Anticipatory anxiety: fear of what might happen and how to manage it

Anticipatory anxiety is the feeling of unease, worry or dread that builds before something happens: a flight, a medical appointment, a social event, a journey, a meeting, or the possibility of another panic attack. The anxiety is about the future, and the body can react as though the event is already happening.

NHS inform describes anxiety as a feeling of unease, like worry or fear, that can be mild or severe. Everyone has feelings of anxiety at some point, for example before an exam or job interview, and during times like these feeling anxious can be perfectly normal. The question is whether the worry is out of proportion, hard to control or affecting daily life.

The NHS adds that panic is the most severe form of anxiety. When someone has had panic attacks, anticipating the next one can become a problem in itself.

There is no separate NHS symptom list for anticipatory anxiety, but the symptoms of anxiety conditions describe what people commonly experience while waiting for something feared. The NHS lists, for generalised anxiety disorder, feelings of stress or worry that affect daily life and are difficult to control, and NHS inform lists physical and mental symptoms.

The NHS explains that panic disorder involves regularly having sudden attacks of panic or fear. You may start to avoid certain situations because you fear they will trigger another attack, creating a cycle of living in fear of fear, which can add to your sense of panic and may cause more attacks. Agoraphobia can follow.

In generalised anxiety disorder (GAD) the anxiety attaches to many different things rather than one event. NHS inform says people with GAD feel anxious most days and may not always be clear what they are feeling anxious about. It is also common to have more than one anxiety disorder at the same time, such as GAD with panic disorder or a phobia.

Anticipatory anxiety can also feature in phobias and in social anxiety disorder, where the dread of a feared situation arrives long before it.

The NHS says to see a GP if you think you might have GAD or have been diagnosed and treatments are not helping. NHS inform advises contacting your GP practice if your mental health is affecting your daily life, you are not looking after yourself, or you are finding it hard to manage responsibilities.

Because most panic symptoms can also be symptoms of other conditions, the NHS notes that you may not always be having a panic attack. A GP can rule out physical causes, such as an overactive thyroid, which can sometimes cause similar symptoms. If you have chest pain or severe breathlessness that is new or not typical for you, seek urgent advice rather than assuming it is anxiety.

The NHS lists things to try during a panic attack: stay where you are if possible, breathe slowly and deeply, remind yourself the attack will pass, focus on positive or peaceful images and remember it is not life threatening. To help prevent further attacks it suggests CBT-based self-help books, yoga or pilates, breathing exercises, regular physical exercise and avoiding sugary food and drinks, caffeine and alcohol.

For GAD, the NHS also advises talking about your feelings, trying recommended self-help courses, getting enough sleep, exercising regularly and eating regular meals, and suggests not avoiding situations that make you anxious but slowly building up time spent in them. It advises against using alcohol, cigarettes, gambling or drugs to relieve anxiety.

For GAD the NHS says the main treatments a GP may offer are talking therapies, usually CBT, medicines to treat anxiety, usually an SSRI antidepressant, and referral to a community mental health team. A GP will usually advise trying talking therapies before prescribing medicine or referring to a specialist.

For panic disorder, the NHS says talking therapies and medicine are the main treatments, and that antidepressants can take 2 to 4 weeks before they start to work and up to 8 weeks to work fully. It advises continuing to take them even if you feel they are not working, and stopping only if your GP advises.

NHS inform says that with treatment many people are able to control their levels of anxiety, that some treatments may need to continue for a long time and that there may be periods when symptoms worsen.

On the NHS, adults can self-refer to NHS talking therapies, see a GP, or use self-help resources such as those listed by NHS inform. Charities such as Anxiety UK, Mind and Rethink Mental Illness offer information and support groups.

Private therapy is an option for quicker access or a particular approach. CBT is the core evidence-based approach in both settings, so check that a private therapist is trained in it and registered with a recognised professional body.