What is Anticipatory Grief?

Contrary to popular depictions and experiences, grief is not something that can only be felt after a death or loss. It is very possible to feel normal grief before a traumatic event, if the loss is imminent. Anticipatory grief is the normal mourning that occurs when a patient or family member is expecting a death or a person who is about to experience a major loss in another aspect of their life, like moving to a completely new state. It has many of the same symptoms as those experienced after a loss or death has occurred, and includes all of the thinking, feeling, cultural, and social reactions to an expected death.

Anticipatory grief is common among people who are facing the eventual death of a loved one or their own death, in contrast to grief after death (conventional grief). Like conventional grief, preparatory grief is not limited to a loved one’s death; it includes many losses such as the loss of a companion, changing roles in the family, fear of financial changes, and the loss of dreams of what could be. Yet, while most people are familiar with the grief that occurs after a death (conventional grief), anticipatory grief is not often discussed. Because it doesn’t have widespread acceptance or understanding, some people experiencing anticipatory grief might not feel comfortable expressing or sharing their grief and getting the support they need. This can create a snowball of emotions since grief doesn’t occur in isolation. Often the experience of grief can bring to light memories of other episodes of grief in the past. This is why it is important to seek help if you or a loved one is experiencing anticipatory grief. Use the therapy matching service, Advekit, to connect with accessible mental health professionals. 

While anticipatory grief includes depression, extreme concern for the dying patient, preparing for the death, and adjusting to changes caused by the death, it can also be a positive and healthy experience. Anticipatory grief can also give the family and friends more time to slowly get used to the reality of the loss. People are able to complete unfinished business with the dying person, giving them an opportunity to say all the things they always wanted to say. 

Oftentimes, anticipatory grief may not occur and, it’s important to note, that does not mean a person feels the same kind of grief before as after a death. Anticipatory grief can be similar to grief after actual death, but is also unique in many ways. Grief before death isn’t a substitute for grief later on, and won’t necessarily shorten the grieving process after death occurs. There is not a fixed amount of grief that a person experiences with loss or death. Yet, while anticipatory grieving isn’t an alternative or even a head-start for the grief experienced after a loss, expressing these feelings prior to the loss or death does provide opportunities for closure.

Differences from grief after death

Grief before death often involves more anger, loss of emotional control, and atypical grief responses. This is likely related to the difficult "in-between place" people often find themselves in when a loved one is dying. It can be difficult to balance holding on to hope for something changing and letting go to face reality.

Not everyone experiences anticipatory grief, and no one person is more likely than another to find themselves in the thick of it. Some people experience very little grief while a loved one is dying or prior to a known future loss. They don't allow themselves to grieve a loss before it occurs because it might be construed as giving up hope. For others, the grief before the actual loss is even more severe.

For those who are dying, anticipatory grief provides an opportunity for personal growth at the end of life, and a way to find meaning and closure. For families, this period is also an opportunity to find closure, to reconcile differences, and to give and grant forgiveness. For both, it is a chance to say goodbye.

Family members will sometimes avoid visiting a dying loved one because it’s painful to see them in a scary situation, but anticipatory grief in this setting can be healing. One study found that anticipatory grief in women whose husbands were dying from cancer helped them find meaning in their situation prior to their husband’s deaths.

Though anticipatory grief doesn’t necessarily make the grieving process easier, it can make death seem more natural. Grief that follows an unplanned death or loss is also different from anticipatory grief. Unplanned loss may overwhelm the coping abilities of a person, making normal functioning impossible and unable to realize the total impact of the loss. Even though the person recognizes that the loss occurred, he or she may not be able to accept the loss mentally and emotionally. Following an unexpected loved one’s death or loss, a person may feel that the world no longer has order and does not make sense.

What are the stages of anticipatory grief?

While the stages of grief and the four tasks of grieving are commonly known, it's important to note that most people do not neatly follow these steps. Instead, any of these stages may be present at any one time and a person can re-experiencing the same feelings of shock, questioning, or despair many times over. Again, there is no right way to feel or grieve. 

Anticipatory grief is a process, research shows. The stages of anticipatory grief are:

  1. Experiencing shock about the upcoming loss

  2. Denying the reality of the loss

  3. Eventual acceptance

Symptoms of anticipatory grief

The emotions that accompany anticipatory grief are similar to those which occur after a loss, but can be even more like a roller coaster. Some days may be really hard, while others may feel totally normal. Though everyone grieves differently, these are typical emotions associated with anticipatory grief. 

  • Unexpected sadness and tears tend to come on fast and strong. Even small things, such as a moving commercial may be a sudden and painful reminder a loved one is dying.

  • Feelings of fear are common, and include not only the fear of death or the loss itself, but fear about all of the changes that will be associated.

  • Irritability and anger are often expressed when there is difficulty coping with a dying loved one’s anger.

  • A sense of intense loneliness is often experienced. Unlike grief after a loss, the feeling that it’s not socially acceptable to express anticipatory grief can add to feelings of isolation. Conversely, this can also result in a strong desire to talk to someone who might understand and listen without judgment. 

  • Anxiety is extremely common during this time and, in turn, can cause physical symptoms such as tremulousness, palpitations, and shaking.

  • Guilt can come in many forms and for different reasons. If the loss is a death, a person may experience survivor guilt, knowing they will continue with life without their loved one.

  • One specific symptom of anticipatory grief is rehearsing the loss or death. A person may rehearse what it will be without the loved one. Or if the person is dying, visualizing how loved ones will carry on after their death. Many people feel guilty about these thoughts, but they are very normal and are part of accepting the inevitability of death.

  • Physical problems such as sleep difficulty and memory problems can crop up during a period of anticipatory grief.

How do you recognize the signs and symptoms of anticipatory grief?

Similar to anxiety vs depression, anticipatory grief bears many of the same symptoms as conventional grief, but there are some key differentiators and, of course, everyone will grieve differently.

During a period of anticipatory grief, it’s possible to experience:

  • Anger

  • Anxiety

  • Major depression or high functioning depression

  • Desire to talk

  • Emotional numbness

  • Fatigue

  • Fear

  • Guilt

  • Loneliness

  • Poor concentration or forgetfulness

  • Sadness

Signs and symptoms unique to anticipatory grief, rather than conventional grief post loss could be:

  • Increasing concern for the person dying

  • Imagining or visualizing what the person’s death will be like

  • Preparing for what life will be like after a loved one is gone

  • Attending to unfinished business with the dying person

Coping with anticipatory grief

Though not everyone will experience it with their loss, anticipatory grief is a normal process in the continuum of grief. But, in some cases, this grief can be so intense that it interferes with the ability to cope and requires grief work. 

One of the most important things a person with anticipatory grief can do to cope with their impending loss is accept their feelings are normal and valid. Creative outlets like journaling, art, or photography are wonderful ways to express the emotions around things like acceptance of the impending death, loss of hope, a person, or an imagined future. Exploring mindfulness is also a great way of being present, being aware of every negative emotion, and learning to overcome stressful moments. 

Anticipatory grief is common among caregivers but, unfortunately when a person’s time is consumed with caregiving, they may become isolated. Seeking out caregiver support groups to connect with others who understand similar challenges, including anticipatory grief, can be very healing. If there isn’t one locally in person, there are many online anticipatory grief forums that can provide solace virtually. 

Therapy for anticipatory grief

Not everyone will need the services of a counselor or therapist during their anticipatory grieving period, but it can be very helpful for those who are really struggling. A qualified professional can help a person understand the grief process before, during, and after a loss. A grief therapist can provide the tools necessary to cope with the complex and volatile emotions that present themselves during the grief process. 

There are some big potential benefits for those who are struggling more than usual. If an individual was experiencing distress before the onset of the impending loss, or if their anticipatory grief is chronic and interferes with normal functioning, grief counseling can help them address their intense emotions and move on with the healing process. Additionally, as with most forms of therapy, it is most effective if the individual voluntarily seeks it out.

Finding a therapist who specializes in anticipatory grief is easy with Advekit. We can help find a great match in a matter of minutes, and help navigate the insurance process to make sure you’re getting the best rate possible.


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