Understanding anticipatory anxiety during key life transitions

At this time of year, millions of graduates at every age and level of education stand poised on the cusp of change. Whether that’s transitioning from elementary to middle school, landing a first internship or job, or setting off toward the next educational or professional milestone, this stretch is both exciting and anxiety producing. 

That potential for anticipatory anxiety, in which someone develops fear or dread in the face of an anticipated event or situation, can be rooted in uncertainty and unknown outcomes, said Julie Buckner, PhD, a psychology professor who directs the Anxiety and Addictive Behaviors Laboratory and Clinic at Louisiana State University in Baton Rouge. 

[Related: Psychology topics: Anxiety]

“When we think of anxiety, it’s really an emotional response to a perceived future threat,” she said. “Even though the outcome might be good—they might get a job—there’s also this perceived threat of not having a job and then of course what the implications of that would mean.”

While not a diagnostic condition, what psychologists refer to as “anticipatory anxiety” often accompanies other diagnoses, such as generalized anxiety disorder or social anxiety disorder, said Stephanie Sarkis, PhD, a psychotherapist in Tampa, Florida, who specializes in treating anxiety. “And it can be excessive,” she said. “It becomes an issue when it’s taking over day-to-day functioning.” The resulting distress is not just emotional but can spawn hyperventilation, stomach distress, and other physical symptoms, she said.

Anticipatory anxiety is not just limited to life transitions such as graduations. It can be sparked by more routine events, such as a dental appointment or a preventive cancer screening (Goodwin, B., et al., Psycho-Oncology, Vol. 32, No. 12, 2023opens in new window). Or the symptoms may stem from more systemic sources of stress and uncertainty, for example, ongoing worry about intense weather events by those living in hurricane zones or fire-prone areas.

Additional elements can further ratchet up anxiety during graduation season. New graduates may be transitioning from a structured setting and a schedule built around school for a dozen-plus years, including related feedback and support, said Sarah Allen, DClinPsy, a Chicago-area psychologist who specializes in anxiety. “Now you’re going out into a very unstructured world where you don’t get that feedback,” she said. “That loss of routine and loss of structure could make people feel more anxious.”

For the current crop of graduates, there may be a one-two punch that spurs anxiety, said Jack Nitschke, PhD. More traditional graduation-related angst may be amplified by economic and other employment-related uncertainties, said Nitschke, a clinical psychologist, neuroscientist, and an associate professor of psychology and psychiatry at the University of Wisconsin–Madison who has studied anxiety for 3 decades. Federal funding cuts, he pointed out, are limiting graduate school options. In addition, there are “potentially dramatic changes to what the workforce is going to look like,” he said.

Younger children “graduating” elementary or middle school are not immune to anticipatory anxiety. Signs may first emerge during preschool age and studies indicate that young students can worry about acceptance by their peers or concerns about a specific teacher (Patel, D. R., et al., Translational Pediatrics, Vol. 7, No. 1, 2018opens in new window). Another study, which looked at gender-related differences among children ages 8 to 18, found that the anxious girls reported more anticipatory anxiety and worry than anxious boys. But among anxious youth of either gender, both groups expressed similar avoidance tendencies (Smith, A. R., et al., JCPP Advances, Vol. 2, No. 3, 2022opens in new window).

Nitschke and others talk about the importance of intervening early to defuse the worry circuit that’s part of anticipatory anxiety to guard against individuals falling into a more deeply engrained anxiety rut. Those strategies can range from helping patients (for younger patients, their parents) to create more structure during life transitions, such as increasing sleep and exercise. In addition, patients can learn how to better ground themselves in the present, practicing mindfulness techniques and working through the what-ifs that an anxious brain can generate.

Individuals vulnerable to anticipatory anxiety may have an inflated sense of a particular threat’s cost and probability. They may exhibit hypervigilance, which has been tied to heightened activity in the amygdala, according to an overview that pairs clinical insights with imaging findings (Grupe, D. W., & Nitschke, J. B., Nature Reviews Neuroscience, Vol. 14, No. 7, 2013opens in new window).

In fact, imaging studies have shown that regions of the brain, including the amygdala and the hippocampus, are similarly activated regardless of whether the potentially bad outcome that’s being anticipated has occurred or not, said Nitschke. “You’re preparing in the event that something bad is either going to happen or potentially is going to happen, so the brain wants to get involved and ready for that,” he explained.

While preparing for potential outcomes is healthy, it’s a fine balance. With too many what-ifs and other anxious thoughts, the brain may construct a related circuitry of neural connections that feeds on and reinforces these thoughts over time, Nitschke said. In other words, the brain is creating patterns of thinking that don’t prepare someone to better face uncertainty but instead trap that individual in a loop of worry. “Somebody who is concerned about something bad happening in the future, which is what we refer to as worry, is building up neural connections that support this process of worrying and often will support even specific worries that they can get stuck on,” he said.

Still, there’s good news for those trying to combat their own innate brain circuitry, Nitschke said. He described the brain as remarkably neuroplastic. With time and effort, patients can create new pathways of thinking to tap into instead of their prior worry-prone ways (see sidebar).

Psychologist Martin N. Seif, PhD, describes anticipatory anxiety as the “third layer” of fear, with the key element involving avoidance patterns. For instance, individuals first recognize that they are fearful about flying when they dread boarding their next flight, said Seif, who developed the airport-based Freedom to Fly program. That anxiety may morph into the second layer, in which they become anxious that their fear of flying will lead to a panic attack and other embarrassing behavior while in the air. Eventually, they may reach the third layer of fear, the avoidance layer, and decide to forgo flying entirely to circumvent the severe anxiety and distress.

In the process, anticipatory anxiety can fuel unhealthy behaviors. Individuals may lean on alcohol to dampen the physical arousal and other uncomfortable symptoms, for example, before attending a social gathering, said Buckner, who authored a related study (Addictive Behaviors, Vol. 102, 2020opens in new window). (At this point, that’s a hypothesis, she noted, as the study didn’t delve into underlying motivations.) In the study, individuals with high levels of social anxiety reported more drinking prior to a social event than those with nonclinical levels.

In scenarios in which people can’t physically avoid the source of their anxiety, such as the impending first day of a new level of schooling, they may instead engage in cognitive avoidance, trying to distract themselves from their worries, said Seif, who coauthored the book Overcoming Anticipatory Anxietyopens in new window. But an excessive attempt to suppress related fears can boomerang on itself to create a worry loop.

One way for new graduates to counteract these emotions is to create an action plan by themselves or with a therapist, Allen said. Break the big picture down into smaller parts and related steps, she said. A high school graduate who is considering a legal career may start by speaking with a few attorneys to gain a better sense of what that career looks like day to day.

But first, individuals likely will need to sit for a while with their anxiety and ride it out until they are calm enough cognitively to develop such a plan, Seif said.

“Our job [as individuals] in some ways is to separate the wheat from the chaff, or the signal from the noise,” he said. Working with a therapist, patients can learn to better identify what thoughts are fueled by anxiety and where they can take action in their own lives, he said.

Therapists can assist patients in getting a better handle on what-if thoughts before those cognitive patterns spiral into a cycle of negativity, Allen said. For instance, a high school graduate may fret that they won’t be able to meet the rigors of college academics. In that situation, a therapist can encourage them to reflect upon successful study skills they have already developed that they could apply moving forward, she said.

“Focus on their history. What does history tell us about them?” Allen said. “And usually, it tells us that they’re resilient, that they have achieved some things. That’s not all going to disappear just because they go into a new situation.”

In other cases, a patient’s anticipatory anxiety may lead them to hold back because their intolerance of uncertainty is so high, such as stalling on applying for a coveted job, Buckner said. “If they apply for a job and they don’t get it, does that mean that they aren’t going to get any job and that there’s something wrong with them? That’s a very scary thought.”

Therapists can provide support through an exposure exercise, such as the mental and logistical process of applying for a job, Buckner said. Under the worst-case scenario, they don’t land the job. Then the patient and therapist can talk through what that means—that it’s one missed job and not a catastrophic individual failure.

“Again, with this anticipatory anxiety piece, oftentimes people are afraid of what’s going to happen,” Buckner said. “But if they actually do the thing, they realize they can handle it, if it does happen.”

Therapists also can lower the stakes involved for people who are going through these stressful life transitions, Allen said. She reminds new graduates that they can always change their minds, that they don’t have “to figure out the perfect job or the perfect degree: If you feel like this decision that you’re making right now, or are about to make, is going to be the rest of your life, everybody is going to become very anxious about that.”

To better reconnect with the external world, Allen recommends that anxious individuals leverage their five senses, naming items that they can see, feel, hear, smell, and tasteopens in new window. Grounding the body can dampen overactivation in the brain, including in the amygdala. Physical exertion plays a key role in settling anxious minds as well. Sarkis cited research showing that the more intense the exercise, the better to ease anxiety, though researchers noted that the dropout rates were higher in the high-intensity groups than in the low-intensity groups (Aylett, E., et al., BMC Health Services Research, Vol. 18, 2018opens in new window).

Engaging in a regular exercise regimen can inherently provide structure during an unsettled life transition, Allen said. Getting regular sleep also matters, though Allen acknowledged that some graduates may be stepping into careers with grueling hours. But even then, she said, it’s important “to figure out in your week where you can have downtime, where you can have control, that is important.”

Shortchanging hours of sleep has been associated with a higher tendency toward perseverative thinking, including worry and rumination, according to one study. The study involved 270 adults ages 65 to 89 who were asked each morning to rate their level of worry about things they had to do or that might happen that day. In essence, researchers were tracking their anticipatory anxiety, said Zexi Zhou, the study’s lead author and a doctoral student in human development and family sciences at The University of Texas at Austin (Journal of Psychosomatic Research, Vol. 179, 2024opens in new window).

When participants slept more hours than usual, the researchers found it “played a buffering role in the link between [the] prior night’s and [the] next morning’s worry.”

While anticipatory anxiety is a common experience during key life transitions, such as graduation, key strategies can help stem the uncertainty and perceived threats associated with these changes. By recognizing the signs and implementing increased structure, mindfulness, and physical activity, individuals can better manage their anxiety. Early intervention is crucial to prevent the development of deeply ingrained anxiety patterns, allowing new graduates to navigate their transitions with greater confidence and resilience.