FINDING HEALING: PRACTICAL STRATEGIES FOR COPING WITH GRIEF

Medically Reviewed by Dr. Sony Sherpa (MBBS) - September 23, 2024

Grief is a universal human experience, an inevitable journey that everyone faces at some point in their lives. Whether it is the loss of a loved one, the end of a relationship, a pet passing away, or even the loss of a job, grief takes many forms and affects individuals in unique ways. Understanding the nature of grief is the first step in navigating its challenging terrain.

In this article, we will discuss what grief is, how it can affect you, and how to cope with loss, emphasizing the importance of understanding and seeking support during this challenging time.

What is Grief? Getting to Grips with the Process

“Grief is not a disorder, a disease or a sign of weakness. It is an emotional, physical and spiritual necessity, the price you pay for love. The only cure for grief is to grieve.” - Earl Grollman

Grief is defined as a natural emotional response in the form of deep sorrow, typically attributable to the loss of a loved one. It is useful to view grief as a process instead of a negative emotion, as well as a healthy way of processing loss. Neurologically, grief is viewed by some researchers as a learning process in which the affected person consolidates memories and emotions in order to recontextualize themselves and move forward. Over time, they arrive at a resolution.^[1]

Bereavement and mourning are synonyms of grief that highlight parts of the process. While grief is a fairly universal process, the way its emotional aspects are experienced is completely different from person to person. Mourning refers to the expression of grief and the period of adapting to life after loss, which are both affected by cultural and religious backgrounds. Customs often dictate the time spent on mourning and the way in which it is carried out.

How Long Does Grief Last?

There is no standard time for grieving, and it is not advisable to think about how long it might take. Most individuals process loss within the course of a year and are able to begin adapting to life after loss within 6 months to 2 years. Taking longer does not necessarily mean that there is a problem.

If the grieving progress becomes a fixed condition that continues cyclically without any improvements after the first year, then it may be an indication of prolonged grief disorder. People with this type of grief experience great difficulty, battling to make progress, and are unable to find relief from their grief and other symptoms that occur as a result. This disorder ought to be distinguishable from other types of prolonged grief in which the deceased might still be missed from time to time at any point later in life.

The 7 Stages of Grief

The 7 stages of grief are a model of how people cope with loss and bereavement. They are based on the five stages of grief proposed by Swiss psychologist Elisabeth Kübler-Ross in 1969 in her book ‘On Death and Dying,’ with two additional stages added later.^[2] Not everyone goes through all the stages or experiences them in the same order or at the same pace.

The seven stages are:

1. Shock and disbelief: The initial reaction to the loss. Numbness, shock, and being unable to accept what happened are common. You may feel in denial, want to question the reality of the situation, create distance from it, or prefer to think of it as a mistake or a dream.
2. Pain and guilt: The stage where the emotional and physical pain of the loss begins to be felt. It usually brings up strong emotions, such as intense sadness, anger, fear, anxiety, or guilt. You may blame yourself or others for the loss and regret things you did or did not do.
3. Anger and bargaining: The pain of loss may transition towards anger, frustration, or feeling upset with the person who died, the self, others, religious beliefs, or life in general. You may look towards or try to bargain with a higher power or fate to change the loss or to avoid further pain. This can also be seen as a reaction to something outside of our control.
4. Depression: Anger and bargaining may be replaced by depression and feeling hopeless, helpless, lonely, or empty. It is natural to lose interest in ordinarily enjoyable activities and withdraw from others. Some may experience lethargy and fatigue or have trouble sleeping or eating. It is important to avoid negative self-talk during this stage.
5. The upward turn: Here, one starts to feel relief from depression and intense negative emotions. You may begin to adjust to the new reality, such as living without your loved one, and find some comfort in your memories, rituals, or support network.
6. Reconstruction and working through: The point at which you start to rebuild your life and identity after the loss. Normal activities are resumed, and people often make new plans, explore new opportunities, and embrace change. You may be ready to work through unresolved issues or emotions related to the loss.
7. Acceptance and hope: This is the final stage where the loss is accepted as a part of one’s life story and may hold a positive meaning and purpose. You may feel hopeful for the future and have already started to move on with your life.

Types of Grief

The 7 stages of grief encompass elements of the standard grieving process. People usually find ways to cope with grief on their own and find support from family and friends.

There are other types of grief one can experience which can be more problematic to deal with or less well understood by those who would otherwise support one. These include^[3]:

• Anticipatory grief occurs before an expected loss, often experienced when someone is facing a terminal illness. While it gives rise to some classic symptoms of grief, it does not usually cause one to go through the entire process. It may help someone prepare for and cope with future loss better.
• Disenfranchised grief occurs when the loss is not socially recognized or validated, such as when someone loses a pet, a friend, an ex-partner, a colleague, a client, or a patient. It can lead to a scenario where someone suffers silently in isolation or feels stigma about the loss, leading to extra anxiety, frustration, or guilt. This type may also prevent someone from seeking the professional help they need.
• Complicated grief is a prolonged form of grief that involves persistent and intense symptoms that interfere with daily life and that do not improve over time.
• Prolonged Grief Disorder is a clinical diagnosis for complicated grief that meets certain criteria, such as lasting more than six months and causing significant impairment in important areas of function. Studies have shown brain changes in those with this disorder that are similar to PTSD and depression, involving structures related to emotion regulation, reward processing (motivation and pleasure), memory (issues forming new memories, over-retrieval of old ones), and attachment (difficulty maintaining or forming new relationships).

Both of these prolonged grieving conditions can be treated with specialized therapies such as cognitive-behavioral therapy or eye movement desensitization and reprocessing.

How Does Grief Influence Physical Health?

Physical stress is the main cause behind all of the physical and cognitive effects of grief. In the body, grief mainly affects the cardiovascular system through the stress response.

Heart arrhythmias and elevated blood pressure are two symptoms that may result from this. It can also cause cholesterol to be disrupted from blood vessels and promote more blood clotting, which can increase the risk of a heart attack. In those experiencing severe distress over loss, grieving may cause panic attacks.

Severe symptoms are more common in traumatic circumstances and in vulnerable people with previous mood disorders or who are isolated.

Broken Heart Syndrome (Takosubo Cardiomyopathy)

In some cases, grief may cause broken heart syndrome, a form of cardiomyopathy in which less blood flows to the heart, the heart ‘balloons’ or swells up, and the heart muscle weakens. Chest pain, breathlessness, palpitations, and nausea are some of the symptoms. It is more common in postmenopausal women, and the risk is thought to be increased in those with pre-existing heart issues, low estrogen levels, and major life stresses. Those affected tend to recover within a few weeks to months.^[4]

How to Cope with Grief: Strategies for Dealing with Loss

Before looking for a viable “strategy” for dealing with grief, it is important to make sure you adopt a kind perspective about the process. If you do not already, allow yourself to grieve and give yourself permission to feel. Suppressing emotions can prolong the healing process. Emotional expression is a healthy way to process the pain associated with loss.

Most coping methods revolve around keeping on track with daily activities while constructively dealing with loss. Some of the most popular ones include:

• Be Patient: It is important to understand that grieving is a unique and individual process that takes time. Being patient with oneself and recognizing that healing occurs gradually is essential. Rushing the process may impede genuine emotional recovery.
• Seeking Support: Connecting with loved ones is a cornerstone of coping with grief. Sharing your feelings and memories with friends and family members can provide a sense of understanding and comfort. Additionally, professional grief counseling offers structured support for navigating the complexities of grief.
• Prioritizing Self-Care: Taking care of your physical health is vital during times of grief. Managing stress, prioritizing sleep, and adopting healthy lifestyle habits contribute to overall well-being. Stress-relieving exercises and activities can help you to process emotions and consolidate the loss better. These include maintaining an exercise routine, meditating, or adopting mindful exercises such as yoga or taichi.
• Journaling and Creative Outlets: Expressing emotions through writing or creative outlets such as art and music can be therapeutic. Grief journaling allows individuals to pace and structure emotional processing (helping to limit the time spent on it), explore their feelings, track their progress, and find solace in the act of self-reflection.
• Rituals and Memorials: Creating rituals or memorials to honor the memory of a loved one provides a tangible way to celebrate their life. This might involve holding a memorial service, planting a tree, or dedicating time to reminisce about shared experiences.
• Joining Support Groups: Depending on where you are in the process, connecting with others who have gone through comparable losses may be very helpful or may even stir up unpleasant emotions. Support groups can provide a space where people can discuss their grief journeys while providing a sense of community and understanding.

How to Help the Grieving

Helping someone else who is coping with grief can be challenging and rewarding at the same time. You may want to support them, but you may not know how to do it effectively or sensitively. It is worth noting that there are no truly comforting words to say to someone dealing with loss. It is more practical to support them in other ways where possible.

Here are a few tips for helping someone else to better cope with grieving:

• Be present and listen. Allow them to speak, and do not judge or advise. It is important to be empathetic and pay attention.
• Respect their grief process. Do not tell them how to feel or cope or compare their grief to others.
• Provide practical help. Offer to do chores, cook meals, or take care of children or pets for them.
• Encourage self-care. Gently encourage them to eat well, sleep enough, exercise regularly, and do things that make them happy.
• Seek professional help. If their grief is overwhelming, suggest that they seek counseling or therapy. If they want, you can volunteer to go with them to their appointments.

When is Professional Help Required?

Grief counseling can greatly help people who lack social support, struggle to cope, or who do not know how to approach their grief. A psychotherapist may prescribe short-term antidepressants and provide helpful counseling to guide you through the process.

There are several therapies that have been shown to be effective in helping people cope with grief and bereavement. Some include:

• Prolonged Grief Therapy (PGT): A structured 6-session psychotherapy that helps people accept and adapt to the loss of a loved one. It involves two areas of focus: restoring effective functioning and thinking about death without evoking intense emotions. This is useful for overcoming grief triggers.^[5]
• Cognitive Behavioral Therapy (CBT): CBT is a focused approach that improves daily functioning by modifying thoughts, feelings, and behaviors related to the loss. It involves four core interventions: psychoeducation, exposure, cognitive restructuring, and behavioral activation.
• Meaning in Loss (MIL) Therapy: A narrative therapy that forms new and adaptive ways to integrate the experience of loss and reconnect with the deceased. It involves four modules: processing the story of the loss, finding meaning in the loss, developing a compassionate bond, and moving forward.
• Eye Movement Desensitization and Reprocessing (EMDR): This trauma-focused treatment aids in the processing and resolution of distressing memories and feelings connected to the loss. It involves eight phases: history taking, preparation, assessment, desensitization, installation, body scan, closure, and re-evaluation.^[6]

Some people with grief may require input from other healthcare practitioners who can treat them for broken heart syndrome or severe anxiety. If experiencing prolonged physical symptoms due to grief, it is important to see a doctor.

Conclusion

Grief management is a difficult and individual journey that can result in healing and development. There is no right or wrong way to grieve, and healing occurs at its own pace. By understanding the nature of grief, embracing diverse coping strategies, and seeking support when needed, individuals can navigate the challenges of loss and emerge with a renewed sense of purpose and resilience. If overwhelming, psychotherapy can be of great benefit to those struggling with intense emotions.

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