Key points
- Anticipatory anxiety is driven by excessive worry and intolerance of uncertainty (Hofmann & Smits, 2012; Gu, et al., 2020).
- Cognitive behavioral therapy for anxiety provides structured skills to test predictions and tolerate uncertainty rapidly (Carpenter, et al., 2018; Dugas, et al., 2010).
- Practical CBT techniques (worry scheduling, behavioral experiments, and IU-targeted exercises) shorten the “what if” loop (Carpenter, et al., 2018; Dugas, et al., 2010).
What is anticipatory anxiety?
Anticipatory anxiety is the excessive fear, worry, or dread about a future event that often takes the form of persistent “what if” thoughts and avoidance of anticipated situations (Hofmann & Smits, 2012; Gu, et al., 2020). This pattern is central to generalized worry and to the way many anxiety disorders maintain themselves over time (Hofmann & Smits, 2012; Carpenter, et al., 2018).
How CBT breaks the “what if” cycle
Cognitive behavioral therapy for anxiety teaches clear, evidence-based strategies to interrupt maladaptive prediction and avoidance cycles (Hofmann & Smits, 2012; Carpenter, et al., 2018). CBT combines cognitive techniques (to identify and test catastrophic predictions) with behavioral work (to approach avoided situations or test feared outcomes), producing measurable reductions in worry and avoidance across randomized trials (Carpenter, et al., 2018; Dugas, et al., 2010). Targeting intolerance of uncertainty – deliberately practicing tolerating unknown outcomes – directly reduces anticipatory worry, as shown in controlled trials that compared IU-focused CBT to relaxation or waitlist conditions (Dugas, et al., 2010; Gu, et al., 2020).
Practical CBT steps you can use
Start with a short “worry schedule”: set aside 15–30 minutes each day to worry, which reduces intrusion outside that window (a well-tested technique from cognitive behavioral therapy for anxiety) (Hofmann & Smits, 2012; Gu, et al., 2020). Use behavioral experiments: write a specific “what if” prediction, test it by gathering data or approaching the situation, and compare the actual outcome to the predicted catastrophe Carpenter, et al., 2018; Dugas, et al., 2010). Practice uncertainty exposures (e.g., choosing not to check for reassurances or deliberately leaving an outcome ambiguous) to build tolerance; these exercises are rooted in intolerance-of-uncertainty research and produce faster reductions in anticipatory anxiety Dugas, et al., 2010; Gu, et al., 2020).
When to seek help
If anticipatory anxiety is causing impairment (e.g., interference with work, school, relationships, personal aspirations, hobbies, etc), cognitive behavioral therapy for anxiety delivered by a trained psychologist is a first-line, evidence-based option that reliably reduces anxiety, worry, and avoidance (Hofmann, et al., 2012; Carpenter, et al., 2018; Curtiss, et al., 2021). Short, focused CBT programs—often 8–12 sessions—are effective for many people with marked anticipatory anxiety (Carpenter, et al., 2018; Curtiss, et al., 2021).
Bottom line: Cognitive-behavioral therapy for anxiety gives simple, actionable tools to test feared predictions and to practice tolerating uncertainty, breaking the “what if” loop before it spirals into avoidance.
References
- Carpenter, J. K., Andrews, L. A., Witcraft, S. M., Powers, M. B., Smits, J. A. J., & Hofmann, S. G. (2018). Cognitive behavioral therapy for anxiety and related disorders: A meta-analysis of randomized placebo-controlled trials. Clinical Psychology Review, 61, 1–18.
- Dugas, M. J., Ladouceur, R., Freeston, M. H., Léger, E., Rhéaume, J., Provencher, M. D., & Boisvert, J.-M. (2010). A randomized clinical trial of cognitive-behavioral therapy and applied relaxation for generalized anxiety disorder: A comparison of treatments targeting intolerance of uncertainty. Behaviour Research and Therapy, 48(4), 272–283.
- Curtiss, J., Klemanski, D. H., & McLaughlin, K. A. (2021). Cognitive-behavioral treatments for anxiety and stress-related disorders: An overview. Focus, 19(3), 299–308.
- Gu, Y., Zhou, Y., Zhu, Y., & Wu, Y. (2020). From uncertainty to anxiety: Intolerance of uncertainty as a transdiagnostic process. Frontiers in Psychiatry, 11, 573.
- Hofmann, S. G., & Smits, J. A. J. (2012). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Clinical Psychology Review, 32(3), 169–177.
