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What to Do When Grief Becomes a Mental Health Issue

Grief is one of the most painful experiences you can go through. If you’re grieving a loss, it can be difficult to imagine moving on. It probably seems unfair. But remember to be gentle with yourself. Try to avoid judging your own feelings, no matter what they are. This kaleidoscope of emotions may range from sadness to anger to resentment, and more. But remember that all feelings are valid, and any feeling might be part of the grieving process.

It’s normal to miss what you’ve lost—whether that’s a person, a place, or just a period of time. But it’s also important to stop your grief from interfering with your needs, goals, and values. You can still honor a memory while living a happy and fulfilling life.

If you’re unable to move forward, you can actually attend rehab for grief. In treatment, you’ll learn to cope with your loss in a healthy way.

When Should You Seek Inpatient Grief Treatment?

Grief is difficult1—there’s no doubt about that. But there’s a difference between a more natural grieving process and one that requires treatment. To quote a study published by the National Library of Medicine, most people will experience these 5 stages of grief:

  • denial and Isolation
  • anger
  • bargaining
  • depression
  • acceptance

Everyone moves through these 5 stages at a different pace. But some people get stuck in them for a longer period of time. This is when “acute grief” turns to “complicated grief.”

Acute vs. Complicated Grief

Immediately after a loss, most people experience “acute grief.”1 During this phase, a person may feel overwhelmed by painful emotions related to their recent loss. After about 6-12 months, most people move on from “acute grief” to “integrated grief.” They may still be grieving, but they’re able to return to their daily lives.

You can also expect that some of your grief symptoms may return occasionally. This often happens around certain times of the year, such as the anniversary of the event. However, that doesn’t necessarily mean you need treatment.

But for about 7-10% of people, painful emotions and sadness persist for over a year after the loss. This is “complicated grief.” With this condition, you may be unable to stop thinking about your loved one, feel empty, have a disinterest in your own life, and find it difficult to sleep.

There are several other terms that describe complicated grief:

  • prolonged grief disorder
  • traumatic grief
  • pathological grief

It’s important to note that the effects of prolonged grief disorder aren’t just mental—they can be physical, too.

Physical Risks of Prolonged Grief Disorder

If you don’t learn to cope with your grief,1 the effects can be very serious. Your emotional distress can manifest into physical symptoms. You can even develop serious health conditions, such as the following:

  • heart attack, which can lead to complications or death
  • heart rhythm disorders (arrhythmias), in which the heart beats irregularly
  • Takosubo Cardiomyopathy, also known as broken heart syndrome, where the left ventricle of the heart becomes weak
  • physical pain, such as headaches, muscle tension, or chest tightness

If you experience any of these symptoms, you should get immediate medical care. However, if the cause is emotional, you might also require mental health treatment. Currently, the gold standard treatment for traumatic grief disorder is complicated grief therapy (CGT).

Complicated Grief Therapy (CGT)

CGT specifically treats prolonged grief disorder.2 This is the most effective treatment we know of for this condition. CGT is designed to help you accept and cope with loss. And at the same time, your therapist will teach you to adapt to the next phase of your life.

What is CGT?

Complicated grief therapy2 uses elements of cognitive behavioral therapy (CBT) and interpersonal therapy (IPT).

CBT teaches patients to change their negative thoughts and behaviors to positive ones. And in IPT, patients use therapy to work on improving relationships and reconnecting to their goals.

CGT implements 7 themes3 that help patients learn to handle their grief:

  1. acceptance of grief
  2. emotion management
  3. considering your own future
  4. improving relationships
  5. telling the story of the original loss
  6. tolerating reminders and triggers
  7. connecting with memories

CGT integrates these ideas through various exercises, such as exposure interventions. In an exposure intervention, your therapist guides you through a triggered grief response. For instance, you might tell the story of a loved one’s death, and then talk through your emotional reaction. But unlike classic exposure therapy, this is only one aspect of treatment. In the same session, you’ll also work toward your aspirations for the future.

What Happens During CGT Sessions?

CGT consists of 16 sessions,3 each about 45-60 minutes long. The treatment is typically split into 3 phases. In the first 3 sessions (the introductory phase), you’ll describe your situation, and learn what you can expect from CGT. Your therapist will also introduce various exercises that you’ll complete in the future, such as the following:

  • The grief monitoring diary is a journal where you’ll list your daily experience of triggers. You’ll also describe any times when your grief felt more manageable.
  • During imaginal revisiting, you’ll spend about 5 minutes telling the therapist how you first learned about the loss.
  • In situational revisiting, you’ll take an inventory of activities or places you avoid because they remind you of your loss.
  • Aspirations work happens in session, with your therapist’s guidance. This is a time for you to discuss activities you enjoy and your goals for the future.

Often, a person close to you will come to your third session of CGT. From sessions 4 to 9 (the intermediate phase), you and your provider will work together on various activities to cope with the loss and re-establish joy in life. During session 10, you’ll discuss your progress. The therapist will ask for your input about how to structure the remaining 6 sessions.

From 11 to 16 (the final phase), you’ll continue to work on the exercises listed above. In the last few sessions, the therapist may lead you through imaginal conversation, in which you’ll act as both yourself and a person you’ve lost. This type of therapeutic roleplaying lets you ask questions, offer reassurance, and find closure.

Medication for Prolonged Grief Disorder

Doctors sometimes prescribe antidepressants to help patients with traumatic grief.4 Data suggests that medication works better with psychotherapy, especially CGT.

Because depression often co-occurs with complicated grief, antidepressants are a way of treating both conditions at once. But this is just one of many possible co-occurring disorders.

Co-Occurring Disorders Can Make Grief Difficult to Diagnose

The most common disorders to co-occur with complicated grief5 are major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). Both conditions have several symptoms that overlap with complicated grief. This can make it difficult to get the right diagnosis.

Major Depressive Disorder (MDD)

Both major depressive disorder and prolonged grief disorder can include the following symptoms:

  • sadness
  • a sense of isolation
  • difficulty sleeping
  • guilt

Although the symptoms are similar, there’s an important difference between these conditions. With MDD, the symptoms are general. They may or may not have a discernible cause. But with complicated grief, they’re directly related to the loss itself. For example, someone with traumatic grief may avoid places that remind them of their loss. Their symptoms have a specific external cause, and aren’t only due to brain chemistry.

Post-Traumatic Stress Disorder (PTSD)

In either PTSD or traumatic grief,4 you may experience unwanted thoughts, and a sense of numbness or dissociation.

But again, there’s a differentiating factor: with PTSD, fear is the core emotion. You could be avoiding situations because you’re afraid of them. But in complicated grief, the primary feelings are sadness and a yearning for what’s lost. For instance, you might stay away from places where you have good memories with someone who’s gone.

People with an anxiety disorder or an addiction are more likely to develop prolonged grief disorder. And if these conditions are present before the loss takes place, it can be even harder to process your grief.

Grief and Addiction

There is a link between the loss of a loved one, prolonged grief, and drug abuse.6 In fact, addiction can make you more vulnerable to traumatic grief7—and vice versa. This is partly because using drugs and alcohol can seem to help you cope with the symptoms of grief. But substance use can also make it more difficult for you to properly process your emotions.

In one study, subjects increased their drug and alcohol use after a loss8 for several different reasons:

  • as a way of honoring the one they lost, especially if substance use reminded them of the person
  • to experience pleasure and escape reality, especially as a distraction that also helped them connect with peers
  • to live life to its fullest, and gain new life experiences
  • as a sleep aid when experiencing insomnia
  • to cope with difficult emotions, and open up to others about them

A number of people in the study lost control of their drug and alcohol use for a period of time after experiencing loss. For some subjects, this issue resolved itself over time. But others developed longer-term addictions. If this is your experience, you might consider going to rehab for both drug use and traumatic grief.

Find Joy in Life Again

You may feel guilty for moving on—it can feel like you’re erasing the past. But moving forward doesn’t mean forgetting what came before. You can honor what you’ve lost by living a life that you love.

During and after treatment, you can try new activities, and maybe even have fun. By fully engaging in the present, you can start looking ahead to what comes next. And you can find ways to carry your best memories with you, in every phase of recovery.

Healing is easier with expert support. Visit our directory of rehab centers that treat grief to read about available treatments, including medication, talk therapy, and complementary therapies.

Reviewed by Rajnandini Rathod

 

  1. Mughal, S., Azhar, Y., Mahon, M. M., & Siddiqui, W. J. (2022). Grief reaction. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK507832/ [] [] []
  2. Iglewicz, A., Shear, M. K., Reynolds, C. F., Simon, N., Lebowitz, B., & Zisook, S. (2020). Complicated grief therapy for clinicians: An evidence-based protocol for mental health practice. Depression and Anxiety, 37(1), 90–98. https://doi.org/10.1002/da.22965 [] []
  3. Wetherell, J. L. (2012). Complicated grief therapy as a new treatment approach. Dialogues in Clinical Neuroscience, 14(2), 159–166. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384444/ [] []
  4. Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). Prolonged grief disorder: Course, diagnosis, assessment, and treatment. Focus: Journal of Life Long Learning in Psychiatry, 19(2), 161–172. https://doi.org/10.1176/appi.focus.20200052 [] []
  5. Ito, M., Nakajima, S., Fujisawa, D., Miyashita, M., Kim, Y., Shear, M. K., Ghesquiere, A., & Wall, M. M. (2012). Brief measure for screening complicated grief: Reliability and discriminant validity. PLoS ONE, 7(2), e31209. https://doi.org/10.1371/journal.pone.0031209 []
  6. Caparrós, B., & Masferrer, L. (2021). Coping strategies and complicated grief in a substance use disorder sample. Frontiers in Psychology, 11, 624065. https://doi.org/10.3389/fpsyg.2020.624065 []
  7. Parisi, A., Sharma, A., Howard, M. O., & Blank Wilson, A. (2019). The relationship between substance misuse and complicated grief: A systematic review. Journal of Substance Abuse Treatment, 103, 43–57. https://doi.org/10.1016/j.jsat.2019.05.012 []
  8. Drabwell, L., Eng, J., Stevenson, F., King, M., Osborn, D., & Pitman, A. (2020). Perceptions of the use of alcohol and drugs after sudden bereavement by unnatural causes: Analysis of online qualitative data. International Journal of Environmental Research and Public Health, 17(3), 677. https://doi.org/10.3390/ijerph17030677 []

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