This is the second entry in the discussion on anxiety and panic.

Before we can get to more practical issues, I need to define one more term. And that is: stress.

There are hosts of definitions for stress. The way in which I will use stress here is most nearly defined by The Free Dictionary. Their definition reads in part, “A mentally or emotionally disruptive or upsetting condition occurring in response to…external influences and capable of affecting physical health, usually characterized by increased heart rate, a rise in blood pressure, muscular tension…”

Note again, like fear, stress occurs in response to events or conditions in the world outside ourselves.

Importantly, the stressor, the outside event or condition, can be either good or bad thing. This was first discovered by Hans Selye. Getting married, an event that is usually very much desired, is a stressor. A meeting with your boss about more job duties for lower pay, a very unwanted situation, is also a stressor.

The experience of stress is less intense than anxiety, fear or panic. There is a world of difference between the situations where someone says “Man, this is stressing me out” and “Oh my God, I’m gonna die. Run!”

But the effects of having a panic or anxiety attack lowers your ability to handle the next stress that comes your way. The same is true if you go through a major stress or a number of lesser stresses. In this way, something that yesterday you might have handled easily might cause an anxiety attack today if you encountered a number of problems in the last 24 hours.

A degree of stress can be helpful. For instance, your wedding is coming up in a month and you still have not selected the wedding cake. The stress associated with that can arouse to you focus on the task and give you the energy to see it through to completion. If a sense of stress was missing, the wedding cake might never get bought.

But stress is a bit more complicated. For one, it is rare that there is only one stressor in a person’s life. While comparing wedding cakes, you might also be trying to impress your soon-to-be in-laws, and trying to stay within a budget and managing to meet all the normal daily demands on your time. The effects of these different stressors are cumulative. That is, the effects of the stress remain with us, adding one upon the other, until we do something to purge them.

And we have to take into account that one person’s stress threshold may be very different from the next person’s. Moreover, one person’s stress threshold can improve or decline over time.

Making matters more complicated, no stressor exists in a vacuum. There is also the person and his or her background to take into account. Buying a wedding cake may be a quite different experience for someone who is pregnant and has morning sickness versus one who is not.

Further, the person and the stressor occur within a social and cultural context that may decrease or increase the stress load. The wedding cake bought by a pregnant teen might be a very different stressor in settings tolerant of teen pregnancy versus a culture of intolerance for sex before marriage.

Hopefully, my point is getting clearer. Calculating the degree of stress someone is under is not a matter of simple math. One wedding cake = One unit of stress. That is just not the case. So, it makes little sense to think that another person “should just get over it. It was no big deal.”

This leads us to George L. Engel. He proposed a biopsychosocial model. As the name implies, it suggests that we have to include the biological or physical aspects of a person; the psychological context or meaning the stress or symptoms have for that person; and the social context in which the person lives.

For our purposes, the take home points of the biopsychosocial model are that stress is the particular effect, mentally and physically, an external event has on a unique individual at a particular point in time within a given social setting.

Remember also that stress levels can build up over time. As stresses increase on a person, it can lead to a worsening situation that might include anxiety, panic, physical illness or other problems.

Treatment strategies have to take all of this into account. That cannot happen with a cookie-cutter or one treatment fits all approach. The type of treatment provided, the style of the therapeutic relationship and other aspects of therapy have to take into account the biopsychosocial status of the person seeking treatment.

Next time, we will consider some of the varieties of treatment available for anxiety and panic related disorders.

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