For many people, finding their way back to life after the death of a loved one is difficult. This article describes the different stages of grief. It also discusses what can make coming to terms with loss easier and what can make it more difficult.
At a glance
- Most people experience intense grief when a loved one dies.
- For some, the grief lasts a very long time and can severely impact life.
- Both strong avoidance of thoughts of the deceased person and constant rumination about the loss make it difficult to cope.
- If the grief is very intense, it can be helpful to still make contact with friends, and participate in positive activities and everyday life.
- Depending on the duration and intensity of the grief, support groups, grief counseling, and psychotherapy options are available.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
How do people cope with grief?
Grief is natural after the loss of a loved one. Depending on the role the deceased person played in the lives of the bereaved, the pain can still be felt years or even decades later.
However, the initial intense psychological stress and impact caused by the loss typically diminishes slowly within the first few months. Of course, there are always intense feelings of grief, especially when memories return at anniversaries, vacations, or Christmas. But for most people, things improve slowly over time. This makes it possible to return to life and participate in it. However, it can be very difficult for some people to process grief and “get back to life”.
What is prolonged grief disorder?
Some people develop what is known as prolonged grief disorder after the death of a loved one. It is even more common when a loved one has died unexpectedly, for example, in an accident or by suicide. In such instances, prolonged grief disorder occurs in about half of those affected.
Prolonged grief disorder is diagnosed when the intense distress and impairment caused by the loss does not improve after more than 6 months. People with prolonged grief disorder consistently and intensely yearn for the deceased person and become almost exclusively preoccupied with him or her. In some people, depression also develops.
The diagnosis of prolonged grief disorder does not mean the person’s grief is “abnormal”. It is natural to grieve the loss of a loved one, even years later. Rather, the diagnosis allows professionals to determine the need for possible psychotherapeutic support.
Important: The goal of psychotherapy is to be able to accept the loss, to decrease the pain of separation, and thus to reduce the overall burden. At the same time, the bond with the deceased person should be maintained.
How can one cope with loss?
There are different ways to cope with loss. The term “mourning” describes the process of actively dealing with the events leading up to and during the death of a loved one, as well as important memories, after the death.
Bereaved people usually alternate between coping with the loss and coping with everyday life; on the one hand, one deals with the loss and looks for a way to deal with the grief. On the other hand, one works to return to everyday life and recover.
In this process, one must temporarily divert one’s attention away from the grief, tackle new tasks, take on new roles, and do things necessary to cope with everyday life without the deceased person. This involves a healthy alternation between coping with the loss and coping with everyday life.
What can help a person cope with grief?
When dealing with grief, it can help to be aware of the circumstances and understand the impact of the loss. For example, people in mourning sometimes feel responsible for the circumstances of the death or the death itself, for example, because they were not with their loved one when the person passed away.
This is understandable and initially helps to maintain a bond with the deceased, however, as the process unfolds, it can be helpful to discuss what happened with a therapist and to work together to reframe the circumstances.
In addition, a mindful, accepting attitude can help process the loss. This means being open to the many feelings, thoughts, and sensations that are present without judging them.
People who completely avoid thoughts of loss may have difficulty processing grief. This is also true, conversely, if people ruminate a lot about the loss, that is, continuously think about the loss in a negative way. Avoiding situations and places that remind people of the person who died also seems to have an unfavorable effect on the mourning process.
Overall, it can be helpful to deal with grief and pain, but also to refocus on the new demands of everyday life: to grieve, but not just grieve. To allow feelings, but also to distract yourself and do pleasant things. To alternate between thoughts of the deceased person and thoughts of oneself and others.
In this process, many people learn that enduring losses is difficult, but possible. The consequence of loss therefore does not have to result in retreating out of fear. It is also possible for people to engage more deeply in relationships after loss and to venture into new roles, new behaviors, and new lifestyles.
Hindering and helpful thoughts
Certain thoughts or attitudes can make it difficult to process loss. These include:
- I betray my love for him/her if I move on with my life.
- I could have prevented the death if I had done something specific.
- I don’t want to live without her/him anymore.
- It is so unfair that she/he had to die.
The following thoughts can be helpful:
- She/he would want me to live on happily.
- I did what I could with my knowledge at the time.
- She/he would not want me to suffer so much.
- Her/his suffering has finally ended.
Where can one find support for grief?
Those who are very sad, feel extremely burdened, or simply want to talk to an external, qualified person, can call the TelefonSeelsorge (telephone helpline) at 0800 - 1110111.
Information on grief-related groups for those in mourning and their family, as well as grief cafés and grief counseling, can be found at Malteser Hilfsdienst e.V. (in German).
If one is still severely affected by the loss after six months, do not be afraid to look for psychotherapeutic support. Psychotherapists can be found through the Association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung). Call 116 117 or use the online directory for physicians.
- Djelantik A, Smid G, Mroz A et al. The prevalence of prolonged grief disorder in bereaved individuals following unnatural losses: Systematic review and meta regression analysis. J Affect Disord. 2020. 265: 146-156. doi: 10.1016/j.jad.2020.01.034.
- Eisma M, Stroebe M. Emotion Regulatory Strategies in Complicated Grief: A Systematic Review. Behavior Therapy 2021. 52:1, 234-249. doi: 10.1016/j.beth.2020.04.004.
- Johannsen M, Damholdt MF, Zachariae R et al. Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord. 253, 69-86. doi:10.1016/j.jad.2019.04.065.
- Lundorff M, Holmgren H, Zachariae R et al. Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. J Affect Disord. 2017. 212: 138-149. doi: 10.1016/j.jad.2017.01.030.
- Rosner R, Comtesse H, Vogel A et al. Prevalence of prolonged grief disorder. J Affect Disord 2021. 287: 301-307. doi: 10.1016/j.jad.2021.03.058.
- Rosner R, Pfoh G, Rojas R et al. Anhaltende Trauerstörung: Manuale für die Einzel- und Gruppentherapie. Hogrefe: Göttingen 2015.
- Stroebe M, Schut H. The Dual Process Model of Coping with Bereavement: Rationale and Description. Death Studies, 23:3,197-224. doi: 10.1080/074811899201046.
- Znoj H. Ratgeber Trauer: Informationen für Betroffene und Angehörige. Hogrefe: Göttingen 2021.
Reviewed by the German Association for Psychiatry, Psychotherapy and Psychosomatics (Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde e. V.).As at: