Monday, August 10, 2020

Anticipatory Anxiety: Fear of Fear?

If you have anxiety attacks, you may spend a lot of your day anticipating what will happen to you.

While driving, when going to the supermarket, or at a dinner party, probably instead of enjoying the moment, you are focused on your body, anticipating a possible anxiety attack.

Anticipatory Anxiety


What if I have an anxiety attack? What if I lose control while driving and have an accident? What if I have an anxiety attack at the supermarket or worse in front of my boss? What if other people notice? What if I make a fool of myself in front of everyone? What if I die? A big "what if" list that keeps growing and so do your worries.

Before you started having panic attacks, you probably didn't even pay attention to these activities, and they were automatic, but now you can't get all those "what ifs" out of your head.

This kind of thinking about the future, which predicts a negative outcome, is part of what's known as anticipatory anxiety, and it can interfere with your life in such a way that it prevents you from doing even the most everyday activities normally.

For example, just "thinking" about going out in the street can seem like hell for anticipating the possibility of having an anxiety attack while away from home.

Anticipatory anxiety. Is that a problem?


It is normal to suffer anxiety due to anticipation, evolution has conditioned us to prepare ourselves to face possible threats. It is your body's way of warning you of a possible problem in the future to which you should pay attention.

The lack of anticipation, and anxiety, could have meant for our ancestors the difference between life and death, preventing the spread of their genes.

Today, anticipatory anxiety is not going to save us from a possible lion, but we all suffer from it to some degree, and it is the way our body warns us of a possible situation that requires our attention, whether because of a possible bad outcome, a possible failure, or the possibility of embarrassment.

Before a job interview, a test, or an appointment it is normal to feel anxiety. It prepares us for that event. The problem comes when you spend the day anticipating possibilities instead of enjoying the present.
I see it mostly in my patients with panic attacks, who spend a large part of their day checking their bodies for the slightest physical sign of an anxiety attack, only to end up provoking it themselves.

Being so attentive to your body, it is easy for a little discomfort in your chest, a heartbeat or even not feeling the heartbeat to start a cycle of thoughts and anxiety that ends up producing the physical symptoms.

These symptoms in turn feed back negative thoughts and so on until the panic attack comes. The funny thing is that it all started with a slight discomfort in the chest... or maybe not... maybe the thoughts anticipating a possible panic attack.

On these occasions the fear and anticipation itself is much worse than the situation that causes it.

Anticipatory Anxiety: Your thoughts

Anticipatory anxiety is closely related to your thoughts, and if you have panic attacks, your thoughts are usually focused on the possibility of having a panic attack and its possible consequences.

For example, the possibility of having a heart attack, the fear of ridicule and or the reaction of others may be on your mind all day long. Even if you don't have a panic attack, the day ends up being a shadow of what it could have been.

If you do have panic attacks, you probably have thoughts like the following:

  • What if I have a panic attack while driving, lose control and have an accident?
  • What if I have an anxiety attack during a meeting and others judge me? What if I faint?
  • What if I choke on food and drown?
  • What if I end up back in the hospital thinking I'm dying?
  • What if this is my last breath and I can't breathe again?
  • What if the doctors haven't found it, but I have something?
  • What if I say something stupid or I can't even speak and I'm exposed in front of everyone?

These kinds of thoughts cause anxiety of anticipation, and they can lead you to avoid the situations that cause them.

For example, if you've had an anxiety attack in a certain place (or situation), it's likely that the thought of revisiting that place (or situation) will bring up the thought of ''what if'' again, and you might end up having a panic attack.

Note that in this case you don't even have to be there to have a panic attack, just anticipate the possibility of going there.

How to deal with anticipatory anxiety


Overcome the fear of what people will say, and of the consequences of a panic attack. Many of my patients avoid telling others that they are suffering from anxiety attacks at all costs, but in fact the mere fact of hiding it is one of the main reasons for their anticipatory thoughts and panic attacks.

Don't try to deny or avoid your thoughts. Trying to avoid them will only give them strength. Try to let them go as they have come without giving them any importance.

Don't avoid situations that make you anxious. Avoidance, besides being a temporary remedy, will make you more anxious in anticipation next time and make it harder and harder to get over it.

Try to anchor yourself to the present. You can try to practice mindfulness. This is an adaptation of oriental meditation techniques, in which the whole spiritual part is eliminated and you try to be aware of your thoughts and the present moment. There are many guided meditations on the internet that can help you.

Try relaxation techniques. Two common techniques that psychologists usually recommend are diaphragmatic breathing and progressive muscle relaxation. On youtube you can find many videos in which these techniques are performed in a guided way.

Try to recognize your anticipatory thoughts and replace them with other more positive and appropriate to reality.

If you have tried all of the above and still cannot get your anticipatory thoughts out of your head, and they continue to interfere negatively with your day-to-day life, consider going to an expert.

A psychologist with experience in cognitive behavioral therapy can help you. This type of therapy focuses on thoughts and emotions and how they affect our behavior.

How to Reduce Anticipatory Anxiety


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