(CNN)Millions of Americans are grieving loved ones taken by Covid-19. Yet even outside of a pandemic — with its staggering losses of lives, homes, economic security and normalcy — grief is hard work.
Grief-induced anxiety: Calming the fears that follow loss
"The funny thing about grief is that no one ever feels like they're doing it the right way," said therapist Claire Bidwell Smith, author of "Anxiety: The Missing Stage of Grief." But there is no right way, she insisted. The only "wrong" way is to not do it.
What often trips people up is misattributing the sensations of grief-related anxiety to some unrelated cause. "Probably 70% of my clients have gone into the hospital for a panic attack following a big loss," Smith said.
After doctors rule out physical illness, clients come to her for counseling, frequently struggling to understand the link between their physical symptoms and bereavement.
This becomes especially problematic in grief-averse places like the United States, Smith explained.
With over 4 million reported Covid-19 deaths reported worldwide since December 2019, grief and loss have touched an untold number of hearts and minds. Smith recommends connecting the dots between loss and anxiety as a critical first step toward healing.
This conversation has been edited and condensed for clarity.
CNN: How are grief and anxiety related?
Claire Bidwell Smith: When some big change comes seemingly out of nowhere and disrupts life, we realize we're not safe, things aren't certain, we're not in control.
All of that is true all of the time, but loss is a huge reminder. The life changes and emotional upheaval are so much bigger than most people understand. Grief, which is the series of emotions that accompany a significant loss, can drop you to your knees. That feeds anxiety.
Grieving people can begin feeling anxious about their own health or the safety of other loved ones. Sometimes, they don't even realize what they are experiencing is anxiety or is in any way related to their grief.
Anxiety, a psychological condition that causes fear and worry, can present with many physical symptoms. These can be misleading, making you think you have heart palpitations, a stomach issue, a new sweating problem, headaches, insomnia. Many people think they have a medical problem and not an emotional one.
CNN: How do you help people ease their grief-related anxiety?
Smith: My first job is to help people connect the dots between their loss and their fears by tracing their anxiety on a time line: When was I last anxious? How were things before my loved one died?
If the loved one had a long illness, the anxiety might begin before the death. After a sudden death, the anxiety might start right away. Usually if someone's going to veer into anxious territory, it's something that happens quickly following loss.
Some people I see, who have never had anxiety in their lives, suddenly begin to have panic attacks right after the death of a loved one. Others, long familiar with anxiety, see symptoms really ratchet up after a loss, or maybe take on new manifestations.
CNN: What coping strategies can people use?
Smith: Seeking out support is really vital. There are so many more support groups and grief therapists available right now. And because of the pandemic, many are available virtually. You can often find support online and start tomorrow. If the therapists or groups you find are booked, get on a wait list. It's never too late to work through your grief.
If people don't seek out help to untangle their emotions, they get stuck in anger or guilt. Those play out in substance abuse, depression and anxiety, in relationship issues and in trouble at work and school. So, the domino effect of trying to muscle through and not seeking out support isn't good.
CNN: What advice do you have for those resistant to formal mental health treatment?
Smith: Self-guided online courses are one option that many therapists provide. Even reading articles or books or listening to a podcast about grief can normalize your experience and help you give you more permission to mourn. You can feel like you're going crazy, like something else is wrong with you, when really, it's grief.
Social media offers so many grief resources. A simple search on Instagram for #grief can help you find solidarity with others. Even just reading about other people's experiences through their posts and comments is valuable because it can help you realize you're not alone.
CNN: Because of the pandemic, so many people have been unable to be with their dying loved ones. What impact might that have?
Smith: We will see more complicated grief, with extended periods of grieving where people may get stuck in a loop of guilt or regret or anger. That comes, in part, from the feeling that a lot of the losses were preventable, and because people were forced to say goodbye to loved ones over Zoom and FaceTime with nurses wearing masks and face shields. Those kinds of endings can lend themselves to complicated grief.
Clients I'm working with who have lost a loved one to Covid-19 are feeling anger as they watch people get vaccinated — or choose not to get vaccinated. Everyone's posting reunion pictures. Someone who lost a parent to Covid a month ago is painfully aware of just how close they were to not having to go through this loss.
Initially, they have to work through shock, anger and guilt. Then we can begin to find new ways to say goodbye. That can look like doing self-compassion exercises or speaking with a pastor, minister or rabbi to work on absolution of guilt. It can involve finding spiritual connections to someone they have lost by writing them letters. I urge people to embrace their own sense of ritual and perhaps even hold memorials.
CNN: What role do meditation and mindfulness play in healing?
Smith: When we are grieving, and when we are anxious, we spend a lot of time dwelling in the past and fretting about the future. Meditation and mindfulness help bring our awareness to the present moment.
Meditation also helps us to understand our own thoughts, and how we can learn to detach from negative ideas and irrational fears.
CNN: You write that imagination can be another powerful tool. How?
Smith: I wasn't there the night my mother died. Even today, I imagine myself crawling into her hospital bed and holding her and saying the goodbye that I didn't get to. I've found catharsis in envisioning what I would have done, had I been able. But it took me years — definitely more than five — to get to that point.
Just like when athletes envision a course the night before, imagination can almost give your body a sense memory, which can be soothing. But it's not something that people are ready to do right away.
CNN: What role does story play in coping with grief and loss?
Smith: People carry around stories of loss and death, but they often feel like they are suppressing them because they haven't found good places to share them. How we hold a story is very indicative of how we feel emotionally. When we are holding a scary story, an uncomfortable story, a story of regret for a long time, it plays out in our day-to-day life.
Healing comes from finding outlets to explore a story and possibly find ways to reframe it. We can do that in therapy, counseling, support groups, online grief forums and grief writing classes, among other places.
CNN: You've come to believe that staying connected with our lost loved ones can be more healing than letting go. What does that look like?
Smith: That looks different for everyone, and it isn't something most o