Anticipatory Grief

What Is Anticipatory Grief?

Anticipatory grief – also known as pre-death or preparatory grief is the emotional process that begins before an impending loss, typically the declining health or death of a loved one.

It involves experiencing grief while the person is still alive and can affect both the individual who is dying and their loved ones. This form of grief encompasses mourning not only for the person themselves but also for the loss of roles, routines, and future possibilities.

It may provoke feelings of sadness, anger, anxiety, or guilt and is a natural reaction that helps individuals and families begin preparing for what lies ahead. Anticipatory grief can begin as early as the time of diagnosis and may last until the actual loss occurs. It often includes a mix of emotional, cognitive, spiritual, and behavioural symptoms associated with the anticipation of loss.

Emotional and Physical Symptoms

Common symptoms of anticipatory grief include:

• Sadness, anger, anxiety, guilt, or fear about future changes
• Social withdrawal and feelings of isolation. Physical symptoms such as fatigue, nausea, or panic
• Cognitive changes such as forgetfulness and difficulty concentrating
• Regret or wishing things had been different
• Emotional exhaustion from prolonged stress and caregiving
• Persistent worry about the loved one’s health and future
• Guilt over feeling you haven’t done enough
• Loneliness or feeling misunderstood by others
• A mix of hope and sorrow – mentally preparing for death while still wishing for more time

Stages of Anticipatory Grief

While many people are familiar with Elisabeth Kübler-Ross’s five stages of grief (denial, anger, bargaining, depression, and acceptance), research suggests that anticipatory grief may follow four overlapping stages. These are not linear, and not everyone experiences all of them.

1. Acceptance – Recognising that a loved one’s death is inevitable. Feelings such as sadness, anger, and denial are common, and depression may arise.
2. Reflection – Coming to terms with emotions such as anger, regret, guilt, or remorse.
3. Rehearsal – Thinking about how you might feel during and after the loss, including planning for practical matters.
4. Imagining the Future – Visualising life after the loss and beginning to adapt emotionally to that reality.
5. Coping Strategies

Coping with anticipatory grief involves caring for both your emotional and physical well-being, which will enable you to enjoy time with your loved one.

Helpful strategies include:

• Talk openly about your feelings with loved ones, professionals, or support groups
• Keep a journal to process emotions
• Maintain healthy habits (nutrition, rest, and regular exercise)
• Limit caffeine and alcohol
• Use mindfulness or meditation to manage stress
• Seek professional, counselling, or palliative care support
• Take regular breaks to recharge and be kind to yourself
• Learn about the condition, treatment, and what to expect
• Ask family, friends, or hired help to share caregiving responsibilities
• Find new ways to spend meaningful time together, even if old activities are no longer possible
• Allow both hope and sadness to coexist – both are natural
• Remind yourself that your feelings are normal and valid

Why Anticipatory Grief Matters

Researchers differ on whether anticipatory grief helps with post-loss adjustment. Some evidence suggests it can foster emotional preparation and closure, while other studies indicate it may increase stress and fatigue for caregivers.
Anticipatory grief is still a form of loss. Feelings such as denial, anger, and depression are normal responses. While it won’t eliminate the pain of bereavement, it may help you begin processing the loss gradually.
Many people feel as though they grieve twice – once for the person they knew before illness, and again after their passing.

What Anticipatory Grief Allows

Anticipatory grief offers an opportunity to:

• Prepare emotionally, reducing the shock of death by processing it over time
• Say goodbye and resolve unfinished conversations or business
• Express love and appreciation to your family member
• Adjust emotionally and practically for upcoming changes
• Reflect on shared memories and create new, meaningful moments
• Find practical and emotional closure by making plans for end-of-life care and funeral arrangements

Making the Most of the Present

While anticipatory grief doesn’t necessarily make bereavement easier, it can help foster acceptance and peace before loss occurs. It’s both a natural and complex process – beginning to let go while still holding on to love and hope.

Self-care and support are essential. Talking about your feelings with family, friends, a professional therapist, or a professional organisation can make the experience more manageable.

Consider practical and meaningful preparations, such as:

• Recording voice messages or videos
• Taking and saving photos
• Creating memory-making activities
• Making a memory box or legacy project
• Encouraging your loved one to share their memories
• Finalising practical matters such as funeral plans or a Will

Above all, focus on the present and cherish the time you still have together. Don’t become so preoccupied with what’s to come that you miss the opportunity for connection and love in the moment.

If you would like to talk to someone, please call our free Support Line on 0800 002 9002.