Center for Prolonged Grief

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Prolonged Grief

What it is

Prolonged Grief (PG) is grief that continues to be intense and pervasive, disrupting everyday life for longer than a year. This happens to about 10-20% of bereaved people, with rates differing depending on who died, when they died and how they died. People experiencing PG often describe it as feeling “stuck” in grief or “frozen in time” as if the death had just happened. Grief dominates their thoughts and feelings, making it difficult to think about or concentrate on anything else. The future seems bleak and empty. They feel lost and alone. Relationships with loved ones flounder as does their own health.

How to understand it

Key things to know about grief to understand Prolonged Grief.

Grief is the natural response to loss and it doesn’t have a time limit.

We usually grieve intensely in the beginning, with grief dominating our life. We call this acute grief. There are strong feelings of yearning, longing, and sorrow, along with insistent thoughts and memories of the person who died. Other painful emotions often include anxiety, anger, remorse, guilt, or shame. The period of acute grief lasts a variable amount of time, as we gradually find ways to accept the reality of the loss and restore our own capacity for wellbeing.

Grief doesn’t go away completely, but we change our relationship to it.

There is no time after which we expect people to stop grieving. In fact, grief is usually permanent after someone we love dies. However, the way our grief shows up changes over time. As we learn to live in a world without our special person, grief’s power over our thoughts, feelings, and behavior lessens. You can think of learning to live with the loss as a process of adapting to all the changes the loss brings, and as we adapt, grief settles down and finds a place in our life. In this more integrated form, it can become a force to help us grow and change.

Losing a loved one is one of the most stressful experiences we ever have.

The loss itself is highly stressful, and it also brings a lot of additional stresses, like intense loneliness, a loss of sense of self and of feelings of belonging and mattering in the world, uncontrollable emotionality, changing family dynamics, feelings of exclusion from social groups, or new responsibilities. Moreover, grief itself is stressful because it’s so powerful and unfamiliar and often contains a lot of mixed feelings and confusing thoughts. So we need to cope with a lot of stress when we are grieving. We need to cope in a way that alternates between confronting the pain and setting it aside.  In other words, its important to have periods of respite from the pain. We do that with some typical kinds of coping mechanisms that are protective ways we try to evade the reality – for example protest or disbelief, taking unwarranted responsibility for the death or assigning it to someone else – as though it could have been stopped.  Another thing most people do is imagine different ways things could have gone – ways the person would not have died or their death would have been easier.  We tend to try to stay away from things that remind us that our special person is gone and we don’t want to think about a future without them, or we spend time trying to be close to them by daydreaming, looking at pictures, listening to recordings of their voice or even smelling their clothes.  All of these are protective and very natural ways to cope with intense disorienting pain, but when we hold onto them for too long, in a way that is the main way we are coping, they can get in the way of adapting to the loss. 

Adapting is different from coping.

Adapting happens naturally. It’s what living things do when we are faced with meaningful changes. When we adapt we adjust our automatic thoughts and behaviors to fit our new situation. Adapting happens gradually, much of it out of our awareness, but it’s not always smooth or easy. Losing a loved one changes many things and adapting allows us to move forward in the most optimal way. Coping is how we bear the pain and manage stress. Coping is helpful as we engage in the longer, ongoing process of adapting – of learning how the world is changed by the loss and restoring the possibility of thriving in that world. As we adapt, grief quiets down and moves into the back of our minds.

There are healing milestones in adapting to loss.

One way to think about the process of adapting to loss of someone close is to track a series of healing milestones. Achieving these milestones, in no particular order, is part of a process that often unfolds naturally. These also provide a framework for others to support grievers in their journey. 

Honor your loved one and yourself; explore your own interests and values.
Embrace your emotions; both painful and pleasant ones; learn to ease the pain.
Accept grief and let it find a place in your life.
Live with reminders of your loss, allowing them to be bittersweet
Integrate memories into your life; let them help you learn and grow.
Narrate stories of the death for yourself and to share with others.
Gather others around; let them into your life; let them support you.
Prolonged Grief: how adapting is derailed.

Thoughts, feelings, and behaviors that are very natural, even helpful, during early grief can gain a foothold and make it more difficult to adapt. They can distract us from accepting the reality of the loss, recognizing the permanence of grief, and learning to live with a changed relationship with the deceased. They get in the way of restoring a sense of purpose and meaning in life and feelings of belonging and mattering with the possibility for happiness.