Psychiatrist

Jenn is the mother of three young children and also holds down a full-time job as a paralegal at a family law firm. Her husband also works full time, and his job requires frequent travel away from home, which makes caring for their kids challenging at times. Nonetheless, Jenn told me that everything was going well for her despite her busy schedule.

“My kids are healthy, and I like spending time with them,” she said at our first session. “My husband is wonderful. I like my job helping lower-income people get legal support and deal with complex family situations. It feels like meaningful, important work.”

Then Jenn took a deep breath, and a troubled look crept over her face. “But I’m having all this… anxiety, she said. “I’m feeling a lot of panic, including difficulty catching my breath and heart palpitations. I’m even having mood swings. Sometimes I get really angry and irritated and then I get afraid I can’t control myself, which makes me feel really anxious about everything.” She paused, but I sensed that she had more to say so I simply nodded.

“On top of that,” she went on, “I’m having really uncomfortable physical sensations of anxiety. I feel a lot of muscle tension. My neck is particularly painful, although I also feel tension in my shoulders and my back. When I wake up in the morning, I have this dread that I’m not going to be able to make it through the day. And I often feel uncomfortable for an hour or more before bedtime because I’m thinking about everything that I have to do the next day. I’m feeling so overwhelmed and anxious, and I don’t understand why.”

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After waiting for her to finish, I smiled and said, “Jenn, I have good news for you and bad news for you.”

“Please,” she said, “can I have the good news first?”

“The good news is that you’re not anxious,” I said.

“What?” she said with an incredulous look. “What do you mean I’m not anxious?”

“What you’re describing,” I said, “is not really anxiety. The bad news is that what you’re describing is stress. You’re so stressed out that you’ve become a bundle of nerves.”

“Well, what’s the difference between anxiety and stress?”

“That’s a great question,” I said, and I proceeded to explain by describing anxiety. (When people have a fear reaction that is disproportionate to the actual level of threat, that’s anxiety.)

“Great,” she said. “So what’s stress?”

“When people have an excess of life demands over and above the resources they have to meet those demands, that creates stress,” I responded.

Balancing demands and resources

We all have a limited number of resources in various domains, such as time, money, emotional strength, and social capital of friendships. All of these facilitate our ability to respond to the demands of life events.

When the demands placed on us outstrip those resources, we experience stress. In a simple analogy: If you are 10 minutes away from an appointment that starts in five minutes, you will feel stress for (at least) five minutes. Similarly, if you have monthly financial demands that exceed your income and savings, you’ll experience prolonged levels of stress to the extent that you are short on cash.

Oftentimes, demands and resources are less tangible than time or money. For example, emotional demands can pile up and exceed our emotional abilities, resulting in significant stress. If you have to deal with a complicated family situation—say, a difficult parent or a child with an eating disorder—that can make it virtually impossible to handle other life stressors. In fact, for some people, even having a minor personal altercation at work can be a catastrophic stressor that throws them for an emotional loop for several days.

If you’re not tuned in to your stress level—the extent to which your life demands exceed your resources—you may feel completely depleted and not even realize what is happening. When this happens, stress can beget more stress very quickly. Indeed, stress can have real-world consequences, affecting our moods, physical sensations, productivity, decision-making, and ultimately our happiness and well-being.

When I explained all of this to Jenn, she still looked a bit baffled. “But I’m having heart palpitations,” she said. “Isn’t that a sign of a panic attack?”

I explained that yes, her symptoms were similar to panic, but they were not coming from anxiety. I pointed out to Jenn that her elevated heart rate and constricted breathing were not being caused by something she didn’t need to fear, which meant she wasn’t anxious. Instead, Jenn was genuinely overwhelmed by not having the resources to handle the stressors in her life.

“Does your ‘panic’ go up and down based on how afraid you are?” I asked Jenn. “For example, do you have concerns that you may suddenly have a heart attack and die when you have panic-like sensations, even though you have no known medical problems?”

Jenn acknowledged that, no, she didn’t worry about things like that. I then asked whether her “panicky” sensations rose or fell depending on how many demands were being made on her and how few resources she had.

“Yes!” she said. “That’s exactly what’s going on. Like the other day, I was at work when my son’s school called and said he was running a fever and could I come and pick him up. Well, we were short-staffed at work, and I was in the middle of helping a family that had just been evicted find a place to stay. My husband was traveling out of state on business, so I started calling friends I trusted to pick up my son, but I couldn’t reach anyone. After the third fruitless call, I started hyperventilating!”

Jenn paused to take a deep breath, almost as if she was afraid that she’d start hyperventilating right there in my office. “In fact, that was the day I called you,” she said. “I was starting to feel panic, and that’s when I started searching the web for anxiety clinics.”

“I’m glad you called and came in,” I said. “If only so I can clarify that you are not suffering from an anxiety disorder. You are overstressed, which is giving you a moderate level of anxiety-like feelings. But there’s a difference between that and panic disorder or another form of anxiety. In truth, it’s not bad news to learn that you’re stressed since it is fairly easy to deal with.”

How to handle stress more effectively

I went on to explain to Jenn that the way stress makes us feel overwhelmed follows an almost mathematical formula: the amount of demand being placed on your system (for example, having challenges at work, dealing with a sick child at school, emotional strain), minus the number of resources you have to draw on (for example, time, family, friends, equanimity) equals the level of stress you will encounter at any given moment.

I also explained that stress has a devious way of multiplying itself unless we remain aware of it and make concrete efforts to manage it. When people feel stressed out by change-of-life events, such as getting married, getting divorced, having a child, losing a loved one, work changes such as a promotion or getting laid off, or being diagnosed with a medical condition, they tend to focus on everything but managing their feelings. In this sense, our natural tendency is to push the feelings of stress away because thinking about them makes us feel overwhelmed.

However, as a result of this, we become less adept at managing our demands, and our stress increases over time. In addition, life-change events often occur together—being laid off from work tends to come with financial changes, for example. This can make it more difficult to get sufficient sleep, which can cause edginess and lead to altercations, which can greatly deplete our emotional resources.

Most people who experience stress say that their symptoms happened “out of the blue.” In reality, though, stress is rarely out of the blue. It usually builds gradually. Our demands start to increase, and our resources become depleted over time until we feel so uncomfortable that we cannot avoid recognizing our stress. Therefore, being aware of stress at low levels to prevent it from mounting is the best medicine since this enables us to balance our resources and demands and make sure the latter never greatly exceeds the former.

From Thriving With Anxiety: 9 Tools To Make Your Anxiety Work for You by David H. Rosmarin, Ph.D. Copyright © 2023 by David H. Rosmarin, Ph.D. Used by permission of Harper Horizon

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