Understanding Relationship Anxiety: Help Clients Build Healthy Connections

What is relationship anxiety?

Relationship anxiety refers to persistent worry, fear, and insecurity related to romantic or platonic relationships. Many healthcare professionals are aware of this type of anxiety, but it is not officially included in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Unlike other types of anxiety, there is no specific guideline on how to treat or diagnose relationship anxiety.

This type of anxiety can cause significant relationship distress and negatively affect relationship satisfaction and overall well-being. Individuals experiencing relationship anxiety frequently seek constant reassurance from their partners or loved ones, which can strain intimate relationships over time.

While some anxiety in relationships is common—particularly during early stages—persistent worry that outweighs enjoyment may indicate an underlying issue. Anxiety disorders, such as generalized anxiety disorder (GAD) or obsessive-compulsive disorder (OCD), can contribute to chronic doubts and fears in relationships (Zaider et al., 2010).  In particular, relationship OCD is characterized by obsessive concerns about the quality and stability of a relationship (Doron et al., 2016), often leading to compulsive behaviors like checking, seeking validation, or avoiding triggers.

Effective anxiety treatment for clients struggling with relationship anxiety may include cognitive-behavioral therapy (CBT) (Curtiss et al., 2021), emotion-focused therapy (Shahar, 2020), and mindfulness-based approaches (Hoffman & Gómez, 2018). Mental healthcare professionals can also support clients in developing healthy communication patterns, strengthening emotional resilience, and addressing underlying attachment issues.

Signs and symptoms of a person with relationship anxiety disorders

Relationship anxiety presents a range of emotional, cognitive, and physical indicators that can disrupt romantic relationships and overall well-being. This also surrounds symptoms similar to social anxiety disorder since it involves interpersonal problems, in particular, difficulty with intimacy (National Collaborating Centre for Mental Health UK, 2013).  

Individuals often experience constant doubt about their current relationship, questioning their partner's feelings and the future of the connection. This persistent uncertainty leads to intrusive thoughts and negative thought patterns, which may focus on perceived flaws in the partner or relationship rather than recognizing positive qualities.

• Constant reassurance-seeking: Individuals repeatedly seek validation from their partner, frequently asking if they are loved or if the relationship is stable, especially after experiencing anxious thoughts or misinterpreting situations.
• Difficulty trusting a partner: This often stems from a fear of betrayal or rejection, making it challenging to maintain open and honest conversations, which are essential for healthy relationships.
• Past relationship experiences: Experiences like betrayal, cheating, or unexpected breakups can heighten fears and anxiety in new connections.
• Anxious attachment style: Individuals with this attachment style are more prone to worry about abandonment and doubt their partner’s commitment.
• Low self-esteem: This can cause individuals to question their partner's feelings, leading them to believe they are undeserving of a healthy relationship.
• Childhood trauma: Experiences of family dysfunction, early-life adversity, or unhealthy family dynamics can shape fears of intimacy and trust.
• Poor communication: Lack of honest conversations creates uncertainty, fostering anxiety and misunderstandings within the relationship.
• Broken trust: Events like infidelity or seemingly minor incidents can erode trust, increasing uncertainty and anxiety.

Physical manifestations are another significant aspect. Physical symptoms like headaches, fatigue, rapid heartbeat, sweating, shaking, and nausea can occur, especially during heightened stress—these somatic experiences, coupled with emotional distress, further strain the relationship dynamic.

Sometimes, individuals engage in self-sabotaging behaviors, starting arguments over trivial issues or canceling plans to create emotional distance. Others may question their compatibility with their partner, focusing on minor differences rather than shared values. Despite enjoying a few moments of happiness, they often spend more time worrying, overshadowing positive experiences.

Problems with relationship anxiety can lead to

Relationship anxiety disorders can cause various challenges that negatively affect both individuals and their close relationships at the present moment. Such challenges can come in the form of:

• Emotional distress: Persistent worry, doubt, and insecurity make it difficult for individuals to feel secure with their significant others. This can lead to anger, frustration, sadness, and anxiety, consuming their thoughts and emotions.
• Misinterpreting partner’s actions: Anxiety often causes individuals to misread their partner’s actions, leading to misunderstandings and feeling uneasy in the relationship.
• Excessive reassurance-seeking: Constantly seeking reassurance strains the relationship. While occasional validation is normal, repeatedly asking for it can cause distress and overwhelm the partner.
• Reduced joy and increased doubt: Anxiety creates tension that diminishes the relationship’s ability to bring joy, fostering a constant state of doubt.
• Communication breakdowns: Anxiety intensifies communication problems, leading individuals to misinterpret comments, assume negative intentions, or become defensive during discussions.
• Frequent arguments: Heightened anxiety can cause individuals to pick fights over minor issues, which damages the connection.
• Jealousy and comparison: Feeling jealous often emerges, with individuals comparing themselves to others or questioning their partner’s interactions, even when no real threat exists.

With ongoing anxiety, many individuals withdraw from daily life activities, avoiding social events or disengaging from their partner to prevent confrontation. This isolation can lead to emotional distance, causing the relationship to deteriorate. For some, past relationship traumas and past experiences heighten sensitivity to perceived threats, reinforcing the cycle of anxiety and disconnection.

How do therapists help clients overcome relationship anxiety?

As mentioned, therapists can use various approaches to help clients who feel anxious in their relationships. These methods focus on identifying root causes, improving communication, and fostering emotional resilience. Here are some ways therapists can help clients with relationship anxiety:

Cognitive behavioral therapy (CBT)

CBT helps clients recognize and challenge negative thoughts that contribute to relationship anxiety. By reframing these patterns, individuals learn healthier emotional responses when anxious about their partner or the relationship. This approach promotes practical coping strategies, allowing clients to manage intrusive thoughts and reduce anxiety’s interference with their daily processes and relationship satisfaction.

Emotionally focused therapy (EFT)

EFT focuses on strengthening emotional connections between partners. It helps clients understand attachment styles, address insecurities, and express their needs for affection and closeness. By fostering emotional safety, clients build stronger bonds with their darling, enabling healthier communication and reducing anxiety related to fears of abandonment or disconnection.

Mindfulness-based therapy

This approach teaches clients mindfulness techniques to manage daily processes and reduce overthinking. By staying present, individuals can better regulate emotions, diminish anxious moments, and handle relationship stressors more effectively. Practicing mindfulness improves awareness of anxious triggers, allowing clients to respond thoughtfully rather than impulsively to their partner’s actions.

Couples therapy

Couples therapy provides a structured space for partners to discuss relationship challenges and unresolved issues. Techniques like the Gottman Method help improve communication, rebuild trust, and address anxiety triggers. Through open dialogue, both individuals can express their concerns, understand each other’s perspectives, and foster mutual affection and emotional support.

Psychodynamic therapy

Psychodynamic therapy explores how past experiences and unresolved conflicts shape current relationship anxiety. Clients gain insight into their relational patterns and how early life events affect interactions with their partners. This deeper understanding allows clients to work through old wounds, enhancing emotional resilience and reducing anxiety’s impact on daily processes and romantic connections.

Tools you can use to help clients

Carepatron offers a variety of practical tools to assist healthcare professionals in supporting clients experiencing relationship anxiety. These resources provide structured ways to explore relationship dynamics, identify concerns, and develop effective coping strategies.

The Relationship Pros and Cons Worksheet helps clients weigh the positives and negatives of their relationships, promoting balanced decision-making. The Relationship Worksheets and Relationship Workbook offer exercises that address emotional triggers, communication patterns, and personal boundaries.

For clients struggling with setting healthy limits, the Setting Boundaries with Relationships Worksheets guide them through establishing clear boundaries to improve relationship satisfaction. The What’s Wrong with My Relationship ACT Worksheet encourages clients to examine patterns contributing to anxiety. At the same time, the Circles of Relationships Worksheet helps them evaluate the closeness and quality of their connections.

Mental health professionals can use these tools to provide clients with practical frameworks to process emotions, enhance communication, and develop healthier relationship dynamics.

Main takeaways

Relationship anxiety can significantly impact clients’ emotional well-being, daily functioning, and the quality of their close relationships. Healthcare professionals must recognize the signs and understand their causes to provide effective support. With evidence-based therapeutic approaches like CBT, EFT, mindfulness-based therapy, couples therapy, and psychodynamic therapy, clients can develop healthier thought patterns, improve communication with their partners, and build emotional resilience.

References

Doron, G., Derby, D., Szepsenwol, O., Nahaloni, E., & Moulding, R. (2016). Relationship obsessive–compulsive disorder: Interference, symptoms, and maladaptive beliefs. Frontiers in Psychiatry, 7, Article 58. https://doi.org/10.3389/fpsyt.2016.00058

Hofmann, S. G., & Gómez, A. F. (2018). Mindfulness-based interventions for anxiety and depression. Psychiatric Clinics of North America, 40(4), 739–749. https://doi.org/10.1016/j.psc.2017.08.008

National Collaborating Centre for Mental Health UK. (2013). Social anxiety disorder: Recognition, assessment and treatment. British Psychological Society. https://www.ncbi.nlm.nih.gov/books/NBK327674/

Shahar, B. (2020). New developments in emotion-focused therapy for social anxiety disorder. Journal of Clinical Medicine, 9(9), 2918. https://doi.org/10.3390/jcm9092918

Zaider, T. I., Heimberg, R. G., & Iida, M. (2010). Anxiety disorders and intimate relationships: A study of daily processes in couples. Journal of Abnormal Psychology, 119(1), 163–173. https://doi.org/10.1037/a0018473