Overcoming Anticipatory Anxiety (with Sally Winston) | Ep. 425
Anticipatory anxiety tricks your brain into believing the worst-case scenario is already happening, but in this episode, Dr. Sally Winston shares powerful mindset shifts to help you break free from the cycle of worry.
In this episode, you’ll learn:
- Why your brain reacts to imagined fears as if they’re real, and how to stop falling for the illusion
- The two types of avoidance that secretly fuel anxiety—without you even realizing it
- A simple mindset shift that can instantly take the pressure off anxious thoughts
- Why trying to “fix” anxiety only makes it stronger, and what to do instead
- How to take action while feeling anxious so fear no longer holds you back
Content
Understanding Anticipatory Anxiety: How to Break Free from the Fear of the Future
If you’ve ever woken up with a nagging feeling that something bad is about to happen—even when everything seems fine—you’re not alone. That uneasy feeling is called anticipatory anxiety, and it has a way of making even the most hopeful mornings feel heavy with worry.
In a recent episode ofYour Anxiety Toolkit, therapist Kimberley Quinlan sat down with Dr. Sally Winston, a leading expert on anxiety, to uncover why our minds jump ahead into the “what ifs” and how we can change our relationship with worry.
If you struggle with anxiety about the future, keep reading. This article will break down what anticipatory anxiety is, why it happens, and the powerful mindset shifts that can help you loosen its grip.
What Is Anticipatory Anxiety?
Anticipatory anxiety is the fear that something bad might happen. Unlike regular anxiety, which often occurs in response to a real situation, anticipatory anxiety is a future-focused fear. It can show up days, weeks, or even months before an event—fueling avoidance, overthinking, and emotional exhaustion.
Dr. Winston explains that this type of anxiety is a transdiagnostic phenomenon, meaning it appears across multiple conditions, including:
- Generalized anxiety disorder (GAD)
- Obsessive-compulsive disorder (OCD)
- Social anxiety disorder
- Trauma-related disorders
- Mood disorders
In other words, if you struggle with anxiety, you’ve likely experienced anticipatory anxiety at some point.
Why Does Anticipatory Anxiety Feel So Real?
Our brains are wired to keep us safe. But sometimes, they misinterpret imagined danger as real danger.
Dr. Winston breaks it down like this:
- When we encounter a possible threat (real or imagined), our senses send information to the brain’s thalamus—the relay station for sensory input.
- That information takes two pathways:
- Fast route: Straight to the amygdala (the brain’s alarm system), triggering the fight-or-flight response.
- Slow route: Through the frontal cortex, where logical thinking happens.
- The fast route reacts before we have time to process whether the threat is real. That’s why we might instinctively jump at a stick on the ground before realizing it’s not a snake.
- The problem? Anticipatory anxiety doesn’t need a real threat. Our own thoughts can trigger the same fight-or-flight reaction—just like a real emergency.
This explains why catastrophic thoughts (“What if I panic at the meeting?”) feel just as real as an actual crisis. Your brain is reacting as if the worst-case scenario is happening right now, even though it’s not.
How Your Relationship with Anxiety Makes It Worse
Dr. Winston shares that it’s not the anxious thought itself that causes problems—it’s how we interpret it.
If you view anticipatory anxiety as a warning or a prediction, you’ll fuel the cycle of fear. You may start thinking:
- “I feel anxious, so this must be a sign that something bad is going to happen.”
- “If I’m this nervous now, I won’t be able to handle the actual event.”
- “I should avoid this situation to prevent the worst.”
But here’s the truth: Anticipatory anxiety is just an illusion. It’s your brain running a mental horror movie—and you don’t have to believe everything it shows you.
The Two Types of Avoidance That Keep Anxiety Alive
Avoidance makes anxiety stronger. But avoidance isn’t always obvious. Dr. Winston describes two types of avoidance:
- Behavioral Avoidance – Avoiding places, people, or situations that might trigger anxiety.
- Example: Skipping a party because you’re afraid of feeling awkward.
- Experiential Avoidance – Mental strategies used to avoid feeling anxious.
- Example: Reassuring yourself over and over, ruminating, or distracting yourself to push away worries.
Even “helpful” coping strategies—like constant reassurance seeking—can actually reinforce anticipatory anxiety. Instead of breaking free from worry, you get stuck trying to fix or control it.
How to Shift Your Mindset and Reduce Anticipatory Anxiety
The solution isn’t getting rid of anticipatory anxiety. The real goal is changing your response to it.
Step 1: Recognize What’s Happening
When you catch yourself spiraling into “what ifs,” pause and acknowledge:
“This isn’t a prediction. It’s just anticipatory anxiety.”
This simple awareness can help you disengage from anxious thoughts before they snowball.
Step 2: Shift from What If to What Is
Anxiety lives in the future. You can bring yourself back to the present by asking:
“What is happening right now?”
Maybe you’re sitting in your kitchen, sipping coffee. Maybe you’re walking your dog. Your thoughts might be in next week’s big meeting, but your reality is right here.
Step 3: Stop Trying to “Fix” Anxiety
Many people make the mistake of treating anxiety as a problem to be solved. They overanalyze, self-reassure, or use distractions to make it go away.
But here’s the paradox: Trying to get rid of anxiety actually keeps it alive.
Dr. Winston shares a powerful shift:
- Instead of battling anxiety, allow it to exist.
- Instead of distracting yourself, shift your attention mindfully.
- Instead of fearing fear, change how you relate to it.
Step 4: Withdraw Energy from the Worry
Anticipatory anxiety is like a fire—it needs fuel to keep burning.
- Planning excessively? Stop.
- Reassuring yourself constantly? Let go of the need to be 100% certain.
- Mentally rehearsing worst-case scenarios? Acknowledge the thought and move on.
By not engaging with anxious thoughts, they lose their power.
Step 5: Take Action While Feeling Anxious
The biggest myth about anxiety is that you have to feel calm before doing something.
Not true. Anxiety doesn’t need to go away first.
- Go to the event while feeling nervous.
- Speak up in the meeting while your heart races.
- Drive while having anxious thoughts.
Action teaches your brain: I can handle this, even if I feel anxious.
The Biggest Takeaway: Anxiety Becomes Powerless When You Stop Fighting It
Dr. Winston reminds us that real recovery isn’t when anxiety disappears—it’s when it no longer controls you.
As the great Dr. Claire Weekes said:
“Recovery is not when symptoms no longer occur. It’s when they no longer matter.”
So the next time anticipatory anxiety shows up, remember:
- It’s just an illusion.
- You don’t have to engage with it.
- You can do the hard thing, even with anxiety present.
And with time, the fear of the future will loosen its grip—one small step at a time.
Transcription: Overcoming Anticipatory Anxiety (with Sally Winston)
Kimberley Quinlan:
If you have any type of anxiety, you are probably very familiar with waking up with a nagging sense that something big is about to go wrong, even when everything seems fine. That’s the grip of anticipatory anxiety, turning a hopeful morning into a cascade of what ifs.
Welcome to Your Anxiety Toolkit. Today, we’re peeling back the layers on anticipatory anxiety with our special guest, Dr. Sally Winston, a trailblazer in anxiety research and treatment.
Known for her accessible, jargon-free teaching style that blends current scientific evidence with a deep sense of compassion, she’s here to help us decode why our minds sometimes jump ahead into the story of worry.
In this episode, we’ll cover all the hidden gems and the mechanisms behind anticipatory anxiety and arm you with practical, evidence-based strategies to regain control. Whether you’re facing these preemptive fears yourself or supporting someone who is, get ready. This is going to be an enlightening and empowering conversation. So thank you, Sally, for being here.
Sally Winston:
Well, I’m very glad to be here. That was an amazing introduction. I hope I can live up to it.
Kimberley Quinlan:
I’m sure you will. So here is what we’re talking about today. As you can see, when I really love a book, I really tab it up and get it all highlighted and everything. So thank you for writing this. I know you co-wrote it with Dr. Steve.
Sally Winston:
We do all our writing together, so it’s two minds rather than one in the book.
Kimberley Quinlan:
It’s amazing. So let’s get straight to it. What is anticipatory anxiety?
Sally Winston:
Well, anticipatory anxiety is actually a transdiagnostic phenomenon. It happens in anxiety disorders, OCD, mood disorders, trauma disorders. It’s a kind of anxiety that drives avoidance behavior. It’s the anxiety that occurs ahead of time when you are thinking about or anticipating facing a challenge, a decision, or something coming up that has caused you trouble in one way or another in the past. It is the anxiety that happens before the event.
Kimberley Quinlan:
Hmm, hmm! It really is a different way of framing anxiety because more often than not, anxiety is about something that hasn’t happened yet.
And you talk in the book about the brain and what’s going on in the brain step by step. Would you be able to share what is actually happening in the brain when someone is experiencing anxiety and anticipatory anxiety?
Sally Winston:
I’ll do my best in ordinary language. I’m not sure that I understand it in more than ordinary language myself.
We have the alarm center of the brain, which is the amygdala and the limbic system that is run by it. We also have the incoming way station, called the thalamus, where the information from our senses comes in.
What happens when you see something that is potentially dangerous or distressing is that the information comes in through your senses and goes to your thalamus. Then, the thalamus has two routes. One is a fast, direct route straight from the thalamus to the amygdala, which is your fight-or-flight response—your alarm. But there’s another route that is actually a little bit slower. This one goes through the cortex, where we do our thinking in the frontal lobe, and then that information is sent to the amygdala.
The route straight to the alarm is faster than the route that goes through our thinking. The example that is always given is that you’re walking along a path, and you see a long, thin thing, and you jump back. Then, you realize, “Oh, it’s just a stick, not a snake.”
One of the things that happens with our alarm system is that the more sensitized we are and the more anxious we are, the more likely it is that the alarm system through the cortex—the slower one—becomes more active. And something that can set off the alarm from the cortex to the alarm system doesn’t have to come through the thalamus. It doesn’t have to come through our senses. It can just come through our imagination.
So our thoughts can set off the alarm—the exact same alarm as an actual tiger running after you or a truck about to smash into you. Your own thoughts can give you exactly the same feeling. Anticipatory anxiety is the anxiety that happens when you’re not actually in danger at all. There’s no sensory information coming in that says you’re in danger. It’s just your own thoughts, and it can set off something that feels exactly the same.
Kimberley Quinlan:
And that’s where it’s so interesting. I love that you explained that because I think so many people can understand that our brains can almost project up onto the screen of our mind the worst-case scenario—the catastrophe.
And it can feel like it’s actually really happening, like we’re in that danger in that moment.
Sally Winston:
Right. It feels the same. It’s the same experience. When we go deliberately to a horror movie in order to experience fear while having one foot in the theater—where we know that it’s not actually dangerous—and yet our heart’s pounding, and we’re breathing fast, and we’re trying not to look. We’re having the same alarm system experience, except a part of us knows that it’s not real. That’s the deliberate use of our imagination for fear and fun.
The context is that we asked for it.
Kimberley Quinlan:
Yeah. So why does our brain do this? Why do some of us have this, and some of us don’t?
Sally Winston:
Well, everybody has the capacity for anticipatory anxiety. It’s not something that is unique to people with anxiety disorders by any means.
People get caught up in anticipatory anxiety if they overinterpret its meaning. If you have a spout of doubt or a what if or a worry about something that’s coming up, it’s how you relate to that that makes the big difference. It is your relationship with that experience.
If you go, “Oh, well, of course, I’m a little anxious,” and you don’t care about it, you don’t interpret anticipatory anxiety as a warning or a signal or a prediction. You know it doesn’t tell you how it’s really going to go. It’s your imagination; it’s not facts; it’s not reading the future.
But if you interpret it as, “Oh, you better not,” or “What if this is real?” or “Maybe if you feel this bad three months ahead of time, it’ll be even worse the closer you get to it, and it’s not worth it,” whatever it is, it’s your interpretation and reaction to anticipatory anxiety that turns it into a problem.
Kimberley Quinlan:
Yeah, and you talk about anticipatory anxiety as the fear of fear.
Can you share a little more about that? So let’s say I have social anxiety, and the fear is that I’ll be judged. Where would anticipatory anxiety be in that sequence?
Sally Winston:
Okay. So let’s say you say, “I’m scared to go to this party.” That’s the first level.
The second level is, “What if I go to the party, and I try to talk to someone, and I start blushing and stammering and fumbling? What if I give myself a panic attack and humiliate myself? And then I can’t stand it, and I won’t be able to go to any parties after that because of how terrible it is.” That’s the second level of fear.
The third level of fear is, “Oh my God! I’m thinking about all that stuff. It feels really terrible even right now while I’m thinking about it, and that party isn’t even until next week. I wonder if I should come up with a migraine so that I can avoid it.”
Kimberley Quinlan:
Yes!
And I love that you broke that down because sometimes we just make a blanket statement—it’s all fear. But that deeper understanding—for my clients and for myself—knowing those layers of fear really helps me feel like I’m getting a grasp on it. Then I can kind of disentangle from it a little easier.
Sally Winston:
I love that you’re using the word disentangle because that’s one of the attitude shifts that our work really emphasizes.
Anticipatory anxiety is basically an illusion that we get entangled with, right? It’s stuff in our heads—it’s not actually happening. Yet, we treat it as if it’s real, and we get absorbed in it. We think about it, we react to it, and we make a big thing out of it when it’s really an illusion.
So I’m glad you used that word.
Kimberley Quinlan:
Yeah, no, it was so cool to read. I’ve read some of your other books—which we can talk about later if you’d like—but this one was so cool because it reflects so much of the language I already use.
You brought up something that I thought was really interesting—you talk about different types of avoidance.
Could you share? You mention two specific types, and I thought that was an interesting way of conceptualizing avoidance that I hadn’t heard before.
Sally Winston:
I think you’re referring to behavioral avoidance and experiential avoidance, right?
Behavioral avoidance is the stuff you do or don’t do in the real world.
Experiential avoidance is the things you do in your mind to keep yourself from having the experience of anxiety. They’re both avoidance, but they operate differently.
It’s one thing to decide not to go somewhere because you think you’re going to get anxious—that’s behavioral avoidance.
But experiential avoidance is much more subtle. It’s the things we do mentally to avoid anxiety.
For example, let’s say you’re driving and anxious about hitting someone. You spend the entire time talking nonstop to your passenger to distract yourself from the thought: What if I hit someone?
Or maybe you listen to a podcast and try to block out your intrusive thoughts. Or, if there’s a party next week, you pick a fight with the person you were going to go with, so you have a reason not to go.
Even things that seem like coping strategies—like reassuring yourself over and over—can actually be a form of experiential avoidance.
Kimberley Quinlan:
Yes, you wrote: Substituting thinking for feeling is a form of avoidance.
And I highlighted that and thought, Wow, that’s so true! Because sometimes we ruminate as a form of avoidance. Would you agree?
Sally Winston:
Absolutely.
Rumination feels like problem-solving. It bears the illusion that if you just think about it enough, you’ll come up with a solution. Or you’ll figure out why you feel this way. Or you’ll analyze yourself into a better spot.
But really, all it does is make you miserable.
Kimberley Quinlan:
Yes! And is that also true of hypervigilance? Would you consider that a form of experiential avoidance?
Sally Winston:
Hypervigilance can be many things. It’s also a transdiagnostic concept, meaning it shows up across different disorders.
For example, if someone has a traumatic experience, their system might become hypervigilant—they’re sensitized to anything that reminds them of the trauma. That’s not necessarily avoidance; it’s a nervous system response.
But hypervigilance can also be fueled by anticipatory anxiety. If someone is constantly scanning their environment for possible dangers, that can become a form of avoidance—trying to preemptively protect oneself from something imagined.
Kimberley Quinlan:
That’s so helpful.
Before we get into strategies and tools, I wanted to ask you about biological factors. You mention in your book that some people have a predisposition toward anticipatory anxiety due to anxiety sensitivity.
Can you explain what that is and how it relates to this topic?
Sally Winston:
Anxiety sensitivity is actually a trait. It runs in families. It’s partly inherited and partly learned.
It refers to how afraid someone is of the experience of arousal—either physically or mentally.
For example, someone with high anxiety sensitivity might feel their heart racing and immediately think, Oh no, what’s happening?—which can trigger a panic attack.
I once had a client who loved watching football, but he had a big bet riding on a game. When his team was about to win, his heart started racing from excitement. But instead of recognizing it as excitement, he panicked about his heartbeat and had a full-blown panic attack.
That’s anxiety sensitivity in action—it’s the fear of the sensations that come with anxiety.
Kimberley Quinlan:
Would you say most people with an anxiety disorder have anxiety sensitivity?
Sally Winston:
Yes, but there’s a full range of it.
People with panic disorder tend to have the highest anxiety sensitivity. People with OCD, on the other hand, may be less concerned about bodily sensations and more focused on intrusive thoughts.
It really depends on the person and the disorder.
Kimberley Quinlan:
That’s fascinating. Let’s talk about strategies.
If someone struggles with anticipatory anxiety, are they doomed forever, or are there solutions?
Sally Winston:
Definitely not doomed! But here’s where our approach is different from traditional CBT.
We’re actually opposed to techniques.
What we teach isn’t about doing something to make anxiety go away—it’s about shifting your attitude and relationship with anxiety.
A lot of people spend years trying every coping tool—breathing exercises, self-reassurance, distraction—but none of them seem to work long-term. That’s because they’re still treating anxiety as something that must be fixed or eliminated.
Instead, what really helps is shifting into metacognitive awareness—learning to observe your thoughts without engaging with them.
Kimberley Quinlan:
Yes! So it’s not about getting rid of anticipatory anxiety but about learning to not react to it?
Sally Winston:
Exactly. The moment you stop struggling with it, it loses its power.
Kimberley Quinlan:
Yes! So it’s not about getting rid of anticipatory anxiety but about learning to not react to it?
Sally Winston:
Exactly. The moment you stop struggling with it, it loses its power.
A big part of this is learning how to shift your attention without avoidance. People often confuse attention-shifting with distraction, but they’re not the same thing.
Let me give an example.
Imagine you’re driving, and you have the thought: What if I lose control of the wheel and drive into traffic? That thought makes you anxious, so you grip the wheel tightly and try to control your thoughts, but that just makes you more anxious.
So instead, you decide to turn on the radio.
There are two ways you can do this.
One way is distraction: Maybe if I turn on the radio, I can block out my scary thoughts. But if the thoughts don’t go away, you end up frustrated, and it turns into a battle.
The other way is mindful attention-shifting: Well, my mind is handing me a bunch of nonsense right now. I might as well listen to music while that happens.
See the difference? The second approach isn’t trying to get rid of the thoughts. It’s allowing them to be there while also focusing on something else.
Kimberley Quinlan:
Yes! The key word you’re using is while.
It’s not instead of anxiety—it’s while feeling anxious, I’m going to do X.
Sally Winston:
Exactly. And that’s the attitudinal shift that makes all the difference.
Kimberley Quinlan:
Is there ever a place in your approach for the bring it on strategy?
Or is it more of a mindfulness-based, observing approach?
Sally Winston:
That’s a great question! There’s room for both.
Sometimes, the best approach is willingness—saying, Okay, I’m anxious, but I’m going to do the thing anyway. That’s the bring it on attitude.
But other times, people are so caught up in anticipatory anxiety that their biggest struggle is with the buildup, not the event itself.
For those people, the focus needs to be on withdrawing energy from the worry. The key is recognizing: This is just my imagination running wild. It’s not a prediction. It’s not telling me anything real.
So, both approaches can work. It depends on what’s most helpful for the person in that moment.
Kimberley Quinlan:
I love that.
Let’s say someone has anticipatory anxiety about an event next Tuesday, and today is Monday.
What should they do today? How would they apply these mindset shifts in real-time?
Sally Winston:
Great question.
Step one is identifying what’s happening: Right now, I am lost in my imagination, treating my thoughts as predictions.
Step two is recognizing: This isn’t real. It’s just anticipatory anxiety.
Step three is shifting from what if to what is.
What is happening right now? You’re sitting at the table, eating lunch. Nothing bad is happening. Your brain is in the future, but you are in the present.
Step four is withdrawing energy from the worry.
Stop planning, analyzing, problem-solving, or trying to “fix” your thoughts. That’s what keeps anticipatory anxiety going. Instead, bring your attention back to the present—your sensory experience, what’s in front of you.
Step five is allowing the feelings to exist while moving forward.
Your goal isn’t to get rid of the anxiety. Your goal is to let it be there without engaging with it.
And over time, that makes all the difference.
Kimberley Quinlan:
That’s such a powerful shift. But what if someone has depression alongside anticipatory anxiety?
What if their brain is telling them, This is going to go badly, just like last time. You’re going to fail, so why bother?
Would you apply the same strategies?
Sally Winston:
That’s an important distinction.
If someone has clinical depression, meaning they have neurotransmitter imbalances and can’t feel pleasure, that’s different. That needs active treatment—whether it’s therapy, medication, exercise, or all of the above.
But if someone is experiencing demoralization—which is common with anxiety—that’s different.
Demoralization is when anxiety makes you feel hopeless, even though the situation isn’t actually hopeless.
The key is recognizing: A hopeless feeling is not the same as a hopeless situation.
Your feelings of dread don’t mean anything about the future. They’re just a symptom of anxiety.
Kimberley Quinlan:
Yes! And that’s such a hard skill—being able to step back and see, Oh, this is just my brain creating a story.
Sally Winston:
Yes! A lot of people don’t recognize their own contribution to their anxiety.
For example, people will say, The grocery store makes me anxious.
But my response is, How does it do that?
Because the grocery store isn’t doing anything. It’s the thoughts you’re having in the grocery store that are making you anxious.
Once you realize that, you can begin to change your relationship with your anxiety.
Kimberley Quinlan:
That’s so important.
I know we’re running out of time, but I want to ask: If someone is struggling with anticipatory anxiety, what’s the most important takeaway?
Sally Winston:
The biggest thing I see people struggle with is paradoxical effort.
That’s when someone is trying so hard to do everything right—exposures, coping strategies, reassurance-seeking—but they still feel stuck.
Why?
Because their efforts are actually keeping anxiety alive.
When you’re trying to “fix” anxiety, you’re still treating it as the enemy. And that resistance makes it stronger.
The real key is shifting from struggle to allowance.
Instead of trying to get rid of symptoms, you learn to stop caring about them.
Claire Weekes, who was one of my biggest influences, put it best:
“Recovery is not when symptoms no longer occur. It’s when they no longer matter.”
That’s what real progress looks like. It’s when anxiety might still show up, but you don’t react to it anymore.
Kimberley Quinlan:
That’s beautiful.
I cannot thank you enough for sharing all of this. Where can people find more of your work?
Sally Winston:
There are four books I co-wrote with Marty Seif:
- Overcoming Unwanted Intrusive Thoughts (about OCD and intrusive thinking)
- Needing to Know for Sure (about compulsive reassurance and checking)
- Overcoming Anticipatory Anxiety (about worry, catastrophizing, and indecisiveness)
- What Every Therapist Needs to Know About Anxiety Disorders (a clinical guide)
All of these books are available on Amazon in print, Kindle, and audiobook formats.
If you Google my name or Marty’s, you’ll also find webinars, interviews, and more resources.
Kimberley Quinlan:
Amazing! I highly recommend your books—I’ve read them all, and they’re fantastic.
Thank you again, Sally. This has been so insightful.
