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Anticipatory Anxiety and Panic: Tomorrow's Dread, Today Anticipatory anxiety is awful. Am I right? And it so often accompanies panic, perhaps being the precursor to avoidance phenomena such as agoraphobia and social anxiety. Of course, anyone can experience anticipatory anxiety, just as anyone can experience measures of panic and social discomfort. But within the context of the anxiety disorders, anticipatory anxiety generally comes in buckets. Well, let’s talk about it; as that’s always the first order of business when approaching relief. Can you relate to this scenario? You haven’t flown in three years, so it isn’t hard to understand why you’ve lost your flying edge, assuming you really ever had one. It’s April 1, and out of nowhere Cousin Ralphie calls inviting you and the family to his daughter’s high school graduation happenings. After you’ve convinced yourself this isn’t an April Fool’s joke, you say yes (though you really didn’t want to), and a weekend trip becomes reality. Yes, in two months you’re traveling 1500 miles away from home. Of course, you’re gonna’ have to fly, though you thought long and hard about driving, taking a train, a bus, a cab, even hitchhiking. Oh man, the trip. And coming to realize flying is your only option. It’s like getting hit upside the head with a two-by-four and the shockwaves rush through your body for hours, even days, after. So, okay, you’re able to manage your fear and anxiety for a few weeks. I mean, after all, the trip’s still a decent amount of time away. But before you know it you’re within two weeks and your life is beginning to spin out of control. Every minute of every day finds you obsessing over the coming events as your body and mind are stuck in a chronic state of anxiety and alarm. And all sense of focus, patience, drive, and hope for relaxation has hit the skids. Hello! This is anticipatory anxiety. And like that cousin of yours, it isn’t going to go away without some effort. Perhaps you can identify with the flying example. Maybe you’ve experienced anticipatory anxiety before a medical or dental procedure, public speaking event, or dinner engagement. It’s a sensation of 100% dread and all-consuming doom, as if there’s a dark cloud following you 24/7 that could open at any time spewing forth oceans of rain and frightening amounts of thunder and lightening. Am I right? Ah, just what you need, another tough issue with which to deal. But it’s something that must be approached and defeated if you’re truly to be set free from the bondage of anxiety and panic. If you’ve read my eWorkbook, Panic! …and Poetic Justice, you know that the anatomical and physiological foundations of our thoughts, feelings, and behavior fascinate me. So here’s yet another bit of research I believe is kind of neat. Anticipatory anxiety, indeed, any sort of long-term anxiety may be controlled by a part of the brain called the bed nucleus of the stria terminalis (BNST). The BNST, a small structure located between the thalamus and the amygdala, the home field of our fear circuitry, is involved with our autonomic and behavioral reactions to frightening stimuli; phenomena such as rapid heartbeat, sweating, dilated pupils, and elevated blood pressure. The key players driving the work of the BNST are corticotropin-releasing hormone (CRH) fibers and terminals. As I discuss in the eWorkbook, CRH, secreted by the hypothalamus, stimulates the secretion of adrenocorticotropic hormone (ACTH) from the pituitary gland. And ACTH knocks on the door of the adrenal glands telling them to secrete the glucocorticoid, cortisol, affectionately known as the “stress hormone.” And cortisol, prompted by mental, emotional, and physical stress directs the hormone and neurotransmitter, norepinephrine (noradrenaline), to flip the switch on our fight/flight response. And, boom, off to the races we go. Yet more biological foundation for what we endure. Now, I’ve experienced anticipatory anxiety so many times over the years and it’s caused me way too much stress, unease, frustration, and melancholy. And as with most everything with which we deal, there’s no “miracle-cure.” However, if you truly want to kiss it good-bye there are strategies that can help you pull it off, in lieu of simply writing off activities and events. Looking back, I started making my most significant progress in dealing with anticipatory anxiety when it dawned on me just how much misery it brought to my life. I hated it. And not only could I very much do without it, it was something I could actually do something about. I mean, what a waste of valuable time and life experience. In the past, for example, had I flown somewhere on a business trip, the anticipatory anxiety regarding the flight home would cause so much way-over-the-top grief for the very few days I was at my out of town location that I couldn’t fully take-in and enjoy the sites and experiences. I began to find that very objectionable, to the point of resentment. Yeah, it made me angry as heck. Indeed, angry enough to do something about it. There was no way I was going to bail-out and just stop doing things and going places. As a result, I made the decision to do all within my power to come out from under anticipatory anxiety’s dark cloud. When I was out of town I saw so many others who seemed to be enjoying their travels and experiences. So why couldn’t I? I mean, it really came down to being willing to throw caution to the wind and letting go of all the control I wanted to hold over everything that touched my life. What a repetitive theme for an anxiety sufferer, right? And I believe it can be boldly stated that we actually use anticipatory anxiety to keep us from unfamiliar and seemingly unmanageable situations. Indeed, our fear of the unknown and unfamiliar, our deeply rooted mandate for self-protection, just gets us in such a tight hold and so totally runs us aground. Please come to the conclusion that life is way too valuable to waste even one minute in dread, anguish, and misguided drives to control. I don’t care what you’re facing, approach it obsession-free. You will emerge the victor; safe, intact, happy, and all-the-better for the experience. Really, it’s true. When you know an unpleasant event is in the offing, don’t freak over it. Rather, divert your mind and fully participate in the day – today - not eight weeks from now. Bring into play the strategies and techniques presented in my eWorkbook (or those you’ve already learned), especially the examination of what your immediate fear truly represents, to arm yourself with strength and confidence. And just watch how cool you’ll feel as what you believed to be an unpleasant event seems so very routine the next time it comes knocking at your door. Anticipatory anxiety is icky, no doubt. But, as I teach over and over again with the anxiety disorders, it’s very manageable and downright beatable.
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