By Ashley Butterfield, PsyD

“All of us have worries. We worry because we are intelligent beings. Intelligence predicts, that is its essence; the same intelligence that allows us to plan, hope, imagine, and hypothesize also allows us to worry and anticipate negative outcomes.” – Norman Doidge, author of The Brain that Changes Itself

Throughout the course of your life, you anticipate a great many things. Often, anticipating activities or events means that you are looking forward to them and counting down the days until their arrival. For example, you might anticipate eating a good meal, watching the premiere of your favorite tv show, celebrating your birthday, going on an upcoming vacation, etc. In these instances, research has actually shown that anticipation of desirable future events is linked to increased well-being. On the other hand, when you are looking ahead to the occurrence of possible undesirable events, your well-being suffers and leads to worrying, obsessing, and ruminating. In the context of anxiety disorders and Obsessive Compulsive Disorder (OCD), anticipatory anxiety often acts as an obstacle to challenging and overcoming one’s anxiety. Oftentimes the looming “What if….” of anxious expectations is enough to deter you from attempting to face your fears, thus keeping you stuck and likely reliant on avoidance or other detrimental safety behaviors. Anticipatory anxiety is notorious for undercutting confidence and squashing beliefs of self-efficacy. The insidious predictions of anxiety and OCD can be very intimidating as they highlight your worst fears and can actually cause these fears to play out in your mind’s eye.

While in some ways it is adaptive to be able to exercise forethought and plan for the future, in other ways it can be debilitating and immobilizing. Across anxiety disorders and OCD there are many common trends, two of which are related to the latter form of anticipation: 1) overestimating the likelihood that something bad will happen and 2) believing that when (not if) that bad thing happens, you won’t be able to handle it. Given these two trends, it makes sense why you would attempt to avoid your anxiety triggers. The trouble with avoidance is that the trigger in question never gets challenged and is therefore able to remain, lurking in your consciousness. Additionally, fearfulness connected to the trigger becomes stronger, while avoidance becomes associated with feelings of relief (albeit temporary relief). These consequences of avoidance increase the likelihood that avoidance strategies will be employed the next time you encounter or interact with the trigger. Essentially, your brain receives the message “You cannot handle XX so the only way to get through the situation is to avoid it.” It can be very difficult to extricate yourself from this loop, but with the proper professional support, it is not only possible, it is also sustainable!

One of the biggest pitfalls of anticipatory anxiety is confusing “what if…” for what is, or in other words, confusing what is possible with what is probable. The truth is that anxiety makes you jump to conclusions, engage in emotional reasoning (i.e., because I feel this way, there must be some truth/legitimacy to the concern), and catastrophize your feelings and situations into worst case scenarios. It blurs the boundaries between what could happen and what will happen. There is a very important distinction to be made here: just because something can happen, does not mean that it will happen. However, anxiety clouds your judgement and floods you with worrisome thoughts and uncomfortable body sensations, which are often misinterpreted as clues precipitating an impending disaster. It is important to see these reactions as symptoms of anxiety and to employ therapeutic strategies to decrease anxiety’s ability to direct you into a state of panic. Here are some strategies for conquering anticipatory anxiety:

1. Externalize anxiety/OCD. Recognize the increase in heart rate, the racing thoughts, and the urge to leave as symptoms of anxiety. Let me be clear: while these symptoms are certainly uncomfortable, they DO NOT spell disaster. Think about symptoms that you may experience in other contexts. For example, your vision may appear blurry until you put on your glasses, you may be wheezing until you use your inhaler, or you might feel a little light-headed because you stood up too quickly. Many of us recognize these symptoms, can trace them back to their source, and then once we have identified the cause, we respond accordingly to mediate the symptoms. This approach also works for anxiety as well. Identify it, label it, and then move into problem solving. Do not panic. Use your strategies

1. Make some positive what-if predictions. In the context of anticipatory anxiety, you are constantly worrying about what might go wrong, anticipating the worst-case scenario. In effect, you have tipped the scale and loaded it down with negative predictions. You need to balance out those thoughts with some positive what-if predictions, or at the very least, some neutral predictions. Remember, your emotions follow your thoughts so if you fixate on negative outcomes, your anxiety will increase. If you work to make your predictions a bit more balanced, it may not completely get rid of your anxiety, but it should allow you to realize that the worst-case scenario is not as likely as your anxiety would like you to believe.

1. Remind yourself of your track record of getting through challenges. Since anxiety attempts to banish feelings of self-confidence and leave a trail of doubts in their place, it is important to hold tight to memories of situations or events in which you felt challenged, you persevered, and you made it through tough situations. Anxiety does not want you to recognize your power because the inverse relationship is threatening to anxiety—as you become more confident and stronger, anxiety becomes weaker!

1. Stay busy before the event. Do not let anxiety fill your head with doubts. To help with the strategy of externalizing anxiety, I liken anxiety to a heckler trying to get into your head and trip you up before a performance. Do your best not to listen and do not engage with the anxiety heckler. Stay focused on other things until you have to engage in the event in question. Go for a walk, listen to music, do some chores, etc. This will help to keep your mind occupied and buffered against anticipatory anxiety’s attempts to invade. When entering the event drop the other activities and be mindful of the event, not anxiety’s jeers and taunts.

1. Put the worry in perspective. Anxiety is a well-known exaggerator and will try to make you believe that the consequences of XX not going well will be dire. Because anxiety can ramp up the intensity pretty quickly, people often find themselves caught off guard, getting swept up in the worries, and accepting the worries at face value. Here are some questions to ask yourself in order to disarm, or at least lessen the credibility of anxiety’s negative predictions:
   1. Is there evidence to believe that XX is true/false?
   2. Is my reasoning about this situation based upon my emotions or facts?
   3. What would my best friend, teacher, parent, spouse tell me about this worry? How would they interpret the situation?
   4. Will this matter next week? Next month? How about next year?

1. Compare your anxious predictions to the actual outcomes of the situation after the event has occurred. Were your predictions accurate? Much of the time people are so relieved to make it through an anxious event that they do not process the discrepancies between their anxious predictions and the actual outcomes of the situation. These discrepancies are highly valuable to note as they can serve as evidence that anxiety is full of bluster. Looking at the situation retrospectively can provide beneficial data that will likely help you to see how distorted anxiety’s predictions were in the first place. If you can notice this trend, perhaps you will be less likely to take anxiety seriously in the future.

Contrary to typical instincts, delaying triggering events is not in your best interest. More time will not be helpful because anxiety will try to take advantage of the extra time to cook up more doubts, worries, and catastrophic outcomes. It is important to note that you do not have to wait for a complete absence of anxiety to be “ready” to do something that is challenging. In fact, research has revealed that experiencing some anxiety is actually helpful to your performance. In order to face your fears, anxiety needs to be present so that you can learn to work through it. Without anxiety’s presence in such situations, new adaptive learning cannot take place. Exposure and Response Prevention (ERP) treatment is helpful in facilitating this new learning, targeting the obstacles laid down by anxiety, and increasing feelings of self-confidence. ERP is known as the gold-standard treatment for anxiety and obsessive-compulsive disorders and has consistently demonstrated high rates of efficacy in decreasing anxiety and reducing functional impairments caused by anxiety. Patients who participate in this treatment experience a decline in their anxious symptoms and improvement in their day-to-day functioning. Those that complete ERP treatment report maintenance of treatment gains and continued progress even after treatment has ended. For more information about ERP, please see our previous blog entry — What is Exposure and Response Prevention (ERP). ERP helps people to discover that avoidance of anxiety is not their only option and that they can overcome their fears and live their lives the way they want to (without the restrictions of their anxiety and/or OCD). Working with an ERP expert will facilitate your ability to become adept at utilizing proactive and empowering strategies to confront and conquer your anxiety and to reach your goals.

“…don’t get more anxious about feeling anxious… It’ll just lead to more anxiety. And there is definitely a tipping point… know that it’s also anticipation … and possibility … and hope. Ride the waves … Feel the excitement. It lets you know you’re alive.” ― Shellen Lubin, singer, songwriter, and actor

Need help or support?

If you or a loved one are struggling with an anxiety disorder, Obsessive-Compulsive Disorder, or any other mental health concerns, know that you are not alone. If you are a parent or a caregiver and are seeking additional information about how you can best support your child, our office provides parent training with the SPACE program. Please see our November 2021 Newsletter for more information on SPACE.

For these or any other mental health concerns, please contact The OCD & Anxiety Center at (630) 522-3124  or info@theocdandanxietycenter.com. We have offices located in Oak Brook and Orland Park, Illinois and our clinicians specialize in helping individuals overcome anxiety disorders, Obsessive-Compulsive Disorders, and other co-occurring mental health conditions.

We provide telehealth services that are available in Illinois, Indiana, Iowa, and Georgia.

At The OCD & Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, work etc.). We will work closely with you to create an individualized treatment plan and discuss the appropriate frequency of appointments (once a week or more, if needed). We look forward to working with you and facilitating your therapeutic journey!

Dr. Ashley Butterfield is a licensed psychologist at The OCD & Anxiety Center in Oak Brook, IL.  She specializes in Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy for anxiety, OCD, and anxiety-related disorders. She is comfortable working with children and adults and is able to provide treatment both in the office and outside of the office, wherever anxiety happens.

Click here for more information on Anxiety Therapy.