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When I went through the deaths of my parents, I didn't know where to turn. I didn't know what books to read or who to talk to. I didn't know how to grieve, so I didn't for a long time. I tried to push away my grief, and it bubbled out in depression, anxiety, and relationship troubles. I really struggled to find a place in my life for my grief. I kept pushing forward, and my grief kept spilling out in different places.

One of the biggest places my grief appeared was in the form of anxiety. I started having panic attacks shortly after my mother died. I ended up in the ER, my heart racing. For a long time, I just struggled with my anxiety, not linking it to the loss of my parents.

It was not until some college classes that I started to learn about trauma and grief. I realized my anxiety was linked to going through so much loss at such a young age.

Around 2010, I wrote an article for Slate called "Anxiety: The Missing Stage of Grief." I got more emails and letters than from any of my talks or books. So many people wrote to me and said, “Is this real, this connection between grief and anxiety?” My office filled up with people suffering from grief and anxiety, and it was something I began to study.

When we go through a big loss, we have this reminder that things aren’t up to us. This can cause an enormous amount of anxiety. I see this for people who have never gone through a loss and then go through a very significant loss: a close family member, a close friend, a spouse. It makes the world feel completely different, and not knowing how to navigate this new world can bring up a lot of anxiety.

These new emotions can show as panic attacks or outbursts of anger. How do you go from your regular life to incorporating all these emotions stemming from your grief? It's hard to figure out where to turn, and it can cause a lot of anxiety. People can get anxious about going into a social situation, worried that they’ll have a grief attack, start crying in the middle of a presentation, or have an angry outburst. Just worrying about these things can cause even more anxiety.

The new or deepened fear of mortality is a part of it. As much as we know that life comes to an end at some point, we often operate as though it doesn't. We're not great, particularly in Western culture, about talking about the end of life, embracing it, and preparing for it. When someone dies unexpectedly, it reminds us that we are mortal and we're not going to be here forever.

Inadequate processing of grief is a major factor as well. I can't tell you how many clients have come to me years after a big loss, having tried everything not to process their loss. That led them to pushing down everything and having it spill out in other places.

The important thing about anxiety is that it is possible to work on it, to diminish it, to get your hands around it and get some control over it. When we don't, it becomes quite insidious. It builds and builds and becomes this big loop of anxiety that we get stuck in, and it can be very debilitating.

So how is grief-anxiety different from general anxiety?

It's linked specifically to the grief. Your client may have never been anxious before or had normal amounts of anxiety, and then they went through a significant loss and started having panic attacks. They may have had a certain level of anxiety throughout their life, but after a loss it’s been exacerbated. Your client will likely have a lot of anxiety about death, excessive ruminations around death, anxious attachments in relationships, and avoidance of their grief.

When I begin to work with an anxious client who has gone through a major loss, these are the first steps I take:



This is an adapted excerpt from Claire Bidwell Smith's keynote at the ������Ƶ Grief Summit. to access the self-study course.