Anticipatory Grief: How To Manage Mourning a Loss Before It Happens

Experts share ways to deal with feelings of worry and sadness

Robin L. Flanigan,

AARP

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Published December 18, 2024

close up of a caregiver putting their hand over the hand of a patient wearing a hospital bracelet

Katie Lukes

There are two kinds of grief.

The one that gets the most attention is conventional grief — the shock, anger, disbelief and other feelings which happen after a loss. Anticipatory grief, on the other hand, is a reaction — often with similar emotions to conventional grief — that happens when an imminent loss is on the horizon.

Reasons for anticipatory grief include a terminal illness, diagnosis of dementia or other progressive disease, scheduled medical procedure, upcoming empty nest, and major transitions such as a divorce or retirement.

And it can show up days, months, sometimes years before the loss actually occurs.

Anticipatory grief can be healthy if managed well, allowing you to face fears and finish any unfinished business. But when chronic or uncontrollable, it can be harmful to day-to-day functioning.

Here’s how to successfully prepare for a situation that you may wish would go away but won’t.

Acknowledge reality

Too often, people come from what’s called a “closed family system,” in which they’re raised to think “they shouldn’t openly acknowledge the reality of what is going on and [they] kind of become their own worst enemy,” says Alan Wolfelt, director of the Center for Loss and Life Transition and author of the guide Expected Loss: Coping with Anticipatory Grief.

When a death or major loss is expected within that system, people “act like what is happening is not happening — it’s layered in denial and ways that inhibit the ability for the anticipatory mourning to unfold,” he explains. “If you don't mourn well, you don't live well, you don't love well.”

So openly acknowledge the reality you’re faced with, which takes courage and can be very difficult to do, says Wolfelt. Otherwise, he adds, you’re faced with “potential fallout consequences physically, emotionally, cognitively, spiritually.” For example, if a loved one is ill, it helps to acknowledge that reality, in doses, as the illness progresses.

“We might say or initially think ‘This person I love is ill,’ then ‘This person I love is very ill,’ then ‘This person I love has entered a transition from being alive and living to dying,’” he says.

“If you don’t acknowledge the reality you are facing,” Wolfelt says, “you often fail to activate your support system. Then you end up grieving but not mourning.”

Feel a full range of emotions

While conventional grief and anticipatory grief share many of the same emotional responses, anticipatory grief is “more dynamic,” says Regina Josell, a psychologist at Ohio’s Cleveland Clinic. There can be a lot of ruminative thought, worry, overwhelming sadness, anxiety, even guilt.

With conventional grief, because the loss already has happened, you can start to heal — but that healing process is harder to start while you’re still anticipating a loss that’s to come, Josell points out.

Susan Krobusek, a 69-year-old retired paralegal and volunteer gardener in Canandaigua, New York, remembers juggling myriad emotions after it was clear she was going to lose her husband, Bruce, to his second bout of cancer.

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While the overwhelming emotion was fear, she says she also felt “dread, for the separation that was coming; nervousness, wondering if I'd be up to the challenge of adapting to life alone; and helplessness [because] there was nothing I could do to make Bruce well again, or at least ease the ending for him.”

Anticipatory grief often includes a wide range of feelings that undoubtedly change all the time and cause discomfort, which can be dizzying but must be embraced and expressed, according to Wolfelt, whose organization helps people who are grieving and those who care for them.

“Your emotions are legitimate and necessary,” Wolfelt writes in his guide.

Reach out to others

Krobusek, who doesn't have children and has no extended family nearby, relied on her friends for support.

“Sometimes friends are better to have around you in this kind of situation because you can vent to them, you can have them talk you off a particular ledge, and they don't carry with them the baggage that families sometimes can,” she says.

Sometimes Krobusek would ask for small favors. Once when her husband’s chemotherapy appointment was taking longer than expected, for instance, she asked a friend to feed their cat.

“Keep your friends close, rely on them, and if they want to do something to help, let them,” she says. “They want to help and be useful, because they're hurting for you.”

You can also lean on a therapist, trusted family members, or member of the clergy, suggests Josell.

“Talking about it really does make it better,” Josell says. “We have to normalize the expression of emotion in our country. [People often say] ‘Don’t cry, don’t feel angry, don’t feel sad.’ It is normal to feel a range of emotions in response to the anticipation of loss. The quickest way for our emotions to dissipate is to allow ourselves to feel them.”

Take care of yourself

No matter the reason for anticipatory grief, it’s important to make sure you’re paying attention to how you’re showing up in the world, notes Josell.

She advises getting enough sleep, eating a healthy diet, drinking lots of water, and moving your body.

These things often go out the window when we’re stressed, and loss “is a huge stress,” Josell says, “so making sure we’re doing things to take care of ourselves gives us the wherewithal to deal with the stuff that’s going on.”

Look for the good

Krobusek tried to find bright spots in a very dark time, making note that her husband tolerated chemotherapy well and had a great medical team.

Her tip: “Make the most of all the time you have. Don’t waste it projecting too much or being too negative because that’s not going to help anybody.”

Focus on new opportunities

Unexpected sadness and worry can also occur during a major life transition — like ending a job or a relationship.

Lisa Cottrell, 56, wishes she had thought more about the perks that would come with retirement before saying goodbye in June 2024 to her job as a high school special education teacher and assistant girls cross country coach. Instead, in her final years of coaching, Cottrell would find herself in the middle of a practice or annual team tradition thinking, ‘Oh my gosh, I'm only going to do this one more time,’” she says.

“I wish I would've thought more about … how I was going to fill that hole instead of just worrying about it,” says Cottrell, who lives in Palatine, Illinois. “It’s an opportunity to connect to something different.”

These days she goes for a walk or run at sunset, now that she doesn’t have to be on the field for track practice.

“Focus on the freedom that it gives you,” says Cottrell, following that piece of advice with some honest humor about being a “stay-at-home dog mom” and “concierge” to her two canines. “I make sure they’re living their best life and have everything they need. I’m like, ‘Do you want to go out again? Did you want to come in again? Can I drag this bed into this patch of sunlight for you? Can I fluff your pillow?’”

Get ready for what comes next

Krobusek recommends that those in her situation — about to lose a partner or loved one — prepare themselves for two main changes.

The first is that “your life is going to be very, very different” once the person passes away, she says, and the second is that even your closest friends eventually will drift back to their own lives and not be as available, which is a normal shift that should be allowed to happen without blame.

“The best therapyis just to tackle what you have to tackle and start adjusting to your new circumstances," Krobusek says.

Make meaning from the experience

Wolfelt calls coping with anticipatory grief a “humbling experience” because we live in a society “that’s pretty high on control … and now you’re faced with a loss where you have to surrender control.”

To that point, Josell reminds us that nothing lasts forever and submits that since that’s the case, perhaps we can make meaning from the experience.

“The anticipation of loss can help us be grateful for what we have when we have it,” Josell says. “The other thing it can teach us is perseverance …[and] people still can enjoy a happy, healthy life beyond a loss.”

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