Anxiety- The Missing Stage of Grief

by Claire Bidwell Smith

  In the case of a panic attack, all of these are magnified. A person can have an irregular heart rate, become lightheaded and nauseous, experience shortness of breath, and feel choking or a lump in their throat. They can feel like they’re having a heart attack.

  The mind is a very powerful tool. I want you to take a moment and really let it soak in that your anxiety, your very real physical symptoms, is coming from the thoughts and feelings you are having in reaction to the death of your loved one. Even if your loss was years ago, you may have become accustomed to experiencing these physical symptoms on a regular basis as a result of the grief you felt.

  What sets grief-related anxiety apart from generalized anxiety is that there is a very specific trigger for the fear-based thoughts. They are stemming directly from the experience of loss.

  Dr. Gupta concludes, “The most interesting thing from a physiological standpoint is that all of this can be very predictive. We think it’s coming out of the blue, but it’s not. What’s important to understand is that something triggered it.”

  BENEATH THE SURFACE

  The second step to grappling with anxiety is recognizing what Dr. Gupta concluded—that we must understand that something triggered it. We have to peer beneath the surface of the anxiety in order to see what the root of our worries and fears are. We have to reckon with all the feelings that accompany deep grief.

  You may feel compelled to try to move quickly through the grief process. It’s a very common instinct; most bereaved people strive to get back to normal as quickly as possible. Some even try to go back to their regular lives as though nothing has changed. And even for those who do let themselves steep a little longer in the grief, there is usually more work to be done. This is almost always the case with people experiencing grief anxiety. Even when they think they have grieved, there is almost always more to process.

  In my ten years of doing this work, I’ve paused often to ponder how it is that we experience so much pain and must do so much work when we lose someone we love. Sometimes I am literally stopped in my tracks thinking about it. How can loss be this big of an experience, this painful, this lengthy, this far-reaching, when it happens to all of us all the time?

  The only answer I’m ever able to come to is that grief is a reflection of our relationships. The deeper and more complex the grief, the deeper and more intense the relationship was, good or bad. And it is the exploring of that relationship, that love or that complexity, that helps us understand more about where the anxiety is coming from. Every person’s grief is completely unique because so are their relationships. You can have two sisters who lose the same father but who have two completely different reactions to his death, based on the different relationships they had with him.

  If we do not do the work to explore the issues left behind in the wake of loss, they do not simply go away. For instance, if you lose a loved one without getting to say good-bye, those feelings of regret and guilt and sadness do not simply disappear on their own. Those feelings must be reckoned with. They must be processed, and sometimes work must even be done to find a new way to say good-bye.

  I’ll never forget the case of a man who came to one of my grief groups in Chicago. His wife had been gone for almost ten years when he joined our group. But because she died in childbirth and he was forced to immediately begin caring for their newborn, he shoved his grief aside for many years. In joining our group, it was like he was taking a lid off a jar that had been put in the cupboard. All the contents were still right there inside; all his sadness and shock and anger were right there waiting for him a decade later.

  So this is the beginning of the work: first, understanding what anxiety is and beginning to alleviate the physical symptoms and, then, digging deeper to understand and process the feelings that are causing the anxiety. To get a better understanding of the whole picture, I’d like to share with you the story of my client Joanne. It’s a story that is similar to mine, but I want to include it here because not only is it a classic example of grief-related anxiety, but all of the techniques I used with Joanne to overcome it will also be covered in this book.

  JOANNE’S STORY

  Joanne first came to see me a week after she’d had her first panic attack, one that was so severe it landed her in the emergency room. At age twenty-three, Joanne lost her father to a rare form of cancer, and now a little more than a year later, she found herself struggling in several areas of her life.

  Joanne was sweet and put-together, with a clothing style surprisingly classic for someone so young. She spoke in a strong and confident voice, smiled at me brightly, and was quite pleasant to be around. In short, she was someone you would never guess was suffering from anxiety.

  In our first session Joanne described her panic attack. She had been driving home from her job as a teacher’s aide in an elementary school. As she sat in traffic, headed to her apartment, she suddenly experienced a severe bout of dizziness, followed by a racing heart and shortness of breath. These physical symptoms immediately filled her with fear. She wondered if she might be having a heart attack or a brain aneurysm.

  Joanne pulled over to the side of the road and called her mother, who came to get her and drove her to the emergency room. After being thoroughly checked out by a physician, it was concluded that Joanne was completely healthy and had likely experienced a panic attack.

  This knowledge did nothing to alleviate Joanne’s anxiety, and in fact, over the course of the next week, she lived in a state of near constant fear of having another attack. She had not even been able to drive to my office, instead enlisting her younger brother to chauffeur her.

  I began to ask her a series of questions to better understand her particular experience.

  Had she had another attack since the one in the car or just the fear of having one? Just the fear, she told me.

  Was she experiencing trouble sleeping? Yes, but only since the panic attack, she reported. Prior to the attack she had been a good sleeper.

  I asked her to repeat how long it had been since her father died. Just over a year, she said.

  And was this the first time she’d experienced anxiety, or was this something she’d grappled with throughout her life? It had only been since her father’s death that she had begun to feel anxious on a variety of levels, and this was the first time in her life she’d ever had a panic attack.

  She answered my questions readily. Joanne was desperate for help. Ever since the panic attack, she had been calling in sick to work, afraid she would have another attack while in the classroom. She wanted to know if I thought that maybe any of this could be related to the death of her father. In response, I asked her to tell me about her life before he died.

  Joanne had been raised in an idyllic suburb by two loving and wonderful parents. She had a younger brother with whom she was close. While she was growing up, her parents had been a constant supportive presence, and they enjoyed family trips and regularly held warm holiday gatherings in their home for their extended circle of friends and family.

  Joanne had sometimes struggled with feelings of insecurity among peers, and later in romantic relationships, but overall she had led a life relatively unscathed by misfortune or psychological struggles. When her father, Steven, grew ill during her senior year of college, the whole family was taken by surprise. Although Steven sought excellent medical care, the doctors were unable to cure his cancer, and Joanne accepted her college diploma with her father absent from the audience.

  Joanne and her mother and brother were rocked by Steven’s death. A vibrant entrepreneur, Steven had been close with all three of them. Always proud of Joanne, he loved talking with her about business ideas and her future career plans. He and Joanne’s younger brother, Sam, shared a love of sports and camping, and Steven also maintained a loving relationship with his wife, Joanne’s mother. Steven’s death instantly shattered the future all three of them had envisioned for their lives.

  In the year since his death, Joanne had gone on to graduate coll
ege and began working as a teacher’s aide in an elementary school that she loved. Her brother was now in his junior year of college and in a serious relationship. Joanne’s mother continued to maintain the family home, despite experiencing a lot of depression and sadness following the loss of her husband.

  I asked Joanne if anything had changed even more recently. She admitted that in the last month, she had moved out of her mother’s house into her own apartment and that she had also broken up with her boyfriend. I pointed out that it sounded as though she were truly on her own in the world for the first time since her father died, and I asked her how that felt.

  Joanne pulled her arms around herself and nodded her head, her eyes brimming with tears. She described feeling vulnerable and more alone than she’d ever felt and admitted that she could see how this might have precipitated the anxiety attack. She suddenly sat up straighter and looked at me.

  She recounted how all that day she had been dreading going home to her quiet apartment. All she could think about was how much her life had changed and how none of it looked like she thought it would anymore. She’d always thought that everything would just go as planned—that she’d graduate college and get the perfect job and eventually get married and have kids, but ever since her father died, it just seems like she didn’t know anything about life, and she felt that terrible things could happen again at any time.

  I nodded at her, sympathizing and remembering how similarly I felt after my mother died. Before Joanne left my office that afternoon, I worked briefly to normalize her anxiety, explaining how common it is to feel this way after a significant loss and also how anxiety is often a sign that we have deeper grieving to do. To help her get through the next week, I reminded her that the doctor gave her a clean bill of health and that even if she began to feel a panic attack coming on to remember that this is just her body responding to thoughts and feelings. I also gave her a list of quick tips she could use if she felt that she might be having another attack (see inset here).

  Joanne and I spent the next few sessions exploring her father’s death on a deeper level. We processed the feelings of fear and sadness she experienced seeing him decline physically, and we talked at length about their final conversations—exploring any regrets or things left unsaid. We discussed the pressure Joanne felt to emotionally support her mother and her younger brother, and we talked about the various ways she felt unprotected and unsafe in life following her father’s death.

  Each week, in addition to talking about her life, I gave Joanne assignments such as writing, meditation, and exercise; exploring her spirituality and beliefs about the afterlife; and initiating conversations with her mother and brother about things that needed to be addressed. And each week I worked on continuing to normalize Joanne’s anxiety. Every time we met, I could see that her anxiety level had decreased a little more. She had two more panic attacks during our time together, but neither of them were as significant as the first, and during each one she was able to calm herself and make it through the attack quickly.

  After about eight months of meeting regularly, Joanne walked into my office and told me she felt ready to end our time together. She told me that she felt like a completely different person than when she had first come to see me and that she had finally processed her father’s death in a way that she had not yet done when we first met. She understood now that her anxiety had stemmed from her unaddressed grief. She acknowledged that she still maintained a low level of anxiety but that she no longer felt afraid of it or hindered by it.

  I watched her walk out of my office knowing that although her life would never look the way she once thought it would, she had done the kind of work that would allow her to walk a full, meaningful path through this world. When I wrote to her two years later to interview her for this book, she replied immediately: “So crazy to hear from you today because it is actually the 4-year anniversary of my dad’s death. But I am doing really well, and I definitely have you to thank for that. I am still using all the skills I learned from you, meditating, journaling and yoga.”

  Joanne is just one example of how grief can bring on sudden and intense anxiety, but she is also an example of how you can overcome it.

  10 QUICK TIPS FOR ALLEVIATING A PANIC ATTACK

  1. Recognize and accept that you are having a panic attack.

  2. Remind yourself that you are healthy and there is nothing physically wrong with you.

  3. Begin breathing calmly to regulate your blood pressure and dioxide levels.

  4. Get grounded in the present moment. Do something that engages your senses: eat a piece of chocolate, pet an animal, take a shower. Doing these things will help return you to the present moment.

  5. Call someone who knows you well and tell them you are feeling anxious. Just saying it out loud can often help lessen the enormity of the thoughts in your head.

  6. Change your environment. If you are outside, go inside and find a comfortable place to rest. If you are inside, go outside and breathe some fresh air.

  7. Visualize something calming to stop the cycle of anxious thoughts.

  8. Allow for all the emotions you are feeling—try to view them with curiosity rather than fear.

  9. Externalize the panic attack—give your anxiety a name. Recognize that it is not who you are.

  10. Tell yourself that this attack will end, that you are not stuck in the attack, and that you are not alone.

  THE PATH TO HEALING BEGINS

  Now that you have a foundational understanding for how anxiety works, it’s time to go beneath the surface. In the coming chapters we’ll be exploring your grief on a deeper level and examining the story of loss you are carrying.

  In my work as a therapist, I’ve come to realize how valuable storytelling is in our day-to-day lives. We tell ourselves stories about our experiences in order to make meaning of them. Unfortunately, our society doesn’t always do a very good job of providing places for people to share their stories of loss, so in the next chapter I’ll provide ways for you to tell your story.

  As you move forward in this book and continue to do the work presented here, I’d like to ask that you also continue to monitor your anxiety level. I’m going to provide anxiety-level check-ins within each chapter, but also feel free to return to this first chapter as often as you need in order to reread or revisit some aspect here that helps you normalize the symptoms you are experiencing.

  Remember: Anxiety is simply an expression of scary or painful thoughts and feelings. Anxiety is normal. Anxiety is not who you are. Treat it as though you would an annoying sibling. When anxiety shows up, recognize that it is here, say hi, and tell yourself that you don’t need to succumb to it. Remind yourself that you are embarking on a journey to alleviate the root cause of the anxiety. And remember that you are not alone.

  A NXIETY C HECK-I N

  Let’s check in with your level of anxiety. In Chapter 1, we learned about the basics of anxiety—what it looks like and how it manifests. Did reading about it help normalize some of the feelings you’re having?

  One of the first steps to managing anxiety is understanding what it is and learning how to separate yourself from it. In this chapter, we’re going to learn how your grief plays a role.

  Rate your current anxiety level on a scale of 1–10 (with 10 being the highest).

  1 2 3 4 5 6 7 8 9 10

  Check the symptom boxes that currently apply:

  Panic attacks

  Insomnia

  Nausea

  Dizziness

  Heart racing/palpitating

  Obsessive worry

  Hypochondria

  Chapter by chapter, we’re going to work on learning more about how to alleviate and manage these symptoms, but feel free to return to here in Chapter 1 and review the quick tips on how to alleviate a panic attack.

  2 | What Is Grief?

  The reality is that you will grieve forever. You will not “get over” the loss of a loved one; you will learn to live with it. You wi
ll heal and you will rebuild yourself around the loss you have suffered. You will be whole again but you will never be the same. Nor should you be the same nor would you want to.

  —D R. E LISABETH K ÜBLER-R OSS

  I N THIS CHAPTER, WE’RE GOING TO TAKE A BRIEF LOOK AT THE overall grief process, because one of the reasons we experience anxiety following a loss is either because we are not facing our grief or because we are not coping with it adequately. So, take a deep breath, and let yourself open up to the idea that perhaps you have not fully grieved yet. And let’s EXPLORE what grief really looks like.

  One of the initial things my clients want to discuss when they find their way to my office and get comfortable on my couch is whether they are grieving properly. They often can’t believe how much bigger, more intense, and more pervasive grief is than they ever imagined.

  Before we lose someone, it is simply impossible to understand the true depths of grief. And often, when we find ourselves plummeting to those depths following a loss, the journey is much more harrowing than we thought it would be.

  Grief can make you feel like you’re going crazy. Grief can have physical symptoms. Grief can leave you confused and forgetful, anxious and angry. Grief can leave you in a heap on the dining room floor in the middle of the day, and it can keep you up in the darkest hours of the night.

  It is precisely because of all these varied reactions and symptoms that grief is so often misunderstood. I can’t tell you how many clients have expressed to me the worry that they are “not doing it right.” I tell them exactly what I’ll tell you—there is no right way to grieve. I’ve said this in every book I’ve written and in every lecture I’ve given. And unfortunately, as much as we want there to be a perfect formula—a quick and easy way out of this torturous state—there simply isn’t one.