Most of us do not like to think about grief. But when we do, what often comes to mind are the well-known “stages of grief”—denial, anger, bargaining, depression and acceptance—coined by the late Elisabeth Kübler-Ross.

Never mind that the Swiss-born psychiatrist originally intended her stages to describe the experiences of people facing their own deaths, not grieving someone else’s. Or that she eventually made clear that not everyone goes through all the stages or in the same predictable order.

The missing stage: What’s become increasingly clear is that one extremely common and often debilitating stage of grief is not included. That stage is anxiety. 

One landmark study published in American Journal of Psychiatry found that the onset of generalized anxiety disorder is strongly associated, especially after age 40, with the unexpected death of a loved one. Beyond that, there’s little research on how many people become anxious—or more anxious—after a death, yet it’s something grief counselors see all the time.

It makes sense. When someone close to you dies, one of your worst fears comes true. You are reminded that your own life will end some day, that bad things happen and that you are not always in control.

And maybe you were anxious already. Nearly one in five adults has suffered from anxiety in the past year, and nearly one in three has experienced an anxiety disorder sometime in their lives, according to the National Institute of Mental Health. 

If you are one of those people, you may be especially vulnerable to renewed or intensified anxiety when a loved one dies. You may feel constantly worried, fearful, restless, jittery and irritable and may experience physical symptoms, such as a pounding heart, shortness of breath, muscle tension and sleeplessness.

For some people, the first undeniable sign is a panic attack—a sudden sense of impending doom that can be accompanied by rapid heartbeat, sweating, nausea, shaking, choking and a fear that you are going crazy or are about to die. 

People often say that anxiety symptoms “come out of the blue.” But here’s what’s often going on—a buildup of suppressed stress and emotion has finally found a way to get your attention. You can try in vain to push the feelings back down…or deal with them—and work past the anxiety. Here are some of the most effective ways to do that… 

Step #1: Tell your story. If you are fortunate, you will have a safe friend or family member who is willing to listen to your story—including your regrets and fears—without judgment or advice. 

Many people find it helpful to see a professional grief counselor or attend a bereavement support group. Many hospitals and hospice organizations offer them, and finding one near you is likely just a Google search away. Many groups are organized by age or type of loss (for example, the loss of a spouse, parent or child or a loss due to suicide). Online grief forums can sometimes be valuable as well. 

Step #2: Hear (or read) others’ stories. While it can be difficult at first, many people eventually find comfort in hearing or reading about the losses others have experienced. It can help you to feel less alone and less anxious. You can find that fellowship in a support group and by reading about others’ experiences in online forums and books. 

Some good memoirs to consider include: Wild by Cheryl Strayed (who lost her mother)…The Year of Magical Thinking by Joan Didion (who lost her spouse)…Her by Christa Parravani (who lost a sibling)…and Truth & Beauty by Ann Patchett (who lost a friend). There are many more. If reading is difficult for you at this time, consider listening to an audio version of the book. 

Step #3: Release yourself through writing. Many people are filled with regrets and a sense of guilt after a significant loss. Maybe they were not there when their loved one died. Or they think they said the wrong thing to the dying person. 

One way to deal with such feelings: Write a letter to your deceased loved one. Apologize, if you feel the need, or say goodbye in the way you missed out on before. Some people also write letters to themselves—forgiving themselves, with kindness and compassion, for any perceived mistakes. 

You can use writing to probe any feeling—including those you might be reluctant to admit to others (such as relief that a loved one who was suffering has died). Get a beautiful blank journal and try to use it for even just five to 10 minutes each day for as long as you feel the need. You can start by just writing what you are feeling—something like “I’m lonely” or “I’m scared,” and then just keep writing for 10 minutes. If you’re intimidated by the thought of writing out your feelings, you can dictate your feelings into your smartphone.

Step #4: Consider using cognitive ­behavioral therapy (CBT) techniques. CBT is a short-term treatment ­often used for anxiety. It is a practical approach that helps people recognize and change thoughts and beliefs that contribute to their distress. While some people need the help of a therapist, there are CBT techniques you can try on your own. The Anxiety & Worry Workbook by the renowned American psychiatrist Aaron T. Beck, MD, is an excellent resource for this, as well as apps you can use on your smartphone. 

Among the things you might try: Writing a list of your anxious thoughts (like I’m afraid I might have cancer)…noting the physical symptoms (such as a rapid heartbeat) and cognitive symptoms (such as an underlying fear that you will die just like your loved one did)…and observing the way you behave as a result (avoiding doctor appointments or seeking reassurance online). 

Becoming aware of such links is a step toward breaking these negative patterns. But this can be hard—if you feel your anxiety is out of control and interfering with your life, be sure to seek professional treatment. 

Step #5: Try meditating. Like CBT, meditation is, at its core, a technique for helping you notice your thoughts—and break free from those working against you. Your mind may be humming with worries about the future, but you can learn to live in the present. It can be as simple as taking a few minutes each day to sit and focus on your breath moving in and out of your body, letting your thoughts come and go without ­judgment.   

Skeptical? Just give it a chance. You might start with a class or workshop or get a good guidebook, such as Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life by professor and meditation teacher Jon Kabat-Zinn, PhD. 

Step #6: Start planning your own death. It might sound counterintuitive to think about your own death when you’re grieving the loss of someone dear to you. But remember this—the root of anxiety is uncertainty. Planning for your eventual death can help set your mind at ease…and lessen the anxieties of those we leave behind. 

So get your own affairs in order—write (or update) your will…decide on a health-care proxy…create an advance directive…make your funeral ­wishes known… and let your friends and family members know what you would like them to have when you are gone. This can be scary, so take your time and enlist the support of a professional and/or friends and family members. But facing your fears can help you put them in their place and get on with life.  

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