Aniety in Grief

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Anxiety in Grief

Think of something that scares you. Perhaps it’s the thought of giving a speech in front of a crowd, taking a test, asking your crush out on a date, or jumping out of an airplane. Even if you’re mostly fearless, everyone’s got something.

Now think about the thoughts and sensations you typically experience right before doing this thing that scares you; this is your fear and anxiety at work. Maybe your stomach starts doing cartwheels, your heart begins to race, or your breathing becomes rapid.  Perhaps your thoughts start running through all the worst potential outcomes and you think to yourself…

“There’s still time. I could still run from this situation.” 

I know you know what I’m talking about. Even the bravest people feel fear and anxiety, they just know how to navigate the experience more exquisitely than most.

Are you still with me? Okay good, now take a second and think backwards to a time when you experienced the thoughts and sensations of fear and anxiety in your grief. Maybe this isn’t one particularly traumatic moment, but a prolonged period of time when you experienced ongoing apprehension and worry, upon worry, upon worry.

Using a personal example, I remember feeling panic-like anxiety when my father told me of my mother’s terminal cancer diagnosis, and then the slow hum of persistent anxiety in the weeks and months afterwards as my family frantically searched for treatments and clinical trials. For one year I held my breath and prepared for the worst, knowing that my mother’s death was not a possibility but a probability.

People experience anxiety after the death of a loved one for a number of reasons and, you guessed it, we’d like to discuss a few of them here today.

After the death of a loved one, you may experience anxiety because…

…you are trying to avoid unpleasant thoughts, memories, and emotions.

I want to start by discussing avoidance because the act of avoidance is involved in perpetuating all of the scenarios to follow. When we talk about avoidance in grief we are usually referring to experiential avoidance. As we noted in a previous article about avoidance…

“Experiential avoidance is an attempt to block out, reduce or change unpleasant thoughts, emotions or bodily sensations.  These are internal experiences that are perceived to be painful or threatening and might include fears of losing control, being embarrassed, or physical harm and thoughts and feelings including shame, guilt, hopelessness, meaninglessness, separation, isolation, etc.  Now please note I say “perceive to be painful or threatening,” these judgements are often subjective and what is perceived as threatening to one may seem totally irrational to another.”

Although grief is always unpleasant and uncomfortable, for some there are aspects that actually seem threatening and these perceptions can lead to attempts to control or avoid frightening feelings and reactions. Although avoidance can be useful in certain scenarios, for many it can become a harmful cycle that persists to the detriment of personal healing.

Many mistakenly think that if they make efforts to avoid their feelings for long enough these unpleasant emotions will be kept at bay or fade away, when in actuality deliberate attempts to suppress certain thoughts often make them more likely to surface. Avoidance is a large factor in the development and maintenance of anxiety.

…it’s a learned response.

There may be elements of your loved one’s death that, in the moment, you perceived as traumatic and terrifying. (We’ve written on traumatic grief before, you can find that article here) One of the quickest routes to acquiring fear and anxiety towards an object or situation is through a direct, negative experience.

When something traumatic happens the thoughts, emotions and sensations experienced in that moment can become paired with objects and situations associated with the event. Psychologists call this phenomena, Classical Conditioning.

Here’s an example, a parent’s phone rings at 5am and the person on the other end tells them that their son unexpectedly died in a car accident the night before (I’m sorry if this situation hits too close to home).  Before this moment a phone ringing in the morning might not have given the parent a second thought, but now every time the phone rings before 8am the parent feels a temporary surge of panic.

Many people can pinpoint at least one thing that, since their loss, makes them feel anxious in ways it never did before.

…you fear grief emotion

The relationship you have with your emotions is complicated and nuanced. People begin learning about emotion from a very early age through learning and observation. Beliefs about emotion can be impacted by many factors, but some common influences include…

  • Adult role models (what they told us and how they handled emotions themselves)
  • Cultural and societal messages and norms
  • Religion
  • Television, books, and movies
  • Personal experience

The death of a loved can evoke such new and distressing emotions that test your existing understanding of emotion.

After a death mourners often feel as though they are going crazy.  If a person interprets their symptoms as dangerous, threatening, or indicative of a larger mental or physical problem, they are more likely to fear their reactions. Those who fear grief responses and grief related emotions (i.e. fear of emotion and anxiety themselves), will likely experience increased feelings of anxiety in a world where emotion is unpredictable and easily triggered. Those who are fearful of their reactions may also engage in maladaptive and persistent avoidance of triggers or reminders of the death or of their loved one, which can prevent the mourner from learning to cope with their thoughts, emotions, and memories, and contribute to the development of ongoing anxiety.

…you aren’t confident in your ability to cope

A person may also experience anxiety if they have little confidence in their ability to cope with their emotions, either because they feel their coping skills aren’t sufficient enough or because they feel that they can’t control their emotions. As noted by Abramowitz, Deacon, and Whiteside (2012),

“Clinically anxious patients typically underestimate their capacity to control or cope with perceived threats, as well as their fear reaction to such threats.”

Although only some people will experience anxiety that would be considered “clinically anxious”, it’s normal to feel anxious about experiencing new emotions, grief triggers, and painful memories. For this reason, we caution people from resisting to temptation to chronically avoid, and encourage people to search for the coping tools that will help them deal with their grief little-by-little.

…you now know bad things can happen.

Prior to your loved one’s death you may have assumed that the world was a good and benevolent place where things happened for a reason. You may have also subconsciously believed that bad things wouldn’t happen to you.  When something bad did happen your assumptions about the world became shattered and the world turned upside down. Depending on your understanding of what happened to you and your loved one, you may now hold new beliefs or engage in modes of thinking that contribute to feelings of anxiety such as probably overestimation, cost overestimation, and intolerance of uncertainty.

Probability overestimation: You may overestimate the likelihood of bad things happening.  Perhaps you overestimate the likelihood of the event that led to your loved ones death, like cancer, accidents, or violence, happening to you or to other loved ones. Or perhaps your loved one’s death led to the belief that bad things can happen to anyone at any time and now you feel that disaster is likely to strike at any moment.

Cost overestimation: Cost overestimation occurs when someone believes that the consequences of something happening will be worse than they truly are.  For example, you may worry that if you encounter a grief trigger in public you will become emotional and lose control in front of everyone and that this will be a mortifying experience. Because you believe that the pain of experiencing this event is so excruciating, you may feel anxiety over the possibility of it happening and engage in avoidance to prevent it.  However, by never allowing yourself to experience the event, you are never able to learn that (1) the cost isn’t as high as you assumed and (2) you are capable of coping with the experience.

Intolerance of uncertainty: Some people have a very hard time dealing with even the remote possibility of something bad happening. Even if the odds of an event occurring are very low, the uncertainty of whether it will happen is enough to cause intense anxiety and distress.

Many of you have learned first hand that worst case, low probability, scenarios can happen, so it may be futile for anyone to tell you to take comfort in the likelihood that these things won’t happen. As someone who has experienced the unlikely, the task for you becomes learning to live in an unpredictable world that you can’t completely control.

…you don’t want to find yourself caught of guard.

There an interesting theory put forth by Michelle Newman and Sandra Llera (2011) to explain worry and avoidance in Generalized Anxiety Disorder (GAD) called the Contrast-Avoidance Model. Newman and Llera (2011) theorize that people with GAD, “…use worry as a coping strategy because they prefer to feel chronically distressed in order to prepare for the worst outcome, rather than to experience a shift from a positive or euthymic state to a negative emotion.”

Newman and Llera (2011) point out, that worry preceding a negative event provides protection from experiencing a drastic increase in negative emotions when the event happens. This makes sense if you think about it because our society promotes worry all the time. We say things like, “brace yourself,” and “don’t let your guard down,” which translates to, “don’t let something bad happen when you least expect it. 

…you are experiencing an anxiety disorder or post-traumatic stress disorder

Anxiety disorders are one of the most common mental health disorders. Logically, many people who already struggle with anxiety will experience grief.  For others, the death of a loved one may lead to new and unfamiliar struggles with anxiety.

While it’s normal to experience a sense of fear and apprehension during times of hardship and high stress, if you feel that you are experiencing excessive worry and panic in the absence of an actual threat and for a prolonged period of time then you might want to speak to a mental health professional.  Your situation is unique and the best way to truly understand your anxiety related experiences is to speak to a trained mental health professional in a one-on-one capacity.  That said, here are some articles that you may find helpful.

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