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Anticipatory Anxiety: Bleeding Before You Are Cut

How to understand and overcome fear of future events, actions, or decisions.

Key points

  • Anticipatory anxiety is the anxiety we experience in anticipation of doing things that frighten us.
  • Anticipatory anxiety is the third layer of anxiety—the avoidance aspect.
  • Anticipatory anxiety varies widely in the way it appears in different settings.
Photo by Vicky Hladynets on Unsplash
Source: Photo by Vicky Hladynets on Unsplash

In the next few posts, we will provide an overview of anticipatory anxiety—how to understand it and how to overcome it. We’ll also look at the related problem of chronic indecisiveness—the habit of not making decisions.

Anxiety comes in many shapes and forms, most of which include anticipatory anxiety as a component. Phobias, social anxiety, panic attacks, obsessive fears, and unwanted intrusive thoughts can cause great suffering. Anxiety can also come in the form of physical symptoms, or an ongoing parade of worries. Anxiety is usually accompanied by apprehension about the future and doubts about performance, safety, or well-being. Anticipatory anxiety may be present with all these forms of anxiety.

Anticipatory anxiety is worry about the future, and the fear that bad things might happen or that you might become unable to successfully accomplish what you set out to do. It is the anxiety we feel when we are anticipating a difficult decision, action, or situation. It is how we feel when we buy into our own creative worry stories. It is the expectation of distress accompanied by a push to avoid. Anticipatory anxiety seems to predict danger; it feels like a warning not to proceed—or, at the very least, to proceed carefully.

We think of anticipatory anxiety as a third layer of fear. Let us explain:

  • First, we can be afraid of something. For example: "I am scared of a bee."
  • Second, we can be afraid of being afraid. This is sometimes called the fear of fear, and we know this as panic: “If I see a bee, I might get so frightened that I have a panic attack and then lose control or have a heart attack.”
  • Finally, we get to the third level of fear—being afraid of being afraid of being afraid. This is not as complicated as it sounds: “I am miserable even thinking about camping next week because I might see a bee and have a panic attack, lose control, and do something crazy. Maybe I should cancel the camping trip."

This third layer of fear is the avoidance layer. Anticipatory anxiety is a powerful motivator of avoidance because it specifically focuses your attention on the negative things that could possibly happen. If your prediction is only mildly negative—for instance, that you’ll sweat a lot when you’re presenting your plan in a meeting—then you might believe that you can push through it.

But catastrophic predictions—like having a panic attack, making a complete fool of yourself, or damaging a relationship—can lead to incapacitating anxiety that stops you from proceeding. Anticipatory anxiety can make it seem like avoidance is your only choice.

Importantly, anticipatory anxiety can also involve expectations not only of anxiety or panic, but also of disgust, anger, shame, regret, humiliation, becoming overwhelmed, or any other unwanted emotion. The urge to avoid emerges from the expectation of unwanted feelings from some dreaded failure, loss, or disaster.

The anxious experience has two separate components: the anxiety disorder itself (phobia, social anxiety, panic, worry, obsession, and compulsion) and, separately, the anticipatory anxiety. Anticipatory anxiety occurs during the period before you expect to encounter what you are worried about.

If you are worried that you might have a panic attack in a situation you expect to enter, anticipatory anxiety may start hours, days, or even weeks before it. If you are trying to decide if it is safe to meet a new person or use a public bathroom or ignore a brief sensation or thought, anticipatory anxiety is the dread you feel when you “try on” that activity or decision and scare yourself with imagining all the ways things could go badly.

Anticipatory anxiety varies widely in the way it appears and looks different in different settings. It can present as phobic avoidance, fear of being alone, performance anxiety, or insomnia. It can look like the elaborate planning that someone with OCD must do to avoid possibly encountering contamination, or the agony that a person with illness anxiety goes through waiting for test results. It can be the haunting fear of the return of an unwanted intrusive thought.

Anticipatory anxiety drives the compulsions that define obsessive-compulsive disorder and related conditions. It is anticipatory anxiety (“I won’t be able to stand it if”) that pushes people to perform the mental rituals and behavioral compulsions to reduce the immediate discomfort caused by the obsession.

Anticipatory anxiety might be expressed as a fear of going to parties or restaurants or travel, lest you encounter something there you believe you can’t handle. A desire to avoid being alone at night might stem from anticipatory anxiety about suddenly becoming ill or having scary thoughts. Anticipatory anxiety about imagined relationships might be why you avoid dating. Anticipatory anxiety about getting fired might make you “sick” every morning before you leave for work.

In the past, anticipatory anxiety has been inaccurately called free-floating anxiety. The body may be habitually tense, sometimes without awareness of specific worries. This may lead to headaches, chest pain, and muscle spasms. In fact, it is anticipatory anxiety that is the primary driver of chronic hyperventilation which is a set-up for panic attacks. Chronic gastrointestinal problems such as diarrhea, nausea, or vomiting might be directly traced to anticipatory anxiety.

Anticipatory anxiety is the primary driver of generalized anxiety disorder (GAD), a tendency toward unproductive and excessive worrying. (Our book Needing to Know for Sure describes this phenomenon in detail.) Simply put, the anxious imagining and distressing “what if” of GAD is anticipatory anxiety.

Anticipatory anxiety can develop out of an overactive imagination or from conditioned responses to memories. It can be driven by a trait called anxiety sensitivity—the fear of the mind and body manifestations of anxious arousal. It can also emerge from a depressed and withdrawn mood state. Or it can find its origins in beliefs about one’s own inability to cope with novelty or challenge.

Effective treatment of anticipatory anxiety, like all forms of anxiety, is targeted at the factors which maintain it. As always, too much thinking is not solved by more thinking. Successful therapy aims for a shift toward sensory input, a modification of attitudinal factors, and a change in one’s relationship with inner experience. These include gently redirecting the attention to the present moment rather than the imagined future, while allowing for and not struggling against the experience of anxiety.

Metacognitive factors which maintain the anxiety, such as the false belief that anxious and doubting thoughts signal danger or predict the future, need to be addressed. And escape planning, ruminative entanglement with doubts and worries, and other forms of avoidance such as empty self-reassurance must be discouraged.

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