What Is Anticipatory Anxiety: Causes, Symptoms, Tips on How to Control it?

May 29, 202411 min
a Women who is in fear just like Anticipatory Anxiety

At some point in time, you may have said to yourself or heard someone say, “I am feeling really anxious.” Anxiety is a real or perceived threat to future events. We may also experience anxiety as a response to everyday life stressors. 

For example, I am anxious about a therapy session and expressing my feelings in front of a stranger. Anxiety is different from fear which often elicits some kind of action to a danger present in real time. 

For example, if a tiger appeared in front of you, you would not be uncertain about feeling fear. Well, of course, everyday anxiety can seem a bit different. In the current social reality we live in, the results of a competitive exam that you spent months trying to crack, are as anxiety-provoking as a beast preying on you. 

So, how you experience anxiety may differ by how long you feel it, how much you feel it and if there is a single thing causing you anxiety or different things that vary in intensity. Anxiety can vary and is known by different names as per its nature, duration, and severity of experience. 

To understand in a nutshell what anticipatory anxiety is, think of the comic Peanuts with Charles M. Schultz’s Charlie Brown suggesting, “My anxieties have anxieties.” 

What is Anticipatory Anxiety? 

Anticipatory anxiety is a fear of future events that are yet to unfold and evoke a sense of uncertainty.  Some form of anticipatory anxiety is experienced by everyone and is just a part of life. 

For example, moving to a new city, the first day at a new job or going on a first date - all these events may evoke anticipatory anxiety. 

On the other hand, some kinds of anticipatory anxiety can happen for routine tasks, leaving you feeling confused and filled with dread. For example, maybe you feel your heart racing while driving around in your neighbourhood, or going to a certain place - let’s say to your place of work - which makes you sweat and experience negative thoughts about something horrible about to happen.

Anticipatory anxiety in itself is not a medical diagnosis. So, you may ask what is the importance of addressing anticipatory anxiety?

1.Anticipatory anxiety is life-limiting: 

In the above example of going on a first date, maybe it relieves you of feeling this way the second time. However, anticipatory anxiety that occurs consistently, and similarly for other life situations can be debilitating.

2.Anticipatory Anxiety invites curiosity:

For many people with other mental health conditions, especially anxiety disorders or severe stress and adjustment disorders it can be life-limiting. If you are not yet diagnosed, excessive anticipatory anxiety can help you be curious about what you’re feeling and the possibility of getting a diagnosis. 

3.Naming it helps taming it: 

Learning how to manage anticipatory anxiety with a mental health professional through medication or talk therapy can help improve symptoms and lead to a better quality of life. 

How do I know if I have anticipatory Anxiety?

If you’re living with Generalized Anxiety Disorder (GAD), Seasonal Affective Disorder (SAD) or Post-traumatic stress disorder (PTSD), your brain is more likely to interpret a situation as threateningleading to anticipatory anxiety in different situations. This contributes to more distress than the situation would demand.

Symptoms and signs of anticipatory anxiety: 

While there are some universal physical and psychological symptoms of anxiety, everyone’s experience of anxiety can be different. However, knowing some common symptoms can help make sense of your experience. 

Following is a non-exhaustive list of common symptoms:

  1. Hyperventilating or shortness of breath
  2. Chest pains 
  3. Tense muscles or spasms 
  4. Rumination or overthinking beyond control 
  5. Difficulty concentrating on tasks 
  6. Apprehensive 

4 Common triggers of anticipatory anxiety: 

Triggers that can prompt anticipatory anxiety can stem from related conditions such as Generalised Anxiety Disorder or Major Depressive disorders or occur on their own. 

Common triggers can include:

  1. Uncertainty about a future event 
  2. Past traumatic experiences 
  3. Specific places related to past negative experiences 
  4. Rumination can be both a trigger and manifestation of anticipatory anxiety. It usually includes delving into situations and imagining worst-case scenarios

The Science Behind Anticipatory Anxiety

Researchers Grupe and Nitschke (2013) highlighted 5 key psychological processes that explain what causes anticipatory anxiety. These psychological processes are based on neurobiological and psychological mechanisms. 

As per their model, an individual has control over some of their behaviours, but not all. This is so because some brain functions prioritise automatic action before planned action to help you feel safe when there’s real or perceived danger. 

Please note these mechanisms don't necessarily happen in a fixed order.

1.Misinterpreting the threat of a future situation:

For individuals with anxiety disorders, there are differences in brain regions in the prefrontal cortex (the executive of action planning) that affect decision-making when a threat is perceived. So, let’s say you have an exam coming up, but it seems really difficult to study for this exam. Feeling anxious, the following thoughts come to your mind:

  • What if I fail this exam? 
  • What if I have to repeat a year?

These are all cues that the threat feels really big for you. 

2.Increased attention to the threatening aspects of the situation

When someone is dealing with anticipatory anxiety associated with an anxiety disorder, they find it difficult to put their attention to anything but the threat. This is often associated with the amygdala - a small almond-shaped structure inside the brain involved in detecting danger and keeping you alive. For many individuals with GAD, SAD and PTSD, the amygdala is hyperactive, i.e., it is biased toward threats because past experiences and/or its default mechanism have shaped the amygdala to assign a higher value to threats. So, in the case of an exam, all your attention is going toward “not failing” but you forget to assess the non-threatening aspect of the situation. 

For example:

  • The GPA you’re maintaining 
  • What is the minimum score you can aim to get to maintain the GPA?
  • What if this is just one exam and does not have a lot of weightage in the overall scheme of things?
  • What are other support systems to access that can help with this exam?

3.Inability to inhibit anxious feelings: 

If the amygdala relays to the prefrontal cortex that the danger is persisting, even neutral cues may seem scary. A sense of safety never materialises and your action is based on anxiety as opposed to composure. So, the exam seems to have more weightage on “job prospects” now, which was originally neutral.  You may start to wonder, “What if this exam affects my grades to the point of impacting my future job prospects?” leaving you distressed further. 

4.Avoidant thoughts and behaviours: 

Extensive fear or anxiety may lead to avoidance of triggering situations. If you think this exam will make or break your future,  you may choose to skip the exam, or completely avoid thinking about it, and as a result, not prepare well for it.  

5.Reactive to uncertainty: 

If one tends to look out for signals of danger as opposed to signals of safety, uncertainty, which is always accompanied by the thought of the future, may make you more reactive. To explain, let’s say you ended up missing the exam. The next term, another exam comes with uncertainty looming above your head again. A previously known and tested solution is missing the exam, and you may just well repeat it - but is it truly offering you support and a solution?

The next time a similar situation arises, the uncertainty looms again because there is no alternative to preparing for the exam. You may also feel more tense considering the situation is repeating itself and may repeat a course of action. 

So, how do you manage the psychological mechanisms driving anticipatory anxiety?

How do I stop uncontrollable anxiety? 

Anxiety is rooted in the uncertainty of the future. A few ways to mitigate the same are to stay in the present. There are a few things that help deal with uncontrollable anxiety. 

These include talk therapies like cognitive behavioural therapy, self-care strategies, and mindfulness and relaxation techniques. 

Cognitive Behavioural Therapy

Therapeutic approaches like Cognitive Behavioural Therapy (CBT) help manage symptoms of uncontrollable anxiety. CBT is a popular and effective psychotherapy for managing anxiety disorders.

One of the major goals of CBT is to assist clients in identifying thoughts, emotions and behaviours that are contributing to anxiety. Some unhelpful thoughts can contribute to feelings of anxiety and avoidance behaviours. Another goal of CBT is to challenge these thoughts and look for alternate ways of thinking or resolutions that would ease this anxiety. 

A therapist trained in CBT works with your Negative Automatic Thoughts (NATs).

When working through your thoughts, emotions and behaviours, you may recognize that there is one overarching theme across situations that contributes to your anxiety. For example, “I am a failure” This can be so routine that we may not recognize how these thoughts and feelings impact us, especially when they are about our abilities. Think of the examination and how, in the example, the thought goes toward all career prospects being affected.

Sometimes, CBT involves collaboratively scheduling tasks that enhance well-being. For example, if one experiences anticipatory anxiety about stepping out of the house, a client and therapist may collaboratively decide that before the next session (let’s assume it’s online, thank you internet) you will try to just open the door to your home and put your head out. You may or may not choose to increase the intensity and duration moving forward.

Best 4 Practical Strategy and Coping Techniques to Deal with Anticipatory Anxiety

Sometimes it takes a while to find the right professional to begin a therapeutic relationship. Until then, here are some practical self-help strategies to work through anticipatory anxiety on your own. Some of these are based on Socratic questioning, a series of questions that encourage reflection and problem-solving:

1. Worry exploration: 

Sometimes we can make our worries bigger than they ought to be. Worry exploration allows you to think of what could happen versus what will happen. 

Some of these questions can look like:

  1. What are you worried about?
  2. What are some clues your worry won't come true?
  3. If it does not come true, what will happen instead?
  4. If your worry does come true, what would happen? Will you eventually be okay?
  5. How has your worry changed after answering these questions?

2. Put your thoughts on trial:

Some thoughts are helpful, while some are not. To truly understand which thoughts are serving your present situation,  pretend you’re a prosecutor and put your thoughts on trial. Use evidence, i.e., anything that is verifiable - not interpretations or guesses or opinions. Then, switch gears and take a crack at defending your thoughts. 

Finally, look at all the evidence to make a verdict as the judge. 

1.Lay out the thought

2.Prosecute - evidence against the thought 

3.Defence - evidence for the thought 

4.Judgement - Is the thought accurate and fair? Are there other thoughts that can explain the facts?

3. Improve daily habits and routines:

Some of the practical strategies can be rooted in daily habits and routines to manage anxiety. 

This could include:

1.Ensuring good sleep and a balanced diet 

2.Reducing intake of stimulants like caffeine and alcohol 

3.Engaging in regular physical activity such as walking or jogging 

4.Surrounding yourself with a supportive network of friends and family who can provide emotional support

4. Have self-compassion: 

Next time you anticipate anticipation anxiety, be gentle with yourself, and curious. Ask yourself, “What does this indicate? It must be here to protect me in some way…” and see how things change! The compassion and support of a loved one can also go a long way to make us feel heard and supported. In your anxious moments, don’t hesitate to reach out to a trusted friend or family member for support. 

5. Mindfulness and relaxation techniques: 

While anxiety brings your attention to the future, mindfulness allows for being in the present moment. Many psychologists use mindfulness and relaxation alongside CBT  to reduce nervousness. 

3 Mindfulness techniques include:

1.Deep breathing: 

Deep breathing allows for deeper and fuller breaths to alleviate physical symptoms of anxiety. Sometimes deep breathing can be difficult and may take us to a place of more worry. Hence, it is advisable to try it first in the presence of a professional. 

2.Guided imagery: 

Guided imagery often requires one to close one’s eyes and visualise soothing imagery. This could look like successfully delivering that speech in public or being able to say no and stay firm on it even with all the shaking. 

3.Mindfulness meditation: 

Mindfulness meditation is simply the ability to focus on the present moment. This allows for worries of the future to float away, and for you to enjoy the present moment you’re in where you may be able to access feelings of safety. 

When should I consider seeking professional help?

Seeking professional help goes a long way in taking care of your symptoms and managing anticipatory anxiety. Maybe self-help strategies have not worked for you or you find that your symptoms are not improving, you can access professional help from a clinical or counselling psychologist. At Mave Health, we are committed to providing holistic mental health care, with the help of the country’s best mental health professionals on our platform - Mave Health Therapy Club.  

Our wearable device, ARC is another tool you can access. This headset uses neurostimulation that has undergone thorough testing to help with symptoms of depression and enhance cognition. 

Over 66% of ARC users have reported a significant reduction in anxiety within the first three weeks of regular use.

  1. ARC is completely safe to use and backed by neurotechnologies 
  2. ARC is shared with you only after a free consultation with a professional to check for eligibility 
  3. ARC is safe to use alongside medicines. Clinical trials reveal that over 70% of participants who utilized ARC's technology with antidepressants achieved remission within 10 weeks, compared to 58% who only used ARC. 

Conclusion

Anticipatory anxiety is found to be co-occurring with clinically diagnosed disorders such as GAD, SAD and PTSD. There are some physical and psychological indications that you may be experiencing anticipatory anxiety. While some of these mechanisms are neurobiological, i.e., different brain regions are at play, others are psychological, i.e., can be worked through working on one’s thoughts to manage symptoms. A few ways to control anxiety include CBT, mindfulness and relaxation techniques.

Remember, you don't need to be alone in this journey. Reach out to loved ones for support, and to mental health professionals who can help you manage anticipatory anxiety long-term.  

References

  1. Braun, J. D., Strunk, D. R., Sasso, K. E., & Cooper, A. A. (2015). Therapist use of Socratic questioning predicts session-to-session symptom change in cognitive therapy for depression. Behaviour Research and Therapy, 70, 32–37. 
  2. Chambless, D. L., Milrod, B., Porter, E., Gallop, R., McCarthy, K. S., Graf, E., Rudden, M., Sharpless, B. A., & Barber, J. P. (2017). Prediction and moderation of improvement in cognitive-behavioral and psychodynamic psychotherapy for panic disorder. Journal of Consulting and Clinical Psychology, 85(8), 803–813. 
  3. Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioural therapy. InnovAiT, 6(9), 579–585. 
  4. Goyal, M., Singh, S., Sibinga, E., Gould, N. F., Rowland-Seymour, A., Sharma, R., Berger, Z., Sleicher, D., Maron, D. D., Shihab, H. M., Ranasinghe, P. D., Linn, S. T., Saha, S., Bass, E. B., & Haythornthwaite, J. A. (2014). Meditation programs for psychological stress and well-being. JAMA Internal Medicine, 174(3), 357. 
  5. Grupe, D. W., & Nitschke, J. B. (2013). Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature Reviews. Neuroscience, 14(7), 488–501. 
  6. Helbig-Lang, S., Lang, T., Petermann, F., & Hoyer, J. (2012). Anticipatory Anxiety as a function of panic Attacks and Panic-Related Self-Efficacy: An Ambulatory assessment study in Panic Disorder. Behavioural and Cognitive Psychotherapy, 40(5), 590–604. 

Neff, K. D. (2023). Self-Compassion: theory, method, research, and intervention. Annual Review of Psychology, 74(1), 193–218.

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Mave
Clinical Psychologist