بهمن
Anxiety
It’s not difficult to recognize anticipatory anxiety—that accelerating angst that can arise before delivering a speech, starting a job, or bracing for changes related to the new presidential administration.
In smaller doses, “it’s a pretty normal human emotion, because as humans we tend to have some trepidation about the unknown,” said Stephanie Sarkis, PhD, a Tampa, Florida, psychotherapist who specializes in treating anxiety. In evolutionary terms, she said, “anticipatory anxiety is letting you know about potential threats.”
[Related: Psychology topics: Anxiety]
Albeit not a diagnostic condition, anticipatory anxiety often accompanies other diagnoses, such as generalized anxiety disorder or social anxiety disorder, Sarkis said. “And it can be excessive,” she said. “It becomes an issue when it’s taking over day-to-day functioning.” The resulting distress is not just emotional, but can spawn hyperventilation, stomach distress, and other physical symptoms.
Anticipatory anxiety can be sparked by daily scenarios, such as anticipating a dental appointment or a preventive cancer screening (Goodwin, B., et al., Psycho-Oncology, Vol. 32, No. 12, 2023). Or the symptoms may stem from more systemic sources of stress and uncertainty, whether worry about climate-related weather events or about anticipated changes emanating from the new administration.
It also can fuel unhealthy behaviors. In an effort to reduce anticipatory anxiety, individuals coping with high levels of social anxiety report more drinking prior to a social event than those with nonclinical levels (Buckner, J. D., et al., Addictive Behaviors, Vol. 102, 2020).
But mental health clinicians, as well as individuals themselves, can implement various strategies to ease anticipatory anxiety. These can range from ramping up sleep and exercise, to practicing mind-body grounding techniques, to better thinking through the “what ifs” that an anxious brain can generate.
Cognitive roots
Anticipatory anxiety represents the “third layer” of fear, characterized by avoidance patterns, said Martin N. Seif, PhD, a psychologist who developed the airport-based Freedom to Fly program. In his experience, individuals first recognize that they are fearful about flying, he said. That anxiety may morph into the second layer, in which they become anxious that their fear will lead to a panic attack and other embarrassing behavior while on the next flight. Eventually, they may reach the third layer of fear, the avoidance layer, and decide to forego flying entirely to circumvent the severe anxiety and distress.
Individuals also may lean on alcohol to dampen the physical arousal and other uncomfortable symptoms of anticipatory anxiety, for example before attending a social gathering, said Julie Buckner, PhD, a coauthor on the Addictive Behaviors study about pre-event drinking. (At this point that’s a hypothesis, she noted, as the study didn’t delve into underlying motivations.)
“Another [hypothesis] is that they could be nervous, feeling anxious about the upcoming social event, so they might be doing it for social facilitation reasons,” said Buckner, a psychology professor who directs the Anxiety and Addictive Behaviors Laboratory and Clinic at Louisiana State University in Baton Rouge. “They may think, ‘If I have a couple of drinks, I will be more comfortable, so I’ll be more social,’” she said.
In scenarios in which people can’t physically avoid the source of their anxiety, such as a growing local risk of extreme weather events, they may instead engage in cognitive avoidance, trying to distract themselves from their worries, said Seif, who coauthored Overcoming Anticipatory Anxiety. But that attempt to suppress related fears can boomerang back on itself, creating a worry loop.
One antidote to these avoidance behaviors, Seif said, is for individuals to develop an action plan, by themselves or with the help of a therapist. For instance, if someone lives in an area with a high threat of fires and has frequent anticipatory anxiety about a fire ripping through their home, they could make a concrete plan to move to a safer area or assemble go bags and exit plans for themselves and family members.
But first, they will likely need to sit for a while with their anxiety and ride it out, until they are calm enough cognitively to develop such a plan, Seif said.
“I think our job in some ways is to separate the wheat from the chaff or the signal from the noise,” he said. “And say, ‘OK, there’s all this stuff going on. What in fact can I do in the real world to make whatever difference I can?’”
Breaking the cycle
Therapists can also teach patients cognitive behavioral therapy techniques such as differentiating fact from speculation, Sarkis said. As one example, the inauguration of a new presidential administration is an inevitable reality, along with any proposed policy changes. But it’s speculative to presume which policy measures leaders will be able to implement, so ideally, patients should be encouraged not to fret over what hasn’t yet happened.
Similarly, working through the “what ifs,” including with a therapist, can help to ease anticipatory anxiety, said Sarkis, who wrote about these and other strategies for Psychology Today. For instance, if patients are fretting about whether climate change will get worse, they can approach that question logically, thinking through potential scenarios and related solutions or survival tactics. Taking action, such as packing a survival kit for different types of disasters, can further reduce anxiety. Volunteering in the community, such as for an environmental organization, can be particularly helpful because it connects people with others, thus shifting the focus off one’s own mental processes, she added.
To reduce anticipatory anxiety, individuals should also strive to cut back on online scrolling and set time limits for news consumption, said Sarah Allen, DClinPsy, a Chicago-area psychologist who specializes in anxiety. She also recommends techniques to reconnect with the external world, such as working through the five senses by naming items that one can see, feel, hear, smell, and taste. By grounding the body more in the here and now, that approach can help dampen overactivation in the brain, including the amygdala. Physical exertion helps to settle anxious minds, as well. Sarkis cited research showing that the more intense the exercise, the better in terms of easing anxiety, though drop-out rates were higher in the high intensity versus the low intensity groups (Aylett, E., et al., BMC Health Services Research, Vol. 18, 2018). Moreover, getting more sleep than typical has been associated with a lower tendency toward perseverative thinking, including worry and rumination.
In one study, 270 adults ages 65 to 89 were asked each morning to rate their level of worry about things they had to do or that might happen that day, in essence tracking their anticipatory anxiety, said Zexi Zhou, the study’s lead author and a doctoral student in human development and family sciences at The University of Texas at Austin (Zhou, Z., et al., Journal of Psychosomatic Research, Vol. 179, 2024). When participants slept more hours than usual, the researchers wrote, it “played a buffering role in the link between [the] prior night’s and [the] next morning’s worry.”
Therapists may also consider checking whether patients with newly emerging anticipatory anxiety have recently experienced any big life changes, since such events can contribute to emotional distress, Sarkis suggested. While not a formal diagnosis, anticipatory anxiety can be distressing, and therapists may sometimes even refer a patient to a prescribing clinician, she added.
“We need to be aware that anticipatory anxiety is a very real feeling for clients,” Sarkis said. “For some clients, the anxiety can be so intense that it’s hard for them to put into words how it feels.”
