Anxiety, stress and emotion regulation difficulties are closely related but not identical experiences. Anxiety describes the response to a possible danger or uncertainty, stress the response to a demanding situation, and an emotion regulation difficulty is a struggle to notice, understand and manage emotions. In psychotherapy, these three areas are often addressed together as processes that influence one another.
How do anxiety, stress and emotion regulation difficulties differ from one another?
NIMH distinguishes stress as mostly a response to an external cause and anxiety as an internal response that can continue after the stress; in practice, the two can overlap. The table below compares the three concepts in general terms.
| Criterion | Anxiety | Stress | Emotion regulation difficulty |
|---|---|---|---|
| In brief | The emotional, mental and bodily response to a possible danger or uncertainty | The bodily and psychological response to a demanding situation, demand or change | Difficulty noticing, naming and regulating the intensity of emotions |
| Course | May become intense, persistent and limiting for daily life | A little may be functional; becomes taxing when it goes on | Not always a separate diagnosis; a shared process in many difficulties |
| Focus in psychotherapy | Threat appraisals, avoidance, bodily sensations | Load, boundaries, thought patterns, coping | Recognizing and naming emotions, regulating the response |
What is anxiety?
Anxiety is the emotional, mental and bodily response a person has to the possibility of a future danger, uncertainty, loss, failure or loss of control. The WHO notes that everyone can feel anxious at times; a certain level of anxiety can help a person prepare, notice risks and take action.
On a mental level, thoughts such as “what if something bad happens?” may appear; on a bodily level, a racing heart, muscle tension, a feeling of breathlessness or sleep problems; and on a behavioral level, avoidance, procrastination or reassurance seeking.
What is the difference between normal anxiety and an anxiety disorder?
Not every form of anxiety is a disorder. The WHO states that in anxiety disorders the fear is “intense and excessive” and that symptoms typically last at least several months; NIMH notes that anxiety can affect daily life; and the NHS cites anxiety felt much of the time for at least six months in generalized anxiety disorder, while stressing that not every form of anxiety means this.
According to the WHO, about 470 million people in the world had an anxiety disorder in 2023; only about 27.6% of those in need receive treatment. This information does not replace a diagnosis.
How can anxiety arise?
Anxiety cannot be reduced to a single cause. Biological predisposition, learned ways of coping, past experiences, difficulty coping with uncertainty, traumatic experiences, family and relationship patterns, perfectionism and a need for control can play a role. When a person avoids an anxiety-provoking situation, they feel relief in the short term; in the long term, however, their belief that they cannot cope with that situation may grow, and anxiety may spread to wider areas.
How is anxiety addressed in psychotherapy?
In psychotherapy, anxiety is first assessed through the nature, duration and daily impact of the symptoms; then the situations that raise anxiety, thoughts, bodily reactions and behaviors are examined together. The WHO notes that cognitive behavioral approaches are among the psychological interventions with the most evidence for anxiety disorders. The following areas may be worked on in sessions:
- Understanding the anxiety cycle and automatic thoughts: in which situations the person feels anxious, what they think (catastrophizing, intolerance of uncertainty, “I can’t cope” thoughts), what happens in the body and how they behave are addressed.
- Examining avoidance and safety behaviors: how behaviors such as constant checking, procrastination or reassurance seeking keep anxiety going is explored.
- Making sense of bodily symptoms: interpreting a racing heart, a change in breathing or a tight stomach as a threat can increase anxiety; these interpretations are addressed.
- Gradual exposure and realistic appraisal: the aim can be for the person to approach anxiety-provoking situations gradually; the goal is not “positive thinking” but being able to evaluate thoughts in terms of evidence.
Anxiety is not assessed only through present-day cycles; why a person is so sensitive to themes such as uncertainty, control, separation, criticism, failure or rejection can also be explored. There are separate articles on specific forms of anxiety: panic attacks, social anxiety and obsessive thoughts.
What is stress?
Stress is the bodily and psychological response a person has to a demanding situation, demand or change. The WHO defines stress as a state of worry or mental tension caused by a difficult situation, and states that “a little bit of stress is good” while too much can lead to physical and mental health problems. Stress can become taxing when it lasts long, recurs often or exceeds a person’s coping resources.
According to the NHS, stress can show up physically as headaches, muscle tension, stomach problems or a racing heart; mentally as difficulty concentrating and constant worry; and behaviorally as irritability, withdrawal, or changes in sleeping and eating.
How can stress arise?
Stress is often linked to a sense of imbalance between the demands a person faces and the resources available to cope with them. Workload, academic responsibilities, financial problems, family burdens, relationship conflicts, health problems, losses and life transitions can all be sources of stress. How a person interprets conditions also matters for stress continuing: thought patterns such as “I must not make mistakes” or “I must control everything,” along with taking on too much responsibility and difficulty setting boundaries, can contribute to stress becoming chronic.
How is stress addressed in psychotherapy?
In psychotherapy, stress is not addressed only through “relaxation techniques.” First, the life areas where stress is concentrated and the thought and behavior patterns that keep it going are assessed. The following areas may be worked on in sessions:
- Recognizing stress sources and reactions: where stress is concentrated and what changes in the body, mind and behavior are addressed.
- Setting boundaries and adjusting load: areas where too much responsibility is taken on or rest is put off can be worked on.
- Evaluating thought patterns: patterns such as perfectionism, catastrophizing and expecting constant high performance of oneself may be addressed.
- Problem solving and planning: which situations can be changed and which require acceptance and adjustment are evaluated together.
- Bodily regulation skills: breathing, relaxation, sleep routine and daily routines may be addressed in a supportive way.
For some people, stress is fed not only by a heavy workload but also by deeper beliefs and relationship experiences such as “I will fall short” or “I have to be strong to be loved.” For the exhaustion that long-lasting stress can create, see burnout.
Which general principles stand out in coping with stress?
The WHO and NIMH include general suggestions such as a regular daily routine, regular meals, consistent sleep times, physical activity during the day, staying connected with trusted people, limiting caffeine and questioning negative, unhelpful thoughts; the WHO also mentions limiting news consumption if it increases stress (for more on this, see What Is Secondary Traumatic Stress?). The NHS also mentions planning ahead and setting small goals.
These are general information; when coping becomes difficult or self-help steps are not enough, contacting a health professional is recommended (WHO, NHS).
What is an emotion regulation difficulty?
An emotion regulation difficulty is a person’s struggle to notice, name, regulate the intensity of and appropriately express emotions, or to return to balance after emotional reactions. It can be related to different emotions such as anger, anxiety, shame, guilt, resentment, sadness or a sense of emptiness.
Emotion regulation does not mean suppressing emotions or not feeling at all; it involves being able to notice emotions, understand what they point to, and regulate behavior not only by the current intensity of the emotion but according to broader goals and values. For Gross’s process model and strategies, see What Is Emotion Regulation?
How can an emotion regulation difficulty arise?
Early relational experiences, how emotions were received in the family, traumatic experiences, chronic stress, anxiety, depressive symptoms or relational difficulties can affect the capacity for emotion regulation. Some people may have learned to suppress their emotions; some experience emotions very intensely but struggle to name them; others notice the emotion but have difficulty regulating the behavior that accompanies it.
An emotion regulation difficulty is not always a separate diagnosis; it can be seen as a shared process across different psychological difficulties. A review by Aldao, Nolen-Hoeksema and Schweizer (2010) that pooled 114 studies reports strong associations between rumination (repeatedly dwelling on negative thoughts) and symptoms such as anxiety and depression, and smaller to medium associations for reappraisal and acceptance. These findings show associations; they do not prove causation.
How are emotion regulation difficulties addressed in psychotherapy?
First, which emotions are harder for the person, how they express them and which emotions they avoid are assessed. The following areas may be worked on in sessions:
- Noticing and naming emotions: the emotions beneath general statements such as “I feel bad” or “I’m tense” are distinguished.
- Understanding the function of an emotion and the emotion–thought–behavior link: anger may point to a boundary violation, anxiety to a perceived threat, guilt to a conflict with values, sadness to an experience of loss; which thoughts intensify the reaction and which behaviors follow are examined.
- Noticing ways of avoiding emotions: ways such as suppression, overthinking, withdrawal or trying to please others may be evaluated.
- Developing alternative skills and understanding recurring patterns: breathing, relaxation, an emotion diary, safe expression and boundary setting may be worked on; in which relationships similar reactions occur is examined.
This work is not only a process of teaching technical skills; why some emotions feel so hard and how they are experienced in relationships can also be part of psychotherapy. Cochrane’s review of short-term psychodynamic psychotherapies notes that these therapies aim to work on emotion processing, behavior and communication/relationship problems.
How do psychotherapies work with all three areas together?
Anxiety, stress and emotion regulation are often processes that influence one another: anxiety may increase under intense stress; bodily symptoms may grow stronger as anxiety rises; and emotion regulation may become harder when those symptoms are interpreted as a threat. For this reason, these areas are addressed together, and the following working line may generally be followed in sessions:
- Defining the difficulty: in which situations the person struggles most, how long it has continued and its impact on daily life are assessed.
- Mapping the thought, emotion, body and behavior cycle: what is thought, felt and done in a specific event is examined together.
- Evaluating avoidance and coping styles: behaviors that bring relief in the short term but keep the problem going in the long term are noticed.
- Understanding emotional needs and relational patterns: which emotions are avoided and which cycles recur in relationships are addressed.
- Building skills and awareness: emotion regulation, boundary setting, problem solving, relaxation and behavioral experiments may be worked on.
- Reviewing the process regularly: goals and how the process is going are reviewed at certain intervals.
For more on the approaches, see What Is Cognitive Behavioral Therapy (CBT)? and What Is Psychodynamic Psychotherapy?
When can professional support be considered?
Professional support can be considered if anxiety, stress or emotional difficulty becomes intense, long-lasting and hard to cope with, or affects areas such as sleep, relationships, work or school. The NHS and the WHO recommend contacting a health professional when coping becomes difficult. For the general framework, see When can psychological support be considered?
If the person has thoughts of self-harm or faces immediate danger, contacting the 112 Emergency Call Center or going to the nearest emergency department is recommended; the NHS stresses that a mental health emergency should be taken as seriously as a physical one. Whenever possible, it is important that the person is not left alone and tells someone they trust what they are experiencing. This article is not a substitute for emergency support.
Expert note
In everyday language, anxiety, stress and emotion regulation difficulties are often used interchangeably; yet they may appear in the same person at different times and in different combinations. For this reason, rather than a label, the situations and the thought, body, behavior and relationship patterns through which the difficulty is experienced can be addressed.
From a perspective that draws on cognitive behavioral and psychodynamic theories, thoughts, emotions, behaviors and relational patterns are evaluated together; the person is considered within their life story and relationships. The information in this article does not replace an evaluation.
Clinical Psychologist Özgün Emre Yaylacı
Frequently asked questions
Are anxiety and stress the same thing?
Not exactly. NIMH distinguishes stress as mostly a response to an external cause and anxiety as an internal response that can continue after the stress; the WHO notes that stress can trigger or worsen anxiety.
When does anxiety reach the level of a “disorder”?
Anxiety is a common emotion; the WHO states that in anxiety disorders the fear is “intense and excessive” and that symptoms typically last at least several months. For generalized anxiety disorder, the NHS cites at least six months; this is general information and does not replace a diagnosis.
Is an emotion regulation difficulty a diagnosis?
It is not always a separate diagnosis on its own; the sources treat it as a shared process associated with many psychological difficulties, such as anxiety and depression (Aldao et al., 2010).
Can anxiety, stress and emotion regulation difficulties be addressed together in psychotherapy?
Because these areas often influence one another, they can be addressed together in psychotherapy. The suitability of a psychotherapeutic approach is determined by the person’s needs, reason for seeking help and clinical evaluation.
Sources
This article is prepared for general information purposes; the following sources were used in preparing it (mostly in English; Turkish-language sources are marked):
- WHO (World Health Organization): Anxiety disorders
- NIMH (US National Institute of Mental Health): I’m So Stressed Out! Fact Sheet
- WHO: Stress
- NHS (UK National Health Service): Stress
- NHS: Generalised anxiety disorder (GAD)
- Aldao, Nolen-Hoeksema and Schweizer (2010): Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217–237
- Cochrane: Short-term psychodynamic psychotherapies for common mental disorders (Abbass et al., 2014)
- Republic of Turkey Ministry of Health: New Generation Emergency Call Center, 112 Single Call System (in Turkish)
This article was prepared by Clinical Psychologist Özgün Emre Yaylacı. Last updated: October 23, 2026. The content is for general information only and does not constitute diagnosis, treatment or personal guidance.
