Anticipatory Anxiety: Symptoms and Coping Strategies

Ever have anxiety about having anxiety? While anticipatory anxiety isn't an official diagnosis, it's a very real experience for many people. At Next Step Psychiatry in Lilburn, Georgia, we help patients throughout Gwinnett County and Metro Atlanta understand and manage this challenging form of anxiety.

What Is Anticipatory Anxiety?

Anticipatory anxiety is characterized by an expectation of fear or distress about something in the future. People often describe it as a "sense of doom." You're not just nervous about an event—you're nervous about experiencing anxiety during the event and having that anxiety cause something unpleasant.

You may experience anticipatory anxiety before:

• Future events: Job interviews, presentations, social events, performances
• Potential threats: Loss of a loved one, end of a relationship, natural disasters, health concerns

Symptoms of Anticipatory Anxiety

Anticipatory anxiety symptoms can overlap with those of other anxiety disorders:

• Feelings of panic, fear, or dread
• Difficulty sleeping
• Difficulty concentrating
• Catastrophizing (dwelling on worst-case scenarios)
• Shortness of breath
• Racing heart
• Trembling or hyperventilation
• Dry mouth

Physical manifestations can include generalized tension, headaches, chronic gastrointestinal issues, and jaw clenching.

Connection to Other Anxiety Disorders

While not a clinical diagnosis itself, anticipatory anxiety can be a symptom of:

• OCD: Characterized by uncontrollable, recurring thoughts and behaviors
• Social anxiety disorder: Intense fear of social situations where you might be judged
• Generalized anxiety disorder: Excessive worry occurring more days than not for at least six months

Coping Strategies for Anticipatory Anxiety

1. Mindfulness Practices

Mindfulness brings you back to the present moment and helps you observe anxious thoughts without judgment. Clinical trials show mindfulness-based interventions perform as well as cognitive behavioral therapy for some patients.

Belly breathing: Breathing directly impacts heart rate. Try placing one hand on your chest and one on your belly. Breathe in through your nose, letting your belly rise while your chest stays still. Exhale through your lips. Practice for 5-10 minutes daily.

Journaling: Writing down your thoughts forces you to slow down while processing and organizing them. Even five minutes can help reduce anxiety.

Meditation: Try a body scan—starting at your toes, notice any sensations and work your way to your head. Observe without judgment.

2. Progressive Muscle Relaxation

Anxiety causes muscle tension you may not even notice. Progressive muscle relaxation (PMR) involves systematically tensing and relaxing muscle groups to cue your body into a calmer state. Find a quiet place for about 15 minutes, breathe slowly, and work through each muscle group.

3. Challenge Catastrophic Thinking

Ask yourself: What's the evidence for my fear? What's the most likely outcome versus the worst-case scenario? Have I handled similar situations before? This cognitive reframing can reduce the power of anticipatory thoughts.

4. Gradual Exposure

Avoiding feared situations reinforces anxiety. Gradual, controlled exposure—starting with less threatening situations—can help build confidence over time.

When to Seek Professional Help

If anticipatory anxiety significantly interferes with your daily life, relationships, or work, it's time to seek professional help. A psychiatrist can determine if an underlying anxiety disorder is present and recommend appropriate treatment, which may include therapy, medication, or both.

This article is for educational purposes only. If you or someone you know is experiencing a mental health crisis, call 911 or the National Suicide Prevention Lifeline at 988.