Anxiety appears in many forms. It could feel like fretting over a doctor visit, dreading a meeting with a new boss, or even worrying about the possibility of a natural disaster.
Specifics aside, anticipatory anxiety is the overwhelming fear that an upcoming event may go wrong or get out of your control.
Feeling a certain amount of worry about the future is natural. Most of us speculate about what may or may not happen in our lives.
But if you find yourself agonizing about terrible things that might happen — especially in anticipation of an event or an uncomfortable situation — it could be a sign you’re experiencing anticipatory anxiety.
“Anticipatory anxiety is anxiety about anxiety,” says Heather Forward, an anxiety therapist in Lawrenceville, Georgia. “It happens because our thoughts are focused on possible future negative outcomes to the anxiety-producing trigger.”
This type of anxiety can range from situational to chronic.
If you’re worried about how your first day of work or school will go or imagining the different ways your first date could go horribly wrong, you might be experiencing situational anticipatory anxiety.
Carley Trillow, a licensed counselor in Cleveland, Ohio, says situational anxiety usually resolves itself when the triggering event is over. “For example, someone may become anxious during the week of performance reviews. In situational anxiety, the end of the review would end the anxiety.”
“If you notice yourself often being anxious for days, weeks, or even months before an anxiety-producing event, on a regular basis, it could be a chronic problem,” says Nereida Gonzalez-Berrios, a certified psychiatrist in Houston.
Gonzalez-Berrios also explains that anticipatory anxiety isn’t a medical condition in itself. Instead, it’s actually generalized anxiety disorder (GAD).
Gonzalez-Berrios says anticipatory anxiety can be caused by fear of failure or starting a new unfamiliar task.
It could also develop from underlying mental health conditions like:
- GAD. This condition centers on excessive stress and worry that tends to be unprompted. It usually involves more than one stressor and it may impact your social or professional relationships. These excessive concerns happen on most days for at least 6 months.
- Specific phobias. This condition — sometimes called “simple phobias” — stems from an overwhelming fear of a specific situation or thing. The fear tends to largely outweigh the actual tangible threat. Some common examples include phobias of heights, animals, flying, and injections.
- Social anxiety disorder. This condition involves a feeling of intense dread toward social situations. Formerly known as social phobia, this anxiety disorder can cause intense fear of negative judgement from others, making it especially distressing or embarrassing to perform or speak publicly.
Anticipatory anxiety, Gonzalez-Berrios adds, is also found in patients living with obsessive-compulsive disorder (OCD). This is particularly so when someone with OCD feels anxious about not being able to engage in social or occupational activities due to compulsive rituals.
Since anticipatory anxiety isn’t a formal mental health diagnosis, it may be tricky to tell for sure if it’s what you’re feeling. In general, you’d present symptoms of general anxiety, but the difference would be the trigger (something that hasn’t happened yet).
Anticipatory anxiety may feel like a quick wave of nervousness or even an overwhelming sense of doom.
As Forward explains, anticipatory anxiety has the same signs and symptoms as GAD — which is also thought of as “regular” anxiety.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), you’d receive a GAD diagnosis after experiencing symptoms nearly every day during a 6-month period.
Specifically, a mental health professional would look for three or more of these six symptoms during this time:
- feeling on edge, restless, or keyed up
- having trouble concentrating or feeling like you have a “blank” mind
- feeling irritable
- feeling easily tired
- feeling muscle tension
- having sleep difficulties like trouble falling or staying asleep, or restless unsatisfying sleep
If you recognize any of these symptoms in yourself, and they’re frequently triggered by thinking about possible future situations, it may be anticipatory anxiety.
Additional signs of anticipatory anxiety
If you notice you’re intensely focused on fearful, unwanted outcomes — especially if you see an increase in feelings of frustration and hopelessness because of this — it’s probably due to anticipatory anxiety.
Here are some additional signs of anticipatory anxiety, according to Gonzalez-Berrios:
- feeling constant fear or nervousness about something that’s going to happen in the future
- always expecting a bad outcome
- being easily distracted
- feeling apprehensive
- having unfounded irrational thoughts
- having trouble sitting in one place due to excessive worrying
Anticipatory anxiety is a common symptom of panic disorder — a condition that includes frequent panic attacks.
Additionally, panic disorder involves fear or stress about possibly having a panic attack. In other words, you anticipate a panic attack, and this causes you great anxiety.
Agoraphobia is another condition related to anticipatory anxiety and panic disorder.
Agoraphobia usually involves fear of public spaces. Fear of these often crowded spaces makes it difficult for someone living with agoraphobia to leave the house.
In other words, you anticipate that something terrible might happen if you leave your house, so you try not to.
Angela Ficken, a therapist in Boston, Massachusetts, explains that cognitive distortions happen when “your thoughts are distorted; what you are thinking and what you are telling yourself is not entirely true.”
Ficken explains that when you’re anxious, thoughts are often more distorted “because that’s what anxiety does. It tells us to be afraid, and while that can be helpful (don’t go down that dark alley, there could be a danger), it doesn’t always tell us the truth.”
Forward says that anticipatory anxiety can be triggered by different cognitive distortions or thinking patterns, like:
- fortune telling (trying to predict the future)
- mindreading (trying to guess what others are thinking or feeling)
- what ifs, should haves (ruminating on different outcomes)
- catastrophizing (exaggerating situations by assuming the worst will happen)
- magnification (exaggerating situations by making small issues large)
- polarized or black and white thinking (assuming something is extremely good or extremely bad)
Whether you live with a mental health condition or not, these tips may be able to help you cope with anticipatory anxiety.
1. Get plenty of sleep
When you’re feeling tense and worried, it’s usually difficult to sleep. When you don’t sleep enough, you may experience more anxiety.
Finding ways to sleep through the night is important, especially since sleep deprivation can make anticipatory anxiety symptoms
Things like managing caffeine intake, starting a meditation practice, or using bedtime relaxation strategies may help you get on a sleep schedule that supports your well-being.
2. Get physical
Exercise is a key component of improving anticipatory anxiety. It can
Trillow says even 15 to 30 minutes of physical movement every day can make a difference. “This can be through anything you enjoy — dancing, walking, yoga. Movement supports your body to regulate itself, which is what is lacking when anxiety is high.”
3. Practice mindfulness
Forward says calming techniques — meditation, drawing or coloring, diaphragmatic breathing, rhythmic breathing, and anything else you may find calming — can help a great deal.
“Mindfulness is an excellent tool and aims to help you stay in the moment, which prevents the future-focus that’s a hallmark of anticipatory anxiety,” she says.
4. Shift your focus
There are simple things you can do to switch your focus in a less distressing direction.
Ficken suggests scheduling something to look forward to right after the anticipated event.
“If you are anxious about an upcoming presentation,” Ficken says, “think about doing something nice for yourself right after, like seeing a friend for lunch to debrief or getting a coffee.”
“You can also try running cold water on your wrists or drinking cold water,” Ficken adds. “When we get anxious, we can feel hot and sweaty, and many of us hold our breath when we get anxious. Temperature change can help regulate our body and our breathing when we are anxious.”
5. Be kind to yourself
When you’re aware that you’re in a cycle of negative, anxious thoughts, it can help to talk to yourself like you would a close friend or family member.
Instead of criticizing yourself or losing patience, try practicing compassion toward yourself and asking some gentle questions.
Questions like, “Will worry actually change the outcome?” may lead you to remember the last time you were this worried and how things turned out better than you thought.
Gonzalez-Berrios also suggests using positive affirmations to help refocus your mind toward a positive perspective.
If you notice that your anticipatory anxiety symptoms are becoming more chronic than situational, and your coping strategies aren’t offering enough support, finding and talking with a therapist may be a good idea if it’s possible for you.
A therapist may use cognitive behavioral therapy (CBT) techniques to help you manage your symptoms, and they may also suggest medication.
Ficken suggests reaching out to a therapist, if one’s available to you, before things get really difficult.
“If you feel like you need help managing your anxiety and stress and can’t find a way out,” she says, “see someone who can help. Learning skills and strategies to manage anxiety can be transformative, and it doesn’t take that long to learn!”
Anticipatory anxiety isn’t a formal diagnosis. Instead, it exists under the umbrella diagnosis of generalized anxiety disorder.
Feeling anxious and uncertain about the future is natural, and it’s also common to want to avoid potentially hurtful or frightful situations. But, since you can’t get in control of events that haven’t happened yet, it may be a good idea to find ways to cope with uncertainty.
Practicing mindfulness, getting enough sleep, and exercising, along with redirecting your focus, may help ease anxiety symptoms. If it’s possible for you, talking things out with a therapist can also help you manage symptoms.