The difference between worry and anxiety

Worry happens in the head

Worry is verbal. It consists of sentences: what if, imagine if, I should have. It is almost always about the future, and it feels productive — as if you were in the middle of solving something.

That is what makes it hard to let go of. You have a sense that it would be irresponsible to stop.

Anxiety happens in the body

Anxiety is physical first: a pounding heart, tightness in the chest, nausea, a sense of unreality, an urge to get away. The thoughts come afterwards and try to explain what the body has already decided.

That is why you can have a panic attack without having thought anything at all beforehand.

Why the difference matters

Each is kept going by something different:

• Worry is kept going by working on the thoughts — turning them over, checking, seeking reassurance, googling. Treatment therefore aims at changing your relationship to the thoughts, not their content. That is the core of metacognitive therapy.
• Anxiety is kept going by avoidance, and by never getting to experience that the body's alarm is false. Treatment is about gradually facing what you avoid — and about finding out which feeling the anxiety is covering.

Anxiety as a lid

That last part is often what gets overlooked. In ISTDP, we see anxiety as something that arises when a feeling comes close — typically anger, grief or longing that at some point was too much to bear.

That explains something many people recognise: that the anxiety comes after a conversation, not during it. Or that it turns up in situations where you ought to be happy. The body is reacting to the feeling, not to the situation.

What you can notice for yourself

The next time it turns up, try to notice the order. Did the thought come first, or did the body? It is one of the most useful questions you can ask yourself — and it is often the first thing we look into together.