Dealing with Fear, Stress, and Anxiety

Dr. David J. Koehn Psychologist Fort Myers, Florida

Dr. David Koehn is a psychologist practicing in Fort Myers, FL. Dr. Koehn specializes in the treatment of mental health problems and helps people to cope with their mental illnesses. As a psychologist, Dr. Koehn evaluates and treats patients through a variety of methods, most typically being psychotherapy or talk therapy.... more

Dealing with Fear, Stress, and Anxiety


Dr. David Koehn


Fear and anxiety often occur together but these terms are not interchangeable. Even though symptoms typically overlap, a person's experience with these emotions differs based on their context. Fear relates to a known or understood threat. It is an emotional response to a known or definite threat. If you're walking down a dark street, for example, and someone points a gun at you and says, “This is a stickup," then you'd likely experience a fear response. The danger is real, definite, and immediate. There's a clear and present object of the fear. 

Anxiety, on the other hand, follows from an unknown or poorly defined threat. According to psychiatrists Sadock and Ruiz, anxiety is a diffuse, unpleasant, vague sense of apprehension. It's often a response to an imprecise or unknown threat. For example, imagine you’re walking down a dark street. You may feel a little uneasy and perhaps you have a few butterflies in your stomach. These sensations are caused by anxiety that is related to the possibility that a stranger may jump out from behind a bush, or approach you in some other way and harm you. This anxiety is not the result of a known or specific threat. Rather it comes from your mind’s interpretation of the possible dangers that could immediately arise.

Although the focus of the response is different (real vs. imagined danger), fear and anxiety are interrelated. When faced with fear, most people will experience the physical reactions that are described under anxiety, see Table One. Fear can lead to anxiety and at times anxiety can lead to fear. Given these interrelationships between anxiety and fear, there are subtle distinctions between the two that give you a better understanding of your symptoms and may be important for treatment strategies.

Most people experience stress and anxiety from time to time. Stress is any demand placed on your brain or physical body. People can report feeling stressed when multiple real-life competing demands are placed on them. The feeling of being stressed can be triggered by an event that makes you feel frustrated or nervous. This feeling of nervousness, worry, or unease can evolve into anxiety. Anxiety can occur as an overreaction to stress, or it can occur in people who are unable to identify significant stressors in their life. 

As noted earlier, many experts believe that there are important differences between stress, fear, and anxiety. These differences can account for how we react to various stressors in our environment.  Muscle tension, increased heart rate, and shortness of breath mark the most significant physiological symptoms associated with a response to danger. These bodily changes result from an inborn fight-or-flight stress response thought to be necessary for our survival. Without this stress response, our mind wouldn't receive the alerting danger signal and our bodies would be unable to prepare to flee or stay and battle when faced with danger.

Stress and anxiety are not always bad. In the short term, they can help you overcome a challenge or a dangerous situation. Examples of everyday stress and anxiety include worrying about finding a job, feeling nervous before a big test, or being embarrassed in certain social situations. If we did not experience some anxiety we might not be motivated to do things that we need to do (for instance, studying for that big test or performing in a big game!).

However, if stress and anxiety begin interfering with your daily life, it may indicate a more serious issue. If you are avoiding situations due to irrational fears, constantly worrying, or experiencing severe anxiety about a traumatic event weeks after it happened, it may be time to seek help.

Stress and anxiety can produce both physical and psychological symptoms. People experience stress and anxiety differently. Table One describes the common causes and physical and psychological symptoms associated with stress and anxiety.


Table One – Common Causes and Symptoms for Stress and Anxiety


Physiological Symptoms

Psychological Symptoms

Common stressors include:

  • moving
  • starting a new school or job
  • having an illness or injury
  • having a friend or family member who is ill or injured
  • death of a family member or friend
  • getting married
  • having a baby

Drugs and Medications

Drugs that contain stimulants may make the symptoms of stress and anxiety worse. Regular use of caffeine, illicit drugs such as cocaine, and even alcohol can also make symptoms worse.

Prescription medications that can make symptoms worse include thyroid medications; asthma inhalers; diet pills.


  • stomachache
  • muscle pain, tension
  • headache
  • rapid breathing
  • fast heartbeat
  • excessive sweating
  • shaking, trembling
  • dizziness, feeling faint
  • frequent urination
  • change in appetite
  • trouble sleeping
  • fatigue
  • tightness felt throughout the body, especially in the head, neck, jaw, and face
  • chest pain
  • ringing or pulsing in ears
  • cold chills or hot flushes
  • numbness or tingling 
  • upset stomach, diarrhea, or nausea
  • shortness of breath


  • feelings of impending doom
  • panic or nervousness, especially in social settings
  • difficulty concentrating
  • irrational anger
  • restless
  • feeling like you’re going insane
  • depersonalization and derealization



For most people, stress, and anxiety come and go. They usually occur after particular life events, but then go away. Stress can do more than just ruin a good day. It may also contribute to chronic inflammation and the development of severe medical conditions such as autoimmunity, irritable bowel disease, heart attack, stroke, depression, hypertension, and even cancer. Germany, as a culture, deals with stress well, even though they smoke and eat unhealthily. Americans, in general, eat better and smoke less but handle stress poorly. Evidence indicates that Germans outlive Americans. Poor stress control may be the culprit because it affects the immune system. 

Learning to deal with stress in a healthy and productive manner is essential for avoiding long-term damage. Here are ten tips for dealing with stress before it becomes a health hazard.


Table Two – Tips in Dealing with Stress

10. Learn to read the signs

Everyone experiences stress differently. Some people become fatigued and lose weight while others have an increase in appetite and anxiety. Be mindful when these symptoms first start to arise and do not ignore them. Prolonged stress may develop into chronic fatigue syndrome, hypothyroidism, and problems with adrenal gland functioning if left untreated. The first step to coping with stress is paying attention to the signs. These may include a daily headache, unexplained muscle pain, joint inflammation, irritability, decreased concentration, or insomnia.

9. Exercise


Exercise does not have to be strenuous to reduce stress effectively. A thirty-minute walk or bike ride around the neighborhood most days of the week will do. Exercise releases a group of “feel good” hormones called endorphins, which are neurotransmitters that interact with the receptors in the brain to create a pleasurable or happy sensation. Endorphins are also natural painkillers that improve the body’s ability to sleep, which may help reduce stress.


8. Meditation


Meditation is a type of connection between the mind and body that induces a deep state of relaxation and peace. It is free, efficient, and can be done just about anywhere. Meditating asks a person to close their eyes and focus their attention on one particular word or thought while consciously pushing stress and crowded thoughts out of mind. The idea is to deliberately push stress out of the body by reducing negative thoughts and focusing on self-awareness.


7. Talk it out


Sometimes talking about stress to a friend or family member is a good way to get it out. Ask a trusted individual to meet for coffee and spend some time talking about life. Therapy is an excellent way to talk to someone who has an outside perspective and is trained to give professional advice. Many therapists are covered by insurance or are willing to work with individual payment plans if necessary.

6.  Write it down


The next best thing to talking to someone is to write out stressful feelings or situations in a journal or planner. Writing down thoughts and ideas is a good way to brainstorm new methods for improving stress or making the best out of a bad situation. Some people prefer to write out their feelings by hand while others enjoy typing at a computer. Either method works well for getting out bottled-up emotions before they become too much to handle.


5.  Eating healthy


Eating a healthy breakfast does more than satisfy hunger. It is also an excellent way to plan the day, collect thoughts, and prepare both mentally and physically for any challenging tasks ahead. Set the alarm for at least fifteen minutes earlier each day and sit down with a bowl of oatmeal with flaxseeds and blueberries, and a cup of hot green tea. Spend this time eating slowly and going over the day’s tasks in a relaxed manner.


4.  Sleep it off


Research shows that sleeping is an effective way to boost brainpower. One study examined test performances between students who either crammed right before the exam and those who took a nap. Results indicated that students who took a nap or slept right before a test did better on their exams. Instead of staying up late at night to work out stressful situations, consider heading to bed early and picking it up again the next morning.


3.  Slow down and count to ten


When a stressful situation occurs, take a step back and slow down. Nothing good is ever accomplished in a rush. Count to ten if necessary and take deep breaths. Focus on positive thoughts and remember that everyone has limits. Prioritize the tasks that need to be done first and concentrate on executing them in an efficient manner. Put stress in perspective by remembering that perfection does not exist. Focus on one thing at a time and ask for help if needed.


2.  Take a detox


Essential oils are an excellent way to lower cortisol levels, which may lead to frequent infections or colds, anxiety, autoimmunity, hormone imbalance, inability to lose weight, thyroid problems, and irritable bowel syndrome. Draw a hot bath and add in one cup of Epsom salt and a few drops of essential oil. This is an excellent remedy if achy joints, muscle pain, and tension accompany stress as the salt will draw out toxins and the essential oils will help induce relaxation.


1.  Take supplements


Ashwagandha, otherwise known as Indian ginseng, has been used for centuries in Ayurvedic medicine to reduce stress and treat anxiety. Ashwagandha has been shown to rejuvenate the adrenal glands, which are useful in treating fatigue and chronic stress. Research indicates that the high antioxidant content in Ashwagandha also helps improve cognitive function for increased concentration and memory. It has also been shown to improve mood and balance hormones. Along with a healthy diet, supplement with no more than one thousand milligrams of ashwagandha each day. Consider BrainMD’s natural supplements such as GABA


Stress and anxiety that occur frequently or seem out of proportion to the stressor may be signs of an anxiety disorder. An estimated 40 million Americans live with some type of anxiety disorder. People with these disorders may feel anxious and stressed on a daily basis and for prolonged periods of time. These disorders include the following:

  • Generalized anxiety disorder (GADis a common anxiety disorder characterized by uncontrollable worrying. Sometimes people worry about bad things happening to them or their loved ones, and at other times they may not be able to identify any source of worry.
  • Panic disorder is a condition that causes panic attacks, which are moments of extreme fear accompanied by a pounding heart, shortness of breath, and a fear of impending doom.
  • Post-traumatic stress disorder (PTSDis a condition that causes flashbacks or anxiety as a result of a traumatic experience.
  • Social phobia is a condition that causes intense feelings of anxiety in situations that involve interacting with others.
  • Obsessive-compulsive disorder is a condition that causes repetitive thoughts and the compulsion to complete certain ritual actions.

Stress and anxiety are treatable conditions and there are many resources, strategies, and treatments that can help. A good self-help resource is Anxiety and Phobia Workbook by Bourne, 7th edition. If you’re unable to control your worries, and stress is impacting your daily life, talk to your primary care provider or seek help from a professional mental health provider about ways to manage stress and anxiety. He or she will want to discuss your current symptoms and your medical/psychological history to help determine a possible cause of your fear and anxiety.

From there, expect your doctor/mental health professional to make a diagnosis or refer you to a specialty treatment provider for further assessment. Once diagnosed, you can start on a treatment plan that can assist in reducing and controlling your fear and anxiety or deal effectively with your stress.