How Stress and Anxiety are Linked and How to Control Anxiety by Managing Stress

We all feel anxious sometimes – a bit worried or concerned about that important client meeting, or that doctors appointment – or that important conversation we have to have with our child.

This feeling of anxiousness – the nerves or worry we feel about something with an uncertain outcome – is perfectly normal.

While feelings of anxiousness and stress are perfectly normal when we feel under pressure, these feelings will typically disappear once the situation or event that is causing the stress is over.

Anxiety, however, goes way beyond this.

Our chest may feel tight, with our heart racing; our breathing can become short and rapid – feeling almost breathless; we’ll feel on edge, dizzy or lightheaded which may also further develop into a full-blown panic attack – with trembling, an inability to breathe, a feeling of intense fear and dread – an inability to function normally for the duration of the attack.

It may happen during the day – or the middle of the night, and typically, you won’t know what has brought it on.

However, with the research clearly linking chronic stress as a primary cause of anxiety, researchers have shown, that by controlling the physiological effects brought on by chronic stress, you are also able to better control both the frequency of onset and severity of symptoms of anxiety and panic attacks.

1.  Stress is not necessarily a bad thing

How is anxiety different to stress?

We often hear of the terms “stress” and “anxiety” used interchangeably – however, while they are related and have many of the same symptoms, stress and anxiety are different conditions.

Stress is our body’s physiological reaction to a particular situation (a stressor) – such as an argument with our family, financial pressures, or a difficult project deadline at work.   It comes from a thought or situation that makes you feel angry, nervous, frustrated or even anxious.

In a stressful or potentially dangerous situation, our body releases a flood of stress hormones into our body, to help our body protect and defend itself against the stress situation – this physiological process, is known as our body’s “stress response”, or sometimes called the “fight or flight” response.

With stress, we can identify the problem (or problems), that are causing us to feel “stressed”.

Anxiety, however, is apprehension over a coming event.  This causes us to feel unease or fear, brought on as we doubt our ability to cope with the event.

Immediate symptoms of anxiety, include sweating, tension, and increased heart rate, with more severe symptoms being chest pains, dizziness, shortness of breath and panic attacks.

Some level of anxiety is a normal human reaction – we all experience it.  If you are facing an interview or you have to give a public presentation, you might feel a little anxious even though you are fully prepared.

However, in some people, the feeling of stress continues after the cause of the stress has gone, and anxiety can also occur in people without an identifiable root cause.

This long term anxiety is known as “Generalized Anxiety Disorder” (GAD) and is one of the effects that can result from exposure to long term, chronic stress.

Sufferers of anxiety experience constant worry, fear or apprehension, with feelings of impending doom.

Anxiety itself can go beyond these physical symptoms, and can develop into phobias; social anxiety with an inability to interact and be around people; obsessive compulsive disorder, or even post-traumatic stress disorder.

How is anxiety different to depression?

While anxiety and depression are different conditions, and they have their own causes and emotional and behavioral symptoms, they also share some of the same causes and symptoms.

It’s also common for someone to suffer both anxiety and depression at the same time – with more than 50% of those with depression, also experiencing symptoms of anxiety.  There is also a causal relationship between anxiety and depression, where the onset of anxiety, can lead to the development of depression.  In fact, having an anxiety disorder, is the most significant single predictor of a person suffering depression.

Current research suggests that anxiety treatment should begin with first treating the depression, as the symptoms of depression can trigger anxiety.  So reducing the symptoms of depression, will often lead to reduced feelings of anxiety,

The Stress => Anxiety => Depression cycle

While not a fixed rule, you can think of the relationship between the three elements as a cycle:

stress can lead to anxiety => anxiety can lead to depression

where, if you are unable to manage and dissolve the feelings of stress that you feel, then you can find yourself living in worry of the stress returning.

You may then find that these feelings of worry, can become a persistent anxiety and this long term anxiety, can then develop further into depression.

2. What are Panic Attacks?

A panic attack is a sudden feeling of intense fear or dread, as if something terrible is going to happen, although there is no danger present.

They can include symptoms including heart palpitations, or increased heart rate, sweating, shortness of breath or feeling like you are choking; shaking, numbness and tingling, chest pressure or pain, nausea, dizziness or feeling weak.

These symptoms and signs, are also often accompanied by feelings of emotional upset and distress, and an inability to calm yourself down; feeling that you need to escape or that you are in grave danger; or feeling that things are surreal or feeling detached.

While some of the symptoms of a panic attack are similar to other anxiety symptoms, it is the intensity and duration of the symptoms that makes a panic attack different.

While the physical signs and symptoms of panic attacks may be mistaken for serious medical problems such as a heart attack, although panic attacks typically leave you feeling tired or exhausted, they are not physically harmful or dangerous.

The signs and symptoms of a panic attack develop very quickly and usually at their worst within 10 minutes, and most last for about 20 to 30 minutes, although this can vary from a few seconds to many hours.

Panic attacks are surprisingly common in the community, with up to 40% of the population suffering a panic attack at some time in their lives.

For those who suffer, they can occur several times a day, or only once every few years, and they can come on at any time, even while feeling calm and relaxed and can even occur during sleep, waking you up during the attack.

What is Panic Disorder?

Panic disorder, is an anxiety disorder, where panic attacks occur on a regular and unexpected basis, and the worry about having another attack, or the implications of a panic attack, causes significant changes in behavior.

What is the cause of Panic Disorder?

There is no single cause for panic disorder, although exposure to long-term chronic stress, is a primary risk factor.

In addition to exposure to long term chronic stress, other factors include:

  • Family history – where studies have shown there are genetic influences on panic disorder, with a hereditary link between generations and a family history of depression and anxiety disorders.
  • Medical conditions – where patients with medical conditions, including cardiac disease, diabetes, respiratory disorders such as asthma, thyroid problems such as hyperthyroidism, chronic pain or irritable bowel syndrome, and alcohol withdrawal, or drug abuse or withdrawal, are known to also suffer from panic disorder.

It’s interesting to note the common thread of “stress” with each of these risk factors – where long term stress, both has a causal link with these medical conditions, plus, patients suffering any long term, significant illness are also subject themselves to significant levels of stress.

Another example of the “cycle-of-stress” as a cause of physiological damage.

How to treat and prevent panic attacks?

For sufferers of panic attacks, there are two key considerations:

  1.   minimizing (or even eliminating) their occurrence, and secondly;
  2.  minimizing the effect of the symptoms of the panic attacks when they occur.

Research has been carried out to test the cortisol levels of panic disorder patients immediately before and after a panic attack episode, with a view to suggesting that it is the response to a specific incident that brings on the panic attack.

Across a range of published findings, approximately 2/3 of the findings showed elevated levels of cortisol in patients with panic disorder.

Specific research has identified that patients with panic attacks inherit a particularly sensitive central nervous system fear mechanism and both heritable factors and stressful life events are responsible for the onset of panic disorder.

The broader research findings consistently point to the ongoing/long term exposure to chronic stress and the activation of the body’s Stress Engine, as a consistent causal factor for panic disorder.

In most people, treatment can be very effective in reducing both the severity of symptoms and the frequency of occurrence of panic attacks.

While medication and psychotherapy are common treatment strategies, the use of stress management and specific breath control techniques, have been highly successful at eliminating or reducing the occurrence of the attacks, while also reducing the severity of symptoms.

Breathing Techniques as a Treatment

A symptom of the majority of panic attacks is rapid breathing or hyperventilation, which acts to multiply the feelings of panic and the sensations of a pounding heart and dizziness.

In addition, further research has shown that many of those suffering panic attacks, have a permanently different breathing pattern to those who don’t suffer.

Given this, a technique/system was developed and then implemented in clinical trials at Stanford University, where panic attack and panic disorder patients, were taught how to adjust their breathing patterns.

The end result of the trials, were that these breathing techniques were successful in reducing panic attacks, with 68% of patients having no further panic attacks, 12 months after the treatment.

Similar trials also show significant reduction in symptoms, in 80+% of participants.

Meditation based Stress Management as Treatment

We’ve seen the research that identifies exposure to long term stress as one cause of panic disorder, so given this, our ability to lower the impact of stress on our body, is key to reducing the onset and frequency of panic attacks.

Specific research into the effectiveness of meditation based stress management compared with anxiety disorder education program, in patients with anxiety disorder, has shown clear results.

Compared with the education group, the meditation based stress management group showed significant improvement in scores on all anxiety scales.

Further research also showed a mindfulness based program used in conjunction with pharmaceutical drugs as a treatment for patients with panic disorder, clearly showed a significant decrease in the panic attack frequency and symptom severity, when compared with patients taking medication only.

3. What is long term Anxiety or Generalized Anxiety Disorder?

Some level of anxiety is a normal human reaction – we all experience it.

If you are facing an interview or you have to give a public presentation, you might feel a little anxious even though you are fully prepared.

Also like stress, anxiety helps us deal with the “stressful situation”, by activating the fight or flight response, activating the sympathetic nervous system and releasing the stress hormones, to help us perform at our peak.

However, in some people, the feeling of stress continues after the cause of the stress has gone.

This long term anxiety is known as “Generalized Anxiety Disorder” (GAD) and is one of the effects that can result from exposure to long term, chronic stress.

Sufferers of anxiety experience constant worry, fear or apprehension, with feelings of impending doom.

In some situations, anxiety sufferers often take one specific cause of stress (such as the stress of driving in peak hour traffic), and amplify its significance to them, such that it can makes a person feel afraid to a point that they can’t face something.

With other examples, anxiety can also occur in people without an identifiable root cause.

People with long term anxiety, sufferer from conditions similar to those with exposure to long term, chronic stress.  This includes diabetes, hypertension, heart diseases, obesity and others including gastritis, nausea, headaches, fatigue and muscle aches – all as a result of the long term exposure to the stress hormones that are released into our body, when we are under stress.

However, anxiety itself can go beyond these physical symptoms, and can develop into phobias, including social anxiety and an inability to interact and be around people; obsessive compulsive disorder, or even post-traumatic stress disorder.

While the feelings of stress normally go once the situations causing the stress have disappeared, anxiety can often persist for much longer and be more difficult to treat.

4. What is the cause of General Anxiety Disorder?

The exact cause of General Anxiety Disorder is not fully known.

But a number of different factors, including brain chemistry, genetics and environmental stresses, appear to be causes and/or risk factors. .

Brain chemistry/ nerve cell pathway damage

There is evidence to show that long term exposure to chronic stress, can damage the brain – more specifically, the nerve cell pathways that connect particular brain regions involved in thinking and emotion.

Chemicals called neurotransmitters, transmit information from one nerve cell to the next through these nerve cell pathways.  If these pathways that connect these areas of the brain together, do not run efficiently, symptoms related to anxiety or depression may result.

Genetics

Some research suggests that the tendency to develop Generalized Anxiety Disorder (GAD), may increase if there is a previous family history of GAD, meaning that GAD may be passed on between generations.

Long term exposure to chronic stress:

Chronic stress is the result of exposure to highly stressful situations that are ongoing over many years, such as relationship problems/divorce, traumatic family situations, long term financial stress, serious chronic illness, early childhood experiences or even difficult workplace environments.

The evidence points to this also being a contributing cause to GAD.  GAD may also become worse during periods of higher stress.

In addition, the use of and withdrawing from the use of addictive substances, such as illicit drugs, alcohol and nicotine can also worsen anxiety.

5. What happens if I suspect that I or someone close is suffering from depression or anxiety?

Because depression and anxiety are mental illnesses, they can be a lot harder to understand than, say, other physical illness.

People who are depressed or who have anxiety may be at risk of suicide or self-harm, and if so, they need urgent help.

If you or someone you know needs support, talk to a doctor or another health professional about getting appropriate treatment.

So, if you know someone struggling with anxiety or depression, there are things that you can do, to support them.

  • Let the person know if you’ve noticed a change in their behavior.
  • Spend time talking with the person about their experiences and let them know that you’re there to listen without being judgmental.
  • Suggest the person see a doctor or health professional and/or help them to make an appointment.
  • Offer to go with the person to the doctor or health professional.
  • Help the person to find information about anxiety and depression from a website or library.
  • Encourage the person to try to get enough sleep, exercise and eat healthy food.
  • Discourage the person from using alcohol or other drugs to feel better.
  • Encourage friends and family members to invite the person out and keep in touch, but don’t pressure the person to participate in activities.
  • Encourage the person to face their fears with support from their doctor/psychologist.

It would be unhelpful to:

  • put pressure on them by telling them to “snap out of it” or “get their act together”
  • stay away or avoid them
  • tell them they just need to stay busy or get out more
  • pressure them to party more or wipe out how they’re feeling with drugs and alcohol.

Important Disclaimer

Please note, that the OnCalm course is different from taking medication or seeing a clinician.  It should never replace any medication or treatment program prescribed by your doctor, unless agreed to by your doctor.

This information is not intended to replace the advice of a doctor. OnCalm disclaims any liability for the decisions you make based on this information.

References

  1. Shin LM, Liberzon I. The Neurocircuitry of Fear, Stress, and Anxiety Disorders. Neuropsychopharmacology. 2010;35(1):169-191. doi:10.1038/npp.2009.83.
  2. Ethan Moitra, Ingrid Dyck, Courtney Beard, Andri S. Bjornsson, Nicholas J. Sibrava, Risa B. Weisberg, Martin B. Keller,    Impact of stressful life events on the course of panic disorder in adults, Journal of Affective Disorders, Volume 134, Issues 1–3, 2011,
  3. Moore TJ, Mattison DR. Adult Utilization of Psychiatric Drugs and Differences by Sex, Age, and Race. JAMA Intern Med. 2017;177(2):1-2. doi:10.1001/jamainternmed.2016.7507
  4. Kantor, E. D., Rehm, C. D., Haas, J. S., Chan, A. T., & Giovannucci, E. L. (2015). Trends in Prescription Drug Use Among Adults in the United States From 1999-2012. JAMA, 314(17), 1818-1831
  5. Amen, D. G., and Routh, L. Healing Anxiety and Depression.  Putnam, New York, 2003.D, Currie, K.  Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence.   Med J Aust 2009; 190 (7): 54-60.
  6. Boudarene M1, Legros JJ, Timsit-Berthier M., Study of the stress response: role of anxiety, cortisol and DHEAs, Encephale. 2002 Mar-Apr;28(2):139-46.
  7. Jakuszkowiak-Wojten K1, Landowski J, Wiglusz MS, Cubała WJ., Cortisol as an indicator of hypothalmic-pitituary-adrenal axis dysregulation in patients with panic disorder: a literature review., Psychiatr Danub. 2015 Sep;27 Suppl 1:S445-51.
  8. Gorman J, Kent J, Sullivan G, Coplan: Neuroanatomical hypothesis of panic disorder, revised. Am J Psychiatry 2000; 157:493-505.
  9. Papp, LA, Martinez, JM, Klein, DF et al. (1997). Respiratory psychophysiology of panic disorder: Three respiratory challenges in 98 subjects. American Journal of Psychiatry, 154, 1557-1565.
  10. Meuret AE, et al. Feedback of end-tidal pCO2 as a therapeutic approach for panic disorder. Journal of Psychiatric Research 2008;42;560-8.
  11. Sang Hyuk Lee, Seung Chan Ahn, Yu Jin Lee, Tae Kyu Choi, Ki Hwan Yook, Shin Young Suh, Effectiveness of a meditation-based stress management program as an adjunct to pharmacotherapy in patients with anxiety disorder, In Journal of Psychosomatic Research, Volume 62, Issue 2, 2007, Pages 189-195
  12. Borah Kim, Sang-Hyuk Lee, Yong Woo Kim, Tai Kiu Choi, Keunyoung Yook, Shin Young Suh, Sung Joon Cho, Ki-Hwan Yook, Effectiveness of a mindfulness-based cognitive therapy program as an adjunct to pharmacotherapy in patients with panic disorder, In Journal of Anxiety Disorders, Volume 24, Issue 6, 2010, Pages 590-595
  13. Shin LM, Liberzon I. The Neurocircuitry of Fear, Stress, and Anxiety Disorders. Neuropsychopharmacology. 2010;35(1):169-191. doi:10.1038/npp.2009.83.
  14. Ethan Moitra, Ingrid Dyck, Courtney Beard, Andri S. Bjornsson, Nicholas J. Sibrava, Risa B. Weisberg, Martin B. Keller,    Impact of stressful life events on the course of panic disorder in adults, Journal of Affective Disorders, Volume 134, Issues 1–3, 2011,

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