The surrogacy journey is best compared to a marathon, not a sprint. Along this path, there are inspiring moments—like connecting with other intended parents nearing their due dates—and challenging detours, such as a cancelled IVF cycle or unexpected medical delays. These twists and turns can stir up anxiety, an entirely normal human response. But when left unaddressed, anxiety can interfere with what matters most: continuing to take the next important steps toward building your family.
In this blog, we’ll explore how anxiety may show up during the surrogacy process and introduce tools from Acceptance and Commitment Therapy (ACT) that can help you stay grounded, even when uncertainty looms large. Our goal is to support you in continuing forward—mindfully and meaningfully—so anxiety doesn’t derail your surrogacy experience.
Surrogacy involves many unknowns—timelines, test results, embryo transfers, and more. These unknowns can naturally trigger anxious thoughts:
“What if my surrogate’s uterine lining doesn’t respond to medication?”
“What if another delay sets us back again?”
Traditional Cognitive Behavioral Therapy (CBT) suggests reframing these thoughts by challenging them with logic: “My doctor is an expert; many transfers succeed every year.” This can be helpful, but surrogacy’s inherent uncertainty can leave many anxious feelings unresolved—even after rational reassurance.
That’s where ACT comes in. Rather than trying to eliminate or suppress anxiety, ACT encourages acceptance of our emotional experiences while still taking values-driven action.
Acceptance and Commitment Therapy views anxiety as part of the human experience. It only becomes problematic when we struggle against it. So how can one live a meaningful, value driven life, even when experiencing anxiety? Let’s explore what anxiety looks like from an ACT perspective:
To return to our metaphor, how do you keep running that marathon, even when you are filled with anxiety and worried about what’s around the next bend? Each of these can show up at different points in the surrogacy journey, but there are tools to help you recognize and respond to them with compassion.
When anxiety strikes, many people instinctively try to escape it—by staying busy, overeating, binge-watching shows, or overexerting themselves so much that they pass out each night. This also could mean avoiding anything that causes pain and anxiety like not going to a baby shower, even though it is a best friend. But this avoidance can distance you from the very experiences and people that matter to you.
The antidote to experiential avoidance is acceptance, especially acceptance of sensations and feelings in your body. The goal is to become an observer or watcher of your emotions. Mindful awareness of where the sensations are in your body is a way to start this.
Breathe into that space without trying to change or judge it.
Observe it like a curious scientist: “What does this sensation feel like? Is it tightness in the chest? Butterflies in the stomach?”
If you want to try some work at home, this workbook under “Tolerating Distress” walks you through this method. Working with a therapist trained in ACT can help you further develop these skills.
If you notice yourself spiraling on a thought process that isn’t productive, then some cognitive defusion techniques may be helpful. One technique is to work on labeling your thoughts. If you can, give them nicknames. Try this:
When you notice a recurring worry, give it a silly name: “There’s that ‘Worry Hamster on the Pregnancy Wheel’ again.”
Add the phrase: “I notice I’m having the thought that…” before the worry.
Example: “I notice I’m having the thought that this cycle might fail.”
Repeating this for a minute or two can create distance between you and your thoughts, helping you shift into an observer mindset.
The reality is, anxiety may never fully leave the surrogacy journey. But it doesn’t have to control your direction. With tools like mindful acceptance and cognitive defusion, you can keep moving forward—signing the contract, following up on test results, or reaching out to your surrogate—even when your mind is flooded with worry.
In an upcoming blog, we’ll introduce more techniques to help you manage anxiety from an ACT perspective, including how to reconnect with your personal values and stay present when things feel overwhelming.
You’re not alone. Many intended parents feel this way. Consider reaching out to a mental health provider trained in ACT or exploring support groups where you can talk openly with others who understand. Finally, check out these additional resources:
Disclaimer: This blog is for informational and educational purposes only and does not constitute psychological advice or therapy. Reading this blog does not establish a therapist-client relationship with the author, who is a licensed psychologist. If you are experiencing distress or seeking mental health support, please contact a qualified mental health professional in your area.
Dr. Diederich at Sweet Springs Consultation and Assessment, can help you navigate through the steps of third-party production. She conducts evaluations of gestational carriers, provides consultations for intended parents, facilitates joint meetings, and runs monthly support groups for parents. Whether you are in Pennsylvania, New York, Hawaii or in one of the other PsyPact states that Dr. Diederich can practice in virtually, she can help you along your journey.
