Grief Box: What Is The Ball And The Box Analogy?

When loss first occurs, the grief one experiences can be overwhelming. This experience may be explained by the “ball and the box analogy.” This analogy describes grief as a ball inside a box representing life. Within this grief box is a “pain” button, which the ball can strike randomly to cause pain. 

While the ball may be larger in the earlier stages of grief, over time, it can shrink, with periodic pangs of pain reminding one of their loss. However, to fully understand how the ball and the box analogy depicts grief, exploring how it parallels different grief phases may be helpful. 

How the ball and the box analogy relates to grief

According to North Central University, the ball and the box analogy was first shared by Lauren Herschel, who claimed she had learned the concept from her doctor. The ball and the box analogy illustrates how grief can evolve, transitioning from the initial painful stages immediately after a loss has occurred to later in the grieving process. This transition may align with a scientific understanding of how grief changes over time and moves through distinct phases. In a scientific review, Grief and Bereavement: What Psychiatrists Need to Know, these phases are described in two distinct categories: acute and integrated grief.  

Acute grief 

Acute grief typically occurs immediately after the loss of a loved one and can significantly impact a person’s emotional state, behavior, and ability to function. This period may involve:

• Intense sadness or hopelessness: Individuals may frequently cry or become overwhelmed by despair. 
• Difficulty concentrating: Everyday tasks and responsibilities can become challenging as a person’s mind constantly drifts back to thoughts of their lost loved one.
• Dysphoria: Dysphoria can cause a person to experience a persistent sense of dissatisfaction or unease, making it hard to find joy in previously enjoyable activities.
• Preoccupation with the loss: Individuals could replay memories and think obsessively about the deceased.
• Loss of sexual drive: The emotional aspects of grief may make it difficult to engage in physical intimacy, which can also cause a lack of interest in sexual activity. 
• Yearning: Individuals may experience an overwhelming yearning for their lost loved one.

Grief may also cause a person to experience physical symptoms, such as:

• Difficulty sleeping
• Difficulty breathing
• Noise sensitivity
• Fatigue or lack of energy
• Pains and aches
• Significant decreases or increases in appetite
• Tightness or heaviness in the chest
• Dryness in the mouth

During this stage of grief, the “ball” in the ball and the box analogy would typically be at its largest. As the ball bounces around the metaphorical box of life, it may be far more likely to strike a person’s “pain” button. In the earlier stages of grief, individuals may experience challenges in avoiding reminders of their grief. While certain events, such as memorials and funerals, can offer valuable opportunities to honor a lost loved one, they may hit that “pain” button numerous times. In some cases, the weight of early grief can be overwhelming, but over time, this “ball” may start to shrink. 

Integrated grief

As time passes, individuals may start to adjust to the loss of their loved one, and symptoms can start to subside. While this transition can take many months, a person may notice signs that they are integrating their grief, such as the following. 

Rediscovery of previous joys

After losing a loved one, individuals may find it challenging to enjoy previously enjoyable activities for some time. As acute grief passes, they may start to rediscover hobbies, projects, or pastimes they once loved. They may begin to sink more time into these activities, which can ease the process of moving on. 

Strengthening of relationships

Acute grief can negatively affect a survivor’s other relationships for various reasons. For example, grief can cause a person to isolate, ignore communication from a friend, or avoid social engagements. Grief can also lead a person to lash out at loved ones, which may involve insults or arguments. As a person integrates their grief as a grieving friend or loved one, they may recognize any damage they may have done to their relationships. Individuals overcoming grief could repair or strengthen these relationships by reaching out or apologizing for hurting those they love.

Making plans for the future

During the initial stages of grief, individuals may find it challenging to think of anything besides the memory and circumstances surrounding the loss of the person they love. In some cases, numerous parts of a person’s life may be connected to the deceased. They may struggle to imagine where they are headed on their journey without their loved one, so they may stop making plans for the future. However, as a person reaches the integrated grief stage, their preoccupation with the loss could lessen. They may start making concrete plans, including those related to education, their professional lives, and potential romantic partners. 

Using the ball and the box analogy, the ball of grief may shrink during this period. However, the ball may not disappear entirely, and the “pain” button at certain intervals may still be struck. Instances of acute grief can still occur, particularly around dates or events that relate to the deceased. For example, on anniversaries, birthdays, certain holidays, or during the loss of another loved one, they may experience worsened grief. However, these occurrences can be less frequent, and the pain one experiences could be less intense. 

What is prolonged grief disorder?

Some individuals may find that the “ball” does not shrink, and their acute grief persists. This persistence may be the result of a condition known as prolonged grief disorder. According to the American Psychiatric Association (APA), prolonged grief disorder is a condition that can cause people to experience persistent acute grief that can interfere with their ability to function in daily life. Also referred to as “complicated grief,” the APA estimates that 7% to 10% of bereaved adults will experience prolonged grief disorder. The symptoms of this disorder can vary but may include:

• Disbelief or denial about their loss
• Disruption of identity
• Intense loneliness or detachment
• Difficulty reintegrating professionally, academically, or socially
• Overwhelming anger or bitterness concerning the death
• Emotional numbness
• A significant effort to avoid reminders of the loss

Specific demographics may be more prone to developing prolonged grief disorder, such as those who have experienced bipolar disorder or depression, as well as older individuals. If the deceased had a caregiver, these individuals may also be at a greater risk. To avoid worsening symptoms and help those experiencing prolonged grief disorder, people may seek treatment. There is no perfect or simple way to experience grief, and talking to a professional can help you receive personalized support through a treatment plan created only for you. 

How to treat prolonged grief disorder

The APA recommends several therapeutic approaches that could treat those experiencing prolonged grief disorder, including the following. 

Cognitive-behavioral therapy (CBT)

Complicated grief therapy (CGT) 

CGT can combine CBT and interpersonal therapy (IPT) elements to help a person analyze their behaviors and relationships. Research suggests that CGT may be more effective than IPT alone. In one study, CGT resulted in faster and higher response rates, with 51% of individuals responding to CGT compared to 28% responding to IPT.

Alternative support options 

While therapy may benefit those experiencing grief or prolonged grief disorder, in-person forms of treatment could be inconvenient for some. For those who have recently lost a loved one, leaving the house or traveling to a therapist's office may be difficult. Grieving individuals may also struggle with concentration or irritability, which could increase the challenge of finding the right therapist. Exploring online therapy through a platform like BetterHelp could be beneficial in these cases. 

Through an online platform, clients can match with a therapist specializing in grief and meet with them via phone, video, or live chat sessions. In addition, online therapy platforms may offer support groups, allowing clients to connect with others going through similar challenges. 

Research has shown that online therapy can be as effective as in-person therapy. In a 2022 meta-analysis of 12 randomized controlled trials, researchers compared the efficacy of these two types of therapy. They found that those who received online therapy had similar satisfaction, symptom severity, and overall improvement to those who received therapy in person.