How to Deal with Grief
Between 10% 1 and 50% 2 of people who have just lost a loved one are at risk of Prolonged Grief Disorder. Mental health providers appear to have a fear of medicalizing grief3. Even though grieving a loss happens naturally and most people grieve without needing help4,5, it can cause problems in your mental and physical health6,7.
Sleep disturbances, psychological problems like depression8, and other symptoms like anger and despair9 happen during grief in bereavement. It’s unlikely that preventative measures will help you before the loss10 , but treatment does help reduce grief in bereaved adults11,12.
For treatment through the creative arts therapies, art therapy that can help you achieve positive changes: for example, helping you continue a bond with the deceased and make meaning out of the loss. There’s some evidence suggesting it helps with alleviating grief symptoms in general (like distress) and even depression and anxiety12. Music therapy, as another creative arts therapy option, is one of the more successful options for children. In this case, it works better for older children than it does for younger children13.
Meaning making and keeping a bond with the deceased both facilitate post-traumatic growth, particularly if you’re a parent who lost a child. By post-traumatic growth, it’s meant that there were positive changes in five core areas (see 14):
- in self-perception, where you feel stronger than you thought you were and know that you can handle difficulties
2. in relationships, where you have more compassion for others and are relating to others more
3. in how you see new possibilities,
4. in how you appreciate life more, and
5. in changes in existential views, where you can turn to religion and feel more spiritual than before the loss.
It’s important to note that the more grief you have, the more growth you will have, and that time had to pass for these positive changes to occur14. In one model, the amount of guilt you have is based on the emotional distress you have because of the loss and 1) whether you were personally responsible, 2) whether you have sufficient justification for your actions, 3) whether you violated your values or morals, and 4) whether or not you believe you could have reasonably foreseen the loss. Basically, believing that you were responsible in the loss also makes you susceptible to believing it reflects on you as a person15. Importantly, self-blame, guilt, and shame are common in bereavement and may hinder the healthy progression of mourning16,17,18, but forgiving yourself can help with the guilt19. Forgiveness includes apologizing, actively forgiving yourself and others, and being mindful of your thoughts15,20. Check out my article on how to make anger constructive for detailed instructions on how to forgive.
Another treatment type you can try is grief counseling. It can help you feel heard and normalize the grief process. If you attend group counseling, it can help you practice ways to cope with the loss, feel like you belong, and feel comfort from others. Just make sure that the group promotes positive relationships, that the members are informal but have an explicit purpose and structure, and that the counselors are culturally competent21.
If you’ve lost a child or someone due to a violent killing, you are more likely to get Prolonged Grief Disorder2, and having another child after the loss of a child is associated with it24. Attachment anxiety, rumination, exposure to traumatic events, and health complications like depression or PTSD also make you more prone to Prolonged Grief Disorder22. The more time after the death showed lower prevalence, and treatment does work, so all is not lost.
References
1. Lundorff, Holmgren, Zachariae, Farver-Vestergaard, & O;’Connor (2012). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis.
2. Djetantik, Smid, Mroz, Kleber, & Boelen (2020) The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis
3. Dodd, Guerin, Delaney, & Dodd (2017). Complicated grief: Knowledge, attitudes, skills and training of mental health professionals: A systematic review
4. Aoun et al. (2012). A public health approach to bereavement support services in palliative care.
5. Aoun et al. (2015). Who needs bereavement support? A population based survey of bereavement risk and support need.
6. Onrust & Cuijpers (2006). Mood and anxiety disorders in widowhood: a systematic review.
7. Stroebe, Schut, Stroebe (2007). Health outcomes of bereavement.
8. Lancel, Stroebe, & Eisma (2020). Sleep disturbances in bereavement: A systematic review.
9. Reilly et al. (2008). ‘When your child dies you don’t belong in that world any more’ — Experience of mothers whose child with an intellectual disability had died.
10. Wittouck, Van Autreve, De Jaegere, Portzky, & van Heeringen (2011). The prevention and treatment of complicated grief: A meta-analysis.
11. Johannsen et al. (2019). Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials.
12. Kennedy, Deane, & Chan (2019). In limbo: A systematic review of psychological responses and coping among people with a missing loved one
13. Rosner, Kruse, & Hagl (2010). A Meta-analysis of Interventions for Bereaved Children and Adolescents
14. Waugh, Kiemle, & Slade (2018). What aspects of post-traumatic growth are experienced by bereaved parents? A systematic review
15. Kubany & Watson (2003). Guilt: Elaboration of a multidimensional model
16. Buckle & Fleming (2011) . Parenting challenges after the death of a child. In R. A. Neimeyer, D. L. Harris, H. R. Winokuer & G. F. Thornton (Eds), Grief and bereavement in contemporary society. Bridging research and practice (pp. 93–105, chap. 9)
17. Humphrey (2009) Counseling strategies for loss and grief
18. Rando (1986). Parental loss of a child
19. Miles and Demi (1983). Toward the development of a theory of bereavement guilt: Sources of guilt in bereaved parents
20. Weinberg (1995). Does apologizing help? The role of self-blame and making amends in recovery from bereavement
21. Harrop et al. (2020). The impacts and effectiveness of support for people bereaved through advanced illness: A systematic review and thematic synthesis
22. Heeke, Kampisiou, Niemeyer, & Knaevelsrud (2017). systematic review and meta-analysis of correlates of prolonged grief disorder in adults exposed to violent lsystematic review and meta-analysis of correlates of prolonged grief disorder in adults exposed to violent lA systematic review and meta-analysis of correlates of prolonged grief disorder in adults exposed to violent loss
