I know that reading or thinking about anxiety can sometimes be difficult, but knowing what anxiety is and how it works is the first step to overcoming it, so keep reading!
WHAT DOES ANXIETY LOOK LIKE?
Anxiety comes in many shapes and sizes. While it can look different for different people, it also has a lot of common symptoms, many I’m sure you’ll recognize. Above all, the most complicated aspect of anxiety is that it can manifest in very real physical symptoms. These symptoms, ranging from heart palpitations to nausea, can deceive you into thinking there is something physically wrong with you, when really there is a deeper, underlying, psychological issue that must be addressed in order to alleviate the physical symptoms.
SYMPTOMS OF ANXIETY AND PANIC ATTACKS
Irregular heartbeat
Dizziness and lightheadedness
Shortness of breath
Choking sensations and nausea
Shaking and sweating
Fatigue and weakness
Chest pain and heartburn
Muscle spasms
Hot flashes or sudden chills
Tingling sensations in your extremities
A fear that you’re going crazy
A fear that you might die or be seriously ill
A colleague of mine, Dr. Philip Pierce, who specializes in cognitive behavioral treatment of anxiety, laughed when I asked him how many of his patients go to the hospital when having a panic attack. “My idea for cutting medical costs is to have a special person at the ER just to deal with panic attacks and save the money spent on doctors and the tests,” Dr. Pierce told me. “I’d say 30 to 40 percent of my patients are calling 911 or going to the ER the first time they have a panic attack.” Dr. Pierce explained:
People have the idea that panic attacks come out of nowhere, but they don’t. Although some people actually wake up with a panic attack, what’s usually happened is that the mind is not completely sleeping when you are. It could have been a dream; it could have been a muscle tightening while you’re sleeping, and the mind notices. The body gets the message that something is wrong, and it builds up to a panic attack.
There’s usually something going on. Usually that day there is some precipitating incident. The most important thing is normalizing it. There’s nothing wrong. You can function during a panic attack. Someone will have a panic attack—they’ll be at dinner and they’ll get up, wind their way through the dining room. They’re fully functioning. So I would say, it’s a good, healthy reaction.
Dr. Pierce reassured me that it is possible to eliminate panic attacks, and we’ll explore more of his cognitive behavioral therapy (CBT) methods in Chapter 8 of this book. “I would say in five to ten CBT visits, 70 percent of panic attacks cease. But rather than panic attacks being seen as something terrifying and scary, I like to normalize them and say, ‘So what if you get an occasional panic attack? It’s not doing you any harm. Your body is testing itself.’ Oftentimes, the same sensations of something like dizziness are misinterpreted. People pay to go on theme park rides so they can feel dizzy. It’s just the unexpected nature of it when you’re having a panic attack.”
After we go through a major loss in life, we tend to become hypervigilant to bodily sensations such as these. Whereas before the loss we may not have noticed these same bodily sensations, now that we have experienced the death of a loved one, we are preoccupied with the thought that something similar could happen to us, so when we feel the sensations of worry in our body, our fear response increases.
At its most basic, anxiety is the sense of fear. These fears can be real or imagined. Your fears can be about something in the past, the present, or the future.
In grief we experience fear for many reasons. We can feel afraid of how the future has changed now that an important person in our lives is gone. We can feel afraid of more loss, worrying that we might lose more loved ones. We can worry about our health, concerned that we may get sick or die soon, too. Some people also have residual feelings of trauma as a result of witnessing or hearing details of the death itself.
While many people experience anxiety for a variety of reasons—divorce, moving, illness, a genetic predisposition—the kind of anxiety that is brought on as result of losing someone close to you is its own breed. While grief anxiety maintains many of the same characteristics as generalized anxiety, there is an underlying situational cause. So when we can allow ourselves to grieve and truly explore the impact of the loss, we are better able to ease and manage the anxiety that accompanies it.
The following questions will help determine whether you are suffering from generalized anxiety or anxiety brought on by grief.
ASSESSING YOUR GRIEF-RELATED ANXIETY
A. A RE YOU TROUBLED BY THE FOLLOWING?
Repeated, unexpected attacks during which you are suddenly overcome by intense feelings of panic or fear for no apparent reason or the fear of having another panic attack YES NO
Persistent, inappropriate thoughts, impulses, or images that you can’t get out of your mind (such as a preoccupation with death, illness, or safety) YES NO
Fear and anxiety surrounding social situations YES NO
Excessive worrying about upcoming events or activities YES NO
Shortness of breath or a racing heart for no apparent reason YES NO
Persistent and irrational fear of a situation such as flying, heights, driving cars, and so forth YES NO
Inability to travel alone YES NO
Replaying a traumatic experience such as receiving bad news or witnessing someone die or become ill YES NO
B. M ORE DAYS THAN NOT DO YOU EXPERIENCE THE FOLLOWING?
Feeling restless and jittery YES NO
Feeling exhausted and drained of energy YES NO
Feeling easily distracted YES NO
Feeling irritable or angry for no reason YES NO
Feeling tenseness in the limbs YES NO
A pounding heart YES NO
A dry mouth and throat YES NO
Shortness of breath YES NO
Nausea YES NO
Problems sleeping YES NO
C. H AVE YOU EXPERIENCED THE FOLLOWING SINCE LOSING A LOVED ONE?
An increase in worry YES NO
A preoccupation with death and dying YES NO
Fear of your own health or the health of other loved ones YES NO
Panic attacks YES NO
An increase in depression or sadness YES NO
An increase in anger YES NO
A preoccupation with feelings of guilt or regret YES NO
A SSESSING
The more times you answered yes on the “Grief-Related Anxiety” quiz, the more likely it is you may suffer from an anxiety disorder.
Sections A and B of the quiz are designed to indicate symptoms of an anxiety disorder, while Section C screens for grief being the complicating or inciting factor of the disorder.
While anxiety disorders are incredibly common, working to determine what the contributing factors of your anxiety are is key to understanding and diminishing the symptoms.
If you answered mostly yes in Section C, you are likely experiencing grief anxiety. This means that the anxiety you are experiencing is directly related to your loss, even if your loss was years ago. This book is designed to help you understand, treat, and overcome these symptoms.
If you answered mostly no in Section C, you may have a preexisting anxiety disorder that has been amplified by the loss of a loved one. This book will be helpful in processing your grief and alleviating the accompanying anxiety, but you may have additional work to do beyond that in order to fully heal from your disorder.
NORMALIZING ANXIETY AND PANIC ATTACKS
The first thing I tell my clients is also the first thing you should know: the anxiety you are experiencing is normal. As we’ve learned, our bodies have a physiological response to thoughts and emotions. Think about how when you feel sad tears come out of your eyes. I mean, really think about that for a moment. You think of a sad memory or a perso
n you miss, and your whole body reacts to that thought, to the point of releasing liquid from your eyes.
Now ask yourself, why shouldn’t your body also react when you are feeling scared? Losing someone we love is incredibly scary. We spend much of our lives acting as though we are going to live until old age. We plan for the future, make present-day sacrifices for later investments, spend inordinate amounts of money and time trying to retain our youthfulness, and then suddenly lose someone we love and are reminded, quite starkly, that life can and does end.
This can be a frightening realization, making us feel vulnerable and worried. We suddenly see our lives with new eyes. We are reminded of not only how precious our time is but also how little control we have over that time. It’s only natural that these realizations can make us feel anxious and fearful.
In addition to this, we are often alone in dealing with these new thoughts and feelings. When we lose someone we love, we are thrust into our own world of pain and grief, while the rest of the world carries on around us as though nothing has happened, when in fact, for us, our whole lives have been turned upside down. It can be a very isolating experience.
There is an enormous amount of processing that the brain must do following a loss. First, there are all the emotions that come with it—sadness, anger, regret—but then there is also a certain amount of logistical adjustment that must come. We are forced to rearrange our lives to accommodate for the absence of this person. Sometimes that means a change of home or job or a family role—all stress-provoking adjustments. It’s never any wonder that clients often come to me with their newfound anxiety during the six- to eighteen-month period following a loss.
It is during this time that they have begun to fully comprehend the enormity of the loss. In the very beginning, people most often are simply coping with the shock that their loved one is really gone. Even those who have lost a loved one to a long-drawn-out illness—in essence, those who were expecting the death—still experience a certain amount of shock that the person is actually gone.
After the shock wears off, then come waves of sadness, rushes of memories that sometimes bring on guilt or regret, and also all the logistical life changes. The stressful buildup of all of these components is so much more than most people anticipate when they think about what grief will be like. In fact, so many people put pressure on themselves to move quickly through the grief that they end up suppressing most of the major emotions described here.
It is this suppressing of emotions and stress that can make it feel like the panic and anxiety have seemingly come out of nowhere. Like the story I told you about my first panic attack in the introduction, I was simply riding in a car, staring out the window, when I was hit with an anxiety attack. It felt as though it came out of nowhere. It was only many years later that I was able to see that the stress leading up to that attack had been building for quite some time, but I had been trying to ignore it or push it away.
This is a common occurrence. The majority of my clients claim that their anxiety came on without warning, but upon further probing it always becomes obvious that there was a significant event (the loss), followed by the buildup of emotion.
The tricky thing about anxiety, though, is that it disguises itself within such very real symptoms that the majority of people experiencing a panic attack for the first time mistakenly think they are having an actual heart attack, as happened with me and also with many of my clients. I find it very useful to understand the physiology of a panic attack. Knowing how your body reacts to stress will help you to cope with, and eventually overcome, these attacks.
When I first began to learn about anxiety, I found it helpful to speak with medical doctors. I found it comforting to have them explain to me how the body works and to assure me that I was not going to die from the symptoms I was experiencing. In order for you to feel that same comfort, I interviewed CNN’s chief medical correspondent, Dr. Sanjay Gupta.
I first met Dr. Gupta working on an end-of-life project in 2016 and have enjoyed many insightful conversations with him about death and dying. He is a kind and compassionate physician who genuinely seeks to make people feel more comfortable grappling with issues of mortality. He shared with me several key pieces of information that will help you make sense of your anxiety.
DR. SANJAY GUPTA ON THE PHYSIOLOGY OF ANXIETY
When I spoke with Dr. Gupta, the first thing I sought was his advice on what to do when a panic attack comes on. “First,” he told me, “realize that panic attacks are not as uncommon as people think they are. Know that before you can gain control over the panic, you have to believe you can gain control. There’s an initial feeling of helplessness. But you have to realize that the attack is not out of the blue. You have to realize that there’s something that triggered it.”
This goes back to what I explained earlier about there being potentially unconscious or suppressed thoughts that can trigger a bodily reaction. When we experience a feeling of panic that seems to come out of nowhere, it can be very frightening.
Dr. Gupta urges us to step outside of that initial response and remind ourselves of what is actually happening. “You need to understand that you’re not dying. If the mind interprets the body as unsafe, the anxiety will increase. The trick is to not perceive it as an unsafe episode. Your body is not great at knowing the difference between the present and past, so if you start to mentally go to a place of fear, then your body responds. If you mentally go to the past, your body may respond as if the event is taking place right now. So the key is to get grounded and remind yourself of the here and now.”
Some easy ways to get grounded are to stop what you are doing and take a walk around. Or if you were already moving, find a quiet place to sit still and take some calming breaths. It also helps to voice your feelings to someone by phone or in person. Getting out of your head and grounded in the moment will send a clear message to the body that there is no threat at hand. I even have one acquaintance who sings loudly, citing that it’s a surefire way to lessen her panic attacks.
Dr. Gupta likened this process to giving bad news in medical school. “If the person receiving the news visualizes that they cannot cope, then they will respond as if they cannot cope. But by empowering them with a plan of how they are going to cope, and giving them hope, it changes the way they respond.”
This means that when you are having a panic attack, it’s important not to feed into the fear. In essence, if you tell yourself you can get through it, your body will respond in kind.
Dr. Gupta reminds us that changing our images, thoughts, predictions, and plans creates a physiological response. “During a panic attack, people start to hyperventilate. They’re blowing off carbon dioxide. It becomes uncomfortable, and it can make the symptoms worse. So focusing on calm breathing really helps. It physiologically makes sense: you can change your dioxide levels. You can develop a clearer mind in terms of what’s happening.”
Most people feel that panic attacks come out of nowhere, and sometimes it can be difficult to understand what triggered the attack. But Dr. Gupta reminds us that “if we break down the physiology of a panic attack, it becomes clear why our bodies are having such very real physical symptoms. In some ways, the body and brain are in constant survival mode. The brain is constantly releasing sympathetic signals that fire up bodily systems and then parasympathetic signals that tone those same systems down. Because of this, we have the ability to react quickly to any given situation. The body is always accelerating and always slowing down.”
Before you were intimately familiar with grief-related anxiety, you probably never even registered this kind of constant accelerating and slowing down occurring in your body. In fact, most people take for granted all the ways their bodies are constantly adjusting themselves. But when you develop anxiety, you can often become hyperattuned to all the little changes your body goes through on an hourly basis.
Dr. Gupta explains, “The physiology of a panic attack always begins with the sympathetic discharge i
n response to something. But what’s really interesting is that you can have that sympathetic discharge far earlier than you’re consciously aware of. Your body can actually start to change in anticipation, in ways you are not consciously aware of and in ways you may not become aware of for hours.”
This means that a person could have a thought or emotion in the morning that could then lead to a panic attack in the afternoon. And this is exactly how people end up overlooking their grief and thinking there is something physically wrong with them instead.
“For the person experiencing the attack, it will seem highly unexpected,” explains Dr. Gupta. “But if you had the person all hooked up to monitors hours earlier, you could basically say that based on things like their breathing patterns, blood sugar, and stress hormone levels, they were likely to have a panic attack.”
I asked Dr. Gupta about the difference between the bodily response to an actual threat (like an intruder in your house) and a threat like experiencing the death of someone we love, and I was amazed by how similar the responses are.
When a human being experiences a crisis, there is a fight-or-flight response. This can also be true in cases of emotional crises, such as grief. There is a physiological response. Pupils dilate. Blood-sugar levels increase. Cortisol and stress hormones release sugar because we need energy. There is increased tension in arms and legs, so movements become quick and precise. You get jittery because you’re too revved up. There is increased blood supply to the brain and the heart.
Anxiety- The Missing Stage of Grief Page 3
