Your question: Why do I get anxiety before appointments?

My reply:

Hi, I hope this message finds you well. My name is Cesar Guedez, a psychologist trained in cognitive behavioral therapy. Through this article I will explain why you feel anxiety before your appointments.

Anxiety is a normal part of life, and should not be a serious problem unless it becomes too recurrent and intense. When anxiety keeps you in a constant state of worry and anticipation of events, generating unpleasant physical and emotional symptoms in your body that drain your energy, then anxiety has become a problem.

What happens to you is called anticipatory anxiety: an excessive worry about events that have not happened, filling the person with overwhelming uncertainty and often catastrophic thoughts about the future.

It is said that anxiety has an intuitive sense as it prepares in our minds different scenarios of something that has not happened. This is not necessarily harmful as it might give you an idea, for example, of what different questions might appear on an upcoming exam.

However, anticipatory anxiety goes further, as it compromises your emotional stability by imagining intimidating and frightening scenarios of situations that in most cases, you are not at all certain how they will occur.

Thus, anticipatory anxiety can lead you to imagine that a business appointment will go terribly wrong, that your boss and other employees will laugh at you, or that in an important presentation at the university you will forget all the content and the professor will humiliate you in front of the whole class.

In this way, anticipatory anxiety keeps you constantly in uncertainty, in the unpredictability of life and overwhelms you by building fictitious scenarios of uncertain situations, preventing you from living in the present.

Although it is an annoying feeling, it is quite common, and the first step before employing strategies to feel better is to accept anxiety as part of your life and find the source of your anxious thoughts.

What does anticipatory anxiety feel like?

Anticipatory anxiety generates various physical and psychological symptoms when you are in expectation of something, be it a job appointment, a medical result or a university exam. Some of these symptoms are:

  • Sweating and tachycardia
  • Intense fear and the urge to cry
  • Intense worry about what might happen
  • Fear of something terrible happening to you
  • Muscle tension
  • Headache or stomach ache

Why do you have anticipatory anxiety?

A study(1) on anxiety and anticipation proposes several reasons why excessive worry about future events appears in people’s lives generating intense distress. Some of these are:

Inflated estimates of threat cost and probability

This refers to the fact that during anxiety, you make biased evaluations of reality that are pessimistic. This occurs as a function of your own anxious tears and pessimistic way of perceiving yourself and your reality.

Increased threat attention and hypervigilance

It is related to the feeling of intense alertness that your brain generates during the period of anxiety. This feeling of hypervigilance causes you to “notice” patterns that make you jump to conclusions, even though these patterns are not in accordance with reality. For example, you felt a sidelong glance from your boss in the hallway, so you imagine that he is going to scold you in the meeting later.

Behavioral and cognitive avoidance

It is related to the feeling of fear and the tendency to avoid threatening situations. Basically it explains that if you are a person who tends to “escape” from problems, avoiding confrontations or situations that you consider a danger to your integrity, you are more likely to feel excessive concern about future events.

How to reduce your anxiety?

Anticipatory anxiety should be worked on along with fear of the future. Worry related to your appointments is based on a general concern about your performance. Therefore, the recommendations seek to address both the physical symptoms of anxiety and your emotional relationship with the future by learning to regulate the thoughts that cause you anxiety and developing more self-confidence and self-assurance.

Relaxation and breathing

Jacobson’s relaxation technique(2) may be useful for you, as it focuses on decreasing the unpleasant sensations associated with anxiety and panic attacks. This technique is done lying down, in a quiet environment and with your eyes closed. It consists in that from your feet to your head, you focus your attention on a part of your body, making slow movements, tensing and releasing the tension. For example in your feet, you make slow circular movements, tense them and then release the tension. 

Then you do the same with your legs, and so on until you reach your head. It will take as long as you feel necessary, but it lasts approximately 10 to 20 minutes. It is a slow but effective exercise, that with time you will learn to control it perfectly and you will notice an improvement in the control of your nocturnal anxiety.

Question your thoughts

In my experience in cognitive behavioral therapy I have noticed that most people’s emotional problems are related to the way they think. Once harmful and burdensome thoughts are questioned or broken down, the emotional state gradually improves. This is done through answering the questions that anxiety asks in your mind.

The questions should be directed at challenging your doubts and concerns related to that future event. For example, you may think “my job appointment will go very badly because my boss doesn’t like my work performance”. This is when you question that thought by looking for the logic “Well, I have not received any complaints from my boss about my work performance”.

In my experience…

Feeling anxious about things that haven’t happened is completely natural. Most people live in the future or in the past, leaving aside the grace and beauty of accepting their present with all the good and the bad. Anticipatory anxiety consumes you because it keeps you on constant watch for what hasn’t happened.

It is a very exhausting way to live, and while it is not your fault that you feel this way because you are not in control of your emotions, you can learn to build a healthy relationship with your future by planning and worrying in moderation about the things you plan to do tomorrow, but not letting it stop you from enjoying the now.

I believe you have the ability to improve and heal these feelings of discomfort you are experiencing now. The fact that you are seeking professional help through this message proves it to me, and I applaud you for making that decision and being on track to improve your mental health and overall, your physical health.

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