Follow these strategies for coping with increased stress levels brought on by the pandemic
During the COVID-19 pandemic itself and now in the new normal environment, I have seen a significant number of veterinary professionals and students struggling with anxiety disorders and related symptoms pertaining to their health, social situations, returning to work, finances, school performance, and overall concerns related to current uncertainties in our world.
One of the most common and challenging anxiety symptoms is anticipatory anxiety. The purpose of this article is to discuss anticipatory anxiety within the context of veterinary medicine, describe the common symptoms, and offer strategies for coping.
Anxiety is a normal human process and a reaction to stress. Anxiety only becomes a problem when it involves excessive fear or worry that affects an individual’s well-being and functioning.1
Although not considered a diagnosable mental health disorder, anticipatory anxiety is challenging but manageable.2 Anticipatory anxiety involves an excessive or debilitating level of worry about a future event or situation, and it tends to focus on negative outcomes.3
Of course, some level of worry, concern, or even stress about future occurrences is typical and understandable. For example, if you are performing anesthesia on a healthy pet for a routine procedure and you notice that its heart rate suddenly drops into the 30s, becoming worried or anxious is totally normal/healthy. However, anticipatory anxiety occurs when the worries become extreme and negatively affect our personal and professional lives because of the potential emotional and even physiological consequences that can result.
Anticipatory anxiety is the type of anxiety individuals experience when they anticipate exposure to triggers that are frightening to them. For example, someone who is claustrophobic may worry about feeling confined on an airplane. Or if someone is afraid of turbulence, they may worry that their flight next week will be rough.4
Anticipatory anxiety fuels one’s need to avoid contact with causes/sources of anxiety. It drives individuals to avoid their irrational fears (phobias) and uncertainties. Anticipatory anxiety can be exceptionally strong and challenging to eliminate. As seen in the above example, it can maintain and intensify a fear of flying.4
Ironically, as with all aspects of anxiety, anticipatory anxiety is completely paradoxical. One’s efforts to avoid it only result in it becoming more intensified. The anticipatory anxiety precipitates more anxiety.4
Here are some important aspects of anticipatory anxiety4:
Individuals with anticipatory anxiety may feel anxious for hours, days, weeks, or months before an event.1 In their professional domain, individuals may experience anticipatory anxiety before work meetings or presentations, interviews, musical or athletic performances, or social events. Individuals also may have anticipatory anxiety about potential future occurrences such as natural disasters, the death of a loved one, or a relationship breakdown.3
Other examples include a well-trained newly graduated veterinarian who isn’t comfortable with emergencies and fears that a critical care case may come in on their next day at work. Or a veterinarian who doesn’t enjoy surgery and fears that there may be a large breed dog that needs a deep-chested gastropexy on their next surgery day.
Let’s examine how anticipatory anxiety might manifest in the routine gastropexy mentioned above. You might start worrying that something could go wrong the day before the procedure to the point that you don’t sleep well. The day of the procedure, you are short with your team members and aren’t fully present for your other duties of the day. Unnecessary worry and fear surrounding something that isn’t likely to happen is anticipatory anxiety.
These represent common anxiety-provoking situations for veterinary professionals. They can generate anxiety-related feelings and reactions regarding potential worst-case scenarios pertaining to potential outcomes, which may never happen. Two elements are clearly discernible: Each scenario encompasses future-based thinking about an event that has not yet occurred, and the feared negative outcome specific to each event may never occur at all.
Anticipatory anxiety causes individuals to automatically assume the worst-case scenario when faced with a perceived challenge or difficulty. They also may experience stress about situations that have yet to happen or find themselves anticipating disaster around every corner.3
Additionally, the prospect of making a decision typically leaves individuals feeling overwhelmed and paralyzed. From subtle avoidance behaviors to the most nightmarish terrors, anticipatory anxiety is the engine that drives it all. Understanding how this hidden enemy tricks you, and, most importantly, how to overcome it will liberate you to live a more flexible and joyful life.4
Notably, those who experience anticipatory anxiety will typically have other anxiety symptoms, which may differ from one individual to another. Each anxiety disorder has its own symptoms, which can vary in intensity and duration.5
Some common symptoms of anticipatory anxiety (and anxiety in general) include the following5:
Good self-care begins with taking care of your basic needs.5 Tips to help with anticipatory anxiety and reduce fear and uncertainty about the future include the following:
Techniques to help relaxation can reduce anxiety over time and enhance sleep quality. Therapists can share useful methods such as deep breathing, progressive muscle relaxation, guided imagery, and grounding techniques. Also, there are numerous online videos and apps that detail each process.5
These techniques are not a cure for anxiety. If used incorrectly, they can serve as avoidant coping.3 Ideally, these exercises should be practiced at scheduled times, rather than when you are feeling anxious. A health care professional can help you mindfully incorporate relaxation techniques into various types of therapy.5
Journaling may help reduce anxiety by exploring your fears and triggers. Do this with the guidance of a trained mental health professional to avoid rumination (dwelling on negative thoughts) or developing a compulsion that functions as avoidant coping.5
Changing your thinking can help change your mood. Do this by considering the source of the anxiety and the negative thoughts that are generated. Then explore how realistic these thoughts are. Instead of imagining a worst-case scenario, challenge negative thoughts when they arise, and these thoughts should become less frequent over time.
Self-compassion—treating oneself with kindness and care in negative situations—may reduce anticipatory anxiety. For example, practice self-compassion by exploring how you might treat a friend who was having anticipatory anxiety. Often we are kinder to others than we are to ourselves.
Treatment options for anxiety may require the assistance of mental health or medical providers or other licensed professionals. There are prescription medications to help manage anticipatory anxiety and other anxiety symptoms. Although primary care physicians can diagnose and manage anxiety, they may recommend that you consult a psychiatrist for severe anxiety, concurrent disorders, or treatment-resistant anxiety disorders.5
Many of us are worrying more and more about things that may never happen, and we waste a lot of mental energy and time doing so. I encourage patients to remember and incorporate a 3-word mantra to enable them to identify and then help them manage their anticipatory anxiety: “Wait to worry.” This approach helps many of them realize what is supported by anxiety research and gives them a simple strategy. More importantly, this phrase reinforces that what they fear, in all probability, will never happen. Incorporating this strategy has proven helpful for many.
Although some anxiety before events and situations is common, excessive levels of anticipatory anxiety can suggest an anxiety disorder.1 If you have overwhelming fears or worry about the future, contact your physician or a mental health professional. Overall, living with an anxiety disorder can be challenging, but such conditions are highly manageable with therapy, medications, or both.
Barry N. Feldman, PhD, is the behavioral health consultant for Get MotiVETed. He is a nationally recognized educator, trainer, and investigator in suicide intervention and prevention and has worked with many veterinary-related institutions.