What is anticipatory anxiety?
It’s dread about something that hasn’t happened yet. An exam, a flight, a hard talk at work. Cancelling feels safer. But the NHS says avoiding things might make anxiety worse.
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What is anticipatory anxiety?
It’s fear and worry about something before it happens. The NHS lists worrying about the future, or thinking something bad will happen, as a common sign of anxiety.
Researchers say uncertainty about a possible threat leads to anxiety. They see some of it as normal and useful. In anxiety disorders, the response to not knowing goes wrong.
| Where | Signs |
|---|---|
| Mind | Feeling tense or nervous, thinking something bad will happen |
| Body | A stronger, faster or irregular heartbeat, feeling short of breath |
| Behaviour | Avoiding places, people or situations that make you anxious |
Sources: NHS: anxiety, fear and panic; NHS Every Mind Matters
Those body signs come from stress hormones such as adrenaline. A clinical psychologist quoted by the NHS says anxious people often think things are more dangerous than they really are.
Start a short diary this week. Note what you were dreading and how you felt. The NHS says this may help you understand why you’re anxious.
Why does avoiding it make it worse?
That’s the avoidance trap. The NHS says avoiding situations, or leaning on habits you think keep you safe, might actually make anxiety worse.
The NHS describes it clearly for panic attacks. People start to avoid places they fear will set off another one.
How fear of fear can build
- 1
Dread
You fear a place or event will set off another panic attack.
- 2
Avoid
You start to stay away from it.
- 3
Fear of fear
The NHS calls this living in fear of fear.
- 4
More panic
It can add to your panic and may cause more attacks.
Source: NHS: panic disorder
Think of a friendly dog you’re scared of. If you cross the road every time, you never find out it was fine. The fear stays, and crossing starts to feel like the only safe choice.
The way out is small steps. The NHS says slowly facing up to a situation might help, and in time it will feel OK.
How to calm anticipatory anxiety before an event
Six NHS steps for the days before
- Breathe in through your nose and out through your mouth, counting to 5 each way, for at least 5 minutes.
- Set a daily worry time to go through your concerns, at the same time each day.
- Break the event into smaller parts and work on feeling calmer with each part.
- Slowly build up the time you spend in the situations that worry you.
- Ask yourself what advice you would give a friend in your place.
- Don’t drink lots of coffee, tea, cola or energy drinks, and don’t use alcohol to calm your nerves.
Sources: NHS: breathing exercises; NHS Every Mind Matters; NHS: social anxiety; NHS: GAD
You may not reach 5 at first. Practise the breathing on calm days too. The NHS says it works best as part of your daily routine.
Make worry time specific. In a 14-day trial, 186 adults tested this. Planning when and how to worry cut daily worry time by about 15 minutes, compared with just putting it off.
Sleep didn’t improve.
Two small tricks for the day itself. In lab studies, saying “I am excited” out loud before singing or a talk helped people feel more excited and perform better. In studies of students, writing about test worries just before an exam improved scores, especially for those who are usually anxious about tests.
More ideas in natural remedies for anxiety and when to stop caffeine.
Is anticipatory anxiety a sign of an anxiety disorder?
Not on its own. The NHS says feeling anxious is a natural reaction to some situations. Dread that keeps coming back can be part of a wider pattern, so match yours to these.
| Pattern | What the NHS describes |
|---|---|
| Panic disorder | Regular, unexpected panic attacks, then at least a month of continuous worry about having more. |
| Social anxiety | Feeling overly worried before, during and after social situations. |
| Phobia | Severe anxiety and worry, usually linked to a thing or situation, such as flying. |
| Generalised anxiety (GAD) | Feeling anxious most of the time, in a way that affects everyday life. |
Sources: NHS: panic disorder; NHS: social anxiety; NHS: phobias; NHS: GAD
The NHS says don’t self-diagnose. If a row sounds like you, take it to a GP.
A racing heart before an event? Most panic attacks last 5 to 20 minutes and aren’t dangerous. But the same signs can come from other conditions.
Worried about your heart? See stress, heart rate and blood pressure.
What treatment helps?
For social anxiety, the NHS says CBT is generally considered the best treatment. CBT is a talking therapy that helps you spot unhelpful thoughts and habits, and change them.
How to get help on the NHS
- 1
Refer yourself
In England, from 18 (16 in some areas), you can go straight to NHS talking therapies.
- 2
Or see a GP
They ask about your worries and symptoms, and can refer you.
- 3
Talking therapy
Usually CBT, or guided self-help with a workbook or online course.
- 4
Medicine, if needed
Usually a type of antidepressant called an SSRI.
Sources: NHS: anxiety, fear and panic; NHS: social anxiety; NHS: GAD
A GP will usually suggest talking therapy before medicine. Never stop or change a prescribed medicine without your prescriber.
Scared of flying? The NHS suggests checking whether airlines run sessions for people with phobias. For work dread, see work stress.
When to speak to a GP
Book an appointment if:
- You’re struggling to cope with anxiety, fear or panic.
- The things you’re trying yourself are not helping.
- You think you have a phobia and the symptoms are affecting your life.
- Worry about social situations is having a big impact on your life.
- You feel anxious most of the time and it affects your everyday life.
Need urgent help for your mental health? Call 111 and choose the mental health option, or ask for an urgent GP appointment. Samaritans are on 116 123.
Call 999 or go to A&E if someone’s life is at risk, or you feel you can’t keep yourself or someone else safe.