Stress and Anxiety: Causes, Effects, and Coping Strategies

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Most people experience stress and anxiety at some point in their lives. Depending on the severity, these experiences can significantly impact one’s quality of life. While stress and anxiety share many emotional and physical symptoms, such as:

• Worry
• Tension
• Headaches
• High blood pressure
• Sleep loss

their origins are distinctly different.

An Introduction to Stress

Stress is a normal bodily response activated when an individual faces real, present danger.

Examples of real danger include:

• Life-threatening situations for you or your loved ones (e.g., illnesses, natural disasters)
• Strict deadlines at work or university
• Conflicts in personal relationships
• Job loss or salary reduction
• Relationship breakups or infidelity
• Serious health issues affecting a loved one
• Personal, national, or global crises (e.g., economic downturns)

Stress, therefore, is directly linked to external stressors that an individual encounters in their immediate environment.

An Introduction to Anxiety

Let’s delve into anxiety. If you experienced unease while reading the previous examples, it’s because you processed these scenarios in your mind. You internally projected these stressful events as if they were actually happening.

However, these events weren’t real or occurring at that moment. They existed only in your thoughts and imagination, influenced by the fear of potential future occurrences.

Anxiety is primarily an internal process—a function of our brain, mind, and thought patterns. It involves a persistent feeling of fear or dread about a stressful situation, even when the person isn’t facing that situation directly.

In anxiety, the dominant factor is worry about an anticipated future. This prediction, however, is rarely based on real evidence. Instead, it primarily stems from the individual’s worried and negative thoughts, interpretations, and imagination. In severe cases, anxiety can evolve into an anxiety disorder.

Thus, our emotional response differs between fear—when we encounter an aggressive dog—and anxiety—when we anticipate visiting a friend who owns an aggressive dog.

The Interplay of Intense Stress and Anxiety

Intense stress and anxiety often coexist. Consider a scenario where someone experiences a highly stressful situation, such as being robbed at gunpoint. In this case, the person’s life was genuinely threatened.

Following such an event, the individual may find themselves in a persistent state of anxiety and hypervigilance. This leads to an anxious and fearful anticipation of a similar future threat. Consequently, they might resort to avoidance as a coping mechanism for this traumatic experience (Roozendaal et al., 2008).

As an extreme example, the person might begin to avoid potential future threats by refusing to leave their house at night or venturing out alone after dark. While this temporarily alleviates their worries, it prevents them from learning healthier strategies to cope with their anxiety and fear.

The risk of being robbed exists regardless of personal experience. However, imagine if everyone fixated on this fear and resorted only to such avoidance tactics.

Understanding Stress

Life would be simple if all our needs were automatically met. In reality, we face numerous personal and environmental challenges. Life’s demands require adaptation. When we encounter or perceive threats to our physical or emotional well-being that exceed our coping abilities, we experience stress.

To clarify terminology:

• We refer to external demands as stressors or stress factors
• The body’s reactions to these stressors as stress
• Our efforts to manage stress as coping strategies

Factors that predispose an individual to stress

Everyone faces a unique pattern of demands to which they must adapt, as people perceive and interpret similar situations differently.

Individual characteristics that have been recognized to enhance a person’s ability to handle life’s stress include:

• Higher levels of optimism
• Greater psychological control
• Increased self-esteem
• Better social support (Declercq et al., 2007; Taylor & Stanton, 2007)

These stable factors are associated with reduced levels of distress when facing life events and more favorable health outcomes.

The amount of stress we experience early in life can also make us more sensitive to stress later on (Gillespie & Nemeroff, 2007; Lupien et al., 2009). Stress effects can be cumulative, with each stressful experience making our system more reactive.

The Self-Perpetuating Cycle of Stress

Stressful experiences can create a self-perpetuating cycle by altering how we think about or evaluate events in our lives. Studies have shown that an individual’s thought patterns may exacerbate stressful situations. This explains why people with a history of depression often perceive negative events as more stressful than others do. When you’re feeling down, you’re more likely to draw negative conclusions about events rather than viewing situations in a balanced or optimistic way.

For instance, if you’re already feeling depressed or anxious, you might interpret a friend’s cancelled appointment as a sign they don’t want to spend time with you. In reality, their own obligations might be preventing them from meeting you.

Characteristics of Stressors

Several key factors determine the severity of a stressor:

1. Its intensity
2. Its duration (chronicity)
3. Its timing
4. Its impact on our life
5. Its predictability
6. Its controllability

Stressors involving crucial aspects of an individual’s life tend to be particularly stressful for most people (Aldwin, 2007; Newsom et al., 2008). These include:

• Death of a loved one
• Divorce
• Job loss
• Serious illness
• Negative social interactions

The longer a stressor persists, the more severe its effects become. For example:

• an individual might feel trapped in a boring unrewarding job
• endure years in an unhappy conflict-ridden marriage
• or struggle with a long-term health problem or physical limitation.

Encountering multiple stressors simultaneously intensifies the overall impact. For instance, if a person:

• loses their job
• learns of their spouse’s serious illness
• and discovers their child’s arrest for drug dealing all at once

the resulting stress and anxiety will be far more severe than if these events occurred separately over time.

Research has consistently shown that unpredictable and unexpected events, especially those for which we lack established coping strategies, are likely to cause intense stress.

Lastly, uncontrollable stressors—those whose impact we can’t reduce through avoidance or other means—are particularly challenging. Both humans and animals experience more stress from unpredictable and uncontrollable stressors than from equally intense stressors that are either predictable or controllable.

Understanding Life Crises

Most of us occasionally face periods of acute (sudden and intense) stress. A crisis occurs when a stressful situation threatens to overwhelm an individual’s or group’s ability to cope. Crises—whether economic, health-related, or otherwise—are particularly stressful because they push our usual coping mechanisms beyond their limits. We can distinguish between stress and crisis as follows:

A crisis overwhelms an individual’s ability to cope, whereas stress, while challenging, doesn’t necessarily push someone to their breaking point.

The Mind-Body Connection

The link between stress and physical illnesses extends to conditions not directly related to nervous system activity, such as the common cold. This suggests that stress can compromise immune function, increasing overall susceptibility to illness.

Mounting evidence shows that the brain and immune system influence each other. An individual’s behavior and psychological state affect immune function, while the immune system impacts mental states and behavior by altering levels of neurochemicals in the blood, which in turn affect brain function.

Stress and Physical Health

Given the brain’s influence on the immune system, psychological factors play a crucial role in an individual’s health and well-being. How one views problems, faces challenges, and even one’s temperament can directly impact underlying physical health.

It’s particularly important to manage intense or long-lasting negative emotions like depression, anxiety, and anger, as they’re associated with poor health. Conversely, an optimistic outlook and the absence of negative emotions may have beneficial health consequences.

Panic, Anxiety, and Their Disorders

Anxiety is a general feeling of apprehension about potential future danger, while fear is an immediate alarm reaction to present danger.

Anxiety serves as a useful physiological reaction. Without it, we’d ignore risks and engage in potentially harmful activities. Thus, anxiety plays a crucial role in our individual and species survival.

However, when anxiety levels become excessive, they cease to be proportionate to the actual threat. At this point, anxiety becomes problematic. Anxiety disorders represent the extreme end of the anxiety spectrum in the general population.

Fear

Fear is a fundamental emotion that activates the amygdala in our brain, triggering the “fight-flight-or-freeze” response of the autonomic nervous system. This near-instantaneous reaction occurs in response to imminent threats, such as encountering a dangerous predator or having a loaded gun pointed at us.

The adaptive value of this primitive alarm response is that it enables us to escape from immediate danger. When this fear response occurs without any apparent external threat, we refer to it as a spontaneous or unexplained panic attack.

The symptoms of a panic attack closely mirror those of a fear state. However, panic attacks often include a subjective sense of impending doom, with fears of:

• death
• losing sanity
• losing control

These cognitive symptoms typically don’t manifest during ordinary fear states. Fear and panic comprise three key components:

1. Cognitive/subjective elements (e.g., “I feel terrified”)
2. Physiological reactions (such as rapid heartbeat and heavy breathing)
3. Behavioral responses (strong urge to flee or escape)

Anxiety

Unlike fear and panic, anxiety is a complex blend of unpleasant emotions and cognitive elements. It’s more future-oriented and diffuse than fear (Barlow, 1988, 2002). However, like fear, anxiety encompasses cognitive/subjective, physiological, and behavioral components.

The Various Levels of Anxiety

Cognitive/Subjective Level

Anxiety at this level includes:

• Negative mood
• Worry about potential future threats or dangers
• Self-preoccupation (e.g., with one’s health)
• A sense of inability to predict or control future threats

Physiological Level

Anxiety often induces a state of tension and chronic hyperarousal, reflecting risk assessment and readiness to confront potential danger.

“Something terrible might happen, and I’d better be prepared for it.”

While anxiety doesn’t activate the fight-or-flight response like fear does, it primes an individual for this reaction should the anticipated danger materialize.

Behavioral Level

Anxiety can foster a strong tendency to avoid potentially dangerous situations. Unlike fear, it doesn’t trigger an immediate impulse to flee. The adaptive value of anxiety lies in its ability to help us plan for and prepare against potential threats. Interestingly, mild to moderate anxiety can actually enhance learning and performance.

Learning Anxiety

While many threatening situations cause innate fear or anxiety, we also learn many of our fears and anxieties. Our basic responses to fear and anxiety are highly conditioned.

Previously neutral stimuli can become associated with hostile or unpleasant events through repeated pairings. These stimuli can then acquire the ability to provoke fear or anxiety themselves.

This preparation is a normal, adaptive process that allows us to anticipate frightening events based on reliable signals. However, this same process can sometimes lead to the development of clinically significant fears and anxieties.

Consider Maria, a young girl who witnessed her father physically abusing her mother on several occasions. After four or five such incidents, Maria began to feel anxious merely upon hearing her father’s car in the driveway at day’s end.

In situations like this, a variety of initially neutral stimuli (such as the sound of a car) can inadvertently become indicators of impending threat, thus provoking fear or anxiety. Our thoughts and mental images can also act as conditioned stimuli, capable of triggering the fear or anxiety response pattern.

Overview of Anxiety Disorders

The DSM-IV-TR identifies seven main types of anxiety disorders. While this article won’t delve deeply into all of them, it will focus on Generalized Anxiety Disorder. Here’s a brief introduction to these disorders:

1. Specific phobia
2. Social phobia
3. Panic disorder with or without agoraphobia (and agoraphobia without panic)
4. Generalized anxiety disorder
5. Obsessive-compulsive disorder
6. Acute stress disorder
7. Post-traumatic stress disorder (PTSD)

These disorders differ in the balance of fear or panic versus anxiety symptoms experienced, as well as in the specific objects or situations that trigger concern.

Key Distinctions Among Anxiety Disorders

• In specific or social phobias, individuals often experience anxiety about potentially encountering their phobic trigger (e.g., flying). When actually faced with the situation, they may experience fear or panic.
• Panic disorder is characterized by frequent panic attacks and intense anxiety about the possibility of future attacks.
• Generalized anxiety disorder primarily involves a pervasive sense of diffuse anxiety. Individuals worry about numerous potential negative outcomes. While they may occasionally experience panic attacks, these are not the main focus of their anxiety.
• In obsessive-compulsive disorder, individuals experience intense anxiety or distress from intrusive thoughts or images. They feel driven to perform compulsive, ritualistic behaviors to temporarily alleviate this anxiety.

Generalized Anxiety Disorder (GAD) According to DSM-5

Individuals with GAD typically report concerns related to minor or everyday issues. Despite recognizing these concerns as such, they struggle to control them.

The General Profile of Individuals with GAD:

• They experience a persistent state of anxious anticipation about the future
• They suffer from chronic tension
• They struggle with uncontrollable worry and pervasive distress
• They exhibit heightened vigilance for potential environmental threats
• They often resort to subtle avoidance behaviors, such as procrastination, excessive checking, or frequent calls to loved ones for reassurance
• They are prone to fatigue and irritability
• They frequently experience sleep disturbances
• Their near-constant worries leave them persistently upset and discouraged
• They struggle with concentration and often experience mental blanks

A study identified the most common areas of concern as:

• Family
• Work
• Finances
• Personal health

Decision-making is particularly challenging for these individuals. Even after making a decision, they worry incessantly—even during sleep—about potential mistakes or unforeseen circumstances that might invalidate their choice and lead to disaster. This illustrates how intense anxiety, worry, or physical symptoms can significantly impair social, occupational, or other crucial areas of functioning.

Unlike most people, they struggle to accept the futility of agonizing over outcomes beyond their control.

As two researchers in this field aptly noted:

“Consequently, they remain trapped in a deceptive world of their own thoughts and images, rarely experiencing the present moment’s potential for joy.”

Psychological Causal Factors

Psychoanalytic Approach

Freud proposed two childhood roots leading to generalized anxiety in adulthood: strict punishment and overprotection.

Neurotic and moral anxiety arise when a child faces repeated punishment for expressing or suppressing Id impulses. Consequently, the child learns to view these impulses as dangerous and requiring control. In adulthood, when parental control diminishes, the individual fears losing control over these impulses, potentially leading to undesirable actions.

Conversely, children constantly shielded from threats and frustrations may fail to develop adequate defense mechanisms for adult life. As a result, even minor threats can trigger high anxiety levels.

Wilhelm et al. (2004) found a link between childhood separation anxiety and adult generalized anxiety disorder (GAD). This supports the notion that childhood separation fears and insecure attachment contribute to long-term GAD issues. Additionally, adult marital relationships can influence GAD outcomes, with poor relationships predicting diminished treatment response (Yonkers et al., 2000).

Humanistic Approach

This model posits that GAD develops when individuals struggle to accept themselves, resulting in extreme anxiety and an inability to realize their human potential.

Rogers (1961) attributes this self-denial to childhood experiences of excessive discipline. Children exposed to criticism and strict standards may adopt others’ standards to receive conditional positive regard.

In striving to meet external standards, individuals suppress their beliefs and desires by rejecting or distorting their authentic thoughts and experiences. Despite these efforts, negative self-judgments may still surface, causing intense anxiety.

Cognitive-Behavioral Approach

Beck (1997) suggests that individuals with high generalized anxiety initially interpret a few situations as dangerous. Over time, these interpretations expand to more situations, gradually developing into generalized anxiety. Beck identified cognitive schemas underlying this disorder, including:

• “Assume situations or people are unsafe until proven otherwise”
• “It’s better to always expect the worst”

Such cognitions keep individuals constantly alert for potential threats, triggering anxiety responses.

Beck also described “emotional reasoning,” where anxious feelings in certain situations lead to cognitions that reinforce the anxiety:

“If I feel anxious, there must be a reason”

This creates a cycle of negative emotions fueling negative thoughts, which in turn intensify negative emotions.

Beck traces the origin of these cognitive biases to childhood. In adulthood, situations reminiscent of childhood threats activate these biases, which then generalize to a broader range of stimuli or situations.

Wells (1995) proposed an alternative cognitive model for GAD, emphasizing excessive worry as its main feature. He identified two types of worry:

• Type 1: Magnified versions of common worries about work, social issues, and health
• Type 2: “Meta-worry” – negative self-assessment of one’s own worries

Examples of meta-worry include:

“If I keep worrying, I’ll lose my mind”

“I’m afraid my worries are overwhelming me”

Complicating the clinical picture, individuals with GAD often hold positive beliefs about worry, such as:

“Worrying helps me cope with problems”

The Paradox of Worry in Anxiety

This paradox motivates individuals to continue worrying, despite the discomfort it causes. Worry thus functions as both a source of stress and a coping mechanism.

People with generalized anxiety disorder (GAD) often attempt to avoid worrying about situations. However, this proves challenging due to the wide array of stimuli that can trigger their anxiety.

Common coping strategies used to reduce worry include:

• Seeking reassurance
• Distraction
• Attempts to control thoughts

Ironically, the last strategy may actually intensify worry. Dugas, Marchand, and Ladouceur (2005) identified four key elements of GAD:

• Intolerance of uncertainty
• Positive beliefs about worry
• Poor problem-solving orientation
• Cognitive avoidance

Perceptions of the Uncontrollable and Unpredictable

Uncontrollable and unpredictable events are significantly more stressful than controlled, predictable ones, unsurprisingly generating more fear and anxiety.

Researchers hypothesize that individuals with GAD may have a history of experiencing many significant life events as unpredictable or uncontrollable.

For instance, having a boss or spouse with unpredictable mood swings or outbursts over trivial matters can keep a person in a chronic state of anxiety.

While the unpredictable and uncontrollable events in GAD are generally less severe than those in PTSD, evidence suggests that individuals with GAD may be more likely to have a history of childhood trauma compared to those with other anxiety disorders (Borkovec et al., 2004).

People with GAD demonstrate a lower tolerance for uncertainty, suggesting they are particularly troubled by their inability to predict the future—a universal human limitation. Some findings indicate that greater intolerance of uncertainty correlates with more severe GAD.

This intolerance of uncertainty, coupled with tension and hypervigilance—a constant alertness for threat—may stem from a lack of environmental safety signals.

Consider two scenarios:

1. An individual experiences predictable stressors:

E.g., “On Mondays, the boss is always in a bad mood and particularly critical“

This person can anticipate when something unpleasant is likely to occur (Mondays at work) and feel safe when the signal is absent (Tuesday through Friday).

1. An individual faces unpredictable or unmarked stressors:

E.g., “The boss is in a bad mood and particularly critical on random days of the week“

This person fails to develop safety signals indicating when it’s appropriate to relax and feel secure. Such uncertainty can lead to chronic anxiety.

This relative lack of safety signals may explain why individuals with GAD feel constantly tense and alert for potential threats (Rapee, 2001).

The Central Role of Worry and Its Perceived Benefits

Worry is now recognized as the core feature of Generalized Anxiety Disorder (GAD) and has been extensively researched in recent years. Borkovec and colleagues (1994; 2004; 2006) studied individuals with GAD to understand their perceived benefits of worrying and its actual functions. Common beliefs about the advantages of worrying include:

• Preventing disaster
  • “Worrying decreases the likelihood of the feared event occurring.”
• Avoiding deeper emotional issues
  • “Worrying about various concerns distracts me from more emotionally charged issues I’d rather not confront.”
• Coping and preparation
  • “Worrying about an anticipated negative event helps me prepare for it.”

Evidence suggests that for some individuals with GAD, these positive beliefs about worry play a crucial role in maintaining high anxiety levels, particularly in the early stages of GAD development.

Recent findings on worry’s functions shed light on why it’s self-perpetuating. Interestingly, when individuals with GAD worry, their emotional and physiological reactions to unpleasant images are suppressed.

This suppression of unpleasant emotional and physiological responses can reinforce the worrying process, increasing its likelihood of recurrence. Worry not only suppresses the physiological response but also isolates the individual from fully experiencing or processing the concerning issue. Full processing is necessary for anxiety extinction to occur. Consequently, the threatening nature of the worry topic persists.

The Negative Consequences of Worry

Worry is far from pleasant. It can actually heighten one’s sense of danger and anxiety by conjuring up a myriad of potential catastrophic outcomes (McLaughlin et al., 2007).

Ironically, attempts to control thoughts and worry often backfire. There’s substantial evidence that such efforts can lead to an increase in intrusive thoughts and a stronger feeling that we can’t control them. These intrusive thoughts, in turn, can become new catalysts for worry. Consequently, individuals with GAD may find themselves trapped in a vicious cycle, developing a pervasive sense of uncontrollable worry.

As mentioned earlier, feeling a lack of control is closely linked to increased anxiety. This creates a self-perpetuating cycle of anxiety, worry, and intrusive thoughts.

Cognitive Biases Towards Threatening Information

People with GAD not only experience frequent frightening thoughts but also process information with a distinct bias. Research consistently shows that anxious individuals tend to focus disproportionately on threatening signals.

This heightened vigilance for threats can occur remarkably early in the information processing stage—even before the individual becomes consciously aware of the information.

For those already experiencing anxiety, this automatic focus on environmental threats appears to sustain or even intensify their anxiety. Recent studies provide compelling evidence that these attentional biases play a causal role in anxiety, not just a symptomatic one.

Generally, anxious individuals are much more likely to interpret ambiguous information as threatening. This tendency to negatively interpret ambiguous situations has been shown to exacerbate anxiety across various contexts.

Conclusion

Life is replete with stimuli and external factors that can prove stressful for individuals. Humans face numerous challenges—some manageable, others more daunting—with some potentially threatening their well-being or that of their loved ones.

Stress, anxiety, and fear are normal reactions to perceived threats. While unpleasant, these emotions have played a crucial role in our survival for millennia.

Stress is the body’s immediate response to present danger. It automatically activates the amygdala—our brain’s “control center” for emotions, particularly fear—even before we’re consciously aware of the threat.

This activation triggers the fight-or-flight response, preparing the body to take action against perceived danger.

Anxiety, on the other hand, is a more internal, mental process. It involves worrying about future situations based on past experiences. Rooted in our thoughts, imagination, interpretations, and expectations, anxiety can be diffuse and, in severe cases, develop into an anxiety disorder.

In response, individuals attempt to cope by preparing for potential threats, seeking a sense of control—even over unpredictable or uncontrollable situations.

Several psychosocial factors contribute to the onset and maintenance of generalized anxiety. Experiences with unpredictable or uncontrollable events can create vulnerability to stress and anxiety, promoting current and future anxiety.

Many believe worry serves important functions and can be reinforced by reducing physiological arousal. However, worry tends to perpetuate itself, creating a sense of uncontrollability that further reinforces anxiety. Additionally, anxiety is associated with an automatic bias towards threatening information and biased interpretations of ambiguous situations.

References

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