Why Grieving & Anxiety Go Hand-in-Hand
Psychological insights to help you as you heal
People don’t often think of anxiety when they think about loss and grief. You expect to be sad, devastated, angry, shocked, even disoriented, but you don’t expect to feel afraid and anxious. Yet grieving and anxiety are very common companions. Understanding how and why anxiety can show up can help you feel more in control so you’re less put off by this unexpected emotion stepping in.
As a therapist, what I have seen with clients and in my own life is that anxiety can creep into your experience for a variety of reasons. When it does, it often complicates what already feels like more than you can bear. Strong feelings and the uncertainty looming ahead can threaten your sense of safety and drive your anxiety to even higher levels. This experience, while deeply unsettling, is completely normal. Grief almost always involves some measure of anxiety.
How could it not when so much of your life has just been turned upside down?
We’ve come a long way in our understanding of grief since Elisabeth Kubler Ross first delineated the 5 stages of grief in her 1969 book, On Death and Dying. While her model has been widely accepted as a roadmap for grief, the omission of anxiety as a normal experience has left many who are feeling anxiously bereaved even more confused and sometimes concerned for their mental health.
Grieving and anxiety need to be normalized as a part of the healing process. Then, you can understand the role anxiety plays in grief as you navigate the emotional upheaval following your loss.
What is Healthy Grief and Bereavement?
Over the last 50 years, the science on grief and bereavement has largely departed from Kubler-Ross’s original model. There isn’t a single model of grief that we all follow, nor are there symptoms or experiences that are fundamental to healing. We all appear to feel and heal in our own ways.
What has emerged in trauma research is an evidence-based model for healing that focuses on psychological resilience as a principal component in healing from loss.
When you think about grief through the lens of personal resilience, it’s easier to normalize anxiety and trauma responses to loss for those who experience it. We know resilience is a natural human process that is achieved through a variety of healthy paths. Importantly, such resilience almost always includes facing and working through the anxiety that accompanies loss.
What is the connection between grieving and anxiety?
While often overlooked, anxiety is a common symptom of grief in the first year following a loss. Estimates of acute anxiety following a loss range from 27% to upwards of 50%, with research suggesting bereaved individuals experience repetitive loops of intense longing, sadness, frustration, and anxiety.
For some grievers, the symptoms they experience may be frightening, shameful, and strange, adding to the distress they already feel. Not only is it scary to imagine life after the loss, but feelings of distress can themselves be scary and worrisome. Grievers often wonder if their symptoms will ever cease which further increases anxiety and their emotional burden.
As overwhelming and disorienting as these experiences are, they are also completely normal. Thankfully, awareness of anxiety as a normal part of bereavement is gaining ground, and a recent book by therapist Claire Bidwell Smith, “Anxiety: The Missing Stage of Grief” contributes significantly to our understanding. In my therapy practice, there has not been a single bereaved client for whom anxiety hasn’t been part of the picture.
Anxiety is a normal human emotion. It is also a predictable response to unexpected life changes, making it a natural and normal reaction to loss. Understanding the connection between anxiety and grief can help restore a sense of control at a time when you need it most. If you can expect it, you can face it. And the more you understand anxiety, the more efficiently you can cope with the messages it’s trying to convey to you.
Does grief cause anxiety?
Absolutely, grief can cause anxiety. Few experiences in your life pose a greater risk of anxiety than facing the loss of a loved one. The person – or people – you care about most are at grave risk, and you are powerless to stop it.
Remember that anxiety’s neurological job is to stand up protective resources to the things we care about most. Yet when there is nothing we can do to protect a loved one from death, our anxiety has nowhere to go, and we must instead face our deepest fears and bear them. The lack of control you feel is at the root of what makes loss such an emotional minefield and anxiety is at the core.
Grief and loss cause our internal sense of stability and safety to feel threatened. We cannot trust the world around us since everything we know has changed. Life has turned upside down, and our feelings are in a tailspin. Emotions feel heavier than you’ve ever experienced, and life in general feels harder to bear. Everything is different, and it is normal to feel disoriented, and spooked.
Additionally, it can be hard to imagine life following a loss, not to mention how to manage the many uncertainties ahead of you. You may be understandably afraid of what life will be like now, and if you can even cope with what you have to face.
For some people, even thinking about the finality of losing a dear loved one has been known to bring on panic and deep wells of anxiety that are truly difficult to overcome. The implications of loss feel overwhelming and scary and your life no longer feels in your control.
So while grief doesn’t always cause anxiety, anxiety is almost always part of the landscape you must traverse to heal.
How can anxiety and grief show up together?
Anxiety may show up in a variety of ways, and flares when you feel out of control, or when something you care about is at risk. I use this formula with clients so they can see the connection between their grief and anxiety: Something you care about is at risk, and you feel out of control.
This simple truth is acknowledged by clients easily because it speaks to their truth. Fear, loss, and powerlessness are all deeply connected. Naming it in this way helps to explain why it grabs you so deeply in your belly and overwhelms you with emotion.
Additionally, there are myriad ways anxiety can show up in grieving, but several key experiences seem to be common.
1) Fears of responsibility and self-doubt – the anxiety of death can lead to personalization of the situation, leaving you questioning yourself. Everything from how you related to your loved one to the decisions you made to how you handled your emotions can come flooding back to you in a parade of exaggerated guilty snapshots. The thinking goes something like “if I had been a better x, then s/he would have y and maybe not died…”
Going over events in your memory can be a natural part of making sense of an upsetting event, but anxiety can also thwart this process. Martin Seligman describes a set of mental traps people can fall into during difficult times that can make you feel even worse. The trap of Personalization, or the idea that you alone are responsible for everything that has gone wrong, is particularly sticky for caregivers under stress, leaving them not only bereaved, but feeling guilty.
2) Fears of forgetting – preserving memories is how we keep our loved ones alive and anxiety about our fragile fading memory can cause additional anxiety. As life moves on, we know that our attention will naturally evolve away from the immediacy of the loss. This can be scary when our memories of a loved one are the only connection we still have following a loss.
For people struggling to accept a loss, a fear of forgetting can be a haunting concern that escalates anxiety. The challenge is to trust your memories as preserved gifts you can recall whenever you need them.
3) Fears of life without your loved one – feelings of loneliness, longing,and heartbreak permeate your experience, but you are also afraid of moving on. Facing life without your person is nothing you want, and it can be petrifying.
Not only is it impossible to imagine life without them, you don’t want to live a life without them. Yet somehow you know you have to. You feel alone, insecure, and scared. Everything is different, your world is upside down, and your disorientation can be scary. All of this can understandably increase your anxiety.
4) Fears of role and identity changes – orphan, widow, and survivor – death can force identity and role changes that you may feel unprepared for or don’t want to embrace. Fears around what the changes mean can make the adjustment even harder to manage.
5) Fear of the unknown – what will life look like, how will you cope, and will you ever feel ok? With death comes uncertainty. The insecurity of life without your loved one feels incomplete and empty, all of which can increase your daily worries and angst.
6) Fears of death – someday for your remaining loved ones and yourself. Death looms large around you and your awareness of its inevitability can be distracting and even frightening.
- Health fears
- Safety fears
- Suffering fears
- Fear of death itself – the process, what happens
- Spirituality fears – absorbing death’s finality often tests people’s faith. What lies ahead (if anything)? What brings you comfort and closeness with the person who has passed? What else is out there?
7) Anxiety of regrets and lost opportunities. Regret about the relationship you had with the person, things said or done, things unsaid, and opportunities lost can torture the bereaved. The “what ifs” and “if onlys” can make you crazy, tempting you to conflate the choices you wish you had, from the choices you actually had.
The key to managing regret is to remember clearly the choices you had: what information you had then, what resources you had, and how and why you made the decisions you did. You may wish things had been different, but it’s critical to understand how you did the best you could with the resources you had. Beware of hindsight conflating the facts of the past, and instead stick with remembering the choices you had control over.
8) Fear of future existential regret. Existential awareness about your stage of life and angst about the time you have left is a common experience of bereavement. Time is precious, life is precious, and it can feel imperative to take this diminishing resource – time – more seriously.
A good way to channel this natural existential anxiety is to ask yourself, What would you do if you only had 6 months to live? Once you have a manageable list, ask yourself how much of what you noted is not already a part of your life? These will become your to-dos moving ahead, and all progress and traction you feel in pursuit of these goals will materially relieve your angst about existential regret. Only when you put anxiety toward solutions does it ultimately stand down.
9) Fear of the grieving process itself – “what if I’m never ok and continue to feel this terrible forever?” You know you have to move ahead, but you are weighed down by your sadness and disbelief, wishing this new reality were simply a bad dream, and frightened by this new reality you don’t yet know, and didn’t want. This disconnect between what you know you have to do and how you feel can cause a great deal of anxiety. The trick here is to rework your expectations to better align with your experience.
Anxiety about the death of a loved one
Perhaps the most common association to grief anxiety I’ve seen is the increase in anxiety about a future death of a loved one. The thinking goes something like this: Death has happened once, it will happen to everyone, so it might happen again to me.
In losing a loved one, the security of your most trusted relationships has been threatened. Attachment and connection are no longer guaranteed, and this uncertainty can quickly generalize to every important relationship in your life. Suddenly you start thinking about losing people and you can’t help but feel anxiety. Remember the anxiety formula? Something you care about is at risk, and you feel out of control.
For many people, the anxiety they feel about death is also connected to the “reasonableness” of the death. It’s “normal” for older people to die, but it’s “unreasonable” for a child to die, for example. The more unreasonable a death seems, the more anxiety its future threat can cause: Something outside life’s order has happened once and it can happen again. Life isn’t safe.
Are there grief attacks?
Like with all kinds of grief and anxiety, your experience of it can vary widely and it can range from a background sad feeling to an acute pain that takes over your awareness completely. In the same way acute anxiety can be experienced as an attack when it seems to take over, grief too can be experienced as taking over your awareness as your feelings of being out of control intensify.
Many people describe grief as coming in waves. Waves of grief are episodes that crest into acute grief but fall away into more of a dull pain until the next episode comes. As time moves on, waves of grief tend to diminish in intensity and frequency. But for people who experience grief more like an attack, anxiety is likely part of the picture. Not just primary anxiety about grief and all that it includes, but anxiety about how you’re feeling and what it means. I call this secondary anxiety, and it’s what you experience when you feel fear of whatever you’re feeling.
Understanding secondary anxiety
The telltale sign of secondary anxiety is a sudden escalation of emotion. When fear and resistance is layered into an uncomfortable emotion, it can amplify it to the point of seeming to overtake you.
Think of a child getting a shot. If the child tenses and fears the needle, the shot will hurt more. But, if the child resists the fear, it will hurt less. All emotions work like this too. The more we fear an emotion or an experience, the scarier it gets.
Anxiety can morph into panic when it is feared and resisted.
Likewise, grief can feel like an attack when you fear and try to resist it.
In my book, Hack Your Anxiety, I use the metaphor of volume to explain the range of anxiety’s impact. There are four main volumes of anxiety: Whisper, Chatter, Nagging, and Yelling. Whisper anxiety is quiet background anxiety, Chatter is more moderate anxiety akin to stress that can be motivating, Nagging anxiety is more ruminative anxiety that drains energy, whereas Yelling anxiety, the most severe, is overwhelming anxiety that limits coping and overall functioning.
Generally speaking, the “louder” you experience anxiety or any negative emotion, including grief, the more likely secondary anxiety is at play. Resisting emotions out of fear doesn’t actually help them to go away, but instead, accelerates your negative experience. Any anxiety you feel about your emotions will tend to be irrational, based on a belief you can’t handle them. The truth is you can handle your emotions even if you may not want to.
This cognitive reframe is a key way to calm secondary anxiety, and quiet the resistance and fear that escalates negative emotions. The key to managing grief attacks is to practice turning toward your feelings as much as possible, however hard that might feel. Remind yourself you can handle them, they are only feelings, and will pass just like all feelings do.
What can you do to manage grieving and anxiety?
Grieving is already hard enough, without having to worry about anxiety. Anxiety is part of almost every major transition, and at its best simply means you care. Expect to be anxious, fearful, and unsettled as you secure your footing in your new reality. Facing it will take courage and resilience, and you need not be spooked by any anxiety you feel along the way.
Similarly, work to lean into your experience rather than try to avoid it. While anxiety is a normal part of grieving, too much fear or resistance risks escalating your suffering rather than easing it. Likewise spending too much time wishing for different outcomes or ruminating on realities beyond your control can slow down the natural resilience that will propel you through bereavement. Instead, aim to redirect focus to things in your control, and the future ahead.
Be gentle with yourself. Remember you are strong, and all you need to do is be present and get through today. There is no right way to do it, and there is no single path. Life will never be the same again, but your grieving process will evolve and you will feel more like yourself again.
More than anything, try whenever you can to keep an open and positive mindset as you walk this path. Grieving means you loved deeply, and focussing on the blessings of your relationship can help amplify your resilience. Your loved one continues to live on in you, your memories, and the ways they helped shape who you are. To remember them is to honor their lives and their impact. Don’t be afraid to talk about them, to tell the stories, and learn new ones. Sometime soon those memories will usher in comfort rather than pain.
Meanwhile if your grief feels overwhelming, or like something you can’t handle, know you don’t have to do it alone. Grief is hard enough without feeling shame for how you’re doing or not doing it. There are many resources available, including experienced therapists, grief support groups, books, and online tools to help.