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Grief, Loss & Bereavement

Loss and grief are universal processes and people ordinarily have the natural capacity to adjust to their new lives in the absence of loved ones. However, some losses are experienced more profoundly than others—they cause greater or more prolonged grieving and such reactions are sometimes described as ‘complicated’ or ‘complex.’ This can be associated with characteristics of the loss, or with the meaning of the loss for the individual concerned. Read more
Grief, Loss & Bereavement
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Activity Menu

Helping clients to choose which activities to target during behavioral activation (BA) can be accomplished in a variety of ways: activity monitoring c ... https://www.psychologytools.com/resource/activity-menu

Information handouts

Am I Experiencing Death Anxiety?

Am I Experiencing Death Anxiety? is an indicative screening tool, designed to help clients self-assess whether their experiences might warrant further ... https://www.psychologytools.com/resource/am-i-experiencing-death-anxiety

Exercises

Audio Collection: Psychology Tools For Developing Self-Compassion

Psychology Tools For Developing Self-Compassion is an audio collection which guides clients through an empirically-supported programme of compassionat ... https://www.psychologytools.com/resource/psychology-tools-for-developing-self-compassion-audio-collection

Audio

Before I Blame Myself And Feel Guilty

Guilt is a common post-traumatic reaction and is often the result of cognitive bias. This CBT worksheet explores common cognitive biases that have bee ... https://www.psychologytools.com/resource/before-i-blame-myself-and-feel-guilty

Exercises

Cognitive Behavioral Model Of Post Traumatic Stress Disorder (PTSD: Ehlers & Clark, 2000)

Anke Ehlers' & David Clark's Cognitive Behavioral Model Of Post-Traumatic Stress Disorder (PTSD) is an influential account of the condition. The ... https://www.psychologytools.com/resource/cognitive-behavioral-model-of-post-traumatic-stress-disorder-ptsd-ehlers-clark-2000

Information handouts

Everyday 'Unusual' Experiences

Everyone has powerful experiences from time to time, and there are many very ordinary reasons why people have experiences that are considered ‘unusu ... https://www.psychologytools.com/resource/everyday-unusual-experiences

Information handouts

Exposures For Fear Of Death

Fear of death is common, and is associated with a variety of psychological disorders including generalized anxiety disorder, depression, panic disorde ... https://www.psychologytools.com/resource/exposures-for-fear-of-death

Information handouts

Externalizing

The Externalizing information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively ... https://www.psychologytools.com/resource/externalizing

Information handouts

Hindsight Bias

The Hindsight Bias information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectivel ... https://www.psychologytools.com/resource/hindsight-bias

Information handouts

Self-Blame

The Self-Blame information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively wi ... https://www.psychologytools.com/resource/self-blame

Information handouts

TEAR Model of Grief

Worden formulated the process of grief as consisting of tasks, including accepting the reality of the loss and experiencing its pain. This client info ... https://www.psychologytools.com/resource/tear-model-of-grief

Information handouts

Understanding Death Anxiety

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are co ... https://www.psychologytools.com/resource/understanding-death-anxiety

Guides

What Keeps Death Anxiety Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ... https://www.psychologytools.com/resource/what-keeps-death-anxiety-going

Information handouts

Window Of Tolerance

The window of tolerance concept was coined by Dan Siegel in his 1999 book The Developing Mind. Siegel proposes that everyone has a range of intensitie ... https://www.psychologytools.com/resource/window-of-tolerance

Information handouts

Assessment

  • Potvin, L., Lasker, J., & Toedter, L. (1989). Measuring grief: A short version of the Perinatal Grief Scale. Journal of Psychopathology and Behavioral Assessment, 11(1), 29-45.  download archived copy
  • Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., … & Miller, M. (1995). Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry research59(1), 65-79 download  archived copy

Intervention

Treatment guides

  • When someone you know has died… – a guide for professionals offering bereavement support  download  archived copy
  • Some principles of grief work by Dr Blatner  download  link

Information handouts

  • Bereavement – a self-help guide download archived copy
  • Your grief: You’re not going crazy download  archived copy
  • Helping children to cope with death download  archived copy
  • Grief and bereavement information sheet download archived copy
  • Restoring hope – short booklet from Cruse bereavement care download archived copy
  • Coping with trauma and loss – short booklet from Cruse bereavement care download archived copy
  • Supporting children through grief download archived copy
  • Common reactions to grief and loss handout  download  archived copy

Exercises, Worksheets & Workbooks

  • Remembering for good – grief workbook download archived copy
  • Solution-focused interventions for prolonged grief download archived copy

Presentations

  • Attachment, loss, and complicated grief | Dr M. Katherine Shear download archived copy
  • Grief and bereavement: a practical approach | Ian Anderson download archived copy
  • Bereavement and loss | Barbara McKay download archived copy
  • Supporting the bereaved: theory and practice download archived copy
  • Complicated grief treatment: the theory, practice and outcomes | Dr M. Katherine Shear download archived copy
  • ACT and grief | Russ Harris link archived copy
  • Using Acceptance and Commitment Therapy to negotiate losses and life transitions | Speedlin, Milligan, Haberstroh, Duffey download archived copy

Recommended Reading

  • Boelen, P. A., Van Den Hout, M. A., Van Den Bout, J. (2006). A cognitive behavioral conceptualization of complicated grief. Clinical Psychology: Science And Practice, 13(2), 109-128 link
  • Clark, A. (2004). Working with grieving adults. Advances in Psychiatric Treatment, 10, 164-170 download
  • Malkinson, R. (2010). Cognitive-behavioral grief therapy: The ABC model of rational-emotive behaviour therapy. Psychological Topics, 19 (2), 289-305 download archived copy
  • An analysis of the concept of ‘chronic sorrow’. Olshanksy coined the term in the 1960’s to describe what he saw as the sense of loss some parents of disabled children have. The term has been expanded to encompass the loss that some people experience when faced with life-limited or option-limiting conditions
  • Rosner, R., Pfoh, G., & Kotoučová, M. (2011). Treatment of complicated grief. European Journal of Psychotraumatology, 2. download download
  • Sabar, S. (2000). Bereavement, grief, and mourning: A gestalt perspective. Gestalt Review, 4(2), 152-168 download archived copy
  • Shear, M. K. (2015). Complicated grief. N Engl J Med, 2015(372), 153-160 download archived copy
  • Shear, K., Monk, T., Houck, P. et al. (2007). An attachment based model of complicated grief including the role of avoidance download
  • Stroebe, M., & Schut, H. (2010). The dual process model of coping with bereavement: A decade on. OMEGA-Journal of Death and Dying, 61(4), 273-289. download
  • Solomon, R. M., & Rando, T. A. (2007). Utilization of EMDR in the treatment of grief and mourning. Journal of EMDR Practice and research1(2), 109-117. download
  • Wong, P. T. P. (2008). Transformation of grief through meaning: Meaning-centered counseling for bereavement. In A. Tomer, G. T. Eliason, & P. T. P. Wong (Eds.), Existential and spiritual issues in death attitudes (pp. 375-396). New York, NY: Lawrence Erlbaum Associates. download archived copy

What Are Grief, Loss, And Bereavement?

Signs and Symptoms of Grief, Loss, and Bereavement

People respond to loss in an enormous variety of ways. Emotional and behavioral responses to loss might include: sadness, preoccupation, yearning, depression, anxiety, or numbness. A grieving patient might oscillate between strong feelings and no feelings. Diagnostic systems are beginning to draw distinctions between normal and ‘pathological’ grief. DSM-5 identified persistent complex bereavement disorder, previously referred to as complicated grief, as a diagnostic category for further research.

Signs and symptoms of persistent complex bereavement disorder are listed below. To meet diagnostic criteria for persistent complex bereavement disorder particular symptoms must have been present: to a clinically significant degree; on more days than not; in a manner which is out of proportion to or inconsistent with cultural, religious, or age-appropriate norms; and must have persisted for at least 12 months following the death:

  • persistent yearning or longing for the deceased
  • intense sorrow and emotion pain in response to the death
  • preoccupation with the deceased
  • preoccupation with the circumstances of the death
  • marked difficulty accepting the death
  • experiencing disbelief or emotional numbness over the loss
  • difficulty with positive reminiscing about the deceased
  • bitterness or anger related to the loss
  • maladaptive appraisals about oneself in relation to the deceased or death (e.g., self-blame)
  • excessive avoidance of reminders of the loss
  • a desire to die in order to be with the deceased
  • difficulty trusting other individuals since the death
  • feeling that life is meaningless or empty without the deceased, or the belief that one cannot function without the deceased
  • confusion about one’s role in life, or a diminished sense of one’s identity
  • difficulty or reluctance to pursue interests since the loss or to plan for the future

Psychological Models and Theory of Grief, Loss, and Bereavement

There are a wide range of models and metaphors to help clinicians and their patients to conceptualize the grief process. A number of models draw upon Bowlby’s attachment theory to understand grief as a rupture in the attachment relationship.

  • Elizabeth Kübler-Ross published a stage model of grief in her 1969 book On Death and Dying. Originally designed to understand emotional states experienced by terminally ill patients, it has been used more widely. It postulates that grieving individuals may go through stages of denial, anger, bargaining, depression, and acceptance.
  • Margaret Stroebe and Henk Schut published their dual-process model of coping with bereavement in 1999. They propose that effective ways of coping with bereavement include both loss-oriented and restoration-oriented process, and that bereaved individuals will oscillate between both processes.
  • Paul Boelen, Marcel van den Hout, and Jan van den Bout published a cognitive behavioral model of complicated grief in 2006. Bearing some similarities to the cognitive model of PTSD, this model identifies mechanisms that may serve to maintain and prolong the grieving process. These maintenance mechanisms include poor integration of the separation (loss) with existing autobiographical knowledge, negative global beliefs and misinterpretations of grief reactions, and anxious and depressive avoidance strategies.

Evidence-Based Approaches for Working with Grief, Loss, and Bereavement

Techniques that specialists in grief therapy have found helpful when working with grieving patients include:

  • encouraging the patient to narrate their story of the loss, the events leading up to it, and subsequent events;
  • exploring the meaning of the loss for that individual;
  • engaging in mourning tasks;
  • using imagery to ‘talk’ to the deceased.

Resources for Working with Grief, Loss, and Bereavement

Psychology Tools resources available for working therapeutically with grief, loss, and bereavement may include:

  • psychological models of grief, loss, and bereavement
  • information handouts for grief, loss, and bereavement
  • exercises for grief, loss, and bereavement including mourning tasks
  • grief and loss worksheets: CBT worksheets for grief, loss, and bereavement
  • self-help programs for grief, loss, and bereavement

References

  • Boelen, P. A., van den Hout, M. A., & van den Bout, J. (2006). A cognitive-behavioral conceptualization of complicated grief. Clinical Psychology: Science and Practice, 13(2), 109–128.
  • Kübler-Ross, E. (1969). On death and dying: What the dying have to teach doctors, nurses, clergy and their own families. New York: Scribner.
  • Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197–224.