Stress Awareness Month: Differences between Stress and Anxiety

What’s the difference between stress and anxiety?

By Sue Jackson

The title for this article is probably the question I get asked the most, so I thought it would be a good topic for Pituitary Life. Good mental health is an important part of our overall health and well-being and is just as important as our physical health. Mental health refers to our emotional and psychological wellbeing - it is about how we think, feel and behave. Being able to handle normal levels of stress, leading an independent and full life and being able to "bounce back" from difficult situations or life events, are all signs of good mental health.

As a way of exploring this, I’d like to start with Dr Paul Gilbert’s work on understanding how we feel and what we do. We have many brain systems, but, according to Dr Gilbert, we have three that are particularly important in terms of how we feel and what we do. My drawing of Dr Gilbert’s model is shown below, and the explanation of the brain systems follows after.

Stress Graphic 

  1. Threat system (also known as the “flight and flight” system). This part of your brain is very important in terms of keeping you safe. Your threat system will come on in response to stressors, e.g., if you are hungry, thirsty, tired, not feeling well, and/or in a situation where you feel unsafe or threatened. Once it is on, you can’t access the two other brain systems. Effectively, you have to do what your threat system tells you to do. The feelings most commonly associated with the threat system are anxiety, anger and depression. The threat system is exhausting to have to live with (anger and anxiety take a lot of energy), the bouts of lowered mood (depression) can be thought of as your body’s way of forcing you to rest, for example, saving energy by reducing your interest in the world around you.
  2. Heart space (what Dr Gilbert calls the “affiliation system”). This part of your brain is very important in terms of relationships both with yourself (your self-esteem) and with others. This is the part of your brain that helps you to feel connected to others, and can help you to feel safe. If you’re feeling generally contented and just pottering about, then your heart space will be on. It’s the bit of your brain that does self-soothing, i.e. it helps you to calm down after you’ve been stressed by something. It also comes on if you do something nice for someone, or if they do something nice for you. Your heart space will not come on if you feel unloved, unappreciated, misunderstood, and if there is no-one to help you to acknowledge and celebrate your successes.
  3. Head space – this is the bit of your brain that does learning, and problem-solving, and it’s associated with feelings of drive, excitement and vitality (feeling “alive”). It’s the bit that is curious about the world and that wants to explore. If you know any workaholics, this is the bit of their brain that they use the most. Too much of this system coupled with poor self-care and/or self-esteem and the threat system will come on (in the form of a bout of low mood) as a safety valve to encourage you to pull your horns in and rest.

 

In an ideal world, the system works like this: you’d spend a fair bit of time in your heart space, at peace with yourself, the world and everyone in it. When something stressful happens (assuming that it’s not life-threatening to you or your loved ones in which case your threat system comes on straight away), your head space would come on, “this is interesting, what do we need to do here?” So during the day you’d move between your heart and head spaces.

 

But we don’t live in an ideal world. And you have, or someone you care about has, a pituitary condition. I’m not going to get into the medical/physiological aspects of stress, anxiety and depression in relation to a pituitary condition. I’m only going to talk about the psychological aspects of those things. I tend to think of stress as being situation-specific and immediate, for example, you’re about to go out of the door and you can’t find your car keys. Stress affects our thoughts, feelings, behaviour and body. So if you can’t find your keys, and you’re in a hurry, you might find that your temperature fluctuates, or you might feel slightly sweaty and sick. You might start to feel upset and a bit panicky, you start frantically looking for your keys whilst trying to remember where you saw them last. Anyone daft enough to ask you what you’re doing will likely get short shrift (possibly including some expletives). I tend to think of worry (the cognitive component of anxiety) as thoughts becoming a source of stress in their own right (as shown in the illustration). So in the example of the car keys, worry (or anxiety) would be having random thoughts about your keys during the day at times when you don’t actually need them, possibly associated with the need to keep checking that you know where they are. It can be confusing because stress and anxiety can feel the same (anxiety affects thoughts, feelings, behaviour and body too) although lots of people say that the feeling of anxiety is far more intense and exhausting.

 Stress V Anxiety

You might be stressed if you’re in a consultation with a healthcare professional, and you don’t understand what they’re telling you. You might be anxious and worried if you have an appointment coming up and you’re having a lot of “what if” thoughts. Having a pituitary condition can change the way we experience our feelings, and I think a lot of healthcare professionals may not understand just how intensely people with a pituitary condition can experience their feelings of stress and anxiety.

 

Stress can be thought of as existing along a continuum, with normal everyday stressors at one end (for example, being too hot/cold, hungry, thirsty, tired, losing the keys), through to traumatic stress where you witness something shocking or difficult to comprehend (e.g. witnessing a car crash where someone dies), through to PTSD (Post Traumatic Stress Disorder). Traumatic stress is like PTSD, but rather than requiring professional help it will gradually self-correct over a period of weeks. Traumatic stress can occur in patients who are very shocked by their diagnosis, or treatment, it may resolve over time, but if the experience is felt severely enough, and no-one checks the psychological aspects of treatment, it can become PTSD.

 

Here is the list of the commonest symptoms associated with PTSD, but not all of these symptoms need to be present for a diagnosis of PTSD to be made.

  • Flashbacks of the traumatic event, which may feel like you are back there and re-experiencing the event. 
  • Intrusive memories, where thoughts about the event pop into mind during the day without being actively recalled by the person. 
  • Dreams or nightmares about the traumatic events. 
  • Feeling distressed when you come across something similar, and it may feel like your whole body is responding. 
  • Actively avoiding thoughts, feelings, conversations, activities, places or people that remind you of the trauma.
  • Incomplete memories for all or part of the event.
  • Feeling detached from other people and an inability to think of yourself living in the future.
  • Hyper-alert, looking out for anything that may be of danger.  You may also have an exaggerated startle response if someone or something makes you jump.

 

A traumatic experience leaves the threat system on, making it very difficult to access the other brain systems outlined in Gilbert’s model outlined at the start of this article. The threat system feelings can be very intense, and this section details the possible feelings associated with each one:

 

  1. Depression. After a traumatic incident, individuals can often feel depressed, down and hopeless.  They find they have little interest or pleasure in doing things.  They may find it difficult to sleep because of traumatic memories, or they may find that they sleep too much.  They may feel tired and have little energy.  They may eat too much or too little.  People who are depressed often feel bad about themselves, feeling they are a failure and have let people down.  Often they have trouble concentrating, and may find it difficult to read a book or watch TV.  They may find that they are slowed down, or the opposite restless and unable to keep still.  Most of all people who are depressed may feel suicidal and wish they were dead, often to get away from their memories.
  2. Anxiety. After traumatic events, the brain goes into hyper-alert to look out for danger in order to protect you.  This becomes generalized into everyday life and soon even everyday things may seem scary.  Some people experience extreme anxiety in the form of panic attacks.  In the severest form, some people become so anxious that they can no longer leave their home. This is called agoraphobia, or fear of fear.
  3. Anger. Irritability and anger can be symptoms of post-traumatic stress.  People may find they are more irritable mainly because they find they cannot cope with stimuli such as noise, too many people, or too much to do.  This is because the brain is so hyper-aroused by the traumatic memories that it feels like it cannot cope with anything more.  It feels overwhelmed.  Intense anger is a way of keeping away from the traumatic memories.  Being angry prevents a person from feeling the intense anxiety and helplessness of the situation.  While this works for the person in a limited fashion, it prevents them from confronting the feared situation and also prevents the fear reducing in a safe environment.

 

PTSD is best worked through with a professional rather than trying to attempt a self-help route. Below are some ideas:

 

  1. Some people find that counselling helps them. For others talking through the traumatic event just makes them more traumatised than they already are.
  2. Cognitive-behavioural therapy (CBT) can work very well for PTSD. It works on adjusting the thinking patterns that are helping to maintain the depression, hyper-arousal and anger and helps people move on.
  3. Emotion skills training can also help individuals with PTSD, this approach teaches individuals how to stay with the emotions associated with the event, rather than avoiding them, thus helping the body to process the memories and the emotions and reducing the impact of them. There are several different types of emotion skills training: EMDR (Eye movement desensitization and re-processing); EFT (Emotional Freedom Technique); the Sedona Method.
  4. Some individuals find that mindfulness works well for them. Mindfulness is a meditation technique where you learn to live completely in the present moment by training the mind to be able to notice, but not get involved in, thoughts and memories as they pass through the mind.

 

I often get asked if it’s possible for a family member to be traumatised by hearing a diagnosis, or seeing what their loved one is going through. Sadly, the answer is yes, and it happens quite regularly. However, since the focus is often on the person who needs the treatment, family members can feel like they are being inappropriately self-obsessed if they say that they need help, too. Whoever is having the symptoms, and whatever their cause, it’s worth seeking assistance if you’re having difficulties handling normal levels of stress, find your life is increasingly restricted by strong feelings of anxiety, and don’t feel able to "bounce back" from difficult situations or life events.