Anxiety- The Missing Stage of Grief

by Claire Bidwell Smith

  Memory-Writing Prompts

  I remember when…

  I loved it when you…

  It always made me laugh when you…

  The first time we met was…

  You were so good at…

  You were most you when you were doing…

  You taught me…

  You were happiest when you…

  The funniest thing that ever happened to you was…

  You always wanted to…

  Your favorite song was…

  Your favorite food was…

  Your favorite hobby was…

  Your favorite clothes were…

  Your favorite place was…

  Your favorite movie was…

  Your favorite book was…

  Your favorite holidays were…

  You got through hard times by doing…

  You were admired for being…

  As you move through these three different kinds of exercises, take time to really get to know yourself as a writer. You may find it difficult to let the words flow in the beginning, but as with anything, practice helps. Do not feel that you have to be a great writer or write the perfect sentences every time you sit down. This writing is just for you.

  This work will be emotional, but that is part of it. So do your best to create a safe space and time in which to do the writing. And strive to find compassion for yourself as you move along. Revisiting old memories or writing through anger or regret can cause powerful emotions to surface, but writing through it is what will help to release and soothe those emotions.

  Know that there is no perfect time to begin this work. You may find yourself, as in some of the examples above, writing through your grief very early on in the process. Many of my clients who are in the initial weeks or months of their loss utilize all of these exercises. But I also have clients who are decades out from a loss, working to process old grief and how it’s impacted their life, who find these exercises equally cathartic and healing.

  Wherever you are in your grief, I urge you to take out a pen and begin to let the thoughts and emotions flow onto the page.

  Please visit the resource section in the back of this book for more ideas and platforms where you can share writing or get further instruction.

  A NXIETY C HECK-I N

  Let’s check in with your level of anxiety. In the last chapter, you learned about all the various ways that using the power of writing can not only help you to process and release your emotions but also help you restore a level of connection to your loved one.

  Remember that much of the anxiety that comes after a loss is directly related to no longer feeling that you can communicate with your loved one and that reinstating that connection through writing can be incredibly soothing.

  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

  If you are continuing to experience a fair amount of anxiety, rest assured that the next two chapters are going to provide many useful tools for calming your mind and giving you much greater control over your anxious thoughts. Read these chapters carefully, and do your best to give each exercise a try.

  8 | Retraining Your Brain

  We can’t solve problems by using the same kind of thinking we used when we created them.

  —A LBERT E INSTEIN

  T HIS CHAPTER IS ONE OF THE MOST IMPORTANT IN THE BOOK. I ’VE purposely placed it deeper into these pages because I really believe that until you’ve thoroughly confronted your grief in all the ways the previous chapters suggest, you’re not ready to do the work that comes in this chapter and the next. Learning how to harness your anxious thoughts is the most valuable tool you can acquire in the process of gaining control of, and relinquishing, your anxiety.

  Once you begin to see this for yourself, the work at hand becomes surprisingly simple, and the positive reinforcement you’ll quickly gain from paying attention to your thoughts will spur you on to keep working the problem.

  This process has been revelatory for my clients when they begin their own work in this arena. Understanding how thoughts work, and learning how to take a step back from them and not let the thoughts control them, changes their anxiety levels in significant ways. In this chapter, we’re going to focus on different ways of looking at our thoughts and beliefs. Take your time reading, and be patient as you let the information sink in. If you are able to really open up and try some of the exercises presented here, you will be rewarded.

  COGNITIVE BEHAVIORAL THERAPY

  One of the most effective and widely used treatments for anxiety is cognitive behavioral therapy (CBT). While this kind of work does not directly address the grief process, it very much works to alleviate and eliminate anxious thoughts that come on as a result of loss. Aaron T. Beck’s The Anxiety and Worry Workbook is a wonderful resource; I source Dr. Beck’s work below.

  CBT is a short-term, goal-oriented treatment that uses a practical approach to change thought patterns and behavior that impact a person’s emotional well-being. It is one of the predominant treatment methods for anxiety.

  Essentially, the term cognitive refers to the way that we know or recognize our experiences, and CBT is a treatment that helps people understand how to change thoughts and beliefs that directly impact negative emotional states such as anxiety. The core of CBT addresses the idea that the way we think directly affects how we feel, so changing the way we think can help change how we feel.

  In grief, many new thoughts come into our minds—thoughts about mortality, about uncertainty, about painful memories, and worrisome visions of the future. Many of the thoughts that occur after a significant loss are new ones, but even if they are not new (for example, death is an inevitability), the thoughts feel more real than ever before following a loss. And because a lot of these grief-based thoughts are scary, our bodies have an automatic fear response that, in turn, elicits anxiety.

  Triggering Event Thought Feeling

  Loss of a loved one Life is uncertain Fear, anxiety

  In this chapter, I’m going to cover various ways that you can apply techniques of cognitive behavioral therapy to lessen your grief-related anxiety. A few things to know going into it: It helps to approach this technique with an openness to trying it and to really learning new ways to understand your thoughts. You also need to be willing to work on the role you could be playing in making your anxiety worse. Last, this technique will take time and practice, so be patient with yourself.

  As we’ve been learning in this book, fear and anxiety are completely normal emotions that enhance our survival skills. But the emotions of fear and anxiety become problematic when they are persistent and unrealistic in our everyday lives. Learning how to manage your thoughts will directly serve you in easing your anxiety. In CBT people learn how to manage their thoughts by recording and writing them down, and we’re going to do just that in this chapter.

  Let’s begin by breaking down your anxiety. The first thing we must do is discover the underlying fear behind your anxiety.

  Anxiety State: List various things that make you anxious, such as events, situations, and specific times.

  Underlying Fear: Name the specific fear, threats, or catastrophe behind each anxiety on the left.

  1.

  2.

  3.

  4.

  5.

  6.

  Anxiety is a complicated creature. We already know that it affects you on many levels, and in Chapter 1 we went over the most commonly experienced physical symptoms.

  Increased heart rate

  Shortness of breath

  Chest pressure

  Dizziness

  Sweating

  Nausea

  Weakness
>
  Tense muscles

  But now let’s take a look at some of the cognitive symptoms. These include:

  Fear of death or physical impairment

  Fear of being unable to cope

  Fear of going crazy

  Painful memories and images

  Perceptions of unreality

  Confusion, lack of concentration

  Trouble reasoning

  Hypervigilance for threat

  The behavioral symptoms that follow the cognitive symptoms include the following:

  Avoidance of situations

  Escape plans

  Feeling the need for safety and reassurance

  Agitation

  A feeling of paralysis

  Trouble speaking

  Finally, the emotional symptoms that arise as a result of both the cognitive and the behavioral symptoms are as follows:

  Feeling scared, even terrified

  Feeling nervous and tense

  Feeling on edge or jumpy

  Feeling impatient and frustrated

  Based on these lists, I want you to make your own personal list correlating all of the symptoms and behavior. Becoming aware of the link between them is the key to overcoming them.

  1.

  Anxious Thought: Thinking I might have cancer.

  Physical Symptoms: Tight chest, light headedness, rapid heart rate.

  Cognitive Symptoms: What if I die just like my mother did and I leave my daughters behind?

  Behavioral Symptoms: Sad, scared, nervous.

  2.

  Anxious Thought:

  Physical Symptoms:

  Cognitive Symptoms:

  Behavioral Symptoms:

  3.

  Anxious Thought:

  Physical Symptoms:

  Cognitive Symptoms:

  Behavioral Symptoms:

  4.

  Anxious Thought:

  Physical Symptoms:

  Cognitive Symptoms:

  Behavioral Symptoms:

  5.

  Anxious Thought:

  Physical Symptoms:

  Cognitive Symptoms:

  Behavioral Symptoms:

  6.

  Anxious Thought:

  Physical Symptoms:

  Cognitive Symptoms:

  Behavioral Symptoms:

  Becoming aware of the patterns you have associated with your anxious thoughts is the key to this work, so complete these worksheets carefully and really study them to understand how your brain is influencing your sense of well-being.

  CATASTROPHIC THINKING

  When we are suffering from anxiety, we have a tendency to exaggerate and catastrophize the possibility of bad outcomes. This can range from finding a strange mole on your arm and immediately thinking you have cancer to a family member being late to arrive home and thinking that something terrible must have happened.

  You’re not alone in these catastrophic responses, and I think they are particularly strong when you are grieving. This is because the very worst thing has, in fact, happened. Someone you love has died. You now have proof that terrible things can happen, so it’s only natural that you begin to worry that more terrible things might happen.

  In Chapter 1 I talked about how highly anxious people sometimes have a tendency to remain in a state of hypervigilance rather than feel unprepared for something terrible happening, and this way of being feeds directly into the cycle of catastrophic thinking. But cognitive therapy teaches us how to detect, and actually override, these exaggerated thoughts of worst-case scenarios.

  Studies have shown that anxious thinking happens in less than half a second. It happens so quickly that most of us do not even realize our brains our processing a threat. It’s like a computer that has an operating system set to perceive and respond to threats in the environment. We must learn how to override this operating system or create a new one altogether. Again, the key to this is learning how to recognize your anxious and catastrophic thoughts.

  At the core of catastrophic thinking lies a belief that you will be unable to cope in the face of another tragedy or disaster. Perhaps you read a news story in which someone has died suddenly. In your anxious-grief response, this article causes you to imagine what it might be like to lose another important person. Often, the very next thought is that you will not be able to cope. You already know how painful grief can be, and you cannot bear the idea of experiencing it again. But changing your belief about your ability to cope can calm your anxiety.

  Study your responses to this worksheet and note the differences in how you think you’ll cope as opposed to how you would actually like to cope. When you find yourself experiencing catastrophic thinking, return to your desired coping methods as a way of diminishing the catastrophe.

  Anxious Worry: Describe what has actually made you anxious.

  Helpless Thinking: How do you imagine coping in this situation?

  Desired Coping Response: How would you like to cope?

  1.

  Anxious Worry: Fear about mammogram results.

  Helpless Thinking: I’ll receive bad news, and I won’t be able to handle it.

  Desired Coping Response: I would like to stay calm and know that I can and will cope with bad news.

  2.

  Anxious Worry:

  Helpless Thinking:

  Desired Coping Response:

  3.

  Anxious Worry:

  Helpless Thinking:

  Desired Coping Response:

  4.

  Anxious Worry:

  Helpless Thinking:

  Desired Coping Response:

  5.

  Anxious Worry:

  Helpless Thinking:

  Desired Coping Response:

  6.

  Anxious Worry:

  Helpless Thinking:

  Desired Coping Response:

  FEAR OF ANXIETY

  By the time my clients come to see me, many of them have developed a fear of the anxiety itself. They are so overwhelmed by the periods of anxiety they have been experiencing that they are terrified of having more. Many people can even overcatastrophize their own anxiety, maintaining a belief that they cannot cope with it. Taking time to look at this belief and recognize that you can cope with it will help alleviate your concern about it.

  When Joanne from Chapter 1 came to me after her panic attack in the car following her father’s death, she was deeply afraid of having more panic attacks. She had become so attuned to the physical sensations of anxiety that every time she experienced heart palpitations or breathlessness, her anxiety would spike even higher, out of fear that another panic attack was coming on.

  In several sessions I worked with Joanne to point out how she had, in fact, coped appropriately and successfully with her first panic attack. She had pulled over to the side of the road, called her mother, received help, not actually had a heart attack, and eventually returned to a state of calm. In an effort to reduce her fear of more attacks, we reviewed various scenarios in which she feared having another attack and discussed ways she would be able to cope in response.

  Joanne had an upcoming trip in which she would need to take a plane ride. She was very worried about having a panic attack on the plane and felt that she would not be able to cope if she did. Together we walked through what it would be like if she did have a panic attack during her flight. We talked through all the coping mechanisms she had been learning and reviewed how these same tools would work just as well on a plane as anywhere else.

  Once Joanne was able to see that even if she did have another attack it would be okay, she stopped responding so fearfully to the bodily sensations of anxiety. Instead, each time she experienced a heart palpitation or dizziness, she would pause what she was doing and acknowledge to herself that she was having an anxious response to a thought, pinpoint the thought, and then remind herself that she was capable of coping. This process was instrumental to Joanne learning to manage, and lessen, her anxiety.

  For many people, their gut re
sponse to anxiety is to avoid it or run from it. But research has repeatedly shown that avoiding the anxiety does very little to eliminate it. When we respond to an anxious thought with fear, and then run from it or shut it down, we are in essence giving it more power. Letting the thought in, examining it, questioning the validity of it, and noting your responses to it take away its power.

  Furthermore, much of anxiety has to do with feeling a need for control. When we lose someone we love, we feel helpless. But seeking to control future outcomes gives us a false sense of security and sets us up for failure. Getting comfortable with the reality of how uncertain our lives are can help us cope with anxious thoughts.

  Now that you’ve begun to understand a little more of how anxious thoughts work, let’s talk about how to return to normalized thinking.

  Here’s where the shift needs to happen. It’s quite simple.

  Anxious Thoughts: Focusing on worst possible outcomes

  Normal Thoughts: Focusing on realistic outcomes

  Anxious Thoughts: Focusing on inability to cope

  Normal Thoughts: Focusing on ability to cope

  Here are a few steps you can begin to take in order to return to a normalized way of thinking.

  1. Normal Anxiety

  As we’ve discussed, it’s natural and healthy to feel a little anxiety during certain situations. Anxiety helps us prepare for things like job interviews, travel, presentations, quizzes, and tests. Think of several things you have experienced recently about which you had normal anxiety. Jot them down, along with your reactions to this anxiety. Doing this helps you to generate a realistic idea of what anxiety can, and should, look like. Then ask yourself how you can think more normally about your overly anxious concerns.

  2. Catch Your Anxious Thoughts

  Fearful thoughts can occur automatically, spinning us out into an anxious state before we have even realized it has happened. Learning how to catch these thoughts takes some work, but often once you begin, it gets easier. Start by recording each exaggerated anxious thought that occurs. Jot it down and then list the likelihood of its actually happening.