Anticipatory anxiety is heightened anxiety and apprehension in anticipation of something bad that could happen in the future. People with anticipatory anxiety may mentally rehearse bad outcomes even when they are highly unlikely to occur. While it’s not its own mental health condition, anticipatory anxiety may happen for those with other conditions like generalized anxiety disorder (GAD).
What Is Anticipatory Anxiety?
Anticipatory anxiety is a heightened feeling of anxiety specifically about the state of something in the future, and can leave you feeling trapped and worried to the point of exhaustion. This type of anxiety lends itself to chronic negative thinking which increases stress and perpetuates this cycle of anxiety. Anticipatory anxiety is often associated with endless “what if” scenarios, worst-case thinking, and dwelling on all possible outcomes in the future. Usually, anticipatory anxiety is a symptom of a larger anxiety disorder.
Normal vs. Problematic Anticipatory Anxiety
Normal anticipatory anxiety tends to be triggered when a person has reasonable cause to predict that a bad outcome is possible. The more likely the bad outcome is or the more severe the consequences that could result, the more normal it is to experience anticipatory anxiety.
Anticipatory anxiety exists on a spectrum related to these factors:1, 3, 6, 7
- What triggers it
- When it starts
- How intense it is
- How much time, energy, and attention is spent worrying
- How much it impairs someone’s functioning
- How much it influences a person’s actions and choices
What Can Trigger Anticipatory Anxiety?
In anticipatory anxiety, a person’s fight or flight response is being triggered by worrying about possible bad outcomes that could occur in the future. Often, these worried thoughts are triggered by some external cue like receiving news or an upcoming event getting closer. Situations that are uncertain, unpredictable or uncontrollable are most likely to trigger anticipatory anxiety.3
Common triggers of anticipatory anxiety include:
- A job interview
- A presentation or speech
- A medical procedure or surgery
- A test or evaluation
- A date or other social activity
- A difficult conversation
- Getting on a plane
- Doing something new
- Being without something used for comfort
- Having to give someone bad news
With anticipatory anxiety, fight or flight is triggered by a future threat, and not one that a person can run from or physically fight off, rendering the response unhelpful. Without a use or outlet for this increased energy and agility, the fight or flight response becomes uncomfortable and is experienced as symptoms of anxiety like a racing heart, increased respiration, hypervigilance, and feeling shaky or restless.
Types of Anticipatory Anxiety
People who experience frequent, excessive, and intense anticipatory anxiety may be suffering from an underlying mental health condition.
Anticipatory anxiety can be a symptom of several mental health conditions, including:1, 3, 4, 7
- Panic Disorder: Experiencing anticipatory anxiety about having a panic attack and imagining or fixating on the idea that they will have another attack.
- Social Anxiety Disorder: Often triggered by planning or preparing for a social event, especially one that is high-pressure or unfamiliar. A person with social anxiety will often imagine interactions or situations where they are embarrassed or criticized.
- Phobias: People with phobias will experience anticipatory anxiety before situations where they may encounter their fears, from public speaking (Glossophobia) to fear of spiders (arachnophobia).
- Generalized Anxiety Disorder: People with generalized anxiety can have anticipatory fear about any situation, particularly one that is unfamiliar to them, but may not be able to pinpoint what exactly they are scared of.
- Post Traumatic Stress Disorder (PTSD): Intense fear of the traumatic event recurring, even in situations where this is highly unlikely. Their anticipatory anxiety also can be triggered by people, places, things or even smells that remind them of the traumatic event.
- Obsessive Compulsive Disorder (OCD): Anticipatory anxiety before encountering specific fears they obsess over, especially when they may not be able to engage in the mental or behavioral rituals that reduce their anxiety (i.e. handwashing or checking).
- Substance Use Disorders: Worried that others may find out about their problem or where they would be unable to use. People trying to quit a substance may also experience anticipatory anxiety about how difficult or painful the withdrawal will be.
- Eating Disorders: Someone might be worried about others finding out about their eating disorder, believing they will get fat, or fearing others will judge them for their eating habits.
Symptoms of Anticipatory Anxiety
Anxiety, like all emotions, causes distinct changes in the way a person thinks, feels and behaves. Anticipatory anxiety is not a diagnosable condition but can be a symptom of an underlying anxiety disorder or other mental illness.
Not all people who experience anticipatory anxiety have an anxiety disorder, but they can experience many of the same symptoms, including:
- Worried “what-if” thoughts
- Inability to focus
- Overestimating threats
- Dissociating
- Hyperawareness of surroundings
- A sense of dread
- Irritability or frustration
- Physical symptoms like:
- Increased heart rate
- Dizziness
- Tense muscles
- Nausea
How to Deal With Anticipatory Anxiety
While it isn’t possible to completely prevent anticipatory anxiety, here are 10 ways to calm your anxiety:2, 6, 7, 8
1. Wait for More Information
Wait until you have more information before you start thinking and planning for the future situation you are worried about. This will help you ensure that your thinking process leads to productive planning rather than unproductive worrying.
2. Resist Letting Your Anxiety Predict the Future
When fight or flight is activated, the prefrontal cortex (part of the brain that thinks, plans, and makes good decisions) is impaired. Resist the urge to worry and predict the future with limited information, as this just offers more unknowns to worry about.
3. Follow Your Normal Routine
When there is a false alarm triggering anticipatory anxiety, work on following your normal routine as much as possible. This signals your brain that you are safe and ok, which will help to rewire your fight or flight system to respond more neutrally in the future.
4. Turn Anxious Thoughts Into “Even If” Thoughts
“Even if” thoughts are much more helpful because they help you focus on your response to a possible bad outcome, which is within your control. These thoughts can help you feel more prepared for a possible bad outcome, more in control and less anxious.
5. Don’t Respond to False Alarms
The more you act as if false alarms (i.e. irrational fears that trigger fight or flight) are real, the more the false alarm is reinforced. Resist the urge to change or cancel plans. Instead, work on reacting in calm and reasonable ways, even if you are still anxious.
6. Don’t Sit & Worry
Worrying is never productive and will only make you feel more anxious. Worrying, rehearsing and ruminating while you are anxious does not provide any outlet for the nervous energy that is generated by the fight or flight response.
7. Move Your Body
Getting up and being physically active is proven to be helpful in reducing both stress and anxiety. Physical activity also provides an outlet for the nervous energy generated by the fight or flight response, and helps restore your body and brain chemistry to normal.
8. Accept the Anxiety & Move Forward With It
You are probably going to have anxiety whether you like and accept it or not. Instead of focusing so much attention on stopping your anxiety, think about where and how your time and energy would be better spent. Refocus yourself on these activities instead of letting anxiety drive and change your behavior.
9. Journal About Your Anxiety
Journaling allows you to write how and what you’re feeling regarding the stressors in your life without any judgment. You can pour your emotions onto a blank page and unload your fear, anxiety or depression from your mind and heart. Journaling allows you to keep a record of your emotions, both positive and negative, over time as well as allowing you to reflect and find opportunities for emotional growth.
10. Don’t Focus on “What If” Thoughts
“What if” thoughts are at the center of anticipatory anxiety but tend to focus on the aspects of the future that are unknown and beyond your control. Focusing on these what if thoughts tends to make anxiety worse and fears more irrational.
11. Try Mindfulness Meditation
Mindfulness skills and formal meditation also have powerful anxiety and stress-relieving capabilities, and these skills are often integrated into therapy. Mindfulness and meditation can help you learn to pull your attention away from unhelpful thoughts and to be more present in a way that allows you to honor the negative emotions and channel towards more positive emotions.
12. Practice Yoga
There are many benefits of yoga for mental health, and it allows you to express emotions through your body. There are a lot of benefits to moving your body and exercising, however yoga takes that one step further as the goal tends to be finding balance. When finding balance and an emotional equilibrium is at the center of your mind, it becomes that much easier to process stressful emotions to get to a balanced state. There are many guided yoga meditations and yoga assist classes that can help restore this missing balance and help you acknowledge the full range of your emotional state.
13. Work With Your Anxiety
While it may seem counterintuitive, trying to stop, control or get rid of anxiety often backfires. Struggling to stop or control anxiety can lead you to become more frustrated, stressed out, and exhausted, and usually does not get rid of it, making it an ineffective use of your time, effort and energy.
14. Take Nature Walks
There is a lot of research which suggests that spending time in nature helps to reduce feelings of anxiety, depression, stress, and other mental health issues. Nature has a way of improving the mood. There is a strong connection between the time spent in nature and overall mental state.
15. Talk to a Therapist
Another great way to deal with this type of anxiety is to speak with a therapist. They are equipped to help you understand and normalize the wide range of emotions you feel and can help you learn strategies of coping with these emotions. You can find a therapist by searching an online therapist directory or reviewing the in-network providers with your insurance. Looking through profiles online and narrowing down a few to contact for initial talks is a good first step. Many therapists offer a free phone consultation and that can give someone an opportunity to evaluate if that may be the right fit for anxiety therapy.
When to Get Professional Help for Anticipatory Anxiety
People who experience more chronic, excessive, and intense anticipatory anxiety that interferes with their quality of life or ability to function should seek professional treatment.
Some of the signs that may indicate a need to seek treatment include:
- Constantly feeling worried, nervous, or on-edge
- Being unable to focus or get things done because of anxiety
- Having your performance impaired because of anxiety
- Being unable to sleep or eat normally because of anxiety
- Canceling plans or avoiding situations because of anticipatory anxiety
- Other significant impairments in routine or functioning related to anxiety
Therapy for Anxiety
Anxiety is a highly treatable condition, and anticipatory anxiety can be treated using the same types of therapy and medication that have been found to be effective in helping people manage symptoms and improve their functioning.
Some of the more commonly used treatments for anxiety disorders include:2
- Cognitive Behavioral Therapy (CBT): Teaches skills to interrupt anxious thoughts that feed the anxiety, as well as helpful responses to the triggers
- Acceptance and Commitment Therapy (ACT): Encourages people to be willing to experience and accept their emotions, and make choices based on personal values
- Exposure therapy: A type of CBT that teaches relaxation skills and encourages people to gradually face their fears
- Mindfulness: Can be practiced numerous ways, including guided imagery, progressive muscle relaxation, and even yoga-based therapies
Medication for Anxiety
In some cases, medication for anxiety may be prescribed, either for daily use or as-needed. If you’re interested in medication, talk to your primary care physician, who may prescribe it or give you a referral for a psychiatrist.
Preventing Anticipatory Anxiety
There are some situations where anticipatory anxiety is normal and even helpful, so sometimes the goal should not be to prevent or stop the anxiety, but instead to learn how to respond more effectively to it. For example, having anxiety before a major life transition like moving away, having a baby, or taking an important exam is completely normal. Sitting and worrying about something is almost never productive, but channeling it to thoroughly plan, prepare, and be proactive ahead of a major event can help ensure a positive outcome.
When anxiety occurs in anticipation of something that is insignificant, unlikely to happen, or impossible to predict or control, it tends to be less helpful and productive. Because stress and anxiety are very similar, many of the same methods of reducing stress also help with reducing anxiety. These include things like being physically active, engaging in active problem solving, and increasing time for relaxation and self-care. These strategies may not completely prevent or stop the anxiety but can prevent it from escalating.
Because anticipatory anxiety is driven by worried thoughts about the future, the best method of preventing and short-circuiting anticipatory anxiety is to stop worrying. While this sounds easier than it is, reducing worrying can be accomplished with the use of distraction techniques, CBT exercises, and even mindfulness skills, which are reviewed in more detail below.
Anticipatory Anxiety Infographics
