Grief and Loss
What is it
Grief is a normal emotional response that encompasses a broad range of feelings, thoughts and behaviours that are common following the loss of someone or something in a person’s life. Grief is not an illness with a prescribed cure, and is a highly individualised and variable process (Morris 2008). Events that may be associated with a grief reaction include the death of a spouse, loved one, unborn child, or family pet/companion animal, or hearing of a similar loss or traumatic event (Worden, 2010). Grief can also arise following other losses that do not involve death – job loss through injury, being laid off, retrenchment or retirement, having to move house or relocate unexpectedly or because of ill-health, changes in health condition, marriage breakdown or divorce, custody issues, loss of friendship or significant trust or any other circumstance involving a loss of something important either short or long term (James, & Friedman, 2009).
It is well known that the death of a loved one is considered to be one of the most powerful stressors in everyday life, often causing significant distress to all those closely connected to the deceased (Holmes & Rahe, 1967). Whilst grief, bereavement and loss are considered to be normal experiences throughout life, and the majority of people impacted are able to adjust over time to their loss, these can also impact people severely where adjustments can take months, even years. These severe grief reactions (complicated grief) can affect around 10% to 15% of people and are more likely to impact people who have had depression and or anxiety present before the loss (Bonanno, 2004). Moreover, bereaved individuals may be more at risk of serious mental health problems such as depression and substance abuse, and increased risk of suicide (Prigerson & Jacobs, 2001; Stroebe, Schut, & Stroebe, 2007).
What it includes
While our knowledge and understanding of grief and bereavement continues to evolve through research, we know that grief affects everyone in different ways (Worden, 2010). The process of grief impacts various areas of functioning across emotional, physiological, cognitive and behavioural domains, is often experienced in waves and recovery can take time. Intense feelings of sadness, disbelief, shock, panic, loneliness, helplessness, anger, anxiety, guilt and numbness may be experienced. Physical experiences may include uncomfortable sensations in the stomach, heart palpitations, chest tightness, sweating, feeling faint, tightness in the throat, noise sensitivity, breathlessness and difficulty breathing, difficulty concentrating, depersonalisation, muscle weakness, dry mouth and a lack of energy. Cognitive difficulties may include denial, disbelief, confusion, preoccupations and obsessive thoughts, a sense of presence and hallucinations. Behavioural difficulties may include problems sleeping, a reduced appetite and weight loss, absentminded behaviour, withdrawing socially, distressing dreams or nightmares, loss of interest in things previously enjoyed, avoidance of things associated with the loss, sighing, restless hyperactivity, and crying. These are normal in the context of a grief experience.
How a psychologist can help
Cognitive Behaviour Therapy has been shown to be efficacious in the treatment of grief and loss (Kavanagh, 1990). Specifically, many of the Cognitive Behaviour Therapy strategies that are effective in treating other mental health problems like depression and anxiety, such as graded exposure to avoided or feared situations, processing emotional reactivity, increasing pleasant events, making sense of and challenging unhelpful thoughts, can be modified for working with grief (Kavanagh, 1990). Cognitive Behaviour Therapy can help people to feel understood, express and make sense of their grief, process their grief and start to move forward with their life. Strategies which focus on increasing a sense of control and wellbeing can also facilitate adjustment (Stroebe et al., 2007). Other therapy modalities that some people report to be beneficial that are also developing efficacy through research in the treatment of some aspects of grief and loss include Mindfulness-based Strategies and Interpersonal Psychotherapy (Kumar, 2013; Marchand, 2012).
ReferencesBonanno, G.A. (2004). "Loss, Trauma, and Human Resilience: Have We Underestimated the Human Capacity to Thrive After Extremely Aversive Events?". American Psychologist 59 (1): 20–8. doi:10.1037/0003-066X.59.1.20. PMID 14736317.
Holmes, T.H., & Rahe, R.H. (1967). The social readjustment rating scale. Journal of Psychosomatic Research, 11, 213-218.
James, J.W., & Friedman, R. (2009). The Grief Recovery Handbook, 20th Anniversary Expanded Edition (William Morrow Paperbacks, 2009), 5.
Kavanagh, D.J. (1990). Towards a cognitive-behavioural intervention for adult grief reactions. British Journal of Psychiatry, 157, 373-383.
Kumar, S.M. (2013). Mindfulness for Prolonged Grief: A guide to healing after loss when depression, anxiety and anger won’t go away. A Self-Help Workbook. New Harbinger Publications Inc. Oakland, CA.
Marchand, W.R. (2012). Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive Therapy, and Zen Meditation for Depression, Anxiety, Pain and Psychological Distress. J Psychiatr Pract. 18(4):233-52. doi: 10.1097/01.pra.0000416014.53215.86
Morris, S.E. (2008). Overcoming grief: A self-help guide using cognitive behavioural techniques. London: Constable and Robinson.
Prigerson, H.G., & Jacobs, S.C. (2001). Caring for bereaved patients – all the Doctors just suddenly go. Journal of the American Medical Association, 286(11), 1369-1376.
Stroebe, M., Schut, H., & Stroebe, W. (2007).Health outcomes of bereavement. The Lancet, 370, 1960-73.
Worden, J.W. (2010). Grief Counselling and Grief Therapy. A Handbook for the Mental Health Practitioner. (4Ed). Routledge Taylor and Francis Group. East Sussex: UK.
AuthorDr Bronwyn Massavelli
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