Have you ever felt your stomach drop when thinking about an upcoming presentation? Or felt your heart race days before a medical appointment? That’s anticipatory anxiety at work.

What is anticipatory anxiety?

Anticipatory anxiety is the worry, fear, or sense of dread you feel before something happens. Basically, you’re anticipating a threat from a potentially stressful event or situation.¹ This could be an upcoming exam, medical procedure, job interview, or social gathering.

For most people, this anxiety comes and goes naturally. It can even be useful, as it can help us spot potential pitfalls ahead of time, prepare mentally or physically, and take steps to prepare ourselves. At its best, it’s your brain’s early warning system, allowing you to assess upcoming situations and decide how to respond in advance.

Anticipatory anxiety becomes a problem when it’s excessive compared to the actual threat and interferes with your ability to function day-to-day. This excessive level of anxiety and fear is a defining feature in many anxiety disorders.²

Signs and symptoms of anticipatory anxiety

Anticipatory anxiety symptoms affect your body, mind, and emotions. These symptoms can start hours, days, or even weeks before the event.

Physical symptoms

Your body’s stress response system kicks into high gear when anticipating a stressful event. Physical symptoms include:

• Breathing fast or hard³
• Increased heart rate⁴
• Elevated blood pressure
• Muscle tension
• Difficulty sleeping
• Upset stomach or nausea
• Sweating⁵

Mental and emotional symptoms

The mental and emotional impact of anticipatory anxiety can be just as challenging as the physical symptoms. Common experiences include:⁶

• Uncontrollable, repeated thoughts about the future event
• Self-focused thoughts and worries
• Heightened negative emotions
• Reduced positive feelings
• Feeling on edge
• Frequently seeking reassurance from others about the event

Anticipatory anxiety can also impair working memory performance.⁷ One study found that people who anticipated they would have a stressful day found it harder to think clearly and focus on tasks at hand throughout it. This was true regardless of how stressful the day actually turned out to be.

In social anxiety disorder specifically, the anticipation of social situations can lead to severe avoidance behaviors, increased self-monitoring, and affect how people behave in those scenarios.⁸

Causes and risk factors

Genetics

Genetic factors play a substantial role in anxiety disorders. Research suggests that between 30% and 60% of the risk of developing an anxiety disorder can be traced to genetics across different conditions.⁹

It’s important to remember that having anxiety run in your family doesn’t mean you’re destined to develop it. Genetics are just one factor for vulnerability. Your personality, life experiences, and many other factors also play a significant role.

Uncertainty

Uncertainty plays a key role in anticipatory anxiety. Research suggests that people experience higher levels of anxiety when the outcome of a future event is unknown or unpredictable, even if the likelihood of a negative outcome is low.¹⁰

This may help us to understand why waiting for an upcoming exam, medical procedure, job interview, social gathering or other uncertain events is often more distressing than the event itself.

Brain science

Studies have identified differences in certain brain regions in people with anxiety disorders.¹¹ Research shows people with panic disorder, posttraumatic stress disorder (PTSD), and social anxiety have heightened amygdala activity even at rest.

However, it’s still unclear whether these differences add to anxiety or result from it.

Environment

Research confirms that genetics and early environmental factors work together to predispose individuals to anxiety later in life.¹² Anticipatory anxiety, like other forms of anxiety, is the result of several factors coming together.

Some factors may make you more vulnerable to developing anxiety, but that doesn’t make it inevitable or impossible to overcome. It’s important that you get personalized care and support for anxiety issues that considers your personal history and environment. If you have concerns, visit our directory to find a mental health professional near you.

Anticipatory anxiety treatment options

The good news is anticipatory anxiety treatment is effective. Both psychotherapy and medication can help you manage symptoms of anxiety and reduce their impact on your life.

Cognitive behavioral therapy (CBT) is among the most effective first-line treatment options for anxiety disorders.¹³ Exposure therapy, a version of CBT that helps you face fears in a controlled environment, can be especially helpful for specific phobias and social anxiety disorder.

Research on anticipatory anxiety shows that efforts to “reappraise” fears can be helpful in managing them. Brain imaging studies reveal that reappraisal is associated with less activity in the amygdala (the brain’s fear center) and lower reported anxiety.¹⁴ Because cognitive restructuring is a central piece of CBT, it may be a particularly good fit for anticipatory anxiety.

Medication can also be an important part of overcoming anticipatory anxiety. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are first-line pharmacological treatments for anxiety disorders including panic disorder and social anxiety disorder, where they target both anticipatory anxiety and acute fear responses.¹⁵

There are many options available to treat anxiety. Connect with a qualified mental health professional who can help determine what form of treatment will best fit your life.

Tips on how to manage anticipatory anxiety

Beyond formal treatment, several evidence-based strategies can help you deal with anxiety on a daily basis.¹⁶

Practice mindfulness. Mindfulness interventions have shown promise in reducing repetitive, worry-filled thoughts. They help by emphasizing awareness of the present moment and nonjudgmental acceptance of negative emotions. Try a simple breathing exercise, such as 4-7-8 breathing. Breathing in for the count of 4, holding for the count of 7, and breathing out for the count of 8 to bring yourself back to the present moment and create space from your anticipatory anxious thoughts.

Challenge catastrophic thinking. Instead of assuming the worst will happen, practice accurate threat assessment. When you feel yourself becoming overwhelmed, ask yourself:

• What’s the actual evidence this will go badly?
• What’s more likely to happen?
• Have I handled similar situations before?

Learning to assess threats accurately rather than catastrophizing may help reduce anticipatory anxiety. You may find your feelings about a threat are stronger than the actual risk.

Build self-trust. Anticipatory anxiety can make us doubt our ability to handle difficult situations, but reflecting on challenges we have handled in the past can help build confidence. This might mean reflecting on your past successes, noting what you’ve already done to prepare, or acknowledging support systems.

Work toward accepting that you can’t eliminate all anticipatory feelings. Some nervousness before important events is natural and even helpful. The goal is to keep those feelings in line with the event and prevent them from stopping you from living the life you want to live.

If your anticipatory anxiety is significantly impacting your daily functioning, work performance, or relationships, reaching out to a mental health professional is an important step. Visit our therapist directory to connect with one online or in your area.