Back in November I wrote about how the field is shifting it’s thinking on complicated grief and some of the controversy surrounding the changes to grief as an exclusionary criteria for depression. I still agree that the change was a step in the right direction and with that in mind, we’re going to look at how CBT can be useful in addressing avoidance behaviors within the context of complicated grief.
Individuals who struggle with complicated grief may engage in avoidance behaviors as a way dealing with the distress caused by situations connected to the loss. Behaviors may include avoiding family gatherings, isolating during certain times of the year, avoiding certain family members, avoiding places that have a connection to the loss - the list can be long or short. Avoidance behaviors carry two big price tags, the first being that they make the distress related to the situation worse in the long run. To understand why this happens it might be useful to understand the culprit behind the behavior namely, faulty thinking.
Avoidance behaviors are generally driven by catastrophic hypotheses . By engaging in the avoidance behavior we get immediate relief from the distress because we avoid whatever catastrophic event we believe may happen if we were to confront or face the situation- this is the hook. In avoiding the situation we rob ourselves of the opportunity to test the hypothesis. Because negative thinking surrounds the situation we are seeking to avoid, our beliefs about the situation become more catastrophic as more time passes between the present and our last successful exposure to the situation. This increases the likelihood that we accept the hypothesis as fact without evidence.
Let’s say a hypothesis someone may have looks ...
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...icipation to exposure but eventually the distress drops below the level prior to the exposure as a result of testing the hypothesis and/or surviving the situation despite it not going as well as you would have wanted.
Although we used family gatherings as an example throughout this post we can really apply this thinking and skill set to anything we avoid as a result of the loss - photo albums, restaurants, sections of town, etc. Although exposure is effective, it is not advisable for every situation. For example, I would never encourage an individual who struggles with a gambling addiction to hang out in a casino. Also, it is very important to remember that exposure can make matters worse if not done correctly and so if there are concerns about safety or fears that exposure may lead to a worsening of symptoms, it is probably best to seek professional assistance.
As in the stages of change, pre-contemplation or denial is followed by the slow understanding that a profound alteration in our lives is occurring. In this early stage, Deits encourages the reader to focus on the immediate personal needs of the grief stricken. Early in this pr...
The characters in Alice Sebold’s The Lovely Bones are faced with the difficult task of overcoming the loss of Susie, their daughter and sister. Jack, Abigail, Buckley, and Lindsey each deal with the loss differently. However, it is Susie who has the most difficulty accepting the loss of her own life. Several psychologists separate the grieving process into two main categories: intuitive and instrumental grievers. Intuitive grievers communicate their emotional distress and “experience, express, and adapt to grief on a very affective level” (Doka, par. 27). Instrumental grievers focus their attention towards an activity, whether it is into work or into a hobby, usually relating to the loss (Doka par. 28). Although each character deals with their grief differently, there is one common denominator: the reaction of one affects all.
It is common for those experiencing grief to deny the death altogether. Many people do this by avoiding situations and places that remind them of the deceased (Leming & Dickinson, 2016). However, by simply avoiding the topic of death and pain, the mourner only achieves temporary relief while in turn creating more permanent lasting agony (Rich, 2005). In this stage, mourners will begin to feel the full weight of the circumstance. Whether the death of a loved one was sudden or long-term, survivors will feel a full range of emotions, such as sadness, guilt, anger, frustration, hopelessness, or grief. While many of these emotions can cause serious suffering, it is important for the survivor to feel whatever emotions come up and deal with those feelings, rather than trying to suppress any
In 1969 Elisabeth Kübler-Ross, a psychiatrist, published the Pioneering book On Death and Dying. The work acquainted the world with the grieving process, called the five stages of grief. Kübler-Ross gathered her research from studying individuals with terminal cancer (Johnson, 2007). The first stage of the grieving process is denial. In this stage the person refuses to believe that their loved one is deceased, a common thought during this period is, “This can’t be happening to me” (Johnson, 2007).The second stage of the grieving process is anger. In this level the person becomes frustrated with their circumstances, a customary complaint is “Why is this happening to me?” (Johnson, 2007). The third stage of the grieving process is bargaining. At this point the individual hopes that they can prevent their grief, this typically involves bartering with a higher power, and an ordinary observance during this time is “I will do anything to have them back” (Johnson, 2007). The fourth and most identifiable stage of grief is depression. This phase is habitually the lengthiest as...
Individually, everyone has their own methods of dealing with situations and emotions regardless of any positive or negative connotation affixed to them. One prime example of this comes with grief. Elisabeth Kubler-Ross in her 1969 book “On Death and Dying” suggests that there are five stages of mourning and grief that are universal and, at one point or another, experienced by people from all walks of life. These stages, in no particular order, are as follows: Denial and Isolation, Anger, Bargaining, Depression, and finally Acceptance. Each individual person works through these stages in different orders for varying levels of time and intensity, but most if not all are necessary to “move on.” In order for positive change to occur following a loss, one must come to terms with not only the event but also themselves.
264). Susan, Dave, and Liz did, in fact, have distinctive grieving processes from one another. For example, Susan grieved by compartmentalizing and continuing with work, whereas Dave preferred seclusion. According to Ariès (1975), seclusion can serve two purposes during mourning, the first purpose being to hide their grief from others and the second being to prevent forgetting the deceased prematurely (p. 134-158). However, neither of these reasons seem to be why Dave prefers seclusion. It appears Dave likes the seclusion to get his thoughts in order, but not necessarily because he wants to hide his thoughts from others. Instead, I think Dave likes the quiet and peacefulness of being alone. There are some individuals that believe an anticipated death is easier to cope with than a sudden death (DeSpelder & Strickland, 2015, p. 371). Using this perspective, this seems to be the case with Dave. He had an easier time coping with his father's anticipated death compared to his brother's sudden death. Whereas, Susan had opposite reactions therefore, her experience does not support the
This article investigates the need for expanded grief interventions in the ID population. The authors look at a growing interest in the signs of grief that cause long term problems while acknowledging that too little is known about the grieving
The Death of Ivan Illych brings an excellent in-depth description of Elisabeth Kubler-Ross’s 5 cycles of grief theory. In the book, it shows how Ivan Illych goes through these cycles in their own individual way. The cycles that Kubler-Ross uses in her theory are: denial, anger, depression, bargaining, and acceptance. To get a better understanding of these cycles, this paper will describe each cycle and provide quotations that will help develop an idea of how someone going through these cycles may react.
Major Depressive Disorder and the “Bereavement Exclusion”. American Psychiatric Association DSM-5 Development. Retrieved March 8, 2014, from http://www.dsm5.org/Documents/Bereavement%20Exclusion%20Fact%20Sheet.pdf
Hutchison (2015) discussed grief work researched by Lindemann (1944) and of the common reactions to loss he identified, my aunt very likely experienced “loss of patterns of conduct, where the ability to carry out routine behaviors is lost” (p.438). Wortman & Silver (1990) proposed four patterns of grieving. My aunt more than likely would have been categorized as experiencing delayed grief. Delayed, postponed inhibited or suppressed grief is demonstrated very slightly “in the first few months after the loss, but high levels of distress at some later point” (p. 440). At the time of her husband’s death, she was very calm and did not seem to be grieving at all, it was if he went on a trip and would be back eventually. However, her behavior after the year of bereavement counseling told a different
Let us first look at adults and grieving. Here the relationship with the decedent is a primary factor in the grieving process. When parents experience the loss of a child, it is considered the “most difficult of deaths” (Leming & Dickinson, 2011, p. 492). The cycle of life dictates that the older shall die first. When this cycle is broken with the death of a child, adults are not prepared for the death. The hope for the future is threaten within the family, and thoughts of what should have been, what will be missed linger. Mothers will talk more about the death while Fathers will keep busy with tasks in an attempt to avoid expressing their feelings (Leming & Dickinson, 2011, p. 492). There may be marital discord as w...
When first receiving news about the death of a loved one, the normal reaction is shock and denial. No one wants to hear that their father, grandmother, or uncle had just died, and according to Kübler-Ross, one way people cope with grief and loss of a loved one is denial. This means that a person may try and hide from the facts and block out what others are trying to say. That person might deny the reality of the situation and have thoughts like, “He not dead, that’s impossible. He was doing fine just yesterday” or “This must be some kind of mistake.” Denial is a defense mechanism that buffers the immediate shock that comes after hearing such news. It is difficult for the person to accept the fact that someone dear to them is no longer with them, so they rebuke the truth and instead choose to avoid any type of encounter that forces them to face the truth and reality. This even extends to avoiding thinking about the situation. Gibran sta...
On the other hand, the concept of immune neglect explains the tendency for an individual to overestimate the timing of such positive effects following these types of situations (Social Psychology text, p. 225). This concept expresses how I was able to focus so much of my energy in completing cosmetology school and finding a job to please my father instead of facing the trauma that had come from the hurtful comments of my father. I felt that I would have immediate signs of happiness and satisfaction in my decision to pursue my own goals; however, as I discussed earlier, it wasn’t until two years later that I saw the positive effects of my
Losing a child is one of the most traumatic events a person can ever experience. This life changing experience is very difficult for parents to cope with. Grief is something we all experience as human beings; we will all lose someone that we love in our lifetime. We all go through the five stages of grief denial, anger, bargaining, depression, and last being acceptance (Bolden, 2007). However, this is arguably not the case for parents who experience the death of a child. Although, parents who have experienced...
We are never truly prepared for a catastrophic event but we spend plenty of time worrying about what we are going to do in one situation or another. We as human beings, much like animals, are hard-wired with survival skills; though sometimes our brains don’t always choose the right response. There are different tendencies the human brain leans toward in a life-threatening event or situation. Situational awareness and normalcy bias are two main tendencies that are displayed in disasters or extreme stress situations. These responses are not only achieved by experiencing a traumatic event but also by high risk activities such as sky diving and skiing. In the following paragraphs I will discuss how the brain responds to catastrophes and risky situations and how it can be a matter of survival and death.