Grief is an individual experience and people can respond to loss in a variety of ways. Responses include emotional, cognitive, physical and behavioural changes.⁴

Emotional responses:

• sadness
• anger
• guilt and remorse
• anxiety
• loneliness
• helplessness
• shock and disbelief
• a sense of yearning
• relief.

Cognitive changes:

• confusion
• difficulty concentrating
• preoccupation with the loss
• a loss of interest in enjoyable activities
• vivid dreams or nightmares.

Physical and behavioural responses:

• muscle tightness
• tiredness/reduced energy
• sleep disturbances
• social withdrawal
• changes in appetite
• crying
• restlessness
• avoiding places or people who remind the individual of the loss
• treasuring objects that are associated with the loss.

In addition, there can be significant changes to a person’s spiritual or philosophical views and beliefs, for example, people may question their faith or the meaning of life.

People cope with grief and loss in a variety of ways. While some might find it helpful to talk openly about the experience, others might prefer time alone. The intensity and duration of the grieving process can also differ between individuals. For most people, the experience of grief will dominate their emotions, thoughts, and behaviours for a number of weeks or months.

As time passes, most individuals learn to cope with their grief and go about their daily lives, although for many the loss will remain a part of them.² Most people who experience loss will not need professional help, however some (approximately 10 to 20%) seek and require professional support.³

Psychologists and researchers have outlined various models of grief. Some of the most familiar models include the five stages of grief, the four tasks of mourning, and the dual process model. 

Five Stages of Grief

In 1969, Elisabeth Kubler-Ross identified five linear stages of grief:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

Kubler-Ross originally developed this model to illustrate the process of bereavement. Yet she eventually adapted the model to account for any type of grief. Kubler-Ross noted that everyone experiences at least two of the five stages of grief. She acknowledged that some people may revisit certain stages over many years or throughout life.

Four Tasks of Mourning

Psychologist J. W. Worden also created a stage-based model for coping with the death of a loved one. He divided the bereavement process into four tasks: 

1. To accept the reality of the loss
2. To work through the pain of grief
3. To adjust to life without the deceased
4. To maintain a connection to the deceased while moving on with life

Dual Process Model

As an alternative to the linear stage-based model, Margaret Stroebe and Hank Schut developed a dual process model of bereavement. They identified two processes associated with bereavement:

Loss-oriented activities and stressors are those directly related to the death. These include:

• Crying
• Yearning
• Experiencing sadness, denial, or anger
• Dwelling on the circumstances of the death
• Avoiding restoration activities

Restoration-oriented activities and stressors are associated with secondary losses. They may involve lifestyle, routine, and relationships. Restoration-oriented processes include: 

• Adapting to a new role
• Managing changes in routine
• Developing new ways of connecting with family and friends
• Cultivating a new way of life.

Stroebe and Schut suggest most people will move back and forth between loss-oriented and restoration-oriented activities.

Helping yourself

• Remember to ask for help if you need it; don’t be afraid to speak up and admit that you are struggling to cope with your loss.
• Be honest with family and friends about how you are feeling and be open to accepting their help.
• Allow yourself time to grieve your loss.
• Talk with others who share a similar experience; joining a bereavement support group (in person or online) can be helpful.
• Take care of your physical health; participate in regular exercise, eat healthy meals, limit alcohol use, attend medical check-ups etc.
• Participate in enjoyable activities, hobbies and interests regularly.
• Maintain normal sleep patterns.
• Practice relaxation or mindfulness activities to help calm the mind and body.
• Reflect on your religious or spiritual beliefs.

Helping someone else

• Provide practical support, such as helping with funeral arrangements, assisting with housework and meal preparation, buying groceries etc.
• Support the person emotionally; providing comfort and reassurance, talking about the person’s loss, listening with compassion, or sharing memories are important to the healing process.
• Be a source of information support, such as financial advice, or helping the person understand how and/or why the loss occurred.
• Do not just focus on the person’s loss; talk about everyday life, current affairs etc.
• Check in with the person weeks, and even months, after the loss to show you still care.
• Suggest that they speak to a professional if their grief does not seem to be lessening over time or they are struggling to function.

Grieving is a difficult and challenging process. Its nature depends on a number of factors, such as the person’s coping style and personality, as well as the type of loss.⁵ However, regardless of the circumstances, losing a loved one can cause great pain and suffering.

Most people learn to manage their grief and adjust to their loss in their own time. Maintaining self-care activities and routines,⁶ and having adequate social support available⁷, can be helpful during this time of adjustment. However, for people who experience prolonged or complicated grief reactions, a number of more targeted psychological treatments and strategies can be of great benefit, including:^2,8,9

Challenging unhelpful thoughts and behaviours

Cognitive-behavioural therapy for complicated grief helps identify and modify a person’s unhelpful thoughts and behaviours in order to improve their mood and increase their quality of life.^8,10

Complicated grief treatment

Complicated grief treatment addresses the symptoms of loss by helping people re-establish relationships and focus on personal life goals.^9,13

Improving family relationships

Some psychological treatments focus on strengthening family bonds and developing good communication patterns as this can help prevent people from experiencing significant psychological distress as a result of the loss. Psychologists sometimes refer to this as focused family grief therapy.¹¹

Finding meaning

Finding meaning and significance in the loss that a person has experienced can also be helpful. Psychologists may use a range of meaning reconstruction approaches to help achieve this.¹⁴

1. Shader, R. I., & Ury, W. A. (2003). Bereavement reactions and grief. In Richard I. Shader (Ed.), Manual of Psychiatric Therapeutics (3rd ed., pp. 220-228). Philadelphia: Lippincott Williams & Wilkins Publishers.
2. Wittouck, C., Van Autreve, S., De Jaegere, E., Portzky, G., & van Heeringen, K. (2011). The prevention and treatment of complicated grief: a meta-analysis. Clinical Psychology Review, 31(1), 69-78.
3. Lobb, E. A., Kristjanson, L. J., Aoun, S. M., Monterosso, L., Halkett, G. K., & Davies, A. (2010). Predictors of complicated grief: A systematic review of empirical studies. Death Studies, 34(8), 673-698.
4. Worden, W. J. (2008). Attachment, loss, and the experience of grief. In W. J. Worden (Ed.), Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner (4th ed., pp. 13-36). New York: Springer Publishing Company.
5. National Cancer Institute: PDQ® Grief, Bereavement, and Coping with Loss. Bethesda, MD: National Cancer Institute. Date last modified 06/30/2011. Available at: http://cancer.gov/cancertopics/pdq/supportivecare/bereavement/HealthProfessional. Accessed 28/04/2014.
6. Utz, R. L., Caserta, M., & Lund, D. (2012). Grief, depressive symptoms, and physical health among recently bereaved spouses. Gerontologist, 52(4), 460-471. doi: 10.1093/geront/gnr110
7. Hewitt, B., Turrell, G., & Giskes, K. (2012). Marital loss, mental health and the role of perceived social support: findings from six waves of an Australian population based panel study. Journal of Epidemiology and Community Health, 66(4), 308-314. doi: 10.1136/jech.2009.104893
8. Boelen, P. A., de Keijser, J., van den Hout, M. A., & van den Bout, J. (2007). Treatment of complicated grief: a comparison between cognitive-behavioral therapy and supportive counseling. Journal of Consulting and Clinical Psychology, 75(2), 277-284. doi: 10.1037/0022-006x.75.2.277
9. Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F., 3rd. (2005). Treatment of complicated grief: A randomized controlled trial. Journal of the American Medical Association, 293(21), 2601-2608. doi: 10.1001/jama.293.21.2601
10. Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond (2nd ed.). New York, NY: Guilford Press.
11. Kissane, D., & Bloch, S. (2002). Family Focused Grief Therapy: A Model of Family-Centred Care During Palliative Care and Bereavement. Buckingham, UK: Open University Press.
12. Kissane, D., McKenzie, M., Bloch, S., Moskowitz, C., McKenzie, D., & O’Neill, I. (2006). Family focused grief therapy: a randomized, controlled trial in palliative care and bereavement. American Journal of Psychiatry, 163(7), 1208-1218.
13. Wetherell, J. L. (2012). Complicated grief therapy as a new treatment approach. Dialogues in Clinical Neuroscience, 14(2), 159-166.
14. Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24(6), 541-558.
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