t immediately sit out in the midday sun for several hours, you acclimatise your skin and get a light tan going, otherwise you’ll just burn to a crisp, and it will hurt, and the next sunny day you’ll be hugging shadows in a long sleeve shirt.

I’m sorry the cbt didn’t help and I also wonder if finding a support group might help. Something like TheTribe or 7 cups of Tea, online.

Is she on any medication for anxiety? I'm diagnosed with GAD and took Escitalopram for a couple of years (low dose). It really helped and broke the cycle of anxiety.

I don't have much advice for the anxiety, but for the panic attacks have you heard of the mammalian dive reflex? For those awful panic attacks that seem to last an age, fill a sink with very cold water and immerse face. It's a shock but it really works for some people.

I think she really could benefit from some medication to help break the cycle. I was previously like your DD and couldn't cope with speaking to Drs on the phone, or order a pizza, or talk to the bank, or anything really.
If you take medication to help with breaking out of the worst of it, once you've made the first call and spoken to a Dr, it does get easier every time until you can actually stop getting stressed at all by it.

Having a list of what she wants to say could help.

Also, what if you spoke to them to give the background and introduce her and then handed the phone to her so she could tell them the list of things she wanted to bring up?

Like PP I really think pets help. If she likes animals and is capable of looking after one, how about a small dog or cat? Or if that's too challenging, what about a couple of Guinea pigs? Mine made a massive difference to me and I find them very calming and good company without being too difficult to look after if I'm not managing so well.

If it's true anxiety, that can often be treated long-term by antidepressants. In the short term, if she has Spotify, there is a podcast called Where is my mind?

For on the phone, sounds bizarre, but, could she get a glass and some water and just stir the water while on the phone?

With a plastic straw - not a metal teaspoon jangling against a cup. Something that would make no noise, but she could focus on in a distracted manner and also would distract her from her thoughts while she's talking. Sorry, might make no sense at all.