Assertiveness

Overview

Assertiveness is a communication style where you express your thoughts, feelings, and needs clearly and respectfully, without being passive or aggressive. It means standing up for yourself while also respecting others. Being assertive helps you build healthy relationships, reduce stress, and feel more confident in daily life.

Many people struggle to be assertive in certain situations. It is very common to feel nervous about speaking up, saying no, or sharing your opinion. You are not alone.

Assertiveness difficulties can affect anyone, regardless of age, gender, or background. It often shows up at work, in family relationships, or with friends. Some people may be assertive in one area of life but not in others.

Symptoms

Common symptoms

• Having difficulty saying no to requests or demands
• Feeling guilty or anxious about expressing your own needs
• Avoiding conflict even when your rights are being ignored
• Agreeing with others just to keep the peace
• Feeling resentful or taken advantage of after a conversation
• Speaking quietly, avoiding eye contact, or apologizing excessively
• Exploding in anger or frustration after holding things in

Symptoms in children

• Difficulty asking for help in school or with homework
• Letting other children make decisions for them
• Not speaking up when they are treated unfairly
• Crying, withdrawing, or having tantrums when they cannot express themselves

Symptoms in older adults

• Not questioning a doctor or family member about their own care
• Feeling ignored in conversations or decisions about their health
• Worrying that being assertive will seem rude or disrespectful
• Accepting unfair treatment from caregivers or family to avoid conflict

Causes

Main causes

• Being taught early in life that keeping quiet and pleasing others is more important than your own needs
• Fear of conflict or rejection
• Low self-esteem or lack of confidence
• Cultural or family rules that discourage speaking up, especially for certain groups
• Stress, anxiety, or depression, which can make it harder to find the right words

Risk factors

• Growing up in a strict or overly controlling environment
• Having a history of bullying, abuse, or neglect
• Living with chronic stress, anxiety, or depression
• Working in a highly demanding or hierarchical workplace
• Being in relationships where your feelings are often dismissed

When to see a doctor

See a doctor urgently if:

• If being non-assertive is causing severe anxiety, panic attacks, or suicidal thoughts, seek urgent care.
• If you are in an abusive relationship where speaking up feels dangerous, contact a healthcare provider or support service as soon as possible.

Book a routine appointment if:

• If difficulty with assertiveness is harming your relationships, job, or health
• If you regularly feel tense, resentful, or exhausted after interactions with others
• If you want help building communication skills and boosting self-confidence

Diagnosis

There is no medical test for assertiveness. A doctor or mental health professional will ask about your feelings, thoughts, and behaviors in different situations. They may also ask about any mental health symptoms like anxiety or depression that could be making communication harder.

Tests that may be done

• No blood tests or scans are needed.
• A healthcare professional may use short questionnaires to check for anxiety, depression, or stress.
• You may be asked to describe specific situations where you struggle to speak up.

What to expect at your appointment

Your appointment may feel like a supportive conversation, not a formal examination. The health professional will listen without judgment and help you understand patterns in how you communicate. They may talk with you about whether talking therapy or self-guided practice would help.

Treatment

The main treatment for assertiveness difficulties is building skills through practice, guidance, and sometimes talking therapy. There are no medicines that directly teach assertiveness, but treating underlying anxiety or depression can make it easier to be assertive.

Self-care at home

• Practice saying no in low-risk situations, like declining an extra request at work.
• Use 'I' statements: 'I feel overwhelmed when you ask me at the last minute.'
• Take a pause before answering, so you can choose your words rather than reacting.
• Role-play tricky conversations with a trusted friend or even by yourself in front of a mirror.
• Start small, such as giving a compliment or asking for a small favour.

Medical treatments

A doctor may suggest talking therapy, such as cognitive behavioural therapy (CBT), to help you identify unhelpful beliefs and practice new communication styles. Some people benefit from group assertiveness training or coaching. If anxiety or depression is contributing, a doctor may discuss treatment options with you, but they will never push you into anything.

When is surgery considered?

Not relevant. Assertiveness is a communication skill, not a medical condition that requires surgery.

Living with this condition

Living with assertiveness means being kind to yourself as you practise. Some days will feel harder than others. You will learn to notice situations that trigger passive or aggressive responses, and gradually choose a more balanced approach.

Lifestyle tips

• Set regular time for relaxation or hobbies you enjoy.
• Get enough sleep, as tiredness makes it harder to stay calm and clear-headed.
• Limit alcohol and avoid using it as a crutch to feel braver in difficult conversations.
• Keep a journal of times when you spoke up or wanted to, to track your progress.

Diet and exercise

Regular physical activity, even a short daily walk, can help lower stress and boost your mood. Eating balanced meals and staying hydrated helps keep your energy and mood steady, which makes it easier to think clearly in challenging moments.

Mental health and emotional wellbeing

Learning to be assertive can reduce anxiety, improve self-esteem, and lower feelings of anger or resentment. It can also help you build healthier relationships and feel more in control of your life. On the flip side, ongoing difficulty with assertiveness can contribute to stress, sadness, and burnout.

Prevention

Assertiveness is not a disease, so it is not about prevention. But you can build healthy communication habits early by practising respectful, honest conversations. Parents and carers can help children by encouraging them to express feelings and make age-appropriate choices.

Vaccines

Not applicable.

Screening programmes

Not applicable. However, if you notice persistent anxiety or low mood, talking to a healthcare professional early can prevent these feelings from worsening.

Complications

If left untreated

• Ongoing stress, anxiety, or depression
• Relationship conflict with partners, family, or colleagues
• Being taken advantage of at work or in personal life
• Bottling up emotions until they explode in anger or tears
• Low self-esteem and a sense of losing control

Long-term outlook

The outlook is very good. Assertiveness is a skill that anyone can learn at any age, and even small improvements can make a big difference in how you feel and how others treat you. With practice and the right support, you can build confidence and improve your relationships.

Find support

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