“Anxiety” and “Stress”

Recently I worked with a client who wanted help with her anxiety. She worked full time, was in school, had a family and had significant crises to contend with. She had a history of anxiety and panic attacks, so wanted support as soon as possible. After hearing an overview from her I said, “You have a tremendous amount of stressors in your life. I don’t think this is anxiety; I think this is stress.” She was relieved at the distinction.

But what is the difference between stress and anxiety? Don’t we treat them the same way?

Stress is a natural and necessary response to triggers or demands. Stress is often the impetus for us to take action. We feel stress mounting as we approach a deadline, and we work harder to complete the work. The baby’s cry is getting shriller, and our stress prompts us to soothe her and figure out what is wrong. Stress has a cause and a reason.

Anxiety doesn’t need a trigger or demand. When we experience anxiety, we can’t point to a cause in the way we can with stress. We feel restless, scared, worried, or panicked; but for no good reason. Anxiety is like the background noise of fear, and it gets louder as out thoughts feed it. We begin to conjure scenarios and outcomes that increase our anxiety, and soon it feels like a runaway train.

Why is this distinction helpful?

If we can discern stress from anxiety, we can know how to better treat it. Some treatment interventions are the same for both, but not all.

For clients who are experiencing stress, I start by clarifying the three legs of treatment:

• Minimize exposure to stressors- We look at ways that stressors can be reduced, such as delegating, avoiding new commitments, or reducing contact with someone.
• Manage stress- We consider interventions that can help manage the onslaught of stressors, such as improved time management, cognitive-behavioral interventions, and relaxation efforts.
• Bolster your baseline- We practice techniques that help reduce the physiological response to stress, so that the client can have a calmer baseline from which to process new stressors. These techniques include breathing exercises, visualization, and muscle relaxation.

For clients who are experiencing anxiety, the approach is different. While calming activities are part of the treatment, mindfulness, grounding techniques and body awareness take precedent.

To treat anxiety, I start with the following interventions:

• Immediate physiological changes- Anxiety in the body perpetuates anxiety in the mind, and it becomes a vicious cycle. To intervene immediately in anxiety, I help clients become aware of their body’s responses and begin to alter them. This includes practices such as progressive muscle relaxation or the 4-7-8 breath.
• Thought-stopping- Anxiety makes thoughts spiral, and one of the biggest complaints I get from anxious clients is that they are ruminating or can’t get these intrusive thoughts out of their head. We practice thought-stopping techniques, such as the “stop sign method” and replacing with alternate thoughts.
• Alter sensory input- Anxiety is often sensitive to sensory input. Increased noise, busy visuals, physical contact and other stimuli can increase anxiety significantly. Often times this causes a client to either have a panic attack, or “zone out” in a way that is close to dissociation. I teach clients the 5-5-5 grounding technique if they have experienced this “zoning out.” For all clients with anxiety, we review sensory input, and look at ways to reduce unnecessary stimuli. This might mean using earplugs, coaching children to do a hand signal instead of tapping them for attention, or turning off background noise like a television.

Stress is something that can be addressed in some very concrete ways with good results. Anxiety is a little more insidious, and requires environment changes, mindfulness, and preventative interventions to best keep it at bay.