When I began my private practice, the majority of my clients suffered from depression.  What I’ve noticed  over the years is a trend towards anxiety ~ especially in the teenagers I see.  When adults ask me why kids are so anxious, I turn the questions back toward them:  “Well, aren’t YOU?”  There’s a lot in the world to be anxious about, even for those without the genetic predisposition for it.  To compound that, as a society we are more aware than ever of every little thing there is to be anxious about because we are under a constant barrage of global information thanks to the internet, mobile phones, and our constant access to computers and social media.

Four years ago I had the distinct pleasure of working with a young lady who spontaneously began describing and labeling different  degrees of anxiety.  I had never considered the nuances and variations of that particular emotion and thought her discussion of it was brilliant!  Working with her descriptions of the various levels of anxiety she felt, we crafted a plan for how to respond to each one of them in order to alleviate her symptoms.

Over these four years, I’ve often thought back to this amazing client and our work together.  It’s taken quite a while but I’m finally developing this exercise into a more formal intervention.  I find it as fascinating as it is helpful as I ask my clients “How anxious do you need to be?”

Like a frightened bird, anxiety likes to find a “safe” place to land.  So, while many folks suffer from generalized anxiety, they can swear that it is absolutely THIS thing that makes them anxious.  Sometimes they are right.  Public speaking, flying, driving, dental work, and needles are all fairly common phobias that can temporarily change the personality of an otherwise calm, cool, and collected individual.   Sometimes what we label as anxiety might be more accurately called stress but, when we and others respond to it as full blown anxiety, our stress might ramp up to more closely resemble it!

What are the various degrees of anxiety?  I’m glad you asked!  Here is a list of words that I and some of my clients have used, along with descriptions (all subjective!) of what these words mean:

1.  Stress – Unfortunately, life means stress and one of our job as humans is to manage it.  Many folks, with some thoughtful consideration, realize that what they’ve labeled anxiety is really stress – from work, school, or life circumstances.
2. Nervousness – This usually stems from an anticipated performance or big event but nerves can get out of control and morph into full blown panic!
3. Concern – Usually concern is focused on someone or something outside ourselves and most of my clients consider concern as low level worry.  I tend to agree.  Think of it like this: concern is to worry as annoyance is to anger.
4. Worry – Parents know this one so well.  Their teen gets their license and heads out on a Saturday night: worry.  Their kid gets mysteriously ill: worry.  Worry is more active than concern, more intense, and usually more specific.  We tend to worry ABOUT something.
5. Anxiety – This state of mind can be torturous and painful and is considered mental illness.  Sufferers of anxiety can see life from a fearful mindset and might see potential problems and obstacles where others see possibility or adventure.  Many of my clients who experience anxiety do so without knowing what triggers it and find it difficult to relax or feel safe.  Consultation with a psychiatrist for medication is usually the best course of action for people who suffer from this disease.  Weekly therapy would be supportive of the doctor’s treatment plan.
6. Fear – Most of my clients who tell me they are afraid of something describe it as more intense than worry but less so than phobia and specific to something.  If they are generally fearful of many or all things, we label that as anxious.
7. Phobia – This is anxiety targeted to specific situations.  This would be those who are fearful of needles, dentists, spiders.  Confronting their phobias can be exceptionally fear and anxiety producing and is also considered a mental illness.
8. Panic – Luckily a panic attack is short term because it feels terrible!  Usually panic is triggered from a specific situation and might start out as a less intense form of anxiety.  Occasionally my clients experience panic without the full blown attack.

I’m certain there are more gradations of anxiety and encourage you to come up with your own ideas.  What I find useful about considering their ideas about anxiety states with my clients is our ability to specify our responses based on what they actually need.  Responding to stress as if it’s panic isn’t going to work and treating someone who is panicking as if they are just stressed out won’t work either! Family members labeling someone as anxious when they are truly just worried about something isn’t helpful. Once upon a time I mentioned to a friend that I had been “worried” about her daughter when the more accurate phrase might have been “concerned” – I haven’t heard from her since!

Another bonus to thinking through these feelings with clients is that the very act of considering how anxious they are tends to bring their anxiety down.  Once they ask themselves that question, they are in a better position to question how anxious they need to be to respond to their current situation.  From there, they can make use of the tools we develop together to calm their emotional reactivity.

Of course, anxiety can be quite serious and can render someone unable to leave their home.  If that’s the case, I urge you to see a doctor.  Anxiety can make someone suffer so horribly and relief can often be found in a prescription and some very mindful weekly therapy.

Nevertheless, I hope next time you feel a little anxious, you can ask yourself: How anxious do I need to be? And  I hope doing so helps you feel calmer.

Please feel free to contact me or make an appointment through my site: www.margaretperlsteinmft.com.