Recently, a listener wrote to me and asked about how to cope with being afraid of a loved one dying. This immediately brought me back to one memorable patient I saw, years ago, as part of my training at a cancer center. She was a thirty-something entrepreneur, wife, and mother to three young kids. She was at the center because her husband had just been diagnosed with brain cancer.
I tried to put myself in her shoes and could not fathom how she continued to function so well. She was still an attentive mother. She continued to run her business. And she did all this while knowing her husband’s grim prognosis: a 50% chance of surviving the next two years.
Don’t get me wrong—she did worry about her husband and her family’s future. But we worked on finding meaning and balance in a way that honored her very valid fears while also allowing her to live her life. I learned a lot through working with her.
Spinning around in the ‘what ifs’ can paralyze anyone with existential fear.
So, what did this brave woman do to quell her profound anxiety? How can we calm our own worries that a loved one will someday die? Or how do we cope if we know that day may well be on the horizon sooner rather than later?
The two types of anxiety over a loved one’s death
Let’s get very concrete about this topic because spinning around in the “what ifs” can paralyze anyone with existential fear. To start with, let’s make an important distinction. There are two major types of anxiety about a loved one’s death:
- When a loved one has a severe illness or is at high risk of dying, and you are anxious about their impending death
- When your loved ones are not particularly at risk for dying, but you can’t stop worrying about them dying anyway
These two types of anxiety are very different and need different types of responses.
Scenario 1: Worrying when a loved one is at a higher-than-usual risk of dying
This is a common experience for anyone, but it’s been tragically even more prevalent in a time when nearly 3 million people have lost their lives to COVID-19, and many millions are at high risk for serious outcomes if they contract the virus. Millions of people also have illnesses like cancer or heart disease that could become fatal. If you have a loved one who’s at high risk, facing a serious illness, or near the natural end of their life, you may be worried about the day when they will die.
Don’t expect yourself to be perfectly rational and poised if you’re facing the impending loss of someone you love. Allow yourself to feel anxiety and grief.
It’s one thing to rationally understand that death is inevitable and that things may be out of your control, but it’s quite another to feel at peace with that knowledge. Don’t expect yourself to be perfectly rational and poised. After all, you may be facing the impending loss of someone you love. Allow yourself to feel anxiety and grief.
At the same time, for both your sake and the sake of your loved one, be wary of natural anxiety and grief turning into an unhelpful state of paralysis or preoccupation. It may be time to take some steps if you find yourself:
- Unable to manage the basics in life
- Unable to engage in proper self-care, or
- So preoccupied with thoughts about your loved one’s death that you can’t enjoy your time with them now.
Let’s look at three things you can do to help yourself.
Climb down from the what-if tree and live in the moment
Whatever your loved one’s prognosis, the best way to make the most of your time together is to live in the moment. Slow down with the to-do lists, get rid of distractions, and most importantly, get down from the what-if tree.
As you climb the what-if tree, with each branching what-if scenario the branches get thinner and your footing gets shakier.
The what-if tree has a sturdy trunk with strong roots at the bottom—that’s the present moment. As you climb the what-if tree, with each branching what-if scenario the branches get thinner and your footing gets shakier. At some point, it’s not useful to think that far ahead.
Of course, you may have practical matters at hand. Medical decisions and contingency plans need to be made. But keep these to the essentials.
Set aside limited decision-making time rather than stewing on important decisions whenever they enter your consciousness. Think of these decisions as tasks to do rather than a new anxiety-fueled way of living your mental life. Whenever it’s not your specified decision-making time, try to set those thoughts aside. Tether yourself back to the present moment knowing you’ll refocus on your decisions later.
Don’t shut down conversations about death
We hate talking about death. We especially hate talking about it when we’re afraid that its shadow may be creeping closer to someone we love. Sometimes, well-meaning family members shut down conversations about their loved one’s death. We say things like “Oh mom, don’t talk like that—you’re going to beat this” or “No, I won’t even entertain the thought of you dying because it’s not going to happen.”
We shouldn’t assume we know how our loved ones feel about the possibility of impending death, and we certainly shouldn’t prevent them from expressing those feelings at a profound moment in their life.
It may feel encouraging and helpful to say “you’re going to beat this.” But denial and dismissal actually prevent your loved one from expressing their very real feelings, making them feel alone when they need closeness the most. They may be feeling afraid, sad, angry, accepting, or any range of emotions in between. More than ever, they need you to hear and understand this.
A recent study asked palliative care nurses about the most common reflections they hear from the dying. They found that people experienced a huge range of emotions from fear to gratefulness. They also faced a variety of concerns ranging from their legacy to finances to family relationships. Many dying patients want to recount their experiences and express their concerns. We shouldn’t assume we know how our loved ones feel about the possibility of impending death, and we certainly shouldn’t prevent them from expressing those feelings at a profound moment in their life.
And you can also tell them how you feel, even if it’s not “positive vibes only.” Avoiding difficult emotions in yourself does not take the burden away from your loved one. They know you’re not okay. Of course they do! They’d rather hear about it from you than be kept at a distance.
If you’re close with someone, they want you to be well. The palliative care nurses’ study also found another major theme—those who are dying are more concerned about their family’s well-being than their own death. So, for this reason, even if not for any other, we should take good care of ourselves.
Self-care doesn’t necessarily mean buying products or services advertised as self-care. It’s more about attending to our mind’s and body’s basic needs—nutrition, activity, rest, routine, social support, and doing things that are meaningful to you. Think of it not only as an important investment in your ability to cope with uncertainty and the possibility of loss but also an investment in your loved one’s peace of mind.
Scenario 2: Worrying about someone’s death when they’re unlikely to die
Have you ever worried about someone’s death so intensely that by the time they walked in the door and explained they were late due to traffic you’d worked yourself up into a panic? I’ve done this myself many times. And the worry took a particular uptick in frequency in the first few months after having a baby. I worried that my husband would die in a car crash during his five-minute drive to the grocery store. Every time he went.
It’s not ‘crazy’ to be worried about your perfectly healthy partner or loved one.
It’s not “crazy” to be worried about your perfectly healthy partner or loved one. We may be more prone to this type of worry if we’ve experienced an unexpected loss in the past or we’re feeling particularly stressed or vulnerable. In my case, I was experiencing common postpartum anxiety fueled by major changes in my life, both hormonal and otherwise.
Another common reason for preoccupation with a loved one’s unlikely death is generalized anxiety disorder (GAD). People with this anxiety disorder spend a lot of time worrying about bad things happening to the point where it interferes with their functioning, prevents them from enjoying life, and causes physical symptoms.
No matter the source of your worry, there are ways to reduce the hold it has on your life.
Understand that worry is your brain’s way of trying to feel safe and in control
A patient asked me once: “Worrying feels terrible! Why does my brain do it? Do I get a sick pleasure from worrying?”
This was a very good question.
Often, people with GAD believe—whether consciously or not—that worrying helps prevent bad things from happening. If I turn this worst-case scenario over in my mind enough times, surely I can head it off, right? And when we worry, we also feel like we’re doing something proactive, which conveniently distracts us from our feelings of fear or sadness.
Worrying doesn’t change situations; it just keeps our negative feelings at a constant medium simmer.
But of course, the idea that worry somehow helps or prevents catastrophe is an illusion. Worrying doesn’t change situations; it just keeps our negative feelings at a constant medium simmer.
We may also worry as a way of purposely keeping ourselves in a negative mental state. That way, if the worst really does happen, we’re not taken off guard and we don’t have far to fall. This is, of course, another illusion the brain cooks up for us. If our loved one dies unexpectedly, we’ll be no less devastated if we’ve imagined their hypothetical death many times before.
Our brains are particularly prone to excessive worry when we feel a lack of control, like when there’s a once-in-a-lifetime pandemic loose in the world. Having experienced trauma, being sensitive to your body’s fight-or-flight responses, or being generally stressed can put you into this state, too.
The first step is to simply understand that there is a good scientific reason for why your brain comes up with persistent worries. It’s trying to help you feel safe. You’re not getting a “sick pleasure” from imagining your loved one’s death. But you are getting some temporary illusion of control, which keeps you spinning for more. Begin to break that spin by reminding yourself not to indulge in the act of worrying.
Understand that thoughts are just stories your brain tells you
Now that you know why your brain cooks up persistent worries, you can start to let them go. The key is to realize that thoughts are just stories. And sometimes they’re even less than stories—they’re just bits and pieces of dialogue your brain has stuck together. It’s up to you to decide if these pieces represent something true, meaningful, or helpful.
Let’s try something. Think to yourself, “I’m a purple elephant.” Now check a mirror, if you have one handy. Did thinking “I’m a purple elephant” make the thought true? Did thinking it somehow make the phrase meaningful or useful? I’m willing to bet you’re not gazing at the reflection of a purple elephant right now.
It’s up to you to decide whether your worried thoughts represent something true, meaningful, or helpful.
Now, think of the stories your brain tells you like “She’s never late, so she must’ve been in a car crash” or “This could be the last time I ever see him.” They’re exactly equivalent to thinking “I’m a purple elephant”—they’re not true, they don’t mean anything, they’re not actionable, and they’re not helping you.
It’s okay if these thoughts pop into your head sometimes—you can’t control that. It’s okay to turn them over a couple of times to see if they’re meaningful. But if you can’t let go of these thoughts after repeatedly thinking them, especially if they’re causing you distress, consider whether you’re reading too much into them. Ask yourself “Are these thoughts based on the facts I have right now … or are they just thoughts?”
Ground yourself in the present moment
Not reading into your repeated thoughts about your loved one’s death is all well and good. But in that moment, after telling yourself to let go of the thought, what do you fill your mental space with instead? I bet you know from experience that it’s very easy to slip right back into the worried-thoughts rabbit hole unless you’re actively engaged in something else.
Practice shifting your attention to what’s going on in the here and now, in your body and your surroundings.
So go ahead and ground yourself in the present moment with some engaging activity. You can certainly watch some TV or play a game to distract yourself, but I challenge you to try for more than simple distraction.
Practice shifting your attention to what’s going on in the here and now, in your body and your surroundings. Name what you can see, hear, feel, and smell in this moment. Follow the rhythm of your breath for a few minutes. This strengthens your mindfulness muscles, making it easier to prevent yourself from going up the what-if tree next time.
When you’re worried about a loved one’s death, be patient and kind to yourself
All the strategies we talked about today are much easier said than done. We already covered prioritizing self-care, but it bears repeating that we really must show ourselves patience and kindness. Whether you’re about to lose someone you love, coping with an uncertain prognosis, or you simply can’t let go of your fear of a healthy loved one’s death, it’s important to remember that you’re experiencing deep, existential anxiety.
One trick for figuring out how to be kind to yourself is to ask what we would want to do for a scared five-year-old who’s worried his parent is going to die. The approach is the same whether it’s true that he’s about to lose a parent or he just had a nightmare about it.
Would you tell the child to “toughen up” or “just be rational”?
No. You’d give him a hug, tell him you understand how scary his worries must feel, and then help him to understand the true situation. Sometimes that might include reminding him that nightmares, like worries, are just stories the brain makes up. And then you’d help him eat breakfast, get ready for school, and continue doing the things he likes to do.
When worries threaten to overwhelm you, treat yourself with the same kind of compassion.
Ent, M. R., & Gergis, M. A., The most common end-of-life reflections: A survey of hospice and palliative nurses. Death studies. 2020
Newman, M. G., & Llera, S. J., A novel theory of experiential avoidance in generalized anxiety disorder: A review and synthesis of research supporting a contrast avoidance model of worry. Clinical psychology review. 2011
All content here is for informational purposes only. This content does not replace the professional judgment of your own mental health provider. Please consult a licensed mental health professional for all individual questions and issues.