GRIEF & LOSS

The experience of grief and loss is unavoidable and can be difficult to process. We know that at some point in our lives, we all lose someone or something we love, but it is impossible to fully prepare for the feelings that will arise when it happens. Everyone’s experience of grief is different and the time that it takes to move through grief varies from person to person. Although people’s grieving processes differ, researchers have identified characteristics of “healthy” grieving patterns. A healthy grief response includes a period of sorrow, numbness, guilt, and anger. As time passes, these feelings often fade as the bereaved person begins to accept the loss.[1]

In contrast to a healthy grieving process, some people may experience Complicated Grief. Complicated Grief occurs when an individual stops making progress in his/her recovery.[2] There are two types of Grief-Related Disorders that fall under the Complicated Grief category. Risk factors for Complicated Grief include a lack of social support, a sudden/unexpected loss, and losing a very important loved-one.2

Types of Complicated Grief-Related Disorders:

Persistent Complex Bereavement Disorder (PCBD): Prolonged or disabling grief can lead to a diagnosis of PCBD. A diagnosis of PCBD requires that at least one of the following four symptoms be present within 12 months following the death of a loved one:[3]

  • Yearning/Longing
  • Intense Sorrow
  • Preoccupation with the deceased
  • Preoccupation with the circumstances of the death

In addition to the above symptom, six out of the twelve of the following symptoms must also be present:2

  • Difficulty accepting the death
  • Feeling shocked, stunned, or numb
  • Difficulty remembering the positive memories
  • Feeling bitter or angry
  • Self-blame
  • Avoidance of reminders of the deceased
  • Difficulty trusting others
  • Loneliness/detachment from others
  • Difficulty pursuing plans/interests
  • Desires to join the deceased
  • Feeling meaningless/empty
  • Feeling as though a part of you has died

Traumatic Grief (TG): TG can occur when one or more of the following circumstances surrounds a death:

  • The death occurred in a way that was sudden, violent, destructive, mutilating, and/or humiliating.[4]
  • The death was random or unexplained.4
  • The mourner was faced or threatened with multiple deaths.4
  • The mourner’s own survival was threatened.4
  • There was a shocking or horrifying confrontation with a dead body.4
  • The mourner witnessed or had some exposure to the death or the crime scene.4

When Grief is complicated by trauma, the mourner may experience symptoms that are similar to those of Post-Traumatic Stress Disorder (PTSD), in addition to the symptoms of Grief. Some of the symptoms of PTSD are:

  • Intrusive memories of the trauma.4
  • Increased arousal.4
  • Avoidance of reminders of the traumatic event.4

TG can complicate the grieving process and can delay one’s ability to accept that the death that occurred.

Situations that Cause Grief:

  • The death of a loved one
  • The loss of a limb or body part
  • The death of a pet
  • Romantic Breakup/Divorce
  • Miscarriage of a pregnancy
  • Chronic Illnesses
  • Chronic Pain
  • Hospitalization
  • Loss of safety
  • Loss of financial status
  • Moving
  • Loss of Health
  • Loss of a job
  • Abusive relationships
  • Aging
  • Retirement

Canadian Statistics

  • Approximately 50% of people do not experience intense emotional shock or Depression as a result of a loss.1
  • About 1% of people under the age of 55 are widowed. By age 85, the majority of people are widowed.1
  • Approximately 30% of people experience difficult symptoms in response to grief, including sadness, sleeplessness, fatigue, poor concentration, and changes in appetite.1
  • Bereaved family caregivers have a mortality risk of 63%, compared to the bereaved who were not caregivers.5
  • A 2012 study found that a person’s chances of having a heart attack increased 21 times in the day following a loved one’s death. Additionally, spouses who lose a partner are at a higher risk for a heart attack or stroke for as long as a month after their partner’s deat5

Behaviours Associated with Grief & Loss:

  • Skipping or quitting activities that you enjoyed before the loss
  • Breaking up with a significant other because you cannot stop missing your deceased spouse
  • Keeping a deceased loved one’s belongings as they were before the death
  • Crying when you see a happy couple after your own breakup
  • Isolating yourself from your friends because they have not experienced a similar loss
  • Refusing to visit a loved one in the hospital because of the trauma of a past death

Feelings Associated with Grief & Loss:

  • Sadness
  • Emptiness
  • Shock
  • Anger
  • Disbelief
  • Longing

Thoughts associated with Grief & Loss:

  • “Life is not worth living without him.”
  • “If only I had done more research on cancer, she would probably still be alive.”
  • “There’s no way that he/ is gone.”
  • “I should have been there when she died.”

Grief & Loss and the Body:

  • Backaches[5]
  • Heart Palpitations
  • Fatigue
  • Difficulty Sleeping[6]
  • Loss of Appetite
  • General Muscle Pain

Grief & Loss and the Brain:

One large study found that participants with Complicated Grief experienced more brain deterioration and had a loss of neurons and the neural pathways between them.[7] Both the frontal cortex and the medial temporal cortex areas of the brain are impacted by Grief. This means that a person may experience difficulties with concentration, decision-making, emotional expression, and forming new memories. Other research has shown that Complicated Grief can cause cognitive impairment due to its effects on the anterior cingulate cortex.8 The anterior cingulate cortex plays a role in attention, and Complicated Grief can result in emotional arousal that consumes attentional resources. Research suggests that the areas of the brain most affected by Grief are unique to each person, and that Grief is mediated by a network of neural pathways that impact processing, memory retrieval, processing of familiar faces, and motor responses.[8]

Does Psychology Work?

  • Cognitive Behavioural Therapy (CBT): CBT can help reduce symptoms of Persistent Grief Disorder by targeting painful memories and addressing behavioural[9] CBT strategies such as exposure, cognitive restructuring, and writing have all proven to be successful at reducing Persistent Grief.[10] Evidence also shows that the exposure element of CBT is more important than the cognitive component for reducing grief.10
  • Complicated Grief Treatment (CGT): CGT is built on the principle and practices of both CBT and Interpersonal Therapy (IPT). The IPT element of CGT focuses on helping clients to re-establish relationships and reconnect to their life goals after the experience of loss.10 The steps of CGT involve fostering a therapeutic relationship, learning about Complicated Grief, involving supportive people in treatment sessions, and introducing exercises to assist the bereaved in accepting the loss.10 Studies have shown that CGT is an effective treatment for Complicated Grief, especially in comparison with IPT alone. In one study, clients who received CGT responded more quickly to treatment than those who received IPT.10 In another study, clients who received CGT had a better response rate (51%) than those in IPT (28%).[11]
  • Eye Movement Desensitization and Reprocessing (EMDR): In the context of Grief and Loss, EMDR is a commonly used to treat Traumatic Grief. The goal of EMDR for Traumatic Grief is to assist the bereaved in accepting the loss and enhance their ability to recall positive memories of the past.3 Research has shown that EMDR is more effective than Guided Mourning (GM) treatments, and had a much greater effect on intrusive symptoms, avoidance, and anxiety.3 Compared to GM, EMDR also helped to reduce traumatic symptoms at a faster rate.3 Other studies back up the claim that EMDR is an effective treatment for Traumatic Grief, and although it cannot shorten or eliminate Grief, it can help people mourn in a less complex way.[12]

Tips to Help Manage Grief & Loss!

  • Find Social Support: Grieving can feel like a lonely process, and going through it alone can make it even more isolating. Reaching out to family and friends can provide hope and comfort. There are also bereavement support groups, many of which are free, to connect and support people who are grieving.
  • Allow Yourself to Feel Sad: Grief and sadness are natural emotions, and although processing them can be hard, it is essential to accept their presence. Avoid numbing out with substances, such as alcohol, and instead process the feelings with a trusted person. If it feels too overwhelming, see a Psychologist.
  • Keep up Your Routine: Grief and Loss can be draining, and even performing the most basic activities can seem like too much work. Although it is difficult, keeping up with daily routines, such as walking the dog or cooking meals, can help maintain a sense of normalcy and comfort during the grieving process.

Although Loss is a normal part of life, processing Grief can be extremely difficult. While some people are able to cope with Grief on their own, others may need extra support to deal with the difficult emotions that arise. If you think you need help coping with Grief and Loss, remember that many people also need help. While you may meet the criteria for a grief-related disorder, your symptoms may vary from those listed in this article. Grief is a personal process, and Hopewell Psychological offers a variety of treatment options to meet your specific needs. Sometimes, Grief can be accompanied by psychological disorders such as Major Depressive Disorder and PTSD. At Hopewell, we offer scientifically researched treatments to address all of your mental health needs. Hopewell Psychological also provides individual therapy, as well as couples, family, and group therapies. Grief is difficult, but it does not have to be traumatizing. With Psychological Counseling, Grief and Loss can be transformed from a horrible experience into one of growth and resilience.

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*Psychologists are covered under Insurance Companies in Canada. You will need to check with your insurance company about the specific details regarding your coverage.

References

[1] Howarth, Robyn. “Concepts and controversies in grief and loss.” Journal of Mental Health Counseling 33.1 (2011): 4-10.

[2] “Psychology Works’ Fact Sheet: Grief in Adults.” Canadian Psychological Association. Canadian Psychological Association, 2015. Web. 16 May 2017.

[3] Wakefield, J. C. “DSM-5 Grief Scorecard: Assessment and outcomes of proposals to pathologize grief.” World Psychiatry 12.2 (2013): 171-173.

[4] Sprang, Ginny. “The Use of Eye Movement Desensitization and Reprocessing (EMDR) in the treatment of traumatic stress and complicated mourning: psychological and behavioral outcomes.” Research on Social Work Practice 11. (2001): 300-320.

[5] Ultz, R. L. “Grief, Depressive Symptoms, and Physical Health Among Recently Bereaved Spouses.” Gerontologist 52.4 (2012): 460-471.

[6] Prigerson, H. G. “Prolonged Grief Disorder: Psychometric Validation of Criteria Proposed for DSM-V and ICD-11.” PLOS Medicine 10.12 (2013).

[7] Perez, H. C. S., et al. “Cognition, structural brain changes, and complicated grief. A population-based study.” Psychological medicine 45.7 (2015): 1389-1399.

[8] Gundel, H., et al. “Functional neuroanatomy of grief: an FMRI study.” American Journal of Psychiatry 160.11 (2003): 1946-1953.

[9] Loebach-Wetherell, Julie. “Complicated grief therapy as a new treatment approach.” Dialogues in Clinical Neuroscience 14.2 (2012): 159-166

[10] Malkinson, Ruth. “Cognitive-Behavioral Grief Therapy: The ABC Model of Rational-Emotion Behavior Therapy.” Psychological Topics 19.2 (2010): 289-305.

[11] Shear, Katherine, et al. “Treatment of complicated grief: a randomized controlled trial.” Jama 293.21 (2005): 2601-2608.

[12] Solomon, R. M., and Rando, T. “Treatment of Grief and Mourning through EMDR: Conceptual consideration and clinical guidelines.” Journal of EMDR Practice and Research 1.2 (2007): 109-117.

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