Imagine you have a time machine. Set the dial to take you back 50,000 years. Welcome! You’re in a prehistoric time. As you begin a leisurely stroll, you hear rustling in the trees — it’s a grizzly bear. Suddenly, your body and mind react. Your heartbeat quickens, your breath becomes shallow, and you become laser focused on survival. This is what anxiety feels like, and anxiety did its job. You reacted appropriately and made it safely back to the time machine.
As with most human tendencies, anxiety was influenced by natural selection, meaning that it got stronger because it helped keep people — and their genes — alive. However, in modern times, most situations that trigger anxious feelings are not life threatening. If we replace the grizzly bear with climate change, economic hardship, social media, or family concerns, we quickly see why nearly 20% of the US adult population experience an anxiety disorder each year.
Additionally, work is a major contributor to feelings of anxiety. The good news is that benefits teams are giving more attention to mental health than ever before. However, understanding anxiety is not always straightforward. That’s why creating a psychologically healthy workplace starts with a better understanding of the various ways anxiety may show up for employees, common signs of anxiety, and understanding what care options are best for a specific population.
Are anxiety, stress, worry, and fear all synonyms?
Before we dive in, we want to clear up some semantic confusion. Stress, worry, and fear are often used interchangeably with anxiety, but they mean different things.
- Stress refers to any event or situation that places a demand on you, which may or may not lead to anxiety.
- Worry is the thinking part of anxiety: imagining future problems and planning ahead to deal with them.
- Fear is the immediate response to a perceived danger in the present, involving a spike in physical arousal that gets the body ready to take action (sometimes called “fight or flight”). Anxiety and fear are closely related, but fear occurs specifically in response to a present threat, whereas anxiety happens in response to threats that are future oriented or undefined.
Common signs of anxiety
As depicted with the grizzly bear example, anxiety changes our thinking, behavior, and physiology. Anxiety looks and feels a little different for everyone, but there are some common signs:
- Anxious thinking: Assuming the worst case scenario, or thinking way ahead about what could go wrong.
- Physical changes: The body mobilizes for action in the form of symptoms like a racing heart, quicker breathing, sweating, shaking, or blushing.
- Increased tension: Fidgeting, pacing, talking over others, repeatedly refreshing email, or becoming irritable.
- Signs of self doubt: Asking for a lot of reassurance, self-criticizing, getting stuck on perfectionistic details, or procrastinating.
- Avoiding or escaping certain situations: Leaving a meeting abruptly, or always declining social invitations.
Anxiety is helpful… until it’s not
Moderate amounts of anxiety can stimulate us, helping us to solve problems and achieve goals. But some anxiety is irrational, overwhelming, or simply not that useful. Let’s compare helpful vs. unhelpful anxiety using some real-world examples:
|Helpful anxiety||Unhelpful anxiety|
Helpful anxiety shows up when there’s a true threat
Example: You get a critical performance review and you start thinking about how to improve your work.
Unhelpful anxiety shows up when there’s no true threat
Example: You imagine getting fired, then get caught up dwelling on how you will never get another job.
Helpful anxiety is proportional to the issue
Example: Your partner says they need to talk to you and you feel slightly concerned.
Unhelpful anxiety is excessive compared to the issue
Example: Your partner says they need to talk to you and you start to panic that they’re going to leave you.
Helpful anxiety appears when there’s an action to take and time to take it
Example: While waiting to be called in for an interview, anxiety prompts you to read over your notes and think about what to say.
Unhelpful anxiety shows up when there’s no useful action to take or time to take it
Example: The night after an interview, anxiety prompts you to repeatedly go over what you should have said instead.
Helpful anxiety goes away when the situation has passed
Example: You feel anxious about money when you’re temporarily unemployed, but you stop worrying once you get another job.
Unhelpful anxiety does not go away, even after the situation has passed
Example: After having your wallet stolen at night you feel jumpy and uncomfortable even during the day when no one is around.
Helpful anxiety is value-driven, making you more like the person you want to be
Example: You care about your job, and the thought of missing a deadline motivates you to be thoughtful and productive.
Unhelpful anxiety takes you away from your values, making you less like the person you want to be
Example: When you’re worrying about missing a deadline at work, you snap at your spouse and ignore your child.
But when does anxiety become a disorder?
As we are starting to see, anxiety is a spectrum — ranging from occasionally helpful anxiety to an anxiety disorder. Plus, there’s plenty of space in between: Someone might experience unhelpful anxiety, but they may not meet criteria for an anxiety disorder. So it begs the question, when does anxiety cross the threshold and meet diagnostic criteria for a disorder?
For a given mental health diagnosis (e.g., Generalized Anxiety Disorder, or GAD), there is a list of common symptoms. Experiencing many or all of these symptoms means a person might meet diagnostic criteria for that disorder. However, in order to be considered a disorder, the symptoms must also be what clinicians call “clinically significant,” meaning they cause:
- Distress: Anxiety disorders are upsetting and distracting on a near-daily basis.
- Impairment: Anxiety becomes a disorder when it starts to cause problems, like lost sleep, reduced productivity, and relationship tension.
- Duration: Anxiety is usually recognized as a disorder only if it shows up regularly for weeks or months, depending on the issue. Worrying about the results of one medical test does not mean a person has hypochondriasis*, and leaving an awkward party is not social anxiety disorder.
Effective and accessible care
Decades of research have identified the care options that are most effective at helping people cope with anxiety. Evidence-based care for anxiety uses a cognitive behavioral approach to build coping skills: strategies for thinking and acting more flexibly, managing physical symptoms, and better tolerating stress, to name a few.
Cognitive and behavioral techniques for anxiety come in many forms. One option is connecting employees directly with a cognitive behavioral therapist through an EAP. In-person therapy is effective and helpful, however it brings with it a host of accessibility barriers. Many employees won’t or can’t access in-person therapy and prefer a more immediate, convenient therapeutic approach that is not restricted by schedules, cost, geography, or stigma. When in-person therapy is inaccessible, cognitive and behavioral techniques can also be delivered via digital solutions like Daylight, which lessens many of these barriers because it’s available 24/7 and self-guided.
The more deeply benefits leaders — and the employees they support — understand the difference between helpful and unhelpful anxiety, and the more companies prioritize accessible mental health care, the more effective they will become in supporting their employees.
*Excessive anxiety about health, which psychologists call “illness anxiety disorder.”
Source: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Disclaimer: In accordance with FDA’s Current Enforcement Discretion Policy for Digital Health Devices for Psychiatric Disorders, for patients aged 18 years and older, who are followed by and diagnosed with Insomnia Disorder or Generalized Anxiety Disorder by a medical provider, Sleepio and Daylight can be made available as an adjunct to their usual medical care for Insomnia Disorder or Generalized Anxiety Disorder, respectively. Sleepio and Daylight do not replace the care of a medical provider or the patient’s medication. Sleepio and Daylight have not been cleared by the U.S. Food and Drug Administration (FDA) for these indications. Users are directed to not make any changes to their prescribed medication or other type of medical treatment without seeking professional medical advice.
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