Anticipatory Anxiety and Panic Disorder

Anticipatory anxiety happens when people experience increased anxiety and stress when they think about an event that will happen in the future. While this is not a distinct mental condition, anticipatory anxiety is a common symptom of other conditions including panic disorder and generalized anxiety disorder (GAD).

Anticipatory anxiety may occur in response to large events such as giving a presentation at work. But it can also precede minor, everyday activities such as driving to work, parking your car, or having conversations with co-workers.

If you have panic disorder, you may find yourself anticipating many life events. Going into a store, attending a social gathering, and other activities may be a daily focus of your anticipation. Before you had panic attacks, you probably didn’t give much thought to any of these common events. But now anticipation may cause you to feel anxious and interfere with your ability to fully function in your everyday life.

Normal vs. Problematic Anticipatory Anxiety

An infinite number of human experiences cause normal anticipatory anxiety. Many times, we experience anxiety in anticipation of doing something new or before we complete a major task or go through an upcoming life event.

You might feel anticipatory anxiety before a first date, a final exam, a job interview, moving to a new home, or before a major trip. This type of anticipatory anxiety is normal.

If you have panic disorder, however, anticipatory anxiety likely goes beyond the limits of what people normally experience with new or major life events, leading to problematic anticipatory anxiety. This is because the anticipation, or the way you visualize a future event, is focused on having a panic attack in certain situations.

The fear of having a panic attack can be associated with any life situation or event, big or small. In some cases, anticipatory anxiety surrounds any activity that involves leaving the safety of your own home.

How Your Thoughts Contribute to Anticipatory Anxiety

Anticipatory anxiety is closely associated with the way you think. With panic disorder, your thoughts are generally focused on worrying about having a panic attack in a situation that will result in embarrassment, extreme discomfort, a heart attack, or even worse.

If you have panic disorder, you are probably very familiar with “what if” worries. Perhaps your worries are similar to these:

• What if I have a panic attack and drive my car into a ditch?
• What if I start to panic in the store and embarrass myself with some bizarre behavior?
• What if, while eating at a restaurant, I can’t swallow and start choking on my food?
• What if I take a walk around the block and start to panic and can’t get back home?

How to Cope With Anticipatory Anxiety

Here are some ways to cope with anticipatory anxiety.

Learn and Practice Relaxation Techniques

By learning and practicing relaxation techniques, you will be able to reduce your level of anticipatory anxiety. You may even be able to defuse a panic attack in the making. Some techniques that may be helpful include:

• Deep breathing: Deep breathing exercises can often be an effective way to decrease feelings of panic and nervousness. Because feelings of panic are often accompanied by rapid, shallow breathing, learning to take slower, deeper breaths can help calm your body.
• Guided imagery: This process involves closing your eyes and visualizing imagery that helps you feel calm and relaxed. You can use this type of imagery to imagine yourself succeeding in different situations or simply to help return your body to a calmer state.
• Journal writing: Writing about your feelings may help you better notice patterns in how your thoughts and emotions contribute to anticipatory anxiety.
• Mindfulness meditation: This type of meditation can be helpful in easing anticipatory anxiety because it encourages you to focus on the present rather than worrying about the future.
• Progressive muscle relaxation (PMR): Panic often causes people to tense up, but practicing progressively tightening and then relaxing the muscles of your body can help you learn to better control this tension. After learning this technique, you will be able to release the tension in your muscles, which can have a relieving and calming effect.

Try Self-Help Strategies

When you find yourself experiencing anticipatory anxiety, there are some things that you can do that may make it easier to cope:

• Challenge anxious thoughts. When you get nervous about something you have to do in the future, ask yourself if you are being realistic. In many cases, you might find that you are catastrophizing or thinking of worst-case scenarios. Challenging these thoughts with more realistic ones can help calm your feelings of anxiety.
• Refocus your thoughts. When negative or anxious thoughts begin, intentionally interrupt your train of thought. Force yourself to consciously focus on good things that may happen rather than running through anxiety-provoking scenarios.
• Take action. Anticipatory anxiety often leads people to put off tasks rather than face them, which can then lead to even more anxiety. If you are dreading something and find yourself getting nervous about it, take control of the situation first. Remind yourself that if you get it over with now, you won't have to spend all of your time feeling anxious about it. 

Get Professional Help

If you can’t get your anxiety under control on your own, it is important to talk to your doctor or mental health professional in person or online. A variety of professionals can help you with problem anticipatory anxiety.

Some of the treatments they may be able to provide include:

• Cognitive behavioral therapy (CBT) to help you identify and change damaging behaviors and thought processes that are contributing to your anxiety.
• Panic-focused psychodynamic psychotherapy to help you become aware of unconscious conflicts and defense mechanisms that reinforce your anxiety.
• Medications, such as the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs) and anti-anxiety drugs known as benzodiazepines, to relieve some of your anxiety and panic symptoms.