Anticipatory anxiety

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Anticipatory anxiety, sometimes called future tripping, describes a type of fear that occurs when an anticipated event in the future causes distress. These events can include both major occasions, such as a presentation, but depending on the individual could also happen before some minor event, like going out. It is not seen as a distinct type of anxiety but rather plays a part in many variations and can be found in numerous disorders and is strongly connected to panic attacks, often following them. [1]

Contents

Description

People who suffer from anticipatory anxiety can have a number of different symptoms. These can include being afraid of an event that will happen in the future and therefore presents an unpredictable threat to an individual, but can also include chest pains or hyperventilation. In some cases they can even make the person feel like they are dying or lose control. [2]

Anticipatory anxiety does not have one definitive cause but rather it plays a part in many anxiety-related disorders. It can arise through social anxiety disorder and be a consequence of bullying. [3] People who often suffer from panic attacks can grow to fear their onset and the repercussions that accompany them. [4] [5] [6] This is then an anticipatory anxiety, as something that is anticipated for the future causes anxiety in an individual. It can come out stronger in a situation where a stress-causing event cannot be predicted. [7] [8]

Increased activity of the amygdala can lead to wrongfully processing threats, which could then be the reason for overly worrying about the future. [1] The anterior insula causes emotional responses to predicted events. If activated too strongly, this can lead to threat-uncertainty. [1]

Symptoms

The symptoms of future tripping can overlap with multiple different anxiety disorders. The main symptom is an extensive fear of an imagined event or situation that lays in the future, which the person thinks of as an "unpredictable threat". [1] [5] [8]

Other symptoms include: [2] [5]

A person suffering from anticipatory anxiety may also experience fear of having a panic attack. Symptoms include hyperventilation, chest pains, and muscle spasms. [2] [5]

Causes

There are no known general direct causes to anticipatory anxiety. Personal sensitivity and probability of anxiety occurring may be elevated by various factors. [9] A person's personality traits may put them at increased risk for anticipatory stress. People characterised as perfectionists have shown to be more vulnerable. [10] Excessive deliberation or overthinking may be a direct cause of the symptoms of anticipatory anxiety. [11] Some studies have shown correlation between stress level and one's perception of whether the stress inducing event is outside of one's control or if it can be affected or mitigated by them. [12]

Anticipatory anxiety has higher chances of occurring in the context of situations where the result of stress-inducing events is unpredictable. [8] [7] Prior knowledge, anticipation, and understanding of potential consequences of the stressful event may significantly decrease the level of the anxiety. [7]

There are indications of smoking increasing anxiety among people with high anxiety sensitivity. [9] [13]

The Sunday scaries are a common form of anticipatory anxiety. [14]

Panic attacks

Anticipatory anxiety is a symptom of panic disorder, playing a role in its onset, maintenance and impairment. People who suffer from frequent spontaneous panic attacks might develop a persistent state of fear, or anxiety, relating to the anticipation of future panic attacks or their consequences. [4] [5] [6] The severity of this anxiety might be modified by cues assumed to trigger panic attacks, including bodily symptoms. [5] The freezing symptom, characteristic for panic disorder, is related to the lessened mobility associated with anticipatory anxiety. [15]

The Panic and Agoraphobia Scale scores on the basis of five elements, including the frequency and severity of anticipatory anxiety. [16] The severity of the anxiety serves as an indicator for avoidance behaviour in panic disorder and agoraphobia. [5] [17]

People experiencing anticipated fear of epileptic seizures may also fear anticipated panic attacks. This can culminate into anticipatory seizure anxiety, seizure phobia, or epileptic panic disorder. [18]

Anxiety disorders

Anticipatory anxiety is a feature of social anxiety disorder. The Social Phobia Scale, a general self-report questionnaire used as measure for social anxiety disorder, contains the 'anticipatory anxiety related to being observed' as one of its main diagnostic items. [19] Peer victimisation, such as bullying, may increase levels of anticipatory anxiety and of developing social anxiety disorder. [3]

Avoidance behaviour associated with post-traumatic stress disorder increases anticipatory anxiety. This can be an indicator of post-traumatic anxiety disorders such as agoraphobia, social anxiety disorder, obsessive-compulsive disorder, or separation anxiety. [20]

Neuroanatomy

A wide network of brain areas are involved in anticipatory anxiety. The activity of the amygdala increases under conditions of uncertainty. The hyperactivity of the amygdala leads to increased vigilance and biased attention towards threat and deficient associative learning, which leads to higher expectancy of threat. These expectations cause a feedback loop where anxious individuals become increasingly more vigilant and attentive towards perceived threats. Increased attention influences the subjective value of potential future events. This value is assigned by the ventral striatum and orbitofrontal cortex, to which the amygdala is bidirectionally connected. [1]

Dopaminergic neurons in the midbrain generate prediction error signals, which reflect a mismatch between the predicted and the actual outcome. These error signals lead to more accurate future predictions for both rewarding and aversive stimuli. Hypothetical future events create an anticipatory emotional response from the anterior insula. Hyperactivity of the anterior insula can be observed in anticipation of negative events connected to absent decision-making or threat uncertainty. Already associated neuronal connections strengthen when behavioural patterns and anxious thoughts occur. [1]

The anterior midcingulate cortex is involved in the regulation of autonomic activity, direction of appropriate defensive responses, facilitation of response selection, and the increase of attentional resources. It projects to the motor cortex, amygdala, midbrain nuclei (including the periaqueductal grey), parietal regions and multiple medial and lateral prefrontal regions (including the dorsolateral prefrontal cortex). In clinical anxiety, the structure, function and connectivity of the anterior midcingulate cortex are altered. [1]

Treatment

Future tripping, another name for anticipatory anxiety, is a form of anxiety and therefore can be treated by a psychologist who can provide strategies to cope in a healthy manner. [4]

A regular practice of meditation can help overcome the want to control and apprehend the future, as the practice includes being aware of the present moment. This technique reduces the persistence of anxious thoughts, limiting the impact. [21] [22]

Eating healthy food and exercising regularly have been shown to have a positive effect. Exercise releases stress from the body and can help distract from anxious thoughts. [21]

Related Research Articles

<span class="mw-page-title-main">Anxiety</span> Unpleasant state of inner turmoil over anticipated events

Anxiety is an emotion which is characterised by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different from fear in that fear is defined as the emotional response to a present threat, whereas anxiety is the anticipation of a future one. It is often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination.

<span class="mw-page-title-main">Fear</span> Basic emotion induced by a perceived threat

Fear is an intensely unpleasant primal emotion in response to perceiving or recognizing a danger or threat. Fear causes psychological changes that may produce behavioral reactions such as mounting an aggressive response or fleeing the threat. Fear in human beings may occur in response to a certain stimulus occurring in the present, or in anticipation or expectation of a future threat perceived as a risk to oneself. The fear response arises from the perception of danger leading to confrontation with or escape from/avoiding the threat, which in extreme cases of fear can be a freeze response.

<span class="mw-page-title-main">Phobia</span> Anxiety disorder classified by a persistent and excessive fear of an object or situation

A phobia is an anxiety disorder, defined by an irrational, unrealistic, persistent and excessive fear of an object or situation. Phobias typically result in a rapid onset of fear and are usually present for more than six months. Those affected go to great lengths to avoid the situation or object, to a degree greater than the actual danger posed. If the object or situation cannot be avoided, they experience significant distress. Other symptoms can include fainting, which may occur in blood or injury phobia, and panic attacks, often found in agoraphobia and emetophobia. Around 75% of those with phobias have multiple phobias.

<span class="mw-page-title-main">Anxiety disorder</span> Cognitive disorder with an excessive, irrational dread of everyday situations

Anxiety disorders are a group of mental disorders characterized by significant and uncontrollable feelings of anxiety and fear such that a person's social, occupational, and personal functions are significantly impaired. Anxiety may cause physical and cognitive symptoms, such as restlessness, irritability, easy fatigue, difficulty concentrating, increased heart rate, chest pain, abdominal pain, and a variety of other symptoms that may vary based on the individual.

<span class="mw-page-title-main">Agoraphobia</span> Anxiety disorder

Agoraphobia is a mental and behavioral disorder, specifically an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. These situations can include public transit, shopping centers, crowds and queues, or simply being outside their home on their own. Being in these situations may result in a panic attack. Those affected will go to great lengths to avoid these situations. In severe cases, people may become completely unable to leave their homes.

<span class="mw-page-title-main">Panic attack</span> Period of intense fear

Panic attacks are sudden periods of intense fear and discomfort that may include palpitations, sweating, chest pain or chest discomfort, shortness of breath, trembling, dizziness, numbness, confusion, or a feeling of impending doom or of losing control. Typically, symptoms reach a peak within ten minutes of onset, and last for roughly 30 minutes, but the duration can vary from seconds to hours. Although they can be extremely frightening and distressing, panic attacks themselves are not physically dangerous. Experiencing a panic attack has been said to be one of the most intensely frightening, upsetting, and uncomfortable experiences of a person's life and may take days to initially recover from. Repeated panic attacks are considered a symptom of panic disorder.

Specific phobia is an anxiety disorder, characterized by an extreme, unreasonable, and irrational fear associated with a specific object, situation, or concept which poses little or no actual danger. Specific phobia can lead to avoidance of the object or situation, persistence of the fear, and significant distress or problems functioning associated with the fear. A phobia can be the fear of anything.

<span class="mw-page-title-main">Amygdala</span> Each of two small structures deep within the temporal lobe of complex vertebrates

The amygdala is a paired nuclear complex present in the cerebral hemispheres of vertebrates. It is considered part of the limbic system. In primates, it is located medially within the temporal lobes. It consists of many nuclei, each made up of further subnuclei. The subdivision most commonly made is into the basolateral, central, cortical, and medial nuclei together with the intercalated cell clusters. The amygdala has a primary role in the processing of memory, decision-making, and emotional responses. The amygdala was first identified and named by Karl Friedrich Burdach in 1822.

<span class="mw-page-title-main">Depersonalization</span> Anomaly of self-awareness

Depersonalization is a dissociative phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of observing oneself from an external perspective. Subjects perceive that the world has become vague, dreamlike, surreal, or strange, leading to a diminished sense of individuality or identity. Sufferers often feel as though they are observing the world from a distance, as if separated by a barrier "behind glass". They maintain insight into the subjective nature of their experience, recognizing that it pertains to their own perception rather than altering objective reality. This distinction between subjective experience and objective reality distinguishes depersonalization from delusions, where individuals firmly believe in false perceptions as genuine truths. Depersonalization is also distinct from derealization, which involves a sense of detachment from the external world rather than from oneself.

Generalized anxiety disorder (GAD) is a mental and behavioral disorder, specifically an anxiety disorder characterized by excessive, uncontrollable and often irrational worry about events or activities. Worry often interferes with daily functioning, and individuals with GAD are often overly concerned about everyday matters such as health, finances, death, family, relationship concerns, or work difficulties. Symptoms may include excessive worry, restlessness, trouble sleeping, exhaustion, irritability, sweating, and trembling.

Affective neuroscience is the study of how the brain processes emotions. This field combines neuroscience with the psychological study of personality, emotion, and mood. The basis of emotions and what emotions are remains an issue of debate within the field of affective neuroscience.

<span class="mw-page-title-main">Worry</span> Thoughts, images, emotions, and actions of a pessimistic nature

Worrying is the mental distress or agitation resulting from anxiety, usually coming from a place of anticipatory fear (terror) or fear coming from a present threat (horror). With more understanding of the situation, worry becomes concern, the recognition of a future outcome that could be troubling, without necessarily having fear in that outcome.

Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

Memory and trauma is the deleterious effects that physical or psychological trauma has on memory.

<span class="mw-page-title-main">Panic disorder</span> Anxiety disorder characterized by reoccurring unexpected panic attacks

Panic disorder is a mental and behavioral disorder, specifically an anxiety disorder characterized by reoccurring unexpected panic attacks. Panic attacks are sudden periods of intense fear that may include palpitations, sweating, shaking, shortness of breath, numbness, or a feeling that something terrible is going to happen. The maximum degree of symptoms occurs within minutes. There may be ongoing worries about having further attacks and avoidance of places where attacks have occurred in the past.

The management of traumatic memories is important when treating mental health disorders such as post traumatic stress disorder. Traumatic memories can cause life problems even to individuals who do not meet the diagnostic criteria for a mental health disorder. They result from traumatic experiences, including natural disasters such as earthquakes and tsunamis; violent events such as kidnapping, terrorist attacks, war, domestic abuse and rape. Traumatic memories are naturally stressful in nature and emotionally overwhelm people's existing coping mechanisms.

<span class="mw-page-title-main">Effects of stress on memory</span> Overview of the effects of stress on memory

The effects of stress on memory include interference with a person's capacity to encode memory and the ability to retrieve information. Stimuli, like stress, improved memory when it was related to learning the subject. During times of stress, the body reacts by secreting stress hormones into the bloodstream. Stress can cause acute and chronic changes in certain brain areas which can cause long-term damage. Over-secretion of stress hormones most frequently impairs long-term delayed recall memory, but can enhance short-term, immediate recall memory. This enhancement is particularly relative in emotional memory. In particular, the hippocampus, prefrontal cortex and the amygdala are affected. One class of stress hormone responsible for negatively affecting long-term, delayed recall memory is the glucocorticoids (GCs), the most notable of which is cortisol. Glucocorticoids facilitate and impair the actions of stress in the brain memory process. Cortisol is a known biomarker for stress. Under normal circumstances, the hippocampus regulates the production of cortisol through negative feedback because it has many receptors that are sensitive to these stress hormones. However, an excess of cortisol can impair the ability of the hippocampus to both encode and recall memories. These stress hormones are also hindering the hippocampus from receiving enough energy by diverting glucose levels to surrounding muscles.

Safety behaviors are coping behaviors used to reduce anxiety and fear when the user feels threatened. An example of a safety behavior in social anxiety is to think of excuses to escape a potentially uncomfortable situation. These safety behaviors, although useful for reducing anxiety in the short term, might become maladaptive over the long term by prolonging anxiety and fear of nonthreatening situations. This problem is commonly experienced in anxiety disorders. Treatments such as exposure and response prevention focus on eliminating safety behaviors due to the detrimental role safety behaviors have in mental disorders. There is a disputed claim that safety behaviors can be beneficial to use during the early stages of treatment.

<span class="mw-page-title-main">Fear of crossing streets</span> Type of phobia

The fear of crossing streets, or its terms dromophobia and agyrophobia, is a specific phobia that affects a person's ability to cross a street or roadway where cars or vehicles may be present. The term dromophobia comes from the Greek dromos, meaning racetrack.

<span class="mw-page-title-main">Interoception</span> Sensory system that receives and integrates information from the body

Interoception is the collection of senses providing information to the organism about the internal state of the body. This can be both conscious and subconscious. It encompasses the brain's process of integrating signals relayed from the body into specific subregions—like the brainstem, thalamus, insula, somatosensory, and anterior cingulate cortex—allowing for a nuanced representation of the physiological state of the body. This is important for maintaining homeostatic conditions in the body and, potentially, facilitating self-awareness.

References

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