Different Stages Of Grief: Phases, Symptoms, And Treatments

Grief can be a challenging yet essential part of the way individuals cope with loss. While each person’s experience with loss can be unique, understanding the grieving process by dividing it into stages might provide clarity for some people. By exploring the different stages of grief according to the Five Stages of Grief model, associated symptoms, and potential treatments, individuals who have lost a loved one may find comfort and support.

What are the different stages of grief? Understanding grief  

Stage one: Denial 

The denial stage of grief typically involves difficulty acknowledging that one has lost a loved one. Denial can be a defense mechanism for the brain to protect itself from the pain and shock of loss. The reasons that a person may enter denial can vary but often depend on the significance of that person in their life. For example, if a person loses their partner for many years, the reality of their absence seems like too much for them to handle. Below are the potential signs of denial: 

• Believing one is unable to discuss a lost loved one
• Avoiding any stimuli or experiences that may remind them of the loss
• Struggling to process feelings
• Isolating oneself from others
• Seeking distractions 
• Having difficulty concentrating
• Substance misuse
• Emotional numbness

Stage two: Anger

The anger stage can be marked by consistent irritability or aggression toward oneself and others. This anger may take many forms, including looking for someone to blame for the death of a loved one, believing one is unable to control anger, and taking a more cynical outlook on life in general. Those with religious beliefs may also struggle with their faith during the anger stage, potentially becoming angry at a higher power or questioning their religion entirely. Below are potential signs of the anger stage: 

• Emotional outbursts
• Physical or verbal aggression
• Targeted anger toward medical professionals, family members, or friends
• Difficulty with patience
• Blaming oneself for the death, even if the fault lies elsewhere
• Uncontrollable rage
• A sense of resentment toward others, including a lost loved one

Stage three: Bargaining

During the bargaining stage, grieving individuals could start to question whether the circumstances surrounding their loss could have occurred differently. Bargaining may involve going over the events that led to the death of a loved one and becoming preoccupied with “what if” scenarios in which different behaviors may have led to more favorable outcomes. For example, someone may wonder if they could have helped a loved one with a terminal illness by getting them to the doctor sooner. 

Some people may also bargain with a higher power, offering to change or act in certain ways for their loved one to be returned or to reduce the pain of their grief. These actions may be a way to regain control, which can be difficult to maintain after a significant loss. Signs of the bargaining stage could include: 

• Anxiety or fear
• Intense scrutiny of oneself
• Obsessive thoughts about the circumstances surrounding the loss
• Rumination about changing the past

Stage four: Depression

The depression stage of a person’s grief journey often occurs once a person begins to accept the reality that a loss has occurred and there is, potentially, nothing they can do about it. During this phase, individuals may have a sense of hopelessness or sadness, particularly when they are reminded of the person they have lost. Those in the depression stage could also have difficulty functioning in different parts of life, including academically, professionally, and socially. These difficulties could have various impacts, including but not limited to failed classes, the loss of a job, or damage to relationships. The symptoms of depression can include: 

• Feelings of depression, sadness, or emptiness
• Difficulty sleeping or excessive sleeping
• Frequent or uncontrollable crying
• Fatigue or low energy
• Social withdrawal

Note that the depression stage does not necessarily mean someone has depression. However, if you’re experiencing signs of depression for over two weeks on most days, consider getting a depression screening from a doctor or mental health professional. Depression can have serious consequences, so seeking help can guide you in moving forward and receiving adequate support. 

Stage five: Acceptance

The last of the five stages of grief is acceptance, during which a person fully accepts that their loved one is gone. While it may take time, accepting the reality of loss can help one understand the impact and consequences of their situation. Individuals in the acceptance stage may search for ways to remember their lost loved one, whether through physical representations like a memorial or mural or by sharing memories of the loved one with others. Acceptance could also allow someone to feel comfortable making plans for the future, such as making a trip, moving to a new city, or considering searching for a new romantic partner. 

• A sense of mindfulness or being in the present moment 
• An increase in positive thought
• Engagement in self-care
• Higher levels of emotional control 
• Increased coping skills
• Comfort with vulnerability or openness
• A sense of security and hope for the future

While the Kübler-Ross model could be one way to understand or structure one’s grief, this theory may not represent how all individuals process loss. In some cases, a person may not experience every stage, skip one stage, or go through the stages in a different order. In some cases, the grieving process may be challenging to navigate without assistance. In these situations, people may seek treatment. However, you do not have to have a mental illness to seek grief therapy. 

Understanding prolonged grief disorder 

The treatments for grief can vary depending on the severity and whether someone has developed a grief-related condition. One example of these conditions is prolonged grief disorder (PGD), which was added to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). The DSM-5-TR criteria for diagnosing this disorder depend on one’s circumstances. 

To be diagnosed, the death of the individual’s loved one must have occurred at least 12 months prior to the present, and, since the death, they must experience at least one of the following two symptoms that is present most days and nearly every day for the last month:

• Intense yearning or longing for the deceased
• Preoccupation with memories or thoughts of the deceased

Since the death, an individual must also have experienced at least three of the following symptoms that are present most days and nearly every day for the last month:

• Difficulty reintegrating 
• Emotional numbness
• A belief that life is meaningless
• Intense loneliness
• Avoidance of reminders of the loss
• Identity disruption
• Disbelief about the death
• Intense and painful emotions, including bitterness, sorrow, and anger

The severity and duration of the reaction to loss must exceed what may be expected, often measured by social, religious, or cultural norms. In addition, symptoms cannot be better explained by other conditions, such as post-traumatic stress disorder (PTSD), major depressive disorder (MDD), or the physiological effects of a substance or another medical condition.

How is prolonged grief disorder treated?

While some forms of therapy could be beneficial for those experiencing grief, PGD may respond to specific therapeutic approaches. Research indicates that narrative therapy, cognitive-behavioral therapy, and exposure therapy may also benefit those experiencing PGD. 

Narrative therapy

Narrative therapy can help individuals understand their lives and integrate the circumstances of their loss into that story. This type of therapy may also allow individuals to separate their personal identity from their grief. By externalizing the challenges of loss, those in narrative therapy could see the true impact that PGD is having on themselves and others. 

Cognitive-behavioral therapy (CBT)

Grief-focused CBT often uses many of the same techniques as CBT utilized for depression and anxiety. These techniques may include the identification of potentially harmful thoughts, changing behaviors that could contribute to grief, and education on coping strategies that may be beneficial. 

Exposure therapy

While often used for the treatment of post-traumatic stress disorder (PTSD), exposure therapy could also help those experiencing grief. Research indicates that exposure therapy combined with CBT resulted in more significant reductions of measures in PGD than CBT alone. 

Alternative support options 

While in-person forms of therapy could benefit those with grief or prolonged grief disorder, they may not be convenient or accessible in all areas. For those living in healthcare professional shortage areas (HPSAs), finding a mental health provider could be challenging and take a significant amount of time. These difficulties may be compounded for those who lack health insurance. In these situations, trying alternative options, such as online therapy through a platform like BetterHelp, can be beneficial. 

Through an online platform, clients can be matched with a grief therapist with experience in specific types of grief. They may also be able to access unique resources like weekly support groups, journaling prompts, worksheets, and goal-tracking features. These resources can allow them to fully immerse themselves in their grieving healing journey. 

Research suggests that online and in-person therapy can provide similar levels of efficacy. In one study, researchers found no significant differences in symptom severity, satisfaction, or overall improvement in those treated with online therapy compared to those treated with face-to-face therapy. These results were seen immediately after therapy concluded and during check-ins at three, six, and 12 months.