Anticipatory Anxiety: Bleeding Before You Are Cut

Anticipatory Anxiety: Bleeding Before You Are Cut

Sally Winston, PsyD

headshot

Dr. Sally Winston is a clinical psychologist and co-director of the Anxiety and Stress Disorders Institute of Maryland. She is nationally recognized for her expertise in the treatment of anxiety disorders. Dr. Winston has been active with ADAA for over 30 years. She has served as chair of the ADAA Clinical Advisory Board and was the first recipient of the ADAA Jerilyn Ross Clinician Advocate Award.

Martin Seif, PhD, ABPP

headshot

Dr. Martin Seif is a master clinician who has spent the last thirty years developing innovative and highly successful treatment methods for anxiety disorders. He helped found ADAA and has served on its Board of Directors and Clinical Advisory Board.  Dr. Seif has offices in Manhattan, NY and Greenwich, CT. For the last 18 years, he has been Associate Director of the Anxiety and Phobia Treatment Center for White Plains Hospital Center. He also trains therapists and psychiatric residents at New York-Presbyterian Hospital.

Anticipatory Anxiety: Bleeding Before You Are Cut

Share
No
burnout

Our newest book, Overcoming Anticipatory Anxiety—the third volume of a self-help trilogy—takes aim at the anxiety we experience prior to contacting something we fear or abhor.  

Anticipatory anxiety is worry about the future, the fear that bad things might happen or that you might become unable to successfully accomplish what you set out to do.  It is the anxiety we feel when we are anticipating a difficult decision, action or situation.  It is how we feel when we buy into our own creative worry stories. It is the expectation of distress accompanied by a push to avoid.  Anticipatory anxiety seems to predict danger; it feels like a warning. 

We think of anticipatory anxiety as a third layer of fear: 

First, we can be afraid of something.  Think, for example: ‘I am scared of a bee.”  

Second, we can be afraid of being afraid---this is sometimes called the fear of fear, or panic. Think of this example: “If I see a bee, I might get so frightened that I have a panic attack and then lose control or have a heart attack.”  

Finally, we get to the third level of fear. We can be afraid of being afraid of being afraid. This is not as complicated as it sounds; it goes like this: “I am miserable even thinking about camping next week because I might see a bee and have a panic attack, lose control and do something crazy. Maybe I should cancel the camping trip”.   

This third layer of fear is a powerful motivator of avoidance.  Catastrophic predictions--like having a panic attack, making a fool of yourself, or damaging a relationship—can lead to incapacitating anxiety that stops you from proceeding.  

Anticipatory anxiety involves worry about—and the urge to avoid—not only anxiety or panic, but also disgust, anger, shame, regret, humiliation, becoming overwhelmed, or any other unwanted emotion. 

If you are worried that you might have a panic attack in a particular situation, anticipatory anxiety may start hours, days or even weeks before the scheduled event.  If you are deciding if it is safe to meet a new person, use a public bathroom or ignore a brief sensation or thought, anticipatory anxiety is the dread you feel when you “try on” that activity or decision and scare yourself by imagining all the ways things could go badly. 

Anticipatory anxiety varies widely in appearance: as phobic avoidance, fear of being alone, performance anxiety, or insomnia. It can look like the elaborate planning that someone with OCD does to avoid contamination, the agony of waiting for medical test results or the haunting fear of the return of an unwanted intrusive thought.  

Anticipatory anxiety drives the compulsions that define obsessive-compulsive disorder and related conditions. It is anticipatory anxiety (“I won’t be able to stand it if”...)  that pushes people to perform the mental rituals and behavioral compulsions to reduce the immediate discomfort caused by the obsession. 

Anticipatory anxiety might be expressed as a fear of going to parties or restaurants or travel, or any encounter you believe will be challenging. Dreading being alone at night might stem from scary narratives of sudden illness or danger.  Anticipatory anxiety about imagined relationships might be why you avoid dating. Anticipatory anxiety about possibly getting fired might make you “sick” every morning before you leave for work. 

Anticipatory anxiety can occur as tension in the body without awareness of specific worries. It can be the primary driver of chronic hyperventilation which is a set-up for panic attacks. Headache or chronic gastrointestinal problems such as diarrhea, nausea, or vomiting might be directly traced to it.  

Anticipatory anxiety is the primary driver of GAD (generalized anxiety disorder), a tendency towards unproductive and excessive worrying.  (Our earlier book Needing to Know for Sure describes this phenomenon in detail.)  The anxious “what if” of GAD is anticipatory anxiety.  

Anticipatory anxiety develops out of an overactive imagination or from conditioned responses to memories. It can be driven by a trait called anxiety sensitivity (the fear of mind and body manifestations of anxious arousal). It can also emerge from a depressed mood state. Or it can find its origins in beliefs about one’s own inability to cope with novelty or challenge.   

Effective treatment of anticipatory anxiety is targeted at the factors which maintain it.  As always, too much thinking is not solved by more thinking.   

Successful therapy aims for a shift towards the senses, a modification of attitude, and a change in one’s relationship with inner experience. These include gently redirecting the attention to the present moment rather than the imagined future while allowing for and not struggling against the experience of anxiety.   

Metacognitive factors which maintain anxiety (such as how we can be hijacked by our own imagination) need to be addressed. And escape planning, ruminative entanglement with worries, and other forms of avoidance such as empty self-reassurance are discouraged.  

Sally Winston, PsyD

headshot

Dr. Sally Winston is a clinical psychologist and co-director of the Anxiety and Stress Disorders Institute of Maryland. She is nationally recognized for her expertise in the treatment of anxiety disorders. Dr. Winston has been active with ADAA for over 30 years. She has served as chair of the ADAA Clinical Advisory Board and was the first recipient of the ADAA Jerilyn Ross Clinician Advocate Award.

Martin Seif, PhD, ABPP

headshot

Dr. Martin Seif is a master clinician who has spent the last thirty years developing innovative and highly successful treatment methods for anxiety disorders. He helped found ADAA and has served on its Board of Directors and Clinical Advisory Board.  Dr. Seif has offices in Manhattan, NY and Greenwich, CT. For the last 18 years, he has been Associate Director of the Anxiety and Phobia Treatment Center for White Plains Hospital Center. He also trains therapists and psychiatric residents at New York-Presbyterian Hospital.

Use of Website Blog Commenting

ADAA Blog Content and Blog Comments Policy

ADAA provides this Website blogs for the benefit of its members and the public. The content, view and opinions published in Blogs written by our personnel or contributors – or from links or posts on the Website from other sources - belong solely to their respective authors and do not necessarily reflect the views of ADAA, its members, management or employees. Any comments or opinions expressed are those of their respective contributors only. Please remember that the open and real-time nature of the comments posted to these venues makes it is impossible for ADAA to confirm the validity of any content posted, and though we reserve the right to review and edit or delete any such comment, we do not guarantee that we will monitor or review it. As such, we are not responsible for any messages posted or the consequences of following any advice offered within such posts. If you find any posts in these posts/comments to be offensive, inaccurate or objectionable, please contact us via email at [email protected] and reference the relevant content. If we determine that removal of a post or posts is necessary, we will make reasonable efforts to do so in a timely manner.

ADAA expressly disclaims responsibility for and liabilities resulting from, any information or communications from and between users of ADAA’s blog post commenting features. Users acknowledge and agree that they may be individually liable for anything they communicate using ADAA’s blogs, including but not limited to defamatory, discriminatory, false or unauthorized information. Users are cautioned that they are responsible for complying with the requirements of applicable copyright and trademark laws and regulations. By submitting a response, comment or content, you agree that such submission is non-confidential for all purposes. Any submission to this Website will be deemed and remain the property of ADAA.

The ADAA blogs are forums for individuals to share their opinions, experiences and thoughts related to mental illness. ADAA wants to ensure the integrity of this service and therefore, use of this service is limited to participants who agree to adhere to the following guidelines:

1. Refrain from transmitting any message, information, data, or text that is unlawful, threatening, abusive, harassing, defamatory, vulgar, obscene, that may be invasive of another 's privacy, hateful, or bashing communications - especially those aimed at gender, race, color, sexual orientation, national origin, religious views or disability.

Please note that there is a review process whereby all comments posted to blog posts and webinars are reviewed by ADAA staff to determine appropriateness before comments are posted. ADAA reserves the right to remove or edit a post containing offensive material as defined by ADAA.

ADAA reserves the right to remove or edit posts that contain explicit, obscene, offensive, or vulgar language. Similarly, posts that contain any graphic files will be removed immediately upon notice.

2. Refrain from posting or transmitting any unsolicited, promotional materials, "junk mail," "spam," "chain mail," "pyramid schemes" or any other form of solicitation. ADAA reserves the right to delete these posts immediately upon notice.

3. ADAA invites and encourages a healthy exchange of opinions. If you disagree with a participant 's post or opinion and wish to challenge it, do so with respect. The real objective of the ADAA blog post commenting function is to promote discussion and understanding, not to convince others that your opinion is "right." Name calling, insults, and personal attacks are not appropriate and will not be tolerated. ADAA will remove these posts immediately upon notice.

4. ADAA promotes privacy and encourages participants to keep personal information such as address and telephone number from being posted. Similarly, do not ask for personal information from other participants. Any comments that ask for telephone, address, e-mail, surveys and research studies will not be approved for posting.

5. Participants should be aware that the opinions, beliefs and statements on blog posts do not necessarily represent the opinions and beliefs of ADAA. Participants also agree that ADAA is not to be held liable for any loss or injury caused, in whole or in part, by sponsorship of blog post commenting. Participants also agree that ADAA reserves the right to report any suspicions of harm to self or others as evidenced by participant posts.

RESOURCES AND NEWS
Evidence-based Tips & Strategies from our Member Experts
RELATED ARTICLES
Block reference