Anticipatory anxiety: why worrying about what might happen can feel worse than the event itself

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I’ve always been a fairly anxious person but I’d never experienced – or even knew much about – the term anticipatory anxiety. In a nutshell, it is anxiety that happens before something has actually happened – basically anticipating about what may happen. For me, it came out the blue and lasted a year, during which time I became so consumed by anticipatory anxiety that I almost became a hermit. And it was difficult to describe to friends and loved ones what I was going through as mention the word anxiety and everyone says they have it. Anticipatory anxiety however is a whole different ball game.

Although I say it came out the blue, on reflection what preceded it was the odd panic attack I’d been getting, particularly when it came to driving and being in a crowded space. Having fortunately gotten over them, I lived in fear of experiencing another panic attack that, when it occurred, had left me feeling dizzy, short of breath and having jelly-like sensations in my hands and legs. Unfortunately, once I had recovered from a panic disorder, I was left fearing another attack would come so my anticipatory anxiety kicked in the day I knew I had to drive, go to a doctor’s appointment or even meet friends for a game of padel.

Panic attacks

Whilst I wasn’t having anymore panic attacks and was better on that front, the fear of one arising was so chronically bad that I’d make myself mentally unwell just thinking about the fact I had to get in a car. And that started playing out in other areas of my life too; I’d have such bad anticipatory anxiety about pretty much everything, staying at home became my safety blanket.

Now I’m fortunately better, thanks to medication, therapy and understanding all about anticipatory anxiety, I sympathise with anyone who gets it. My brain was filled with “What if’s” all the time, even when I was going on a lovely dog walk with my husband. It was draining constantly thinking about what happens if I feel panicky again, even when I was absolutely fine.

How common is anticipatory anxiety?

Although there are no set figures of how many people experience it – due to the fact it comes under “anxiety” as a condition – it is thought to be very common. I know from my own experience of seeking medical help for it I was reassured it was a well-known condition, plus from the health experts I spoke to for this piece, they said the same.

Whilst almost anyone can get it, anxious or not, mental health counsellor Adebisi Gbadamosi, founder of Blooming with Bisi, said she has seen more women than men get anticipatory anxiety.

“I think that is because women tend to do more planning and detail-oriented preparation ahead of time, which can make them more susceptible to anticipatory anxiety,” she explained.

What is actually happening to your body when you get anticipatory anxiety?

Anticipatory anxiety is when the amygdala (brain’s emotional center) become hyperactive due to a negative experience from the past,” explained psychotherapist Mandy Lam, founder of Mindful Roots Collective

“For example, if a person had a negative experience where they froze during public speaking, they are more likely to experience higher levels of anxiety, specifically anticipatory anxiety the next time they have to speak in front of others. Some of the symptoms they might experience include an increase in heart rate, flustered face, clammy hands, shaky voice and shallow breathing.”

Why is anticipatory anxiety worse than the event you are actually anxious about ?

Mandy Lam explains: “Most of the time, the anticipatory anxiety is worse than the actual event itself because once the amygdala has been activated, the body goes into fight or flight, which then triggers thoughts of “what if”, thus sending our thoughts into a spiral as we then plan for the different worst case scenarios that can happen and how we would respond to it. There is no end to it, while the event itself as a clear start and end time.”

When should you seek help for anticipatory anxiety?

“If you find that your anticipatory anxiety is consistently holding you back from opportunities in your life or in your work, or it becomes debilitating (e.g. a person who’s afraid of public speaking will find all the different ways possible to avoid speaking publicly), seeking professional support would be warranted,” advised Mandy Lam.

She also points to CBT as “the gold standard for anxiety to look at how your thoughts impact your emotions, which then inform your behaviours.”

For me personally, I found talking to a therapist on a weekly basis super helpful. Not only did she validate my feelings but the tips I learnt and tools I took from her, I was able to put into practice; for example, not cancelling plans and pushing myself out of my comfort zone. And, in some cases, your doctor may prescribe medication – a short course of an SSRI helped calm my brain and thoughts down.

Can you recover from anticipatory anxiety?

As someone who has had it, I can say yes absolutely! Whilst I got better by learning to change my mindset through therapy, being open about it with loved ones, and medication, there’s lots of health tools and advice out there.

According to Adebisi Gbadamosi: “It is possible to recover from! It starts with questioning your thoughts.

“What do you think will happen at the event? What emotions are coming up for you besides fear? Is their evidence for these thoughts, and is it possible that you’re missing information? Are you jumping to conclusions and making assumptions? By being willing to assess and challenge the thoughts, it’s much easier to lessen the power of the anxiety.”

How to explain to someone who doesn’t understand why anticipatory anxiety is not the same as anxiety?

“For people who don’t understand why it’s worse than anxiety, I encourage them to think about it as a magnifier,” said Adebisi Gbadamosi. “Anticipatory anxiety takes the anxiety and zooms in on it. This makes it easier to see all the components and start picking it apart at a higher level. It becomes overwhelming and hard to forget about once you see it, leading you down more rabbit holes with greater opportunities.”