Anxiety Disorders

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by Jill Aitoro

he emotionally overinvolved are excessively self-sacrificing—never going out without the person, carrying a beeper at all times, some even accompanying the person on dates. They give up their lives. Chambless suspects that such behavior has a negative effect on treatment because the patient is less apt to confront fears if the relative shares in those fears, and the actions of the relative reinforce the inadequacies of the patient. "If you live with someone who treats you like a fragile piece of glass, you might think of yourself as a fragile piece of glass," Chambless says.

Nonhostile criticism either had a positive affect on treatment or didn’t affect the treatment one way or another. "A patient often tried harder when confronted with something that frightened her if she had a relative that was critical but did not reject her as a person." Without hostility, patients were 50 percent more likely to improve than those with hostile family members. With the hostile family members, patients were six times more likely to not even complete the treatment.

When the family members were videotaped talking with patients about the most important problems in their relationships, hostile relatives were negative in face-to-face interaction and could not—or would not—come up with constructive solutions. The nonhostile relatives were more likely to find some means of resolution. For those who are afraid to get in a car and drive, Chambless says a family member should be taught to say, "Maybe it would help if we practiced driving together," rather than, "Stop the nonsense, get into the car, and suck it up!"

As for the emotionally overinvolved, relatives should be educated as the patient begins treatment. "They must understand that it won’t hurt the person to confront anxiety," Chambless says. One woman was afraid her husband, suffering from OCD, would have a heart attack if he became too upset. Therapy was never successful because facing his fears seemed—to both him and her—too risky. That thinking was actually counterproductive. "His physician said that the ongoing stress of the OCD was much riskier than any immediate behavior therapy," Chambless says. Both patient and family must know that if the patient gets upset, that’s okay; it is going to get better over time. "The overinvolved have their own fears that are not addressed properly. We want to spend more time listening."

ith graduate student Steffany Fredman, Chambless is now developing ways to look at the videos to see how the emotionally overinvolved act in face-to-face interaction; maybe then Chambless will understand how the feelings of the relatives are channeled to the patient. "In this area of research, there are connections between how the relatives feel and the impact on the patient," Chambless says. "We wonder how it is communicated."

Researchers also plan to study and categorize family members’ gestures from the videos. Voice tones, facial expressions, body language, and intrusion of space are all examples of ways a person may attribute blame—often unintentionally. Just raising an eyebrow can send a strong message.

Chambless hopes the study will lead to intervention that can improve the chances of successful treatment by keeping the family better informed and directly involved. "Two or three percent is an undercount of the people suffering from the problem because there is also the family around them."

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