Supporting People with Anxiety: A Guide for NDIS Support Workers
This guide brings together current research and the practical experience we have gained supporting people with anxiety across South East Queensland. Our hope is that by sharing what we have learned, more individuals, families and support workers can benefit from support that is respectful, person-centred and evidence-informed.
Registered NDIS Provider · Gold Coast, Logan, Ipswich & Brisbane
Anxiety is a different and valid way of experiencing the world. Effective support is not about eliminating someone's feelings or pushing them to "just get over it." It is about understanding how a person's nervous system responds to their environment, reducing unnecessary friction in daily life, building a genuinely trusted relationship, and creating conditions in which they can pursue the goals that matter to them.
At Hearts In Action, these principles guide the way we support people every day. This guide combines evidence from current anxiety research with practical insights from our work alongside people with anxiety and their families. We hope it encourages thoughtful, compassionate support that helps people build on their strengths, develop confidence and live life on their own terms.
A note before you read on
Every person is unique, including every person who experiences anxiety. The patterns in this guide come from research, but no two people feel anxiety in the same way, and no single approach here will suit everyone.
Use this guide as a way to build understanding while remaining open, curious and responsive to the person you are supporting. Their experiences, preferences, strengths and communication should always guide the support they receive.
The Relationship Is the Intervention
If there is one finding that cuts across major studies of anxiety treatment, it is this: the quality of the relationship between a helper and the person they support is one of the strongest predictors of positive outcomes. A systematic review of lived experience research found that effective anxiety treatment depends less on any single protocol and more on creating conditions in which people feel emotionally held, cognitively understood, and able to participate actively in their own care (Lindeberg et al., 2026). People engage more fully with coping strategies, digital programs and therapy when they feel safe, respected and genuinely understood.
Be a consistent, continuous presence rather than one of a rotating cast of workers. Qualitative research with people living with generalized anxiety disorder found that being treated as a genuine partner in decisions about their own care, with their values and preferences respected rather than overridden, was central to how safe and respected participants felt in that care (Hurtado et al., 2020). That same principle applies to the day-to-day relationship with a support worker: for many, anxiety has been minimised as "just stress" or "worrying too much" for years, so a support worker who is reliable, non-judgemental and encouraging can radically change that experience. It's the same everyday consistency our personal care and daily living support is built around.
It's worth remembering
Be someone they can rely on. Keep your word, arrive when you say you will, and follow up when you say you will. When anxiety is part of someone's life, even small ruptures in trust can confirm their fear that people are unsafe or unpredictable, and it may take time to repair that.
Understand What Anxiety Actually Is
Anxiety is not simply being nervous or overthinking. Clinically, anxiety disorders involve patterns of persistent fear, worry and bodily arousal strong enough to interfere with everyday life, relationships, health care and work. Some people experience constant, free-floating worry about many areas of life; others feel sudden, intense panic in specific situations, or overwhelming fear of social judgment.
Anxiety is also a whole-body experience, not just a mental one. Qualitative, arts-based research exploring how young people experience anxiety found that headaches, stomach pain, chest pain, muscle aches, a racing heart and breathing difficulty were described as central parts of the anxiety itself, not separate or secondary symptoms (Woodgate et al., 2020). These reactions are driven by the nervous system's threat-detection processes, which can become highly sensitive after years of stress, and are not signs of weakness or "being dramatic."
It's worth remembering
Anxiety is physiological, not moral. When someone freezes, avoids, or feels "overwhelmed by nothing," those reactions are features of how their nervous system is responding, not choices they are making. Treat the person as someone living with a nervous system on high alert, not as someone failing to cope.
Embrace Person-Centred, Autonomy-First Thinking
Research on anxiety care consistently shows that people do better when they are active participants in their own support. A qualitative study of adults living with generalized anxiety disorder, titled around participants' own words, "I have anxiety, but I have values and preferences," found that treatment decision-making and being seen as more than a diagnosis were central concerns for people navigating care for their anxiety (Hurtado et al., 2020). Being invited into decisions, about goals, pacing, environments and strategies, helps to restore a sense of agency that anxiety often erodes.
Support that respects autonomy does not mean leaving someone to manage everything alone. It means making plans together, explaining why a strategy might help, and adjusting based on feedback rather than insisting that a manual knows best. When people feel heard and informed, they are more likely to practice coping skills between sessions and to stay engaged when things feel difficult.
It's worth remembering
Ask what the person wants from the session before you decide what to do. Some people will know exactly what they need; others will need ideas and encouragement, but the starting point is always their priorities, not the plan on the sheet.
Recognise the Hidden Costs: Avoidance, Hypervigilance and Masking
Many people with anxiety spend significant energy managing how they appear to others. They push themselves through situations while masking panic, rehearsing conversations so they sound "confident," or silently enduring distress until they can leave. From the outside, they may look calm and capable; on the inside, they are exhausted and braced for failure or judgment.
Avoidance and safety behaviours, leaving early, always sitting near exits, repeatedly checking and seeking reassurance, are common short-term coping tools that can carry long-term costs. These strategies reduce immediate fear but can reinforce the belief that situations are dangerous, and they can contribute to shame when people feel they are "failing" at tasks others find straightforward. Masking distress ("I'm fine") also makes it harder for workers to see how much support is truly needed.
It's worth remembering
Don't assume that someone who seems fine is coping easily. They may be burning through all their energy to appear okay. Create an environment where the person doesn't feel they have to perform: accept pauses, honest "I'm anxious" statements and small steps rather than pushing for big leaps.
Emotional and Physical Dysregulation Are Core, Not Character Flaws
For many people, anxiety is as much a physical experience as an emotional one. In arts-based qualitative research, young people living with anxiety described headaches, stomach pain, chest pain and a level of physical exhaustion that participants described as wearing the body out, as core parts of their anxiety, not separate conditions (Woodgate et al., 2020). From the outside, reactions can appear disproportionate: intense distress over an upcoming appointment, or days of rumination after a brief comment or unanswered message. These patterns reflect how the brain and body process threat and social evaluation, rather than someone being "over-sensitive" or "dramatic." When emotional and physical intensity is treated as a character flaw, people often internalise shame and delay seeking support.
It's worth remembering
Don't read emotional reactions through a neurotypical lens. What looks excessive from the outside often makes sense given a nervous system wired for high alert. Be clear, concrete and kind in your feedback, and avoid vague phrases that invite worst-case interpretations.
Structure and Predictability Are Supports, Not Controls
Structure can dramatically reduce daily friction for people living with anxiety. Predictable routines, clear plans and agreed-upon steps give the nervous system fewer surprises to react to. A large network meta-analysis of psychotherapies for generalized anxiety disorder found that cognitive-behavioural therapy, which typically breaks tasks down, plans exposures carefully and practices coping skills in a structured way, outperformed usual care and showed the most consistent long-term benefit of the approaches studied (Papola et al., 2024).
However, the most effective structure is co-created, not imposed. Research with people living with generalized anxiety disorder found that being genuinely involved in decisions about their own coping and treatment mattered more than being handed a plan and simply told to "face their fears" (Hurtado et al., 2020). In everyday support work, that same principle plays out in how appointments, phone calls, transport or social events get planned, together, rather than dictated, the same everyday participation our community access support is built around. In adulthood, when childhood scaffolding disappears, many people are building healthy routines for the first time, and that process works best when someone is genuinely alongside them.
It's worth remembering
Help the person build their own system, not yours. Ask what has worked in the past and what has failed and why, then try things together and adjust. A reminder, schedule or exposure plan the person chose and helped design will work far better than one you impose.
Evidence-Based Strategies You Can Support
You are not a therapist, but you can support the use of evidence-based strategies in everyday life. Research gives us several approaches that are both effective and adaptable to NDIS support work.
Cognitive-behavioural strategies: A systematic review and network meta-analysis of psychotherapies for generalized anxiety disorder found that CBT was associated with the strongest short- and long-term effectiveness of the approaches studied, and may represent a first-line treatment (Papola et al., 2024). Support workers can reinforce these skills by using the same language, helping plan small experiments (e.g., trying a short shopping visit instead of avoiding shops entirely), and celebrating effort rather than perfection.
Digital and internet-delivered CBT: Randomized controlled trials of a digital CBT program (Daylight) for generalized anxiety disorder show meaningful reductions in anxiety, worry and sleep difficulty, both in a feasibility study (Miller et al., 2021) and in a larger trial where 71% of users achieved remission of GAD by ten-week follow-up, compared with 33% of the waitlist control group (Carl et al., 2020). A systematic review of internet-delivered CBT in routine care settings found it to be effective for both depression and anxiety outside of tightly controlled trial conditions (Etzelmueller et al., 2020), and an updated umbrella review of internet-delivered CBT reports moderate-to-large effects across a broad range of anxiety and affective disorders (Käll et al., 2024). Support workers can help by scheduling time, troubleshooting access and checking in about how the person finds the program.
Relaxation, breathing and body-based skills: Relaxation therapy was one of the approaches shown to outperform usual care for generalized anxiety disorder (Papola et al., 2024), and is often experienced as immediately helpful alongside other strategies. Practising them together in low-stress moments makes it easier for the person to use them when anxiety spikes. That kind of everyday skill-building, practised patiently and side by side, is exactly what our capacity building support is for.
Mindfulness and acceptance-based approaches: Third-wave CBTs that focus on acceptance, mindfulness and values, such as acceptance and commitment therapy, also showed effectiveness for generalized anxiety disorder compared with usual care (Papola et al., 2024). Support workers can reinforce these themes by helping people identify what matters to them and taking small steps in those directions, even when anxiety is present.
It's worth remembering
Your role is to make it easier for people to use the strategies they already have or are learning, not to diagnose or prescribe. Ask what tools they've been given by therapists, clinicians or apps, and explore together how those can be woven into ordinary days.
Support Identity, Not Just Symptoms
People are not their anxiety. Many have spent years being told they are "weak," "too sensitive" or "negative," and may have internalised these labels. A systematic review of lived experience of therapy for anxiety found that feeling respected, believed and seen as more than a diagnosis is central to positive change, and that effective support depends on people feeling emotionally held and able to participate actively in their own healing (Lindeberg et al., 2026).
Connecting with others who understand anxiety and having professionals who recognise strengths, empathy, care for others, preparedness, attention to detail, can directly contribute to rebuilding a more confident, authentic sense of self. For some, managing anxiety has built resilience, creativity in problem-solving and a deep capacity for supporting others in distress. These are real strengths, not side notes.
It's worth remembering
Notice what the person does well and name it genuinely. Many people with anxiety have spent years hearing only about what they avoid or how distressed they are. Paying consistent attention to strengths plays an active role in rebuilding the confidence that fear and misunderstanding quietly dismantle.
Address the Training Gap
Inadequate training around anxiety is a structural issue that directly limits support quality. Qualitative research capturing the direct experiences of people living with generalized anxiety disorder found that navigating healthcare for their anxiety, and being properly understood within it, was a recurring and significant concern for participants (Hurtado et al., 2020). When professionals treat anxiety as "just nerves," offer generic advice, or fail to understand how avoidance and physical symptoms shape daily life, these experiences can increase shame and make people reluctant to ask for help again.
Anxiety-specific knowledge, including recognising different anxiety presentations, understanding how trauma and neurodivergence intersect with anxiety, and knowing what evidence-based support looks like, is not a bonus; it is the baseline that makes support useful. Most generic disability or mental health training modules touch only briefly on anxiety, and rarely from a neurodiversity-affirming perspective.
It's worth remembering
Seek out anxiety-specific training and resources on your own initiative. The more clearly you understand what someone is actually managing, physiologically, emotionally and socially, the more naturally your support adapts to what they need.
Families and Networks Are Partners, Not Peripheral
For many people with anxiety, family members and close friends carry a substantial informal support load: reminding, accompanying them to appointments, doing "hard" tasks, and advocating when systems feel overwhelming. These roles can be supportive but also exhausting and tense if misunderstandings and stigma are present.
Where appropriate and with the participant's consent, keeping families informed and involved in what strategies are being used, such as graded exposure, digital CBT or breathing practices, can help everyone reinforce the same approach instead of inadvertently working against it. A brief, clear update can reduce household tension and help everyone provide support that fits together. You are not working in isolation, and neither is the family.
It's worth remembering
Families are often carrying more than they show, and are rarely working from a place of full information. A short, honest check-in goes further than either shutting them out or leaving them to guess.
References
- Carl, J. R., Miller, C. B., Henry, A. L., Davis, M. L., Stott, R., Smits, J. A. J., Emsley, R., Gu, J., Shin, O., Otto, M. W., Craske, M. G., Saunders, K. E. A., Goodwin, G. M., & Espie, C. A. (2020). Efficacy of digital cognitive behavioral therapy for moderate-to-severe symptoms of generalized anxiety disorder: A randomized controlled trial. Depression and Anxiety, 37(12), 1168–1178. https://doi.org/10.1002/da.23079
- Etzelmueller, A., Vis, C., Karyotaki, E., Baumeister, H., Titov, N., Berking, M., Cuijpers, P., Riper, H., & Ebert, D. D. (2020). Effects of internet-based cognitive behavioral therapy in routine care for adults in treatment for depression and anxiety: Systematic review and meta-analysis. Journal of Medical Internet Research, 22(8), e18100. https://doi.org/10.2196/18100
- Hurtado, M. M., Villena, A., Vega, A., Amor, G., Gómez, C., & Morales-Asencio, J. M. (2020). "I have anxiety, but I have values and preferences": Experiences of users with generalized anxiety disorder: A qualitative study. International Journal of Mental Health Nursing, 29(3), 521–530. https://doi.org/10.1111/inm.12690
- Käll, A., Biliunaite, I., & Andersson, G. (2024). Internet-delivered cognitive behaviour therapy for affective disorders, anxiety disorders and somatic conditions: An updated systematic umbrella review. Digital Health, 10, Article 20552076241287643. https://doi.org/10.1177/20552076241287643
- Lindeberg, T., Patmisari, E., & McLaren, H. (2026). Lived experiences of therapy for anxiety: A systematic review of qualitative studies using a realist-informed approach. Journal of Contextual Behavioral Science, 40, Article 101001. https://doi.org/10.1016/j.jcbs.2026.101001
- Miller, C. B., Gu, J., Henry, A. L., Davis, M. L., Espie, C. A., Stott, R., Heinz, A. J., Bentley, K. H., Goodwin, G. M., Gorman, B. S., Craske, M. G., & Carl, J. R. (2021). Feasibility and efficacy of a digital CBT intervention for symptoms of generalized anxiety disorder: A randomized multiple-baseline study. Journal of Behavior Therapy and Experimental Psychiatry, 70, Article 101609. https://doi.org/10.1016/j.jbtep.2020.101609
- Papola, D., Miguel, C., Mazzaglia, M., Franco, P., Tedeschi, F., Romero, S. A., Patel, A. R., Ostuzzi, G., Gastaldon, C., Karyotaki, E., Harrer, M., Purgato, M., Sijbrandij, M., Patel, V., Furukawa, T. A., Cuijpers, P., & Barbui, C. (2024). Psychotherapies for generalized anxiety disorder in adults: A systematic review and network meta-analysis of randomized clinical trials. JAMA Psychiatry, 81(3), 250–259. https://doi.org/10.1001/jamapsychiatry.2023.3971
- Woodgate, R. L., Tennent, P., Barriage, S., & Legras, N. (2020). The lived experience of anxiety and the many facets of pain: A qualitative, arts-based approach. Canadian Journal of Pain, 4(3), 6–18. https://doi.org/10.1080/24740527.2020.1720501