Have you ever experienced
Strong anxiety related to future events?
...Finding yourself having all your attention on possible catastrophic scenarios that could happen...
..and consequently avoiding all situations related to that event?
If so, you might have experienced Anticipatory Anxiety.
This form of anxiety manifests itself as a symptom, and not as a mental condition in its own right.
Anticipatory anxiety can be defined as a profound feeling of anxiety, fear and discomfort, accompanied by specific physical symptoms, that occurs at the thought of facing a situation perceived as dangerous or risky to one's physical or psychological health.
You may experience it for a new event, new acquaintances, in your intimate relationship (e.g. if you suffer from Affective Dependency) or before an exam, an important task, a trip or a job interview.
This form of anxiety is normal and usually lasts for a short period of time.
On the contrary, anxiety becomes problematic when these same situations create very strong and persistent feelings, noticeable bodily manifestations and an excessive fear that leads to continuous avoidance of the situation.
This fear is always linked to something that may happen in the future and not to a threat in the present.
As I pointed out earlier, however, this form of anxiety manifests itself mainly as a symptom of something else. It is often directly linked to Panic Disorder, but it can also be a manifestation of other disorders.
ANTICIPATORY ANXIETY AS A SYMPTOM OF PANIC DISORDER
Anticipatory anxiety is closely related to the way we think and feel.
In Panic Disorder, thoughts are usually focused on real or imagined worries that you will have an attack in situations that could be embarrassing, uncomfortable or that you might have a heart attack or die.
Within that, anxiety can go far beyond the limits considered as 'normal'. The fear of having an attack can be associated with any situation or event, whether small or large.
This can even lead some people to never leave their home.
Some common thoughts may be:
What happens if I find myself driving and have a panic attack?
What happens if I start to feel panicky in a shopping centre or in a crowded place and risk making a bad impression?
What if I go out for a walk and start to feel sick and can no longer get home?
These kinds of thoughts cause strong Anticipatory Anxiety that can lead to avoidance in many situations. It can be so intense that it causes a condition called Agoraphobia (fear of open spaces and unfamiliar environments).
WHAT ARE THE PHYSICAL SYMPTOMS OF ANTICIPATORY ANXIETY?
The physical symptoms of this form of anxiety are often similar to those of Generalised Anxiety Disorder.
The most common ones are
muscle tension and pain
excessive sweating
rapid heartbeat
tiredness and fatigue
headaches and other somatisations
gastrointestinal disorders
concentration difficulties
rumination
active avoidance of the feared situation
These symptoms can occur alone or in combination and are often closely linked to a situation perceived as 'dangerous'.
Rumination refers precisely to what I described in the previous paragraph and can also create various problems at the relationship level, low self-esteem, problems in attention and concentration and emotional management.
ANTICIPATORY ANXIETY AS SYMPTOM OF OTHER DISORDERS
You will certainly have heard of this form of anxiety as a symptom of Panic Attack Disorder. We have already seen how in this case it manifests itself mainly as an excessive fear of having other attacks.
Actually, this form of anxiety also manifests itself in other disorders, namely:
1) Social anxiety
In the context of social anxiety, it can be related to thoughts such as:
What happens if I blush?
What happens if I find myself with nothing to say?
What happens if I freeze up?
Nobody is really interested in what I have to say
The thoughts are related to future events, but also to one's own self-perception and low self-esteem which tends to anticipate future failure. This often leads to experiencing a deep sense of loneliness.
2) Anxiety related to health conditions
It can be related to thoughts such as:
What if the doctors are wrong?
What if I am a special case and there is no cure for me?
What if the tests show a tumour or a serious heart problem?
As we can see, these are all excessive thoughts and worries related to a condition that may be there in the future but is not present at the moment.
It also manifests in Hypochondria.
3) Post Traumatic Stress Disorder
In this disorder, anxiety may manifest itself as a fear that the traumatic event will somehow reoccur in other perceived similar situations.
This leads to efforts to physically and psychically avoid any elements associated with the trauma such as places, people, activities, thoughts and feelings.
Linked to this is a real general increase in the level of activation: hypervigilance, concentration difficulties, sleep disturbances, intrusive memories, flashbacks, etc.
HOW TO DEAL WITH THE SYMPTOMS OF ANTICIPATORY ANXIETY
1. deep breathing
In particular, 'belly' breathing is a technique that is very easy to implement and does not depend on where you are. Here is an example:
You can sit with your eyes closed and focus your attention on your breath.
Remain aware of the sensation of the breath entering and leaving your nostrils. It doesn't matter how long you can do it, the intention to do it matters.
As you breathe try to breathe from the belly and not from the chest. You can tell if you are doing it right if your belly is swelling (yes, I am talking about Diaphragmatic Breathing).
Inhale for 5 seconds, hold and then exhale for another 5 seconds.
You can try this exercise for about 5-10 minutes or when you feel that your anxiety and agitation are very high.
Deep diaphragmatic breathing is a very powerful anxiety-reduction strategy because it activates the body's relaxation response: this helps the body move from the attack-escape phase to the relaxation phase.
2. Practice Progressive Muscle Relaxation
This technique teaches you to relax your muscles (often tense due to anxiety) in a 2-step process.
The first step is to voluntarily create tension in particular muscles in your body, such as your neck and shoulders.
The second step is to try to release as much tension as possible and notice the sensations in your muscles when you relax them.
This exercise can help you lower your muscle tension and stress levels. It can also help reduce physical ailments such as headaches and improve sleep quality.
3. Use other meditative, relaxation or visualisation techniques
There are many techniques that can help manage anxiety symptoms as a result of their practice. Some examples:
Visualisation techniques
Autogenic training
Yoga
Meditation
Among the many techniques, the one I recommend is Mindfulness meditation, which is much more than a relaxation technique.
4. Test your thoughts
As we saw earlier, rumination is one of the most difficult symptoms to deal with because it tends to be focused on everything negative that can happen. Some questions you can ask yourself are:
Is worrying so much realistic?
Has this always happened in the past when I have been in this situation?
Could I deal with the situation in some way?
If something negative happens, what does that say about me?
In moments of lucidity, it is easier to answer these questions objectively. It is not easy not to listen to one's thoughts, but one can certainly question them.
5. Exercise
Here again, exercise (as with depressive symptoms) can be a valuable ally in reducing anxiety symptoms.
WHAT ARE THE POSSIBLE TREATMENTS FOR ANTICIPATORY ANXIETY?
If the level of anxiety that you experience on a daily basis is high, my advice is to consult a mental health professional.
There are several approaches that can help you deal with and resolve this disorder:
Cognitive Behavioural Therapy can, for example, help you identify and change unwanted thought processes and behaviours.
There are many articles on the effectiveness of cognitive therapy in this type of disorder and in particular on the reduction of symptoms (sometimes in conjunction with pharmacological treatments).
Little is written, however, about the effectiveness of another type of approach to anxiety disorders, which can help you not only on a symptom or thought level but also understand the deeper meaning of your anxiety and associated symptoms: the psychodynamic approach.
Psychodynamic Psychotherapy as a treatment for Anticipatory Anxiety
According to this approach, anxiety is seen as the so-called 'tip of the iceberg' and is caused by unexpressed emotions that manifest themselves on a bodily level.
This approach is not only interested in understanding 'how' to deal with symptoms, but also in understanding 'why' they are there and what causes them.
It is about becoming aware of unconscious conflicts and defence mechanisms that reinforce anxiety disorders.
Anxiety is seen as a signal to anticipate danger and activates an internal psychological response: the use of defences or adaptation mechanisms. Once activated, defences become the means to protect oneself and the best way to manage emotions, perceptions, impulses or desires.
Contrary to other approaches, during psychodynamic psychotherapy sessions, the disorder is examined by considering the whole context and history of the person.
The focus is therefore not on behavioural changes.
You may be asking yourself:
but how does change happen?
The therapist offers a relationship of empathy and eliminates all judgement, encouraging the patient's curiosity about their own thoughts and emotions.
Through this relationship, it will be possible to go through various stages that will allow the person to discover parts of him/herself and hidden meanings.
The ultimate goal is to be able to confront these fears and anxieties in the light of the present and in a protected context. This often requires a pathway that takes time and patience but brings gradual desensitisation and reduction of anxious symptoms by also working on the causes.
Expressing what you feel, especially in a context such as therapy, is precisely what helps to 'heal'.
CONCLUSION
To sum up briefly, in this article I have spoken about Anticipatory Anxiety by emphasising
the difference between the normal and the problematic form
how it manifests itself in Panic Disorder
which are the most common physical symptoms
what other disorders it manifests itself in
how to deal with the most common symptoms
what are the possible treatments
I will leave you with a couple of questions at this point!
1) What do you think of the article and what would you like to discuss further?
2) Do you have any other strategies you know of that you would like to share?
SOME REFERENCES:
https://www.healthline.com/health/anticipatory-anxiety
- Butler, G., Mathews, A. (1987). Anticipatory Anxiety and Risk Perception, Cognitive Therapy and Research, Vol. 11, 5, pp. 551-565.
- 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.
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