Anticipatory Anxiety: Definition, Symptoms, & What You Can Do

Anticipatory Anxiety: Definition, Symptoms, & What You Can Do

Reviewed by:
Austin Lin, MD
Staff Psychiatrist
at Talkiatry
August 21, 2023

Ever have anxiety about having anxiety? Anticipatory anxiety isn’t an official mental health condition or a medical term, but it’s a very real experience for many people. Anticipatory anxiety can feel uncomfortable but there are things you can do to cope.  

In this article, you’ll learn more about what anticipatory anxiety is and some psychiatrist-backed strategies to manage it.  

What is anticipatory anxiety?

Anticipatory anxiety, which is not a medical term, is characterized by an expectation of fear or distress about something in the future.  

"People often describe it as feeling a ‘sense of doom.’ We worry about something bad happening or that something will not go well,” says Dr. Lin, a double board-certified psychiatrist at Talkiatry.  

This expectation of fear often leads to avoidance. You can also think of anticipatory anxiety as a “third layer of fear.” You aren’t just nervous about a big presentation. You are nervous about experiencing anxiety during a big presentation and having that anxiety cause you to do or feel something unpleasant.    

You may experience anticipatory anxiety before a:

Future event:

  • Job interview
  • Presentation
  • Social events
  • Musical or athletic performances

Potential future threat/scenario:

  • Loss of a loved one
  • End of a relationship
  • Natural disaster
  • Pandemic

With anticipatory anxiety, negative thoughts develop from an overactive imagination, a pre-conditioned response to memories, and/or beliefs about one’s inability to cope with certain social situations, challenges, or perceived threats.  

Such negative thoughts can arise days up to months in advance of the upcoming event and lead to:

  • Avoidance out of phobia
  • Fear of being alone
  • Performance anxiety
  • Insomnia

Physically, it can manifest in the body as:

  • Generalized tension
  • Headaches
  • Chronic gastrointestinal issues (diarrhea, nausea)
  • Chronic hyperventilation
  • Jaw clenching

As mentioned above, anticipatory anxiety is not a clinical disorder; but it can be a symptom of other anxiety disorders such as obsessive-compulsive disorder (OCD), social anxiety disorder, and generalized anxiety disorder.

What are the symptoms of anticipatory anxiety?

Symptoms of anticipatory anxiety can overlap with those of other anxiety disorders and include:

  • Feelings of panic or fear  
  • Difficulty sleeping  
  • Difficulty concentrating  
  • Feelings of dread  
  • Feelings of doom (also known as “catastrophizing” or dwelling on worst-case scenarios and potential negative outcomes)  
  • Shortness of breath  
  • Racing heart rate
  • Breathing rapidly (hyperventilation) and/or trembling  
  • Dry mouth  

How can you ease anticipatory anxiety? 4 psychiatrist-backed strategies

Anticipatory anxiety can feel uncomfortable, but there are simple things you can do to cope. Check out these psychiatrist-backed tips for easing anticipatory anxiety.  

1. Mindfulness

The goal of mindfulness is to bring you back into the present moment. Your thoughts have as much power as you give them. Mindfulness practices help you distance yourself from anxious thoughts by simply observing them in a non-judgmental way.   In clinical trials, mindfulness-based interventions have performed on par with treatments like cognitive-behavioral therapy (CBT).  

If you’re thinking...easier said than done to stay mindful and present...know that it’s both a skill AND a practice. The more you do it, the easier it will become over time.  

Here are mindfulness practices to get you started:

Belly Breathing
Breathing directly impacts heart rate. When you’re anxious, your body responds by increasing your heart rate. Belly breathing is a great way to lower your heart rate and put your body into a more relaxed state.  

To do it:

  • Lay on your back or sit in a comfortable position  
  • Place one hand on your chest and the other on your belly
  • Breathe in through your nose. Your belly should rise. Your chest should remain still.  
  • Exhale through your lips. Your belly should fall.  
  • Repeat for 5-10 minutes per day or as needed

Curious about other breathing techniques? Check them out here: Tips on How to Calm Down during Anxiety or Stress  

Journaling
Writing down whatever is on your mind is a great tool to help reduce anxiety. It forces you to slow down while processing and organizing your thoughts. This time spent in a more reflective state — which can be as little as five minutes when starting out — can help you stay present, become aware of recurring thought patterns, and identify coping strategies.

Read more about the benefits of journaling

Meditation
There’s no one way to practice meditation. If you’re just starting out, try this exercise known as a ‘body scan’:

  • Sit or lie down somewhere comfortable
  • You can close your eyes or keep them open  
  • Take your attention into your physical body. Starting at your toes. Notice any sensations you may be feeling.  
  • Work your way from your toes to your head, one body part at a time. Noticing any sensations. Observe these sensations without judgment.  
  • Your mind may wander and that’s okay. When you notice your mind wandering, bring yourself back to the present moment and continue the exercise.  

2. Progressive muscle relaxation

Anxiety can cause your muscles to tense and sometimes you may not even be aware of it.  Progressive muscle relaxation, also known as PMR, can help you relax your muscles and cue your body into a calmer state.  

Here’s how to do it:

  • Find a quiet place where you can focus for about 15 minutes; we recommend lying down or sitting in a chair.  
  • Breathe slowly and evenly, focus on the muscles in your forehead. For 5-15 seconds, squeeze those muscles as hard as you can, being sure to keep the rest of your muscles relaxed. Then, slowly release the tension. Notice how your muscles feel now that they’re completely relaxed.
  • Next, focus on the muscles in your jaw. Squeeze those muscles for 5-15 seconds, then slowly release them. Focus on the new feeling of relaxation.
  • Repeat with the muscles in your neck and shoulders, arms and hands, buttocks and legs, and, finally, feet. Always keep your focus on the feeling of relaxing your muscles after tightening them.

Note that you should never feel sharp or shooting pain while tensing your muscles. If you have any history of pulled muscles or broken bones, be sure to consult with your healthcare provider before trying the PMR technique.  

3. Practice positive affirmations

Anticipatory anxiety is defined by “what ifs” centered around the negative. Positive affirmations involve reframing thought patterns, so instead of dwelling on the possibility of a bad thing transpiring, you’re instead asking yourself “what if it DOES work out?”

And there’s science to back it up. In a 2016 study, people with Generalized Anxiety Disorder practiced replacing worry with a positive alternative (mental image or affirmation) and experienced reduced anxiety and worry.  

Examples of positive affirmations include:

  • I am capable of handling anything that comes my way.  
  • I am safe, and I will stay safe.  
  • I’ve done this before, and I can do it again.  
  • I am prepared, and I will succeed.  

The “practice” part can involve writing down the affirmations several times in a notebook, writing them on post-its that you place around your home, recording them to play back when needed during the day, or simply repeating them to yourself.  

If it feels too difficult to shift from the negative to the positive, start with going from negative to neutral and seeing how that feels.  

4. Confide in loved ones

Oftentimes, anticipatory anxiety can lead one to isolate from loved ones as negative thoughts and worries become too consuming. But speaking to someone you trust, whether it’s a friend or family member, about whatever it is that’s worrying you can be an incredibly powerful way to receive reassurance and validation that you are capable of handling whatever it is that comes your way. Plus, outside perspectives can help put worries in perspective as these conversations often bring up considerations like:

  • In five, 10, 15 years, will I even remember this?
  • What evidence do I have proving that I won’t be able to handle/succeed at [stressor]?  

When to seek professional help for anticipatory anxiety

While some anxiety in daily life is to be expected, more severe anticipatory anxiety can negatively impact one’s overall well-being, impact professional and personal relationships, and make it difficult to function and get through the day. If this is the case, it’s important to seek support from a mental health professional. You may be experiencing an anxiety disorder. Treatment can help you manage your symptoms.  

Struggling with anxiety and not sure where to start?  

If you’re experiencing an anxiety disorder, or think you might be, you may feel hesitant about reaching out for help. What if my symptoms aren’t severe enough? What if I can get better? These types of thoughts and feelings are expected. Don’t let them stop you from getting help. Mental health professionals like psychiatrists provide judgment-free support and can help you find a treatment option that’s right for you.  

With Talkiatry, you can see a psychiatrist from the comfort of your home, and you can schedule your first appointment in a matter of days.  

If you believe you have an anxiety condition (or are not sure), start by taking our free, easy assessment, see if Talkiatry is a good fit, and get matched with a psychiatrist that meets your needs and takes your insurance.    

About Talkiatry  

Talkiatry is a national psychiatry practice that provides in-network, virtual care. Co-founded by a patient and a triple-board-certified psychiatrist, Talkiatry has over 300 doctors, 60 insurance partners, and first visits available in days. We treat patients with anxiety, depression, bipolar disorder, ADHD, and more. Get started with a short online assessment.  

The information in this article is for informational and educational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.

Dr. Austin Lin is a double board-certified adult and addiction psychiatrist who has been in practice for over 9 years. At the center of Dr. Lin’s clinical approach is a strong emphasis on establishing trust and using a collaborative approach to help patients develop an individualized and cohesive plan so that they are able to achieve their goals.

Dr. Lin's practice focuses on medication management. Typically, he offers this in conjunction with supportive therapy, motivational interviewing, and/or cognitive behavioral therapy in 30-minute follow-up visits. Occasionally, Dr. Lin may recommend that additional therapy is needed and ask that you bring a therapist into your care team in order to provide the best outcome.

Dr. Lin received his medical degree from St. George’s University School of Medicine. He went on to complete his residency in psychiatry at Harvard South Shore, an affiliate of Harvard Medical School, where he served as Chief Resident and earned his 360° Professionalism award. He then had additional training in Addiction Psychiatry through his fellowship at the University of Texas Southwestern Medical Center. After completing training, Dr. Lin has worked as an Addiction Psychiatrist and Director of Adult Services in the Trauma and Resilience Center (TRC) at the University of Texas Health Science Center at Houston (UTHealth). He specialized in treating patients with a history of depression, anxiety, trauma, and substance use disorders.

Dr. Lin has held an academic appointment at UTHealth, and he has spent his professional career supervising and teaching medical students and psychiatry residents.



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