You may have heard the term anticipatory grief, which generally references an emotional state experienced by those who have, or have a loved one with, a terminal illness. It may also be connected to other negative outcomes that have not yet happened, but will occur in the near future. As the name infers, the mental health phenomenon is accompanied by strong feelings of sorrow and stress over what is to come. It’s a rational feeling when terminal illnesses and other certain outcomes are involved, which (rationality) is what separates it from the phenomenon being discussed in this particular article – anticipatory anxiety.
There has been a marked rise in outreach for information and counseling services related to anticipatory anxiety over the last few years. In fact, each month, up to one-thousand individuals per major U.S. state perform an online search for “how to deal with anticipatory anxiety”. This may have to do with a nationwide feeling that we’re living in exceedingly uncertain times (more on this below). That being said, it’s something that generations prior have also struggled with, even though few were able to place a label on what they were experiencing.
What is anticipatory anxiety? The Anxiety and Depression Association of America (ADAA) defines it as the experience of excessive fear and worry about an upcoming event or situation, often focusing on potential negative outcomes and leading to avoidance behaviors. It’s a future-oriented form of anxiety, where the mere anticipation of distress causes significant mental and physical symptoms, even before the event itself occurs. In many cases, the anticipated event does not actually come to fruition, ergo the connection to often being an irrational fear, which is in contrast to anticipatory grief. Irrational or not, it’s a very real mental health issue for millions in our country. Of further concern, is that it can become a self-fulfilling prophecy in that it can alter one’s behavior to the point that they contribute to their own demise.
Below is an overview of anticipatory anxiety for those who suspect that it’s connected to their current negative mental state. In developing a better understanding of one’s fear of the unknown and potential negative outcomes, one may instead learn to focus on more productive thoughts and feelings and potentially change outcomes for the better.
Overview of Causations, Signs, Symptoms, and Comorbidities of Anticipatory Anxiety and How to Deal with it in a Healthy Way
I. Common Issues People Have Anticipatory Anxiety About
Physical Health
Anticipatory anxiety over physical health is also referred to in some circles as illness anxiety disorder or health anxiety. It involves excessive worry about being seriously ill, even with minor symptoms. This anxiety cycle can begin with a normal body sensation, triggering catastrophic thoughts that are often reinforced by seeking constant reassurance through online searches or frequent visits to a medical clinic or family physician.
Sociopolitical Events
Anticipatory anxiety over sociopolitical events is an excessive fear of future, unpredictable societal developments. It stems from a perceived threat and uncertainty that can be heightened by media consumption, heated discussions with friends, family, coworkers, and/or other personal experiences. The current political divide felt by millions of Americans, and the chronic worry about it, is an example that many can relate to.
Career and Income Stability
Anticipatory anxiety over career and income involves excessive worry about stability of work or business and related financial outcomes. The connection to self-fulfilling prophecy is very real with this form of anticipatory anxiety. For instance, if an individual has convinced themselves that their boss is unhappy with their work and will terminate their employment, the individual may mentally “check out”, form a negative attitude, and exhibit reduced productivity. The behavioral changes may end up causing a termination that may not have been on the horizon.
Relationship Status
Anticipatory anxiety over a romantic relationship involves feeling fear and dread about future relationship events, often driven by uncertainty or past negative experiences, which can manifest as excessive reassurance-seeking, overthinking, and even physical symptoms such as decreased libido. As with income instability, the connection to self-fulfilling prophecy is also very real. If an individual has convinced themselves that their spouse or companion is unhappy and will eventually terminate the relationship, the individual may stop being attentive and may turn to infidelity and subsequently cause the end of the relationship.
Life Changes
Anticipatory anxiety is strongly linked to life changes such as a move to a new city, a transition to a new job, or graduation from one educational experience towards a higher level of education. Fear and worry over safety, stability, and adequacy creep in and compromise what may otherwise be an entirely positive life event.
One-Off Events
These are more specific and often linked to mild, moderate, and more severe phobias (more on this below). For example, an individual may experience varying levels of anticipatory anxiety about upcoming air-travel or having to give an oral presentation at school or the workplace.
II. Signs and Symptoms of Anticipatory Anxiety
Common signs and symptoms of anticipatory anxiety are broken down into mental, emotional, and behavioral issues in addition to physical manifestations. These include the following:
Mental, Emotional, and Behavioral Symptoms
- Excessive Worrying: Persistent, unproductive, and excessive worry about potential future events that typically focuses on worst-case scenarios.
- Feeling of Impending Danger: A pervasive sense of dread, panic, or doom that isn’t tied to a specific, palpable, or immediate threat.
- Irritability: Feeling tense, jumpy, or irritable due to constant worry.
- Restlessness: An inability to sit still and/or a general feeling of being on edge.
- Difficulty Focusing: Trouble concentrating on the present moment or on tasks other than the source of the anticipated concern.
- Avoidance: An urge to avoid situations, places, or things that are perceived as triggers for the anticipated anxiety.
Physical Symptoms
- Elevated Heart Rate: A pounding or racing heart when thinking about potentially negative outcomes.
- Shortness of Breath and Rapid Breathing: Rapid breathing (tachypnea) shortness of breath (dyspnea), and chronic hyperventilation.
- Muscle Tension: Body-wide muscle tension (including jaw clenching).
- Headaches and migraines: Thinking about potentially negative outcomes can trigger or worsen headaches.
- Gastrointestinal Problems: Nausea, an upset stomach, or diarrhea.
- Fatigue: Feeling weak or tired due to the chronic mental and physical stress associated with anticipatory anxiety.
- Trembling or Sweating: Uncontrolled trembling or excessive sweating.
- Insomnia: Trouble falling asleep or staying asleep.
III. Mental Health Issues That Cooccur with Anticipatory Anxiety
While the number of mental health issues (depression, etc.) that relate to anticipatory anxiety in varying degrees is quite extensive, research confirms that the following are among the most commonly cooccurring ones.
Panic Disorder: As a type of anxiety disorder (view more) it is a condition characterized by recurrent, unexpected panic attacks. On top of the focus on a potentially negative outcome of some event, anticipatory anxiety may also manifest as a persistent fear of having another panic attack.
Generalized Anxiety Disorder (GAD): Involves excessive, uncontrollable worry about various events or activities, which can include persistent dread about future situations.
Agoraphobia: The fear of being in places or situations where escape might be difficult or help unavailable, such as crowded spaces, can lead to anticipatory anxiety about leaving home or other “safe” space.
Obsessive-Compulsive Disorder (OCD): Individuals with OCD may experience extreme anticipation and worry about upcoming events. This often stems from a fear of outcomes going poorly, or a need to resolve doubt through excessive rumination.
Other Specific Phobias:
Anticipatory anxiety is a symptom or associated with phobias that can lead to avoidance behaviors, including the following:
- Fear of flying (aerophobia or aviophobia)
- Fear of social situations (social anxiety disorder)
- Fear of public speaking (glossophobia)
IV. Unhealthy Coping Mechanisms for Anticipatory Anxiety
Unhealthy coping mechanisms for anticipatory anxiety are about the same as they are for Generalized Anxiety Disorder, chronic stress, depression, and other mental health issues that cause one to seek escape from negative feelings via the release of dopamine. Common examples of coping mechanisms that can result in unhealthy habitual behavior include but are not exclusive to the following:
- Gambling to cope with anticipatory anxiety
- Gaming to cope with anticipatory anxiety
- Consumption of pornography to cope with anticipatory anxiety
- Seeking sexual encounters to cope with anticipatory anxiety
- Substance use (alcohol and drugs) to cope with anticipatory anxiety
- Eating excessively, or unhealthy foods, to cope with anticipatory anxiety
If you have turned to any of the above coping behaviors please refocus your attention to the healthy, sustainable, and effective outlets below.
V. Healthy Coping Strategies for Anticipatory Anxiety
Deep Breathing Techniques
Breathing exercises such as diaphragmatic breathing can stimulate the release of your brain’s feel good hormone – dopamine – and help reset your brain in a positive direction. Here are the general directions:
- Sit or lie-down in a comfortable space and close your eyes.
- Place one hand on your chest and the other hand on your abdomen.
- Inhale through your nose for approximately 4-seconds as you feel your abdomen expand.
- Hold your breath for 2-seconds, then exhale slowly and steadily through your mouth for about 6-seconds.
- Repeat the process from anywhere between 5 and 15 minutes. Your mind and body will let you know when you have calmed down sufficiently to move on to the next step.
Mindful Meditation
In the context of managing anticipatory anxiety, mindful meditation is a clinician-guided practice that involves focusing on the present moment without judgment, often through techniques such as sensation observation and deep-breathing exercises. A counselor will help you train your attention and become more aware of your thoughts, feelings, and physical sensations as the urge to focus on potentially negative outcomes of some future event arise. It takes time to become adept at mindful meditation, especially when triggers to worry infiltrate your space, but when working closely with a counselor you will develop the skills to overcome.
Counseling for Anticipatory Anxiety
Cognitive Behavior Therapy (CBT) focuses on changing thought patterns and behaviors to promote a healthier state of mind and body. As a primary form of anticipatory anxiety treatment at Kindbridge Behavioral Health, CBT has demonstrated both short-term and long-term positive effects for clients. CBT can be effectively delivered via virtual (online and by-phone) private one-on-one sessions or group counseling, as preferred.
Do You Struggle with Fear and Worry Over an Uncertain Future?
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