Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Is overthinking the same thing as anxiety? A therapist’s take

By Elle Warren

Dec 20, 20237 min read minute read

Reviewed byApril Kilduff, MA, LCPC

Most people overthink from time to time, especially when it comes to emotionally charged or challenging situations. And no one is immune to feelings of stress and anxiety. You may feel anxious while you’re overthinking. Or you might overthink and then feel anxious. 

But are they the same? And more importantly, when do overthinking and anxiety become something that you should seek help for? All good questions! And April Kilduff, LPCC, LCPC, LMHC, a therapist and clinical trainer at NOCD, has some answers. 

What is overthinking?

Overthinking is the act of ruminating about something beyond the point of what is reasonable. It becomes excessive and even debilitating, consuming large chunks of time. You might think about a particular topic so much that you lose track of how you originally felt about it. And often, overthinking has the opposite effect of what we want it to: Rather than giving us answers, it leaves us with more questions and fears.

“Worry can be a helpful emotion when it gets you to take action,” says Kilduff. “But when it’s just worry spinning around and around on itself 24/7, then you’re stuck in overthinking that’s problematic. It’s not solving anything.

“In that way, overthinking can be sort of a cause and result of anxiety at the same time.”

Rumination like this is foundational to both anxiety disorders and obsessive-compulsive disorder (OCD). It can feel like a sort of comfort in the moment if you believe it will provide you with clarity on a particular situation. In the long-run, however, it only keeps you stuck in the cycle of fear and anxiety.

What is anxiety?

Anxiety is a feeling like any other feeling. It can be helpful for preparing you for important events, allowing you to focus, and warning you about dangerous situations. It can also become disordered when you get so fixated on the feeling of anxiety that you’re unable to distinguish real threats from perceived ones. 

Anxiety—which is an umbrella term for a cluster of disorders characterized by excessive, chronic, and debilitating levels of anxiety and fear—is the most common mental disorder. It affects nearly 30% of adults at some point in their lives. Some anxiety disorders include:

Generalized anxiety disorder (GAD). GAD is not so much concerned with several specific themes or triggers, but rather involves anxiety tied to anything—especially routine, everyday activities. It’s sort of like looking at the world through a filter of worry. As with all anxiety disorders, GAD often comes with physical symptoms like restlessness, fatigue, racing heart, muscle tension, and trouble sleeping.

Social anxiety disorder. This condition has to do with worry over being judged, criticized, rejected, or humiliated by others. Those with social anxiety disorder may try to avoid meeting new people or entering unfamiliar (or even familiar) social settings.

Specific phobias are fears that are concentrated on very particular objects or experiences, such as a fear of vomiting (emetophobia), or anxiety over loud noises (ligyrophobia). Those with phobias often avoid anything that reminds them of their feared object, activity, or other feared stimuli.

Agoraphobia. This is the fear of being in a situation where it would be difficult or embarrassing to escape—or one where help will be unavailable should panic symptoms arise. People with agoraphobia might avoid the situations they’re most afraid of, require someone to accompany them, or get through it with levels of anxiety that can feel unbearable. If it gets severe enough, they might stop leaving home altogether. 

Panic disorder is marked by chronic panic attacks, where you experience intense physical and psychological terror—so intense that you might believe you’re having a medical emergency. While panic attacks can’t actually hurt you—not physically, at least—they feel like a major threat.

Separation anxiety disorder. This can occur in both children and adults and happens when you’re highly fearful of being separated from someone they’re attached to, leading to problems with everyday functioning. You might not want to leave the house without someone you’re close to, and may try to stop them from going out without you.

No matter the specific condition, anxiety is a painful experience rife with fear and worry. Whether or not you meet the criteria for a diagnosis, you can still get highly effective help for feelings of anxiety—more on that in a moment.

Can overthinking and anxiety be the same thing?

While people with anxiety are almost always prone to overthinking, overthinkers don’t always have anxiety. So they’re certainly not the same thing. But let’s look at an example of how they can occur at the same time:

Matt doesn’t like meeting new people because he can never stop thinking about how they perceive him. He’s terrified of saying or doing the wrong thing and feeling embarrassed or rejected. He gets sweaty and sometimes even feels dizzy. He clenches his jaw and tenses his shoulders. 

Sometimes Matt consciously avoids meeting new people, but it’s important to his wife that he attend her company’s holiday party next week. Ever since she told him about it a few weeks ago, he can’t get it off his mind. He tries to predict everything that will happen and how he will act. In his mind, he practices the perfect way to say hello. He wonders what he should wear that will gain him the most favorability. He keeps experiencing the same intrusive thoughts: “What if I humiliate myself? What if they think my wife is with a loser because of me?”

In this scenario, there is the presence of anxiety, fear, and an inability to stop thinking about the situation ahead. In a case like this, Matt’s overthinking may even be an example of compulsive rumination as a symptom of OCD: an urgent attempt to rid himself of the fear that he could accidentally do something to let his wife down. In doing so, however, he only makes his worries stronger, teaching his brain that the slightest intrusive worry or uncertainty is a threat that he must address through rumination and overthinking. 

But overthinking isn’t necessarily a sign of anxiety disorders or OCD. To highlight the difference, consider this example of overthinking without the presence of anxiety:

Marianne is taking her daughter to Disney World for the first time. She is so excited for her daughter to have this experience that she finds herself daydreaming about it all the time. She thinks through every moment of the trip, trying to figure out what rides and foods will make for the most possible enjoyment. She just can’t contain her excitement and can’t stop thinking about it. 

In this scenario, Marianne might be overthinking her trip to Disney World. However, it’s not coming from a place of anxiety or fear, but excitement and joy. It could give way to anxiety at some point, but is not automatically anxiety-fueled.

How do you know if you need help?

I know it can be challenging to make the call to seek help. There’s still some stigma surrounding mental health and therapy. You may be holding on to the belief that asking for help means you’re “weak,” or “lazy,” or a “loser.” 

Alas, those ideas couldn’t be further from the truth—it’s courageous to ask for help, to take a big step toward a better life. If any area of your life is being affected by anxiety or overthinking—even if it’s all internal, and even if you’re “functioning” in your external life—you deserve to give therapy a chance at giving you a full life back.

How can you get help for overthinking or anxiety?

If you resonated with any of the information on anxiety disorders or OCD, Kilduff says the “go-to” treatment is most often going to be exposure and response prevention (ERP) therapy. This modality works best for fear-based disorders because it teaches you that you can tolerate discomfort and uncertainty without engaging in safety behaviors (namely, avoidance of the situations, places, people, sensations, or objects that give you anxiety). 

To begin, you and your therapist will discuss the nature of your anxiety. What does it feel like? When does it come up? Are you engaging in avoidance? From there, you’ll develop therapy exercises to confront your worry and anxiety, and you’ll start small before working your way up. Rather than avoid your triggers, you’ll learn that they, and your anxiety itself, is not as dangerous as you previously perceived it to be.

Even if you don’t identify with what you learned about OCD and anxiety disorders, but still want assistance with overthinking, you can seek help—therapy is for anyone, not just those with specific diagnoses. For general concerns about overthinking, your best option is likely cognitive behavioral therapy, or CBT. In working with a trained therapist, you would have the opportunity to learn what thoughts, feelings, and actions are contributing to your pattern of overthinking. Ultimately, you’d learn what you can change in order to stop engaging in excessive overthinking.

Of course, the best way to ascertain a treatment plan is to consult with a trained, licensed specialist. The important thing to remember is that no matter your experience, there is help available for you. You can feel like your brain is yours again, and stop the constant cycle of worry.

We specialize in treating OCD

Reach out to us. We're here to help.