Anxiety- The Missing Stage of Grief

by Claire Bidwell Smith

  An example here would be when you have a thought that maybe that pain in your side is a cancerous tumor. Instead of following the thought down the rabbit hole and playing out the scenario in which you are diagnosed with cancer, try to catch it and recognize that you are having an anxious thought. Then move on to the next step.

  3. Gather Evidence

  Become a detective of your own thoughts. Each time you have an exaggerated anxious thought, look for evidence that it is true. Write down the evidence you collect and rate the likelihood of the outcome. Doing this serves two purposes. It serves to help you see that often the catastrophe you are imagining is often unlikely, and it also helps distance you from the thoughts, making you a powerful observer of them.

  4. Create a Cost-Benefit Analysis

  Many of us who have been living with anxiety have grown used to it. However, we forget how exhausting and unfulfilling it can be to live in such a state of hypervigilance. Looking at the costs and benefits of this way of being can be a powerful way to change your thinking about how you’ve been living. Write down all the costs and benefits of your anxiety. Return to this list when you are anxious to remind yourself of the unhealthy costs.

  5. Embrace the Catastrophe

  Most of us run from our catastrophic thoughts. We have them, then have an intense physical and emotional reaction, and generally shut down from there. However, allowing yourself to really embrace the catastrophe helps to diminish it. Really allow yourself to play the scenario all the way through and generate coping methods that you would use along the way.

  6. Correct Your Thinking

  Now that you’ve started to identify your problem thoughts, it’s time to correct them each time you become aware of them. Note the exaggerated thought, and then write down any errors associated with that thought. You can watch for these errors every time you have an anxious thought.

  In cognitive therapy, the real shifts occur when we become aware of our exaggerated anxious thoughts and take steps to change them into normal thoughts. Doing the above work will help you to make this powerful shift.

  However, if you are feeling resistance to this work, I want you to keep a couple of things in mind. One, it’s important to remember that this kind of work takes time and practice and patience. If you feel overwhelmed but think these techniques could be useful to you, then enlisting the help of a therapist trained in CBT can be beneficial. Second, it’s important to recall many of the messages in this book about how letting go of anxious thoughts does not mean you are letting go of your loved one. You can still grieve your loved one but do so in a less anxious state.

  THE DOCTOR WEIGHS IN

  For more advice on CBT methods, I turned to Dr. Philip Pierce, whom you’ll recall from Chapter 1. A University of California lecturer and psychologist in private practice in Los Angeles, Dr. Pierce, PhD, specializes in treating anxious patients using CBT methods.

  “People think of worry as a protective mechanism,” Dr. Pierce told me. “This can be one of the precipitating things for panic attacks. I don’t think this is such a conscious thing. I think it’s an unconscious mechanism. But I think quality of life is significantly decreased because people are making negative predictions most of the time about things that rarely, or probably, won’t happen.”

  This is that state of hypervigilance I spoke about earlier in this chapter. When we choose to maintain that state, it can feel like we are doing so because it will help us be prepared in case something terrible happens, but, really, it is just causing more stress and lending itself to more panic attacks.

  “To work with someone, I would start by making them aware of their worry. They’re thinking of it as a protective mechanism. They think their worry is helping. What if something happens and I hadn’t thought of it? If I hadn’t prepared, then I could never forgive myself. But this behavior actually decreases quality of life.”

  For the kind of grief-related anxiety this book focuses on, Dr. Pierce also reinforces the usefulness of the tools covered in this chapter and also suggests breathing techniques.

  I would have patients do thought records to help them identify the thoughts that are triggering the anxiety. I would give them tools like, “Let’s go to the worst possible thing that could happen and explore how emotionally likely it is, how realistically likely it is.” And the most important part is, “How would you cope with that?” People usually stop once they get to the worst possible case scenario, telling themselves, “Oh my god, that would be terrible.” And they stop there, and they’re frozen in that spot, as opposed to “How likely it is, and how would you cope with it?” I would also give them relaxation exercises, like diaphragmatic breathing or progressive muscle relaxation, to decrease their anxiety level in general.

  Diaphragmatic breathing is breathing that is done by contracting the diaphragm, rather than focusing on the lungs. Air enters the lungs and the chest rises, but the diaphragm, the muscle located horizontally between the ribs and abdomen, contracts and expands.

  Dr. Pierce explains, “When you start getting anxious the tendency is to take short fast breaths from your upper chest to get as much oxygen as possible into your bloodstream. What you’re doing with diaphragmatic breathing is sort of the opposite. You’re resisting the fast breathing, so it has a calming effect. You’re also sending a message to the brain that things are cool and there’s no emergency here.”

  DEEP BREATHING AND RELAXATION

  1. Sit comfortably, or lie down on your back in a relaxed state, with one hand on your stomach and one hand on your chest.

  2. Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain still.

  3. Tighten your stomach muscles, letting them fall inward as you exhale.

  Practice this technique for five to twenty minutes until you feel your body begins to relax.

  Progressive muscle relaxation is when you relax your muscles through a two-step process. You begin by systematically tensing particular muscle groups in your body, such as your neck and shoulders. Then you release the tension and notice how your muscles feel when they are relaxed.

  1. Lie down in a comfortable position on your back.

  2. Begin by focusing on a target muscle group—your legs, for instance. Take a slow, deep breath and squeeze the muscles as hard as you can for about five seconds. It’s important to really feel the tension.

  3. Next, quickly relax the tensed muscles. After a few seconds, you should feel all the tension flow out of your muscles, and they will become loose and limp.

  4. Deliberately focus on the difference between the tension and the relaxation. This is the most important aspect of this exercise.

  5. Remain in this state for fifteen to thirty seconds, and then move on to the next muscle group and repeat steps 2 and 3. Systematically move through every muscle group of your body.

  Any time you feel anxious, try this exercise as a way to relax and ease tension that comes with anxious thoughts. This sends a message to the brain that all is well.

  BYRON KATIE’S METHOD OF SELF-INQUIRY

  Another fascinating authority in this field is Byron Katie. The author of multiple books, Byron Katie is known for her method of self-inquiry, a system that teaches people how to look at their thoughts and beliefs and shift them to attain better outcomes.

  In the Motherless Daughters retreats I lead with Hope Edelman, we always employ Byron Katie’s work, as many of the women we are working with have developed belief systems following the loss of their mothers that do not serve them in their day-to-day lives.

  Byron Katie’s work is quite simple, and it is based around four essential questions:

  BYRON KATIE’S FOUR QUESTIONS

  1. Is it true? (Yes or no. If no, move to number 3.)

  2. Can you absolutely know that it’s true? (Yes or no.)

  3. How do you react? What happens when you believe that thought?

  4. Who would you be without that thought?


  Okay, so let’s break these down. I’m going to give you an example using one of the beliefs I developed after my mother’s death. Hope and I have discovered that it’s a belief that many motherless daughters carry. And I suspect that many people who have lost a significant loved one are subject to it as well.

  The belief that I carried with me for a long time after my mother died was I am alone.

  Let’s apply Byron Katie’s questions to this belief.

  1. Is it true?

  When I first started to work with this belief, I answered yes to this question. At the deepest level, I felt incredibly alone after my mother’s death. Her absence left me feeling wholly on my own in the world. So initially I would have answered yes to this first question.

  2. Can you absolutely know that it’s true?

  Okay, so when I had to answer this question, I had to admit to myself that no, it was not really true. Even when I was married, I felt alone. But that wasn’t really true, was it? I was not alone. Not at all. In fact, I was surrounded by people who loved me and cared for me.

  3. How do you react? What happens when you believe that thought?

  I had to admit that my reaction to that thought caused immediate sadness and anxiety. There was never a time when I had the thought and did not respond with negative emotions. These emotions created more self-limiting thoughts and a lot of fear.

  4. Who would you be without that thought?

  Wow. This final question always served to stop me in my tracks. Who would I be without that thought? I had never considered it. I had never even considered letting go of the thought because I believed it so deeply. Yet I couldn’t deny that the idea of being a person who didn’t have this thought was very appealing.

  This is where the transformation took place. I suddenly realized that I could have that thought but that I didn’t have to believe it. And as soon as I had this realization, I quickly began to notice each time I had that thought, and then I began to make a choice about whether to believe it. In the beginning, I had been so used to believing this thought that I sometimes still went with it, spiraling out into anxiety and sadness, but now there was this new and very persistent voice that made me question if doing that was really serving me.

  Still to this day, I sometimes have that thought. I am alone. Something difficult will arise in my life, and my initial reaction will be this thought, this belief. But I almost always catch it now. “Hi, old thought,” I’ll say to it. And then I will remind myself that I am not actually alone, and I will move through the difficult event with a healthier attitude, knowing I can cope with whatever hard thing is at hand.

  In fact, Byron Katie’s work became useful in all areas of my life. I began to understand how many false reactions I had to life stressors or perceptions about relationships and people, and once I was able to see this clearly, it became easy to change the thoughts. I’d like you to try it for yourself now.

  Think of any of your big current fear-based beliefs. They can be anything from “I will always be sad” to “I cannot cope with my grief and anxiety.” Answer truthfully, and take your time to really think about your answers.

  YOUR SELF-INQUIRY

  Is it true? (Yes or no. If no, move to number 3.)

  1. Can you absolutely know that it’s true? (Yes or no.)

  2. How do you react? What happens when you believe that thought?

  3. Who would you be without that thought?

  Much like cognitive behavioral therapy, Byron Katie’s work asks us to become aware of our thoughts and beliefs and to then deconstruct them, allowing ourselves freedom from anxiety, worry, and negativity. Byron Katie’s work is a simpler approach to many of the CBT angles presented earlier, but it is also a quick and easy place to start.

  AWARENESS, AWARENESS, AWARENESS

  Learning how to become aware of your thoughts is the most effective way to treat anxiety. When we lose someone we love, our worst possible fears have come true. This causes us to become more hypervigilant in our lives and to overcatastrophize uncertainty. Using techniques of thought awareness and reinforcing your innate ability to cope with difficult life events will help you gain control over your anxiety.

  Throughout all of this work, be patient with yourself. It really does take some getting used to, but if you are able to make a solid commitment to working on your thoughts in this fashion, you will begin to experience palpable relief from your anxiety and worry.

  A NXIETY C HECK-I N

  Let’s check in with your level of anxiety. Hopefully, this last chapter was an illuminating one, helping you understand where anxious thoughts come from, how they can perpetuate themselves, and also how you can stop the cycle of worry and panic.

  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

  Learning how our brains work and where anxious thoughts come from and how we can learn to control how much we feed into those thoughts is an integral part of knowing ways to reduce and eliminate anxiety. In the next chapter we’re going to focus on mindfulness and meditation, techniques that build on everything we’ve learned here. Go slowly and be patient with yourself as you digest everything you’re learning.

  9 | Being Present

  We must be willing to encounter darkness and despair when they come up and face them, over and over again if need be, without running away or numbing ourselves in the thousands of ways we conjure up to avoid the unavoidable.

  —J ON K ABAT-Z INN

  M INDFULNESS AND MEDITATION HAVE CONSISTENTLY BEEN THE most powerful antidotes to healing the anxiety of the majority of my clients and also my own. Please don’t stop reading if you think that meditation isn’t for you. This chapter is about much more than meditating, and it builds on everything we learned in the last chapter. Mindfulness and meditation are about becoming aware of our thoughts and using that awareness to break free from anxiety.

  If you’re like me, you wake up in the morning, and the moment you open your eyes, a ticker tape of thoughts begins rapidly flowing through your brain like the headline banner on the bottom screen of a news channel. Sometimes the thoughts are just daily maintenance ones—you have to give that presentation at work today, your kid has a math exam, you’ve got a dentist appointment in the afternoon, and you have to remember to get lightbulbs on the way home.

  Mixed in with these thoughts are larger ones—how am I going to cover the car repair expenses, could that persistent ache in my shoulder be something serious, or does my boyfriend really love me? And often when we are in the throes of grief, our thoughts are colored by the loss. You wake up, and the first thing you think about is how it’s another day without the person you love. Then a bigger thought is wondering if every day is going to feel this hard. Will you always be sad? You may flash to an image of that person—maybe one from their dying days that continues to haunt you or even a fond memory that then causes you pain.

  There is seemingly little order to any of these thoughts, either the small ones about running errands or the bigger ones about your future. They just flow through your mind, and eventually you push yourself out of bed and begin to go through your morning routine, yet all the while the thoughts keep streaming through your mind. The thing to note is that every single one of these thoughts creates an emotional response. Each one may bring something different—anger, fear, frustration, sadness, or even despair. And those emotional responses, in turn, create a physical response in your body.

  What I’m going to teach you in this chapter is how to become aware of these thoughts, how to have compassion for yourself when you have them, and ultimately how to stop them from causing you anxiety.

  Teaching my clients this tool and helping them understan
d the foundation of mindfulness is one of my favorite aspects of the work we do together. And that’s because I’ve never failed to see them achieve rapid results if they truly give this practice a try.

  I also lead meditation workshops at each grief retreat I hold. Learning how to get quiet and hold space for ourselves is vital, but also learning how not to let thought patterns and negative beliefs dominate our days and send us on a roller coaster of emotions is important.

  I was first introduced to mindfulness and meditation in my late twenties. I had newly discovered yoga, and even though I’d spent a large part of my life largely shrinking from any kind of serious physical activity due to a fear of connecting with my body after watching my parents die from illness, I was immediately comfortable with yoga. I was surprised by how good it felt to stretch my body and to finally begin to pay attention to it. I was also happy to find that I didn’t need to be “good” at yoga in order to enjoy the benefits.

  Not long after I had developed a regular yoga practice, I made a friend in one of my classes who suggested I also try meditation. I balked at first. It sounded too hippie and spiritual for me. But I went anyway. During this time in my life, I was emerging from an intense few years of grief, and I had a great desire to turn my life around and find ways to feel peaceful and happy again. I decided it couldn’t hurt to try meditation.

  Now when I tell this story to my clients or at the grief retreats I lead, I always chuckle to myself, thinking back on that twenty-eight-year-old version of myself. That version of myself never could have imagined that one day I’d not only actually be meditating regularly but even teaching others how to do it.