What Is Distress? It’s the Dose That Makes the Poison

Hundreds of years ago, Swiss physician and alchemist Paracelsus determined Sola dosis facit venenum – or Only the dose makes the poison. In other words, at a high enough level, anything can be toxic. And on the flip side, in small enough quantities, even something very difficult might not get to you. 

If you think about this in terms of stress, when it gets to a high enough level or long enough duration, you might begin to experience distress. Eventually, this could lead to a crisis. 

For example, imagine you have too much on your plate this week – a big deadline at work, say, and you’re stressed out. Even though it’s overwhelming, you may be able to lean on your resources and manage the added pressure temporarily. 

But if you lived in that pressure cooker day in and day out, you might turn to food, alcohol, gambling, or other coping strategies that impact your quality of life and well-being. 

What is distress?

Psychological or emotional distress is a particular response to life stressors that is not in alignment with your values or desires for how to live. 

To this end, distress might be considered a “negative” response to stress. 

Distress vs. stress

Stressed, depressed, anxious, distressed… what’s the difference? 

These terms are often used interchangeably because there is some overlap in their meaning. When thinking about the difference between stress and distress, a simple way to think about it is that distress is one type of stress response.

To back up a little bit, stress is usually thought of as an internal state that occurs in response to some form of external stressor.

The stress response consists of a person’s emotional reaction mixed with behavioral and physiological changes that can shift depending on the situation. 

Responses to stress can range from healthy to unhealthy and mild to severe. 

Distress, on the other hand, is, by definition, an aversive state. Emotional or psychological distress can occur in response to one or multiple stressors, particularly when those stressors outweigh a person’s tools and resources to cope.

Stress level test

Perceived Stress Questionnaire (PSQ-30)

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Symptoms of distress

Our bodies and brains have systems in place to respond to dangerous situations and help keep us alive. This is where the fight-or-flight response comes in. 

If you’re starting to cross the street and you suddenly notice a big car speeding straight for you, you’ll jump out of the way. You might feel your heart beating faster and your muscles tense, and you likely won’t be feeling very hungry or sleepy in that moment. 

This is because your body has gone into the “flight” response. 

Once the external stressor has gone away, your body is meant to equilibrate. If it doesn’t, you might develop mental health concerns such as anxiety, depression, or acute stress disorder, and you might also experience distress. 

While there is no universal and agreed-upon set of symptoms, some signs of distress may include:

• Difficulty sleeping 
• Sleeping too much
• Changes in appetite 
• Being unable to relax
• Feeling overwhelmed 
• Isolating from your friends 
• Feeling fatigued and low energy 
• Having unexplained aches and pains
• Experiencing sudden changes in mood 
• Smoking, drinking, or using drugs to cope
• Displaying increased irritability, sadness, or worry 

Keep in mind that a person’s cultural background, beliefs, temperament, and upbringing can all impact the way that they experience and express distress.

– Kate Dubé, Licensed Clinical Social Worker (LCSW)

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What’s more, the same person can have a different response to stress based on a variety of factors that impact their life. [1] Merino, M. D., Vallellano, M. D., Oliver, C., & Mateo, I. (2021). What makes one feel eustress or distress in quarantine? An analysis from conservation of resources (COR) theory. British journal of health psychology, 26(2), 606–623. https://doi.org/10.1111/bjhp.12501  

Some of these factors include:    

• Time
• Health
• Family
• Friends
• Racism
• Housing
• Finances
• Knowledge
• Employment
• Discrimination
• Transportation

Causes of distress

We all experience stressors both big and small. For example, you might be: 

• Planning for a life transition
• Upset by your parents’ separation
• Late and stuck in unexpected traffic
• In an argument with your best friend
• Dealing with the aftereffects of trauma
• Coping with the illness of a family member
• Overwhelmed by the responsibilities that you’re juggling
• Worried about whether you can pay your bills next month

All of these potentially distressing situations can contribute to your overwhelm. 

And while it’s not particularly useful to label emotions as negative, they can be uncomfortable and are important signposts that guide us toward a life that’s in alignment with our values. 

Eustress vs. distress

While there’s debate around whether “eustress” is really a thing, it is generally thought of as a “positive” response to stress. [2] Vašků, J. B., Lenárt, P., & Scheringer, M. (2020). Eustress and Distress: Neither Good Nor Bad, but Rather the Same? BioEssays, 42(7), 1900238. https://doi.org/10.1002/bies.201900238  

Let’s go back to the example of the car speeding toward you as you cross the street – it was your stress response that allowed you to jump out of the way and not get hit. 

There are more subtle examples, too. Perhaps you are stressed about a big presentation at work, and that stress motivates you to prepare. Or maybe you are stressed about the end of a relationship, and that stress leads you to realize what type of partnership you are looking for. 

How to cope with distress

It’s not always possible to manage your stress, but there are some tried and true tools that you can start practicing to help cope with your distress.  

Start with the basics

Getting 7-9 hours of sleep, eating healthy food, and moving your body regularly are the fundamentals of stress management. But easier said than done, right? [3] About sleep. (2024, May 15). Sleep. https://www.cdc.gov/sleep/about/?CDC_AAref_Val=https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html   

When we’re stressed, there’s usually too much on our plate, and sleep is often one of the first things to go out the window. Getting on a good sleep schedule may take some experimentation and exploration of sleep hygiene practices. 

Regular exercise can also improve your sleep while boosting your mood and combatting your stress. 

Practice self-care 

Taking a break isn’t just about scheduling a vacation once or twice a year. In fact, the core of self-care happens in your day-to-day life by creating space to do things that are fulfilling. 

This can be as small as noticing a blade of grass growing through a crack in the sidewalk, eating something delicious and nourishing, or taking a short walk during sunset. 

What fills each of us is different and can also change with time. Explore what works for you and try to come up with creative ways to fold self-care into your regular routine.

– Kate Dubé, Licensed Clinical Social Worker (LCSW)

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Stay in the present 

While it can be tempting to try to power through, it’s important to know that burnout and stress often take root in your body. 

Taking moments throughout the day to pause and ground yourself in the present moment can help keep you centered without getting lost in a spiral of stress. There are many grounding techniques that you can draw from and experiment with. [4] Treatment, C. F. S. A. (n.d.). Exhibit 1.4-1, Grounding Techniques – Trauma-Informed Care in Behavioral Health Services – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/NBK207188/box/part1_ch4.box5/    

One example is called ‘5-4-3-2-1,’ and here’s how you do it: 

1. Start by looking for five things you can see – maybe it’s the shadow cast by a leaf or the tiny hairs on your arm. Whatever it is, take your time to really see what you’re looking at. 
2. Next, find four things you can touch or feel, for example, your tongue against the roof of your mouth or the breeze across your cheeks. 
3. Then, notice three things you can hear. This might be a siren wailing down the street or the constant buzz of your refrigerator. 
4. Now, notice two things you can smell – maybe the coffee leftover from this morning or the freshness of the air after it rains. 
5. And lastly, bring your attention to one thing you can taste. You can take a bite of something or simply notice the taste of your mouth as it is right now. 

Seek support

Distress can feel overwhelming and lonely. You might be tempted to bottle up your emotions, grit your teeth, and push through. 

Yet carrying the entirety of your stress, embarrassment, shame, and confusion will typically only entrench the distress more deeply.

Opening up to trusted friends and family, as well as your therapist, can help expand your perspective while providing you with the support you need. 

A word from Calmerry 

When too much stress piles up, or it goes on too long without a break, you might become distressed. Rather than face this alone or hope it will magically get better on its own, consider reaching out to a therapist (online or in person) who can help you sort through what this means in your life and how to move forward.