Joanne first came to see me a week after she’d had her first panic attack, one that was so severe it landed her in the emergency room. At age twenty-three, Joanne lost her father to a rare form of cancer, and now a little more than a year later, she found herself struggling in several areas of her life.
Joanne was sweet and put-together, with a clothing style surprisingly classic for someone so young. She spoke in a strong and confident voice, smiled at me brightly, and was quite pleasant to be around. In short, she was someone you would never guess was suffering from anxiety.
In our first session Joanne described her panic attack. She had been driving home from her job as a teacher’s aide in an elementary school. As she sat in traffic, headed to her apartment, she suddenly experienced a severe bout of dizziness, followed by a racing heart and shortness of breath. These physical symptoms immediately filled her with fear. She wondered if she might be having a heart attack or a brain aneurysm. Joanne pulled over to the side of the road and called her mother, who came to get her and drove her to the emergency room. After being thoroughly checked out by a physician, it was concluded that Joanne was completely healthy and had likely experienced a panic attack.
This knowledge did nothing to alleviate Joanne’s anxiety, and in fact, over the course of the next week, she lived in a state of near constant fear of having another attack. She had not even been able to drive to my office, instead enlisting her younger brother to chauffeur her. I began to ask her a series of questions to better understand her particular experience.
Had she had another attack since the one in the car or just the fear of having one?
Just the fear, she told me.
Was she experiencing trouble sleeping?
Yes, but only since the panic attack, she reported. Prior to the attack she had been a good sleeper.
I asked her to repeat how long it had been since her father died.
Just over a year, she said.
And was this the first time she’d experienced anxiety, or was this something she’d grappled with throughout her life?
It had only been since her father’s death that she had begun to feel anxious on a variety of levels, and this was the first time in her life she’d ever had a panic attack.
She answered my questions readily. Joanne was desperate for help. Ever since the panic attack, she had been calling in sick to work, afraid she would have another attack while in the classroom. She wanted to know if I thought that maybe any of this could be related to the death of her father. In response, I asked her to tell me about her life before he died.
Joanne had been raised in an idyllic suburb by two loving and wonderful parents. She had a younger brother with whom she was close. While she was growing up, her parents had been a constant supportive presence, and they enjoyed family trips and regularly held warm holiday gatherings in their home for their extended circle of friends and family.
Joanne had sometimes struggled with feelings of insecurity among peers, and later in romantic relationships, but overall she had led a life relatively unscathed by misfortune or psychological struggles. When her father, Steven, grew ill during her senior year of college, the whole family was taken by surprise. Although Steven sought excellent medical care, the doctors were unable to cure his cancer, and Joanne accepted her college diploma with her father absent from the audience.
Joanne and her mother and brother were rocked by Steven’s death. A vibrant entrepreneur, Steven had been close with all three of them. Always proud of Joanne, he loved talking with her about business ideas and her future career plans. He and Joanne’s younger brother, Sam, shared a love of sports and camping, and Steven also maintained a loving relationship with his wife, Joanne’s mother.
Steven’s death instantly shattered the future all three of them had envisioned for their lives. In the year since his death, Joanne had gone on to graduate college and began working as a teacher’s aide in an elementary school that she loved. Her brother was now in his junior year of college and in a serious relationship. Joanne’s mother continued to maintain the family home, despite experiencing a lot of depression and sadness following the loss of her husband.
I asked Joanne if anything had changed even more recently. She admitted that in the last month, she had moved out of her mother’s house into her own apartment and that she had also broken up with her boyfriend. I pointed out that it sounded as though she were truly on her own in the world for the first time since her father died, and I asked her how that felt.
Joanne pulled her arms around herself and nodded her head, her eyes brimming with tears. She described feeling vulnerable and more alone than she’d ever felt and admitted that she could see how this might have precipitated the anxiety attack. She suddenlysat up straighter and looked at me.
She recounted how all that day she had been dreading going home to her quiet apartment. All she could think about was how much her life had changed and how none of it looked like she thought it would anymore. She’d always thought that everything would just go as planned—that she’d graduate college and get the perfect job and eventually get married and have kids, but ever since her father died, it just seems like she didn’t know anything about life, and she felt that terrible things could happen again at any time. I nodded at her, sympathizing and remembering how similarly I felt after my mother died. Before Joanne left my office that afternoon, I worked briefly to normalize her anxiety, explaining how common it is to feel this way after a significant loss and also how anxiety is often a sign that we have deeper grieving to do. To help her get through the next week, I reminded her that the doctor gave her a clean bill of health and that even if she began to feel a panic attack coming on to remember that this is just her body responding to thoughts and feelings. I also gave her a list of quick tips she could use if she felt that she might be having another attack.
Joanne and I spent the next few sessions exploring her father’s death on a deeper level. We processed the feelings of fear and sadness she experienced seeing him decline physically, and we talked at length about their final conversations—exploring any regrets or things left unsaid. We discussed the pressure Joanne felt to emotionally support her mother and her younger brother, and we talked about the various ways she felt unprotected and unsafe in life following her father’s death.
Each week, in addition to talking about her life, I gave Joanne assignments such as writing, meditation, and exercise; exploring her spirituality and beliefs about the afterlife; and initiating conversations with her mother and brother about things that needed to be addressed. And each week I worked on continuing to normalize Joanne’s anxiety. Every time we met, I could see that her anxiety level had decreased a little more. She had two more panic attacks during our time together, but neither of them was as significant as the first, and during each one she was able to calm herself and make it through the attack quickly.
After about eight months of meeting regularly, Joanne walked into my office and told me she felt ready to end our time together. She told me that she felt like a completely different person than when she had first come to see me and that she had finally processed her father’s death in a way that she had not yet done when we first met. She understood now that her anxiety had stemmed from her unaddressed grief. She acknowledged that she still maintained a low level of anxiety but that she no longer felt afraid of it or hindered by it.
I watched her walk out of my office knowing that although her life would never look the way she once thought it would, she had done the kind of work that would allow her to walk a full, meaningful path through this world. When I wrote to her two years later to interview her for my book, she replied immediately: “So crazy to hear from you today because it is actually the 4-year anniversary of my dad’s death. But I am doing really well, and I definitely have you to thank for that. I am still using all the skills I learned from you, meditating, journaling and yoga.”
Joanne is just one example of how grief can bring on sudden and intense anxiety, but she is also an example of how you can overcome it.
Excerpted from Anxiety: The Missing Stage of Grief by Claire Bidwell Smith, LCPC. Copyright ©2018. Available from Da Capo Lifelong Books, an imprint of Perseus Books, LLC, a subsidiary of Hachette Book Group, Inc.