Can therapy help with anxiety from childhood emotional neglect?

You can spend a long time using self-care strategies and mindfulness apps, but if you don't understand where your anxiety stems from, they simply do not get to the root cause of it.

“I do everything I can to soothe my anxiety, but I'm still feeling the same way.” This is one reason why people might seek therapy. Therapy gives you the space to explore what may actually be driving the anxiety, rather than only focusing on how to calm it down when it shows up.

Now let me be clear: I'm not saying not to use mindfulness or engage with self-care strategies (as long as they are actually helpful), but it may be helpful to reframe the idea that they can cure your anxiety.

How can childhood emotional neglect affect anxiety?

Let me explain. For example, for some people, childhood emotional neglect may contribute to anxiety and relationship difficulties, such as the need to seek approval, validation or reassurance, struggling to set boundaries, or losing yourself in one-sided friendships or romantic relationships. Sound familiar?

As children, we survive through the relationships with our caregivers. But if, for whatever reason, you felt you needed to perform, change, or be a certain way to be accepted by them, or the care felt inconsistent, it taught you to adapt for survival. Every time you successfully secured the attachment, your body would feel relief. Your body learnt that if I adapt, they stay, and I'm safe.

This is why you may be good at reading the room, identifying others' needs and meeting them. You may even be known as the 'strong one' of the friends group or the 'go-to' person when someone is in crisis. The problem is, this childhood survival mechanism may persist into adulthood. You are still adapting to make things work instead of learning when something or someone simply isn't good for you and walking away. Your priority is still to preserve connection no matter what, even if you consciously don't realise it. 

People-pleasing, hypervigilance and relationships

The struggle with uncertainty in early dating, for instance, can be your anxiety showing up. You may worry that you said something wrong or that they may be upset with you, rehearse what to say in advance to make sure you don't upset them, struggle to disappoint others or uphold boundaries, or overly focus on how others perceive you.

It's hypervigilance, to be more precise. It's you trying to make sure you are safe. It's not a matter of you being 'an anxious person', a people pleaser, or someone 'overly sensitive'. Your nervous system may simply be doing what it is familiar with, and the mechanism itself may keep you anxious. You chase that relief because it's the only thing you know that makes you feel somewhat OK.

The problem is that the relief is temporary, conditional, and dependent on other people. That puts you in a very vulnerable position and may negatively affect your interpersonal relationships. But why?

Because on top of just struggling with anxiety, you are now making relational decisions based on a survival mechanism, not based on whether someone is actually good for you. You are surviving through others' perceptions of you, which is not something you can fully control, not really, no matter how well you may have been able to adapt in the past.

And your body knows it, which is why it might be constantly worried about others. Anything that feels out of control is something anxiety will hold on to, so ironically, the one thing you try to do for yourself to feel secure is what destabilises you, because you're constantly checking, performing, adapting, and making sure you are securing other people's approval. That's not emotional safety with others, and it can make it impossible for your body to truly let your guard down and relax.

On top of that, it can also deprive you of really getting to know yourself. This is the deep disconnect. You chase validation; you need others, but you also don't really know who you'd be without them. So you're not just anxious, you're also anxious in your relationships. This is why, until you address the childhood wounds and learn how to feel safe within yourself instead of outsourcing it, this pattern may keep playing out.

How can therapy help?

The good news is that therapy can help with exactly this.

Therapy allows you to explore whether the anxiety you experience is connected to people-pleasing behaviours, trace back when that started, and potentially connect it to your childhood experiences. A psychologist or therapist can help you make sense of this with you and find a way forward.

This may look like slowly challenging some of your current behaviours and finding healthier alternatives, so you can start relating to yourself and others differently. You may learn to set boundaries without backtracking, tolerate disappointing someone, express what you actually need, and recognise when you are trying to preserve a connection that simply isn't good for you.

If that brings up the question, “But I have no idea who I am outside of this pattern,” don't worry. Exploring who you are outside of this survival mechanism and finally discovering your own needs is a common part of therapy when you're working through these difficulties.

And the outcome of all of this is that your anxiety can start to calm down, because the more comfortable you become with who you are, the less you need the hypervigilance that was there to keep you connected to people and secure their approval.