Grief is something that affects everyone. This is because grief is a natural reaction to losing something that means a lot to us. As long as we have something or someone we love, we will sooner or later be affected by grief. 

Photo: by Lachlan Thompson on Unsplash


 

What is a grief reaction?

Grief reactions are natural when we lose something or someone that means a lot to us. In some cases, the grief reaction may be difficult to cope on your own, and it may be necessary to seek help.

NHI.no writes [NHI, 2019][1] :

A grief reaction is a mental reaction where a person can feel sadness, despair, fear and anger. Grief is often closely linked to feelings of loss. This can be, for example, the loss of a spouse, friends or work, but it can also be the loss of one's own health, such as in the event of a serious illness, or the loss of personal security, such as having been subjected to acts of violence and abuse.

The extent of a grief reaction will vary, and will depend on the size and severity of the triggering cause, as well as on our personal characteristics. In this way, our personality, our resources and our previous experiences will lay a foundation for how we will react to a trauma or loss of something that is important to us. In addition, the resources available to us in our network will be important for the development of a grief reaction.

 

Common phases of grief

NHI.no further writes that it is common to operate with four phases of grief [NHI, 2019] :

  

  1. The shock phase. In this phase, one tries to understand what has happened and to let it sink in. It is common to struggle to acknowledge that what has actually happened is the case.
  2. The reaction phase. In this phase, crying, sadness, protest ("it is not true") or anger are common. You react emotionally to what has happened and the reactions can be strong. 
  3. The repair phase. You gradually move into a phase where reactions are put into perspective and it begins to dawn on you what has happened.  
  4. The reorientation phase. In this phase, life begins to fall back into place again and one masters to see more ahead.

Not everyone goes through all these phases. How one experiences the phases is also individual, and it is common to go back and forth between them.

 

How to help someone who is grieving

Health Norway writes [Health Norway, 2018][2] :

It is common to feel helpless in the face of a grieving person. Words can feel empty and meaningless. But it is usually not necessary with so many words or to be so advanced. The most important thing is to have time to listen, and often eye contact and a handshake are enough.

One who mourns seldom has the strength to ask others for help, even if he needs it. Offers of practical help are often welcome, and a great way to show care.

It is important to show generosity and patience to someone who is grieving, and for example not to take rejections so seriously. Do not push yourself with words, just be present and feel free to offer help repeatedly - and over time.

 

Advice for processing grief

Health Norway also provides the following advice for processing grief [Health Norway, 2018] :

 

  1. It is important to allow yourself to feel what you are feeling and be prepared for the fact that your feelings will change. Remember that it is not a decision for what the right reactions are, this is completely individual.
  2. Make sure you get enough nutrition and sleep, even if everything feels indifferent.
  3. It can be good to cry, and it is often good to have someone to cry with.
  4. Allow yourself to spend time thinking about the deceased and the moments you had together. Feel free to talk to others who were close to the person who has died, or who have lost a loved one.
  5. When grief becomes particularly heavy, it is important to contact someone you can talk to. There may be people you trust in the local community or in the support system.
  6. It can be good to try to get back to routines and normal life. Go to school, work, participate in leisure activities and be with friends. Then you avoid being stuck with the heavy thoughts all the time.
  7. It is allowed to be angry and upset, and you may want to get it out, either by talking to someone, writing a diary or by exercising.
  8. It is allowed to laugh. Even if you, and others around you, are sad, it is important to take a break from grief. It is allowed to have fun with your friends even if you are sad - without having a bad conscience for it.
  9. Many people find it a support and great comfort to meet others who are in the same situation. In several places in the country, there are offers for discussion groups for mourners. Contact a doctor, health and care services or a ward and ask if there are grief groups nearby.
  10. If you feel guilty about something that has been or should have been said while the deceased was still alive, it may be a good idea to talk to a confidant so that you are not alone in these thoughts.
  11. It is especially important to seek help if the grief negatively affects daily life over a long period of time, or you do not experience any relief or variation in the heavy emotions.

 

What is complicated grief?

Psykologisk.no writes [Dyregrov et al., 2014][3] :

There are various forms of complicated grief, the most common being grief that does not go away, called both prolonged grief and chronic grief. Usually, complicated grief reflects that the grief has an intensity and duration that goes far beyond normal grief reactions.

In addition to the fact that the diagnosis cannot be made until after six months with the ailments summarized above, the ailments must cause a clinically important impairment of social functioning or impairment in other important functional areas. The disorder should also not be (better) accounted for through other diagnoses such as severe depression, generalized anxiety disorder or post-traumatic stress disorder (PTSD). 

They also add:

Although it can be difficult to distinguish normal grief from complicated grief, there is no doubt that many people struggle for a very long time with reactions for which it is possible to get help. It is estimated that between 10 and 15 percent of all survivors, regardless of the cause of death, develop complicated grief reactions of an extended type. 

 

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Different forms of help

 

  1. Psychotherapy

     

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    Psychotherapy / treatment is a process characterized by a time-limited contact between a therapist and a patient / client, in which specific problems are thematized and worked with. Include different therapeutic traditions (for example cognitive behavioral therapy (CBT), psychodynamic therapy, family therapy, and more)

    A useful source that evaluate the effectiveness of specific therapies for different mental health problems is the website to the Cochrane Institute [Cochrane Institute][4] .

     

  2. Online therapy

     

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    Online therapy is similar to traditional therapy or treatment, but is provided by digital means (either phone, video conference, or similar). Digital interventions can include a broader range of options, such as therapist-guided self-help programs online.

    The current research literature provide strong support for the adoption of online psychological interventions as a legitimate therapeutic activity [Barak et al., 2008][5] .

     

  3. Support / self-help groups

     

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    Support / self-help groups can take a variety of forms, from providing a safe and supportive social environment; more or less structured group meetings; information and guidance relating to how to use available help services; and a lot more.

    While it is difficult to know the effectiveness of such services, due to very different compositions of support and self-help services, the research generally show the self-help groups may have important benefits for the participants [Kurouz et al., 2002][6] .

     

  4. Helplines and chats

     

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    Different helplines and chats exist. Some helplines are specialized in providing you with information and guidance, while others are more specialized in providing emotional support. Some helplines are highly professional, while others are more based on voluntary workers, that merely wish to be a caring listener.

    It is difficult to evalute how effective such services are, and it probably depends on many factors. For example, while the state of the science regarding the effectiveness of crisis response services remains limited, overall results provide support for such services [Hoffberg et al, 2020][7] .

     

  5. Online communities and forums

     

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    Online communities and forums are options to get in contact with other individuals that struggle with something similar to you or someone you know. Some communities are moderated by professional health workers, while most of them are not.

    Online communities is traditionally not understood as a support or health service, but rather a social area - that may have the potential of being supportive for the individual that uses it. Importantly, research has shown that "people with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours" [Naslund et al., 2016][8] .

    This seems to indicate that online communites should not be underevaluated as a potential resource to recovery, coping and enhanced quality of life for people affected by mental health problems.

     

 

Find help for bereavement where you live

Please choose your location to find help for bereavement where you live:

 

You can also browse from different options of help where you live:

 

References & Footnotes
  1. NHI, 2019: NHI (2019). Sorgreaksjon [Grief reaction]. Retrieved 10th of February 2021 from: https://nhi.no/psykisk-helse/psykiske-lidelser/sorgreaksjon/
  2. Health Norway, 2018: Health Norway [Helsenorge] (2018). Dødsfall – sorg og sorgreaksjoner [Death - grief and grief reactions]. Retrieved 10th of February 2021 from: https://www.helsenorge.no/psykisk-helse/dodsfall-sorg-og-sorgreaksjoner
  3. Dyregrov et al., 2014: Dyregrov, A., Dyregrov, K., & Kristensen, P. (2014). Hva vet vi om sorg og komplisert sorg? [What do we know about grief and complicated grief?]. Retrieved 10th of February from: https://psykologisk.no/2014/09/hva-vet-vi-om-sorg-og-komplisert-sorg/
  4. Cochrane Institute: Cochrane Institute: "Trusted evidence. Informed decisions. Better health." Retrieved 9th of February 2020 from: https://www.cochrane.org/
  5. Barak et al., 2008: Barak, A., Hen, L., Boniel-Nissim, M., & Shapira, N. A. (2008). A comprehensive review and a meta-analysis of the effectiveness of internet-based psychotherapeutic interventions. Journal of Technology in Human services26(2-4), 109-160.
  6. Kurouz et al., 2002: Kyrouz, E. M., Humphreys, K., & Loomis, C. (2002). A review of research on the effectiveness of self-help mutual aid groups. British Journal of Clinical Psychology33, 198-200.
  7. Hoffberg et al, 2020: Hoffberg, A. S., Stearns-Yoder, K. A., & Brenner, L. A. (2020). The effectiveness of crisis line services: A systematic review. Frontiers in public health7, 399.
  8. Naslund et al., 2016: Naslund, J. A., Aschbrenner, K. A., Marsch, L. A., & Bartels, S. J. (2016). The future of mental health care: peer-to-peer support and social media. Epidemiology and psychiatric sciences25(2), 113-122.