What’s the difference between stress and anxiety? Here’s how to cope with both

Dr Meg Arroll shares the difference between stress and anxiety, as well as coping mechanisms to help reduce any anxious thoughts and feelings…

Words: Meg Arroll | Images: Shutterstock

Are we born to be stressed or anxious? What’s the difference and does it even matter?

Anxiety and stress are the most common difficulties I see in my practice. People experiencing both anxiety and chronic stress come to me after they have travelled down many psychological treatment and self-help paths, as well as visiting their GP and sometimes specialist consultants. For some, these therapies help to a point or in certain situations, for others, they arrive at my office with little hope that there might be something that can substantially help free them from the debilitating effects of anxiety and stress.

For quite a few people, the difficulty arises because we tend to conflate and use the terms “stress” and “anxiety” interchangeably. However, it is my belief that if we separate the innate, physiological stress response from the cognitive and perceptual aspects of anxiety, we will be at a massive advantage when it comes to managing these issues.

Stress or anxiety?

The fundamental difference between stress and anxiety has to do with our place in time: the stress response is about a present threat and/or is triggered by an association, whereas anxiety is about thoughts based on the future (worry) or the past (rumination). The confusion arises because we can imagine a whole host of scenarios – dangerous and safe. This is how both worry and rumination, which are forms of anxious thinking, trigger the stress response – our minds and bodies don’t know the difference between a present and a perceived threat, and, as such, thinking about the past and future negatively can also activate the fight-flight-or-freeze stress response. Actually, let me correct that – our minds and bodies don’t know the difference until we train them to see what is stress, and what is anxiety.

It can be helpful to ask yourself the following question to find out whether you’re experiencing stress or whether it’s anxiety: ‘Where do I find myself most – in the past, present or future?’

Understanding the subtle differences between stress and anxiety is vital, as different methods work for stress as opposed to anxiety. It can be tricky to know which is which because the symptoms are similar – a present threat, associations, rumination and worry all trigger the physiological stress response in a deep part of the brain called the amygdala, which is all about instincts and is somewhat automatic, rather than analytical.

However, anxiety is about higher-level cognition and thought patterns, so it has to be processed through the cortex before these thoughts can trickle down to the amygdala.

One way to figure out whether you’re stressed or anxious is by considering if how you feel is linked to a current problem or to a hypothetical situation. Ask yourself: ‘Is there something I can do about this right now?’ If the answer is yes, you are most likely dealing with a present stressor, for example a demanding customer.

The curse of Busy-itis

Just as some people can have depressive symptoms but still seem to function at a high level, the same can be said of those with anxiety. People with high-functioning anxiety are often top of the class, high achievers and individuals who make you think: ‘How do they do it all?’ The root may be what I call Tiny Traumas, or Tiny Ts, fuelling what I also call the ‘Curse of Busy-itis’, in which we constantly busy ourselves to distract from anxious thoughts.

Do you find it uncomfortable to do nothing, to simply be? You may jump from one task to another mindlessly, feeling like a voyeur on your own life. If this sounds familiar, high-functioning anxiety and Busy-itis may be at play – check in with yourself and ask:

• Do you find it hard to relax?

• Does your mind immediately move to the next task as soon as or even before the present task is finished?

• Do you find it difficult to focus on one thing at a time?
• Would other people describe you as a “high achiever” and/or “good under pressure”?
• Do you fear letting yourself down (or, even worse, others) if you don’t keep on top of everything?
• Are you usually early, or the first person to arrive at a meeting or social gathering – and the last to leave as you volunteer to clean up?
• From the outside, do you appear calm and in control, but on the inside your mind is racing a mile a minute?
• Would you say you tend to overthink, overdo and overprepare?

If you answer yes to most of the above, anxiety is most likely running your life, so it pays to bring in some awareness to first identify whether this is familiar.

Controlling the stress response

This method is a way to train yourself not to immediately react to the stress response and, in time, to control it. Here we are encouraged to be curious about the physical symptoms of the stress response, so that we won’t feel the overwhelming desire to escape these physiological sensations when they occur. With practice, this technique will allow you to control the scary signs your body gives you when the stress response is in full swing, such as a racing heart, dizziness and trembling voice.

• Sit or lie down in a comfortable position and imagine the situation that triggers your stress response. Bring to mind details: where are you? What is your position in the space? In your mind, look up, down, left and right.
• As you start to feel the sensations of the stress response, know that you are OK. If the sensations haven’t started, try to remember what this triggering situation felt like before.
• Now, scan your body, noticing what the sensations feel like in different areas. Sit with these sensations for a moment, even if they feel uncomfortable. If one sensation is very strong, get curious about it – explore it. Think in terms of, ‘this is fascinating, I wonder what will come next?’.
• Describe the feeling in your own words; e.g. ‘this heart is beating as quickly as a rabbit’s’.
• Be curious also about any thoughts you’re having; for instance, ‘I really want to escape from this now!’ Rather than pushing physical feelings aside, stay with the experience – allow it to be uncomfortable yet interesting.
• Next, accept this is your body attempting to keep you safe, and thank your body for taking care of you.
• You can move on to another sensation now or bring the exercise to a conclusion by reassuring your body that it’s OK, you’ve got it from here and can create a more adaptive response to this trigger.

Like any technique, the more this is practised the easier it becomes – and over time you will notice that your stress responses change and weaken.

Dealing with anxious thought patterns

Find out if your anxiety is based on faulty thinking, then try Dr Arroll’s three-step process to break the negative thoughts…

Anxiety, whether past-based rumination or future-focused worry, stems from thoughts within the brain’s higher-functioning cortex, so it’s useful to use mental strategies to overcome the negative thought patterns feeding the anxiety, rather than purely relying on in-the-moment stress response management. To start, it’s helpful to identify what types of negative thought patterns – often called “cognitive distortions” in psychology – you may be playing in your mind. Here are some of the most common categories:

• Catastrophising: If I do badly in this job interview, I won’t get the job and my fiancé will lose all respect for me and leave me.
• Mind-reading: I can see that my date thinks I’m boring just by the look on their face.
• Fortune-telling: I know my meeting will just go to pot, I can just tell.
• Negative focusing: Even though my line manager gave me a mixture of feedback in my performance review, I can only see the criticisms of my work.
• Discounting the positive: Yeah, I passed and got my driver’s licence, but it was just luck that the traffic wasn’t bad today.
• Magnification: My situation is so awful, much worse than everyone else’s.
• Minimisation: I managed to buy a house, but most people do that as well, it’s not such a big deal.
• Low frustration tolerance: I just can’t bear this any longer!
• Personalisation: No one’s talking to me at this party – it must be the way I look.
• Labelling: My colleague just ignored me – she’s such a rude person.
• Blaming: It’s my parents’ fault that I haven’t moved out yet.
• All-or-nothing thinking: If I don’t ace all of my tests, I’m simply a failure.
• Overgeneralising: My relationship broke up so I must be completely unlovable.

Next, use my three-step ASK process, which is based on the Socratic Disputation method of challenging negative and maladaptive thought patterns. You can use this simple process to challenge all the above examples of thoughts that feed anxiety and other cognitive distortions that initiate or maintain anxious feelings. So, now “ASK” yourself:

• A is for Accurate: Is this thought accurate? If so, what’s the hard evidence for this cognition?
• S is for Sensible: Is this thought sensible? Does it make logical sense objectively?
• K is for Kind: Is this thought kind? If not, what function does this way of thinking have?

Finally, ask yourself: What would your life look like if you didn’t have this thought?

Now, write down your answers as a record of your thoughts. Thought records can be an extremely helpful way to challenge these skewed cognitions and act as a document to review your progress in overcoming anxiety.

For more great advice on stress, anxiety and trauma, check out Tiny Traumas: When you don’t know what’s wrong, but nothing feels quite right, by Meg Arroll (£16.99, Harper Collins), on sale now.