Anticipatory Grief: How to Cope & When to Get Help

What Is Anticipatory Grief?

Anticipatory grief occurs prior to an expected loss. Essentially, it refers to feelings associated with a loss that someone knows is coming. Typically, anticipatory grief is associated with impending death, however, the definition of anticipatory grief has expanded to include other major losses.¹

When Would Someone Experience Anticipatory Grief?

Examples of anticipatory grief include:²

• Primary caregiver may grieve while caring for a seriously ill loved one
• Someone may grieve the loss of partnership during the process of divorce
• Someone with a terminally ill spouse may begin grieving before their spouse’s death
• Someone whose employment contract is ending might grieve their loss of income and livelihood
• Someone with a debilitating chronic illness might grieve the loss of their independence
• Child whose best friend is moving away might grieve the loss of a meaningful friendship

Anticipatory Grief Vs. Grief After a Death

Grief is a term used to describe the intense and sometimes overwhelming feelings that occur following the death of a loved one.² Typical grief occurs after a loss while anticipatory grief describes feelings that begin before an expected loss. In short, anticipatory grief may be conceptualized as the grieving that’s done leading up to the actual loss, and may also be accompanied by anticipatory anxiety.

Anticipatory grief is sometimes used interchangeably with the terms “pre-loss grief” or “pre-death grief,” or “anticipatory bereavement” because it refers to the symptoms of grief in the period of time before death or loss.¹ It is important to remember that not everyone will experience anticipatory grief.

Anticipatory Grief Symptoms

The symptoms of anticipatory grief are very similar to typical symptoms of grief. A person may experience a combination of feelings, thoughts, behaviors, psychological symptoms, and physical effects grief.⁴

Common symptoms of anticipatory grief include:^3,4

• Guilt
• Denial
• Helplessness
• Shock
• Numbness
• Tearfulness
• Depression
• Anxiety
• Anger
• Sadness
• Disbelief
• Preoccupation
• Difficulty concentrating
• Confusion
• Impaired ability to function or perform tasks (sometimes called grief brain)
• Dizziness
• Stomach upset
• Fatigue
• Tightness in the chest

Grief Vs. Depression

According to the DSM-5, the common feature of depressive disorders is sadness, or an empty or irritable mood, which is accompanied by cognitive or physical changes. A person’s ability to function must be affected by these symptoms in order to be clinically diagnosed with depression.⁷

Grief and depression share many of the same feelings, thoughts, behaviors, and psychological and physical symptoms. A trained professional is helpful in distinguishing between normal feelings of grief versus depression.

Signs and symptoms of depression include:

• Low or depressed mood
• Loss of interest and/or pleasure
• Appetite changes
• Sleep changes
• Loss of energy
• Fatigue
• Feelings of worthlessness, hopelessness, or helplessness
• Difficulty concentrating
• Suicidal thoughts or recurrent thoughts of death

The Stages of Anticipatory Grief

There are four designated stages that occur with anticipatory grief, though they don’t have to happen in any specific order and there is no special time frame associated with any of these stages. The stages of anticipatory grief may occur simultaneously and there may not be any distinct beginning or ending for each of the stages. Emotions can be fluid, intense, or expected as people begin to prepare to face the loss of a loved one. One day you may be flooded with emotions and the next you may feel emotionally empty.

Here are the four stages of anticipatory grief:

Stage 1. Recognizing Death as Inevitable

In this stage there is at least an intellectual understanding that a loved one is going to die, as well as an awareness that no cure is available to stop the dying process. The primary emotions experienced in this stage are depression and sadness. The person dying and their loved ones can both share these beliefs.

Stage 2. Concern for the Dying Loved One

This stage is primarily focused on concern and support for the loved one who is dying. It is a time for close family and friends to look back on previous interactions with the person dying that did not go well. This stage may be influenced by feelings of regret or guilt. In this stage, the person who is dying may begin to reflect on their feelings and fears about their impending death.

Stage 3. Rehearsing the Death

This can be an especially poignant and challenging phase. Discussions are held between the patient and loved ones about what life will be like without them. Often in this stage, time is made to speak about funeral or memorial plans. It is also when people begin to exchange their goodbyes and talk about what their relationship and life together has meant.

Stage 4. Imagining the Future

This stage offers time to begin to consider what life without a significant loved one will be like. How will it feel to participate in milestone events like birthdays without them there? The person who is dying may consider what happens after death and imagine how life will be for loved ones when they are gone.

Are There Any Benefits to Anticipatory Grief?

Anticipatory grief triggers the exploration and sharing of feelings between loved ones and the person who is dying. It can eliminate regrets or confusion for loved ones questioning whether they honored the final wishes of the person who has died. It also gives all of those who participate in this process a chance to clear up any previous misunderstandings.

There are mixed opinions about whether anticipatory grief lessens the emotional pain after a loved one has died. Having an opportunity to process and cope with feelings prior to a death can help many people to cope after the loss of a loved one. This is especially true when this death and dying process is facilitated by healthcare professionals like hospice staff and other bereavement specialists.

How to Deal With Anticipatory Grief

There are many ways to support yourself and reduce negative feelings when living with anticipatory grief. Acknowledgment and acceptance of your feelings, learning more about the grief process, mindfulness and meditation, exercise, and talking with someone are healthy ways to cope with anticipatory grief.

Here are nine strategies to help you to deal with anticipatory grief:

1. Consult a Therapist

Talking with a trained professional can help you to cope with your feelings. Addressing anticipatory grief may help you to feel more prepared for the loss when it occurs. One-on-one counseling can help to facilitate and improve adjustments to the loss and create better coping skills and mechanisms. Grief counseling can provide a safe, non-judgmental space to process difficult feelings and emotions.

Family counseling may be helpful when the loss affects the entire family. Group therapy or support groups can provide an opportunity to heal and connect with other people who have a shared experience and a common purpose.

2. Educate Yourself

Grief is not linear and you can begin your grief process at any point. For example, if you have a loved one in your life who is ill, it’s common to feel grief as you come to an understanding that we all have to face our own mortality. It’s important you learn about what grief is and read books about grief as well. It can really help to validate your grief experience and learn more about what others do to cope. Once you learn what your feelings are and why you are having them, it makes it that much easier to manage them.

3. Find Sources of Support

For some people, it is helpful to know they aren’t alone in their grief. Lean on friends and family who are understanding and supportive. Find connection and comfort in a spiritual or religious community. Connect with online resources and support communities.

4. Accept Your Feelings

Accept that how you are feeling is normal. Acceptance doesn’t mean that you agree with or want to feel the way you do, it simply means that you acknowledge your feelings, and you are not actively fighting them or the reality of the situation.

5. Practice Self-Care

Stay physically well by nourishing your body with healthy foods, getting enough rest, and exercising. Spend time doing things that you would typically enjoy such as taking a walk, listening to music, or reading a book. Try grief journal prompts to express any emotions you may be feeling. Use relaxation techniques such as guided meditation or mindfulness.

6. Make the Most of the Time You Have Left

Another way to cope is to really make sure you are spending quality time with your loved one. It’s important to take these moments in and make sure you are having meaningful conversations and are able to remember good times together before you are apart. For those leaving jobs or moving to a new area, it can also be a hard time, but knowing you have an end date in that job or place can help you make sure you take time to prepare. Spending the time you have left doing things that are positive and peaceful can be a good way to cope.

7. Forgive & Accept

Loss can bring up a lot of challenging emotions. It’s common for people to have feelings of frustration and anger, and feeling as though things are unfinished is a common source of pain for both those who are dying and those who are watching a loved one die. Learning to cope can mean learning to accept what cannot be changed. For some, it can involve resolution and forgiveness, and it can make everyone feel better after getting through those conversations and knowing you’re in a good place before the change occurs.

8. Address Any Unresolved Matters With Your Loved One

One of the major emotions that comes up for people when a loved one dies is a feeling of regret. This regret is about things that were said or left unsaid in the past. There is regret regarding the fact that there will not be another opportunity to address unresolved issues. Anticipatory grief offers a chance for resolution if you choose to take it.

9. Ensure That Legal & Financial Matters Are Taken Care Of

There are many financial and legal matters that must be addressed after a death. Make sure you understand what is in place and where information on finances and legal status can be found. Confirm that you have access to all of it and identify a lawyer or financial advisor who may have worked with a deceased loved one to assist you. This process can be very complex depending on what is in place, so making sure you have access to everything you need can ease the grieving process.

When to Get Professional Help for Anticipatory Grief

Professional help might be warranted when anticipatory grief causes clinically significant distress or impairment in any area of their life. Outside help may be beneficial if there’s uncertainty whether your feelings of grief are normal, and it may be helpful to contact a medical professional or a therapist for assessment, guidance, or treatment.

Strong physical reactions, disabling feelings, extreme depression or anxiety, or destructive behaviors are symptoms indicating that an assessment or consultation by a medical professional or therapist should be considered.

Who Should I Consult For Help?

Therapists, especially those with extensive training in grief and loss, may be helpful to reach out to for support. Hospice and palliative care social workers and counselors are also specially trained in this area and are often part of a multidisciplinary team involved in the care of terminally ill individuals.

Support groups are excellent sources of support, resources, and guidance. Specifically, grief support groups, bereavement groups, or caregiver support groups. Connecting with people who have a shared experience and purpose can be helpful.

How to Find a Therapist

Begin your search is with a trusted medical professional, such as a primary care physician or family doctor. Ask friends and family for recommendations, too. Another way to locate a therapist, especially if you plan on using health insurance, is to contact your insurance company directly for a list of in-network providers and inquire about out-of-network provider benefit information.

There are also many online therapist directories where you can search by geographical location, discipline, and specialization.

How to Support a Loved One Through a Time of Anticipatory Grief

Supporting a loved one during a time of grief can be challenging. It can be hard to know what to say to someone who has lost a parent, family member, or other loved one, and you might worry about doing or saying the wrong thing. It may be difficult to be around the intense and overwhelming feelings and emotions of grief, but your loved one needs you more now than ever.

You can show support to someone who is grieving in these ways:

• Allow the grieving person to share their feelings and communicate openly: try to listen without passing judgment or giving advice. Having a safe space to share difficult feelings may be an invaluable source of support to a person dealing with grief and loss.
• Make specific, rather than general, offers of assistance: practical help, such as doing light chores, running errands, providing childcare, or preparing a meal are all ways to provide tangible assistance.
• Be empathetic: what may not be helpful to a grieving person is saying that “Everything is going to be ok,” because this is likely not what they are feeling at the present moment. Empathy is a much better approach. For example, “This must be very difficult for you to go through. It must be profoundly difficult to endure this type of loss.”
• Acknowledge their feelings without minimizing them: it could be helpful to say, “You sound like you are really suffering right now,” to someone with a terminally ill loved one
• Remind the grieving person of their strengths: for example, “You’ve always been creative in finding solutions, perhaps that will happen again in this situation,” might be a helpful thing to say to someone who was terminated from their job
• Be present: this can often be the most important way to show support to a grieving loved one

Final Thoughts on Anticipatory Grief

Anticipatory grief is a common experience that many of us feel when we know we are going to lose something. Dealing with loss of any kind is challenging, but it doesn’t have to overcome you with constant grief. Coping and managing grief is a process and having a supportive community can make a big difference. When grief becomes too much, it can be important to consider speaking with a therapist or a hospice social worker to learn more about how you can manage your grief and live a fulfilled life.