The Psychology Of The Grief Process: What Does Healthy Grief Look Like?

The process of coming to terms with a significant loss, also known as grief, is a dreaded but common experience. When you’re going through a painful transition like grief, you may be surprised by some of your emotional and behavioral responses. You might also find yourself wondering how long you’ll continue to feel this way. Psychological research on the grief process may offer some insights. 

Despite the popularity of theories dividing the process of adapting to loss into orderly stages, different people can experience grief in many ways. Emotional reactions often vary, as can the duration of intense negative feelings and the time it takes someone to begin moving on. Grieving people may alternate between periods of confronting their new circumstances and periods of grappling with their loss.

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What is grief?

In psychological terms, grief is the experience of emotional pain and distress following a notable personal loss. People are often familiar with grief as a response to the death of a loved one. However, grief can also occur after events like divorce, miscarriage, relocation, or the end of a cherished dream for the future. 

Grief responses may vary significantly between individuals, but commonly reported reactions include:

• Sadness
• Shock, disbelief, or confusion
• Vivid memories or dreams of the person or circumstances you’ve lost
• Emotional numbness or emptiness
• Anxiety
• Anger
• Lack of energy, motivation, or enjoyment
• Relief
• Acceptance

Grief may also involve physical signs of distress, such as headaches, nausea, weight loss, and changes in appetite. Emotional stress can lead to an elevated risk of mortality, especially for people who have lost someone with whom they were extremely close.

Your responses to bereavement may be very different at different times, and they can be influenced by your temperament as well as factors like:

• Your closeness with the deceased
• Whether the loss was unexpected or anticipated
• Your social and cultural background
• How much support you have from friends, family, and community members
• Your financial, social, and personal resources
• Your spiritual or religious beliefs, if any

Grief vs. mourning

The mental, emotional, and physical responses caused by grief may vary strongly between individuals, but the outward expression of grief is often shaped heavily by culture. People from different parts of the world or different ethnic, religious, and sociocultural backgrounds may exhibit uniquely different behaviors when mourning a loss. 

In some cultures, for example, dramatic and public demonstrations of anguish over death are considered normal and appropriate. In others, bereaved individuals may be expected to maintain a reserved and quiet demeanor around others. Cultural traditions of mourning may involve a wide variety of elements, such as:

• Formal rituals
• Spontaneous expressions of grief 
• Shared recollections of the deceased
• Communal celebrations
• Quiet contemplation
• The creation of works of art expressing grief or honoring the deceased
• A period of social withdrawal or isolation

None of the ways of expressing grief are necessarily more or less psychologically healthy. If your culture’s mourning rituals provide a sense of meaning or community for you personally, they may help you during the grieving process. 

Are there stages of grief?

Popular theories of bereavement and grief describe the mourning process as a succession of distinct phases. The most well-known example is the Kübler-Ross model, which describes five stages of grief:

1. Denial stage: Disbelief in or refusal to acknowledge the loss
2. Anger stage: Rage or blame toward oneself, other survivors of the loss, or people trying to offer comfort
3. Bargaining stage: Fantasies or appeals to a higher power centered around the idea of undoing the loss
4. Depression stage: Intense sadness and difficulty engaging in the activities of daily life
5. Acceptance stage: Finding ways to cope with the reality of life after the loss

Other theories expand this model to six or seven stages, adding phases like “shock,” “testing,” or “making meaning.” Although these multi-stage models of grief may help some people come to terms with their reactions during bereavement, contemporary research suggests that there’s little empirical evidence to support them. Not everyone experiences all of the stages described, and those who do may not progress from one stage to the next in a linear fashion. An individual may shift rapidly between feelings of depression, anger, disbelief, and others. 

The dual-process model of grief

An alternate theory with stronger empirical evidence than the “stages of grief” is the dual-process model of grief (DPM). According to this theory, bereaved individuals typically undergo two simultaneous adjustment processes. On the one hand, they’re looking back, processing their negative feelings over their loss. On the other hand, they’re looking forward, attempting to adapt to the changed circumstances of their life.

According to the DPM, an individual repeatedly shifts back and forth between two processes:

1. Loss-oriented coping, in which they wrestle with or attempt to express feelings such as sorrow, irritability, anxiety, and despair. In this mode, the individual directly confronts their loss and difficult emotions. 
2. Restoration-oriented coping, in which they address the practical challenges of life without their loved one or former life circumstances. In this mode, the individual may focus less on their feelings of grief and more on how they can function in society and find meaning, purpose, and happiness in life. 

Early in the grief process, people often spend more time on loss-oriented coping. As time passes, life's responsibilities, stresses, and opportunities begin to occupy more and more of their attention, shifting the balance toward restoration-oriented coping. Individuals may still sometimes feel intense grief, but this response can become less common with time. 

How long does the grieving process last?

There may not be a well-defined endpoint to the process of mourning. Some people still experience feelings of sadness and yearning years or decades after the loss of a loved one. The sense of a significant absence in your life may never go away completely — you might go for months without thinking of the person or situation you lost, only to have a pang of sorrow when a specific memory pops into your mind.

However, some people find that the pain of grief becomes less intense over time, and instances of intense distress when thinking about their bereavement happen less frequently. Resources from the National Institutes of Health suggest that many people begin to experience a decrease in the intensity of grief reactions after around six months and return to their approximate former level of psychosocial functioning after one to two years, depending on the circumstances of the loss. 

Healthy vs. pathological grief

If severe grief reactions persist for a year or more and disrupt your ability to fulfill your everyday responsibilities, manage your interpersonal relationships, and pursue your life goals, you might be experiencing a mental health condition known as prolonged grief disorder (PGD). This disorder can involve symptoms like:

• Intense emotional pain (strong feelings like anger, sorrow, bitterness, and guilt)
• A persistent sense of disbelief
• Avoidance of reminders of the loss
• Difficulty engaging in ordinary activities
• Feelings of meaninglessness, numbness, or emptiness
• A sense that you’ve lost part of your identity
• Detachment or loneliness

PGD symptoms may be mixed with symptoms of other mental disorders, such as depression and post-traumatic stress disorder (PTSD). Poor psychological health after bereavement may be more likely after an unexpected or violent loss. Certain maladaptive attitudes, beliefs, or coping mechanisms could also contribute to pathological grief, including:

• Substance use (formerly referred to as “substance abuse”) 
• Avoidance of thoughts or reminders of the loss
• Blaming oneself 
• Viewing life as pointless
• Social isolation
• Ruminating excessively about the loss

Some of these reactions may not necessarily be unhealthy when they’re brief or balanced by more constructive responses. For instance, if a loved one dies of an illness, it may be natural to feel guilty and wish that you had pushed them to see a doctor sooner. However, dwelling on this idea for too long may be harmful to your mental health. A constructive grief process may involve accepting the limits of your control and letting go of self-blame. 

Learn evidence-based coping skills to process grief

Talk to a licensed counselor

Getting professional help with the grieving process 

While connecting with trusted friends and family members may be a powerful source of support in times of grief, it may also be helpful to talk with a therapist, especially if you think you might be experiencing grief-related mental health symptoms. Early studies suggest that techniques like cognitive-behavioral therapy may relieve symptoms of conditions like prolonged grief disorder. 

If you find the idea of trying to locate a mental health provider daunting, especially when navigating other responsibilities following the loss of a loved one, online therapy may be more convenient for you. Online therapy platforms like BetterHelp can connect you with a therapist who matches your preferences and has expertise in grief counseling. Through these platforms, you can choose a therapy time that works for you and access resources like support groups to help you cope with loss. 

Researchers are accumulating a growing body of evidence for the effectiveness of web-based mental health care. A 2021 review of past scientific studies noted evidence that Internet grief counseling treatments may lead to significant improvement in symptoms of pathological grief, depression, and post-traumatic stress among bereaved patients.