Stress vs anxiety — it is one of the most common questions in clinical work, and one of the hardest to answer from the inside. Most people in London live with some level of stress. After a difficult week, a packed Tube carriage, a missed deadline, a household expense that lands at the wrong time, the body responds. Heart faster, shoulders tighter, sleep lighter. That is stress doing its job.

But for many people we see in our online therapy practice, stress is no longer the right word for what they are carrying. The worry no longer switches off when the situation does. The body never quite comes down.

The line between ordinary stress and Generalised Anxiety Disorder (GAD) can be hard to see from the inside. Understanding stress vs anxiety is not about labelling yourself. It is about recognising a pattern early enough to do something useful with it.

Why this question matters in London right now

London is, by the most recent figures, the most anxious region in the United Kingdom. Greater London Authority research found that 41.3% of London adults reported high levels of anxiety, against a national average of 38.5%. A separate survey found that 91% of Londoners reported feeling stressed at least once a month.

Work is a large part of the picture. Roughly 51% of London employees work weekends — about 11% higher than the national average — and the Burnout Report 2026 from Mental Health UK found that nine in ten UK adults experienced high or extreme stress at some point during the past year. NHS Talking Therapies, for those who manage to access them, currently run waiting lists of 16–18 weeks.

Behind those numbers are people who arrive in therapy saying some version of the same thing: I think I might just be stressed, but it doesn’t feel like normal stress anymore.

What stress actually is

Stress is the body’s response to a specific demand. A deadline, a difficult conversation, a financial worry, an exam. The nervous system reads the situation as something to respond to, and it shifts into a state of activation — adrenaline and cortisol rise, the heart works harder, the mind narrows its focus.

In short bursts, this is healthy. It is what helps you finish the project, sit the test, hold the difficult conversation.

The key feature of ordinary stress is that it has a beginning and an end. When the situation resolves, the body resolves with it. After the deadline is met, the shoulders drop. After the conflict is repaired, sleep returns. Stress is uncomfortable, but it is connected to something.

Even when stress is heavy — and London life can make it very heavy — it usually still has a shape. You can name what is causing it. You can imagine, at least in principle, what it would feel like for it to be over.

What Generalised Anxiety Disorder is — and how it is different

Generalised Anxiety Disorder is not just a louder version of stress. It is a different pattern.

With GAD, worry becomes persistent, excessive, and difficult to control. It is not always tied to a specific external problem. The mind moves from one concern to the next — work, health, money, relationships, the safety of loved ones, small daily decisions — without much rest in between. Reassurance helps, briefly. Then the worry returns, often about something else.

Clinically, GAD is considered when this kind of worry is present on most days for at least six months, and when it begins to interfere with daily functioning. In England, around 6 in 100 people in any given week meet criteria for GAD. It is one of the most common reasons people come to us for anxiety counselling in London. You may also find our companion piece on GAD symptoms and signs useful reading alongside this one.

The most common things clients say:

• “My mind won’t switch off, even when nothing is wrong.”
• “I know I’m overthinking, but I can’t stop.”
• “Even on a calm Sunday, my body feels like something is about to go wrong.”
• “I solve one worry and the next one is already waiting.”

The clearest sign it has moved beyond ordinary stress is when the worry no longer needs a reason.

Stress vs anxiety: seven key differences

It can help to lay these side by side. None of them on their own is a diagnosis. Read them as patterns.

What it shows up as	Ordinary stress	GAD
Trigger	Linked to a specific situation	Often diffuse or anticipatory; no single cause
Duration	Short-term; resolves when the issue resolves	Persistent — most days, six months or more
Control	Worry can usually be set aside	Worry is difficult to switch off
Focus	Stays on one problem at a time	Shifts between topics, even when one is resolved
Body	Tension that eases with rest	Restlessness, fatigue, tension that doesn’t fully ease
Sleep	Disturbed during pressure, then returns	Persistently affected, often for months
Daily impact	Functioning maintained with short-term dips	Concentration, relationships and enjoyment all affected

Why this looks different in migrant and multilingual communities

At Talking Counselling, a significant part of our work is with London’s migrant, multilingual and ethnic minority communities. The way stress and anxiety present in these clients is not always the way the textbooks describe.

For people from collectivist cultures — Vietnamese, Chinese, South Asian, African, Middle Eastern, Eastern European and others — emotional difficulty is often carried quietly. Many of our clients have grown up understanding that you do not bring trouble home. You do not add to a parent’s burden. You hold it.

When that pattern meets London — high-pressure work, expensive housing, distance from family, and often a language of mental health that does not exist in the mother tongue — the result can look very specifically like GAD. Constant low-level worry. A body that never quite rests. A mind that anticipates the next problem before the current one is finished.

It is rarely just one thing. It is often stress, plus inherited responsibility, plus the cognitive load of living between two languages, plus the absence of a clear word in the first language for what is happening. We explore some of this in more detail in our piece on career, culture and mental health.

Working in a client’s first language, where it is possible, is not a comfort feature. For some experiences, it is the only door in. This is why we have built a multilingual therapy team in London across Vietnamese, Mandarin, French, Arabic, Tagalog, Japanese, Yoruba, Hausa and others.

Why the body matters as much as the mind

Stress and GAD both involve the autonomic nervous system. The difference is in the pattern.

In ordinary stress, the nervous system fires up to meet a demand, then settles. In GAD, the nervous system stays on. The body keeps preparing for something to go wrong, even when nothing is. Clients often describe this as being stuck in survival mode — alert, tense, exhausted but unable to rest.

This is why thinking your way out of it is rarely enough. A person can know intellectually that they are safe, and still find their body unconvinced. Good therapy works at both levels — the thoughts and the body. Tools that help the nervous system come down (breathwork, grounding, paced exposure) are often as important as the conversation itself. We run free online breathwork sessions from time to time as a starting point.

When it might be time to ask for help

It can be useful to think about getting support when:

• Worry is present on most days, not only when something specific is happening.
• Reassurance helps for a moment, then the worry returns about something else.
• Sleep has been disturbed for weeks or months, not days.
• There is a constant low background of unease, even on calm days.
• Physical symptoms — tension, fatigue, gut discomfort, headaches — are ongoing and not explained by anything medical.
• Relaxation has started to feel difficult or unsafe.
• Work, relationships or enjoyment are beginning to be affected.

None of these on their own is a diagnosis. Together, in a pattern, they are worth taking seriously. If you are unsure, an initial assessment with one of our therapists is a low-stakes way to talk it through.

How therapy with us can help

Our work with chronic anxiety usually moves in three directions at once: understanding the pattern, easing the body, and exploring what sits underneath.

Depending on what is most useful, your therapist may draw on cognitive behavioural therapy (CBT) to work directly with worry cycles, trauma-informed and psychodynamic approaches to look at the deeper roots, and body-based work to help the nervous system come down. Most of our clients are seen weekly, by video, through our online therapy service — meaning no commute, no waiting room, and the option to be supported from wherever feels safe.

Sessions are available with both fully qualified therapists and with closely supervised trainees through our affordable therapy programme, so cost does not have to be the reason this gets left for another year. Our individual therapy page explains what to expect in more detail.

A gentle ending

Stress is part of being human, and especially part of being a Londoner. Most of it passes. Some of it does not.

If what you are carrying has stopped feeling like stress — if it is no longer attached to a clear cause, if your body has not fully settled in a long time, if your mind has been quietly bracing for the next thing for months — that is worth taking seriously. Not as a failing. As information.

Stress responds to the situation. Anxiety responds even when the situation has passed. Recognising which one you are living with is the first step toward changing it.

If you would like to talk to someone, you are warmly welcome to get in touch. If you are in immediate distress, please see our immediate support page for crisis resources.

Anh Doan
BACP-registered Psychotherapist & Clinical Supervisor
Founder, Talking Counselling London

Further reading

• Greater London Authority. Survey of Londoners — anxiety and wellbeing data.
• Mental Health UK. The Burnout Report 2026 — UK-wide stress and burnout data.
• MHFA England. Workplace Mental Health Statistics 2026.
• Priory Group. Mental Health Statistics UK 2026 — including GAD prevalence.
• Porges, S. W. (2011). The Polyvagal Theory. W. W. Norton.
• Van der Kolk, B. A. (2014). The Body Keeps the Score. Viking.
• Bhui, K., et al. (2018). Cultural competence in mental health care, BJPsych Bulletin.
• Pavlenko, A. (2005). Emotions and Multilingualism. Cambridge University Press.

This article is a clinical reflection and is not a substitute for individual therapy. If anything here speaks to your experience, you are warmly invited to get in touch.