It all comes down to empathy.

Your heart aches when people in your life wrestle with over-the-top anxiety and worry. And let’s be honest: It can be frustrating when loved ones ditch plans to go out with you because they’re having an anxiety attack.

You want to ease their angst, but what if you say or do the wrong thing? If you really want to know how to help someone with anxiety, think about how you can empathize with them. It’s about being “a good listener and a good coach,” says David Shanley, PsyD, a Denverbased private practice clinical psychologist and author. “Getting them out of their shell to even talk about it is really going to loosen the grip the anxiety has on them,” he explains.

Here’s what you can say or do to help someone deal with anxiety.

Be your friend's wingwoman

Some people come undone by the mere thought of being scrutinized by others in a social setting. Instead of letting loved ones go it alone, support them in ways that lower their anxiety to a manageable level, suggests Misti Nicholson, PsyD, director of clinical services at Austin Anxiety and OCD Specialists in Texas.

She describes one young woman who was pregnant with her first child and terribly conflicted about an upcoming baby shower her friends had planned. What if she blushed or her hands trembled while unwrapping gifts? People would know she was anxious. She considered backing out. But then her best friend offered to sit next to her and read cards aloud to divert eyes in the room.

“It made her feel like they were sharing the spotlight,” Nicholson says.

Don't let someone's panic attack become a spectator sport

People don’t always know how to help someone with anxiety, especially if the person is in panic mode. They’ll often be so concerned that they start calling 911 because it looks scary, Nicholson says.

If you see that your loved one is having another panic attack (and you’ve established that it’s not some other type of medical emergency), help them move to a more private area.

You’ll be doing that person a favor because “unwanted attention can often exacerbate symptoms of panic,” she says, “especially if the person has social anxiety.”

Model calmness

“When people panic, their thinking brain shuts down,” says Margaret Wehrenberg, PsyD, a Naperville, Illinois-based clinical psychologist, anxiety coach, and author. That’s where you come in. You can help your friend regain control.

The first thing you should say is “breathe,” and then model it for a panicky person. Take slow, deep breaths and slow your speech.

“In the field, it’s called co-regulation, where my nervous system entrains your nervous system,” Wehrenberg says. “I deliberately move myself to calmness so that you will calm down better.”

Offer your services

People with anxiety disorders can’t simply “get over” their anxious thoughts and feelings. It requires therapy. But you can lend a hand through role play.

For example, during flu season, Nicholson’s practice sees young people with a fear of needles. She suggests helping a needleaverse anxious friend by pretending to get vaccinated. Wipe your friend’s arm with an alcohol swab, for example, and make like you are giving him the shot. Offer to drive the person to the doctor’s office and sit in the waiting room when it’s time for the real deal.

Guide her back to reality

People with anxiety tend to greatly exaggerate the difficulty of a task and the horrible outcome if they fail, Wehrenberg says.

What you can do is get real with your friend or loved one. She’s worried about what could possibly happen. Ask her what will probably happen, she says, “because when you bring people a little bit into reality, they are more able to shake off the fear.”

Practice conversation starters

Do you know someone who’s anxious about meeting new people or making small talk? Do you have friends or family who dodge uncomfortable social situations because they fear others will judge them negatively?

Wehrenberg, author of several books, including The 10 Best-Ever Anxiety Management Techniques and The 10 Best Anxiety Busters, says there are a number of really good YouTube videos on how to talk to anybody and how to start a conversation.

“You could watch a few of these together and practice,” she suggests.

Brainstorm solutions together

Sometimes people worry excessively about life’s challenges: their health, work, school, finances, whatever it may be.

“When people get worried,” Wehrenberg says, “they forget that they could actually make a plan that could resolve the problem.”

She recalls a married couple who was struggling with debt the husband had piled up. Not only did his wife offer encouraging words, she laid out specific steps to mitigate the problem: see a credit counselor, negotiate with each credit card company, etc.

Be compassionate…

Often people with anxiety say things like, “Ugh, I’m the only one struggling with this. What’s wrong with me? I’m such a loser,” Shanley observes.

Don’t pile on. That person already feels “bad or crazy” for having anxiety, he says. Help your friend open up about what he or she is anxious about and try to “normalize” it.

He suggests using language like, “That sucks. I’ve struggled with these kinds of anxieties myself. Yeah, it’s annoying; it’s frustrating.”

…but try not to aid the person's avoidant behavior

If you give your loved ones permission to sit out situations that make them anxious, it doesn’t help them with their anxiety in the long run, psychologists say. A better way is to gently encourage them to push themselves.

“You're trying to get them to start approaching the world…even if they feel some anxiety,” explains Shanley, author of The Social Anxiety Workbook for Work, Public & Social Life: Strategies to Decrease Shyness and Increase Confidence in Any Situation.

Host a game night

Dragging your friend out for a night of clubbing probably isn’t the most productive way to ease her social anxiety. But you could offer to host a craft night or some other structured activity at home, like playing a board game.

“It reduces the pressure to maintain constant conversation,” Nicholson explains.

To engage your socially anxious friend in the banter, raise a topic that she knows something about and ask her open-ended questions.

Find a clinician

Anxiety is no joke. When it’s extreme and persistent, your loved one may need your help finding a qualified professional counselor.

Both the Anxiety and Depression Association of America and the Association for Behavioral and Cognitive Therapies have search engines that allow you to find a therapist by location and specialty.

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