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There are numerous studies in the field of mental health about grief and bereavement following traumatic events. Some of these studies examine certain conditions such as complicated grief (CG), which is characterized by prolonged grieving, and posttraumatic stress disorder (PTSD).
According to Elhai and Schinider (2007), more than 50% of the world population had experienced a significantly high level of a potentially traumatic situation, such as a fatal accident, natural calamity, or witnessing a trauma. A majority of people, who have been faced with a form of grief or bereavement, can overcome their grief within a period of several months to one year.
People suffering from uncomplicated incidents of stress manage to overcome their grief and resume their regular operations after some time. However, some individuals who face a tragic loss respond by refusing to acknowledge the trauma. This causes the individual to go through a persistent phase of sorrow, commonly known as complicated grief (CG).
Studies show that the risk of CG is increased by a lack of emotional support, especially for individuals who are geographically distanced from conventional support systems such as family, relatives, or a home church. CG can, at times, be accompanied with PTSD, which is characterized by re-experience of the distressing event, isolation and emotional freezing, and hyper arousal in response to the trauma.
Description of grief
Grief is defined as the normal response of emotion, sorrow, and confusion that results in the loss of someone or something that bears deep meaning and importance to an individual. It is a normal reaction when an individual is separated from things and people who form their typical livelihood due to death, illness, job loss, or separation from friends and family.
Grief is often mistaken with depression, though the latter is characterized by a whole body disorder arising from the loss. The first reaction to death or loss involves a feeling of shock, accompanied by a feeling of emptiness and numbness. Grief is also characterized by physical changes such as nausea, difficulty in breathing, trembling, loss of appetite, and insomnia.
People experiencing grief also exhibit anger with things and other people, as well as, a feeling of guilt, thinking that they could have altered the events leading to the loss. This causes grief-stricken people to withdraw socially and be absent-minded for a period following the loss.
The grief period extends until the individual accepts the loss and learns to live with it. Some people may grieve for months and others for years. The symptoms of depression are similar to those of normal grieving though the thoughts of the individuals may cause them to contemplate or attempt suicide.
Stages of grieving
Studies show a typical four stage grief process in most people who suffer death or loss (Boelen & van den Bout, 2005). The first stage involves accepting the loss, followed by a physical and emotional expression of the pain of grieving. The third stage involves adjustments made by the individual in order to continue living in the absence of the lost person or item, while the fourth stage involves the individual overcoming the grief and moving on with life.
Unless the individual goes through all four stages, he or she is said to be still in the grieving process. The length of time spent in this process is varied and dependent on the type of relationship with the person lost, and other personal factors including personality, culture, and life experiences (Boelen & van den Bout, 2005).
Grief is one of the many reactions encountered by individuals due to separation. As mentioned above, there are multiple causes of grief besides actual death. Separation by death may be caused by a variety of factors, though the separation is characterized by its irreversibility and finality.
Studies show that grief may be caused by numerous factors besides bereavement, such as the experience of a separation followed by the departure of a close person into the armed forces (Schnider & Elhai, 2007). Grief in this case is not caused by death, but the threat of death, which is referred to as anticipatory grief.
In such situations, the grieving individual is worried about her adjustment after the potential death if the family member or friend, causing them to go through the usual phases of grief.
These phases include depression, increased occupation with the departed, a review of the possible dangers that the person is exposed to, and an anticipation of the kinds of adjustments that might follow in the event of death. Studies claim that this kind of reaction safeguards the individuals against the implications of an abrupt death notice (Schnider & Elhai, 2007). However, the reaction may bear negative repercussions in the event of a re-union.
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There have been a few complaints that soldiers who returned to their homes experienced reduced affection from their spouses, and in some instances, they demanded instant divorce. In such cases, the patient had gone through the grieving period and decided to move on by interacting with new people. Studies show that such instances of anticipatory grief can be avoided through prophylactic measure (Schnider & Elhai, 2007)s.
Psychiatric management of grief caused by death
Studies show that grieving individuals who undergo a certain level of psychiatric management do not experience prolonged and serious variations in their social adjustment. In addition, such individuals are able to evade potential medical diseases that grieving people are prone to.
The role of the psychiatrist involves sharing the individual’s grief work, which involves the efforts made by the bereaved to disentangle himself from the bondage of the deceased or the lost item, and finding new ways of positive living in the absence.
The psychiatrist is required to observe the reaction of the bereaved, who may either over-react or under-react. Such delayed reactions may happen at erratic times and the harmful misrepresentations of the grief reaction that are initially hidden, may prove to be destructive at a later time, while they can be prevented at the moment.
Religious agencies are one of the leading bodies in handling the bereaved. Some religions provide comfort to grieving individuals by providing a backing of dogma to the patient’s wish for continued interaction with the deceased. This involves the use of well-developed rituals that preserve the patient’s interaction with the bereaved.
In doing this, the religions can assist the bereaved in overcoming the morbid feelings of guilt of the patient by ‘Divine Grace’ and by the promise of an opportunity to interact with the deceased at the time of a ‘later re-union.’ Studies show that these religious procedures have helped numerous numbers of mourners who have suffered grief from death (Chochinov & Holland, 1990).
Despite the positive results obtained from such forms of comfort, studies reveal that the process does not provide adequate assistance in the patient’s grief work. This is because the bereaved individual is required to review his relationship with the deceased to become fully aware of the alterations and cope with them in his own mode of emotional reaction.
The individual needs to overcome some emotions on his own, including the fear of insanity, and the fear of accepting the hostile feelings arising from the sorrow and sense of loss. This process allows the bereaved person to come up with an acceptable means of relating to the deceased individual in the future.
The individual is required to verbalize his feelings of guilt by finding a person that he is comfortable with in sharing his emotional state, and one who can influence new patterns of conduct. This individual acts as a primer, and psychologists who assume this role provide their patients with about ten sessions of personal interaction (Chochinov & Holland, 1990).
Some bereaved individuals react by becoming hostile, in which case, special techniques are adopted to manage the grief reaction. This hostility may be directed at the primer, causing the patient to be filled with guilt for their aggression towards the psychiatrist; hence, avoiding the sessions.
In such cases, the psychiatrist seeks the assistance of other persons who comprehend the reaction, such as social workers, ministers, or members of the family, who can persuade the patient to continue seeing the psychiatrist.
While the services if an expert psychiatrist is necessary for bereaved persons, especially those who suffer because of war casualties, they may not be available to all of them. In such cases, knowledge of how to handle and assist bereaved individuals is passed on to auxiliary workers such as social workers and ministers (Chochinov & Holland, 1990).
Grief and stress
Walter Cannon, a physiologist, defined the term ‘flight’ as the physiological reaction of the human body to one or more external stressors (Laureate, 2012). The body’s responses cause the sympathetic nervous system to instantly become aroused, as it prepares to either fight or flee the stressor (Laureate, 2012). The human sympathetic nervous system operates as an intricate and unconscious response that is protective in a variety of ways.
It prompts the cardiovascular system to increase the heart beat rate, which in turn, increases oxygen to the human brain and limbs so the individual can act and think more hastily (Laureate Education, 2012). Dhabhar (2011) claims that the “fight or flight” response enhances the immune system as physiological changes prepare the human body for potential wound healing and infection resistance.
The rapid changes are accompanied by a series of chemical signals including a surge of hormones and neurotransmitters as the brain processes the stressor’s potential impact and prepares the body to respond to it (Laureate Education, 2012).
The system response mentioned above forms the basis of the trigger mechanism for flight or fight stress response. The process begins with the activation of the anterior-pituitary adrenal cortex system within the hippocampus region of the brain.
As a result, the adrenocorticotropic hormones are released, causing the biochemical reaction to trigger. The latter reaction activates a relevant stress response depending on a variety of factors including: the nature of the stress; the type of stress event; the environment; timing of stress occurrences; duration and; the individual natural cognitive style, or psychosocial development of the individual to become vulnerable or resilient to stress. (Pinel, 2009)
High levels of stress can be caused by a variety of situations including relationship issues, financial concerns, health issues, or situations involving natural and manmade disasters. Li Wang (2011) claims that individuals who experience high stressful situations are prone to high anxiety or depression. Psychiatrists implement various stress reduction techniques to assess an individual’s stress.
One of the techniques used is mindfulness-based intervention. This technique involves procedures such as in-person vs. online, pre and post evaluation, and group repeated-measures. Health psychologists can use stress reduction techniques to evaluate pain levels, sleep quality, blood pressure, heart rate, mood, and breathing rate that measure the autonomic equilibrium of stress.
In a randomized clinical trial (RCT) therapeutic yoga workplace using the mindfulness-based stress reduction techniques to alleviate stress from the immune systems, with forty percent of depressed and sixty percent non-depressed individuals participated in, it was noted that 40 % of sad individuals are more stress than non-depressed individuals (Li, Wang, Lin, & Lee, 2011).
Coping with stress
A majority of the coping responses involve a problem or emotion-focused coping. “The former refers to the adaptive mode of coping that requires active planning or engagement in a specific behavior to overcome the challenge causing the distress” (Schnider & Elhai, 2007).
Emotion-focused coping, on the other hand, refers to the efforts made to manage the emotions of an individual, and are often considered as either active or avoidant. Active emotional coping refers to a strategy that involves adaptive emotion-regulation.
It may involve the individual venting their emotional distress or consciously reframing the stressor’s effect. “Avoidant emotional coping, on the other hand, is a maladaptive strategy that involves defiance or self-distraction to evade the source of the distress” (Schnider & Elhai, 2007). The latter involves evasion with the view to avoiding engagement win problem-focused mannerisms (Schnider & Elhai, 2007).
Some of the steps involved when coping with grief and loss include letting yourself feel the pain and other emotions instead of guiding the emotions, being patient with the grieving period, acknowledging the mixture of emotions experienced, sharing the loss, memories, and experiences with others, and taking care of oneself by eating well and exercising.
While most people take some time off from regular activities to grieve, studies show that it is necessary to occupy oneself and break from grief through constructive destructions like games and music, as opposed to picking up destructive habits like alcohol and drug abuse. Where possible, people are advised to join a support group where they can be provided with comfort, guidance, and encouragement (Boelen & van den Bout, 2005).
My reaction to stress
There are two mechanisms that I often use to reduce stress: cognitive restructuring and relaxation breathing. Like other grieving parties, my stressful moments are marked with both physiological stress symptoms, such as agitation and psychological stress symptoms like ruminating about what I could have done and what could have been.
Additionally, I go through numerous episodes of cognitive restructuring or reframing, as a problem-focused strategy that involves the identification of alternative ways of looking at or experiencing the challenge at hand. This strategy is ideal for me since it helps me to identify ways of changing my relationship to the stressor when I cannot change the state of the stressor itself. At times I exercise for forty-five minutes before getting ready for work.
Sometimes, I do this following a late night of studying. At other times, I adopt an all-or-nothing attitude whereby I sleep in until I am ready to get up, and then blame everything on my environment.
Alternatively, I get up and exercise for thirty minutes because I know that those few minutes of exercising are more useful to me than sulking about my altered exercising routine. My grieving reactions are acknowledged by Carver (2010), who claims that an individual’s ability to use reframing as a coping mechanism has been linked to the personality trait of optimism.
I use my second grieving mechanism, relaxation breathing, daily. This strategy was developed and proposed as one of the best methods for dealing with grief (Herbert, 2010). Although I have never developed a full-fledged meditation practice, I practice relaxation breathing every day and use it often for “minis” (a version of relaxation breathing that requires less than two minutes).
Relaxation breathing works by stimulating the parasympathetic nervous system (Laureate, 2012) and is sometimes referred to as the “rest and digest” response. It calms and re-centers me no matter where I am and what I am doing.
I also engage in physical exercises including work-out at the gym, hiking, walking with friends at a local park, playing on the slide with clients, and yoga, which has taught me how to breathe and relax my mind from the everyday hustles of life. I also like to picture myself in what I believe are serene environments, such as Bermuda, to help me relax and calm my nerves.
Problem-focused and biology focused coping mechanisms have worked for me because I have changed my mind set to make sure that I can utilize these mechanisms to reference them for clients. I have learned that being spiritual and employing stress coping mechanisms has changed my life. Sometimes I am faced with stressful moments, but I remind myself that if I cannot change the cause of the grief, then it is not something to stress out about.
Emotion-focused coping can be a good mechanism to utilize. Lazarus and Folkman (1984) define the mechanism as involving cognitive processes focused at lessening the emotional distress of an event which includes escape, avoidance, distancing, and self-controlling. Sometimes when people are in a relationship, and one of the partners causes undue stress, the other partner distances himself or herself by not talking as often or hanging out with them.
When the individual has not accepted responsibility for the action that has been caused, the person sometimes avoids facing the consequences or problems which will indeed cause stress.
Positive, meaning-focused, and spiritual coping mechanism works for people who have a spiritual background. This mechanism is good for an outreach program from church members. When people devote their energy in something positive, it normally produces happy endorphins.
Boelen, P. A., & van den Bout, J. (2005). Complicated Grief, Depression, and Anxiety as Distinct Postloss Syndromes: A Confirmatory Factor Analysis Study. Am J Psychiatry, 162, 2175-2177.
Chochinov, H., & Holland, J. (1990). Bereavement: A Special Issue in Oncology. New York: Oxford University Press.
Dhabhar, F. S. (2011). A Hassle a Day May Keep the Doctor Away: Stress and the Augmentation of Immune Function. Integrative and Comparative Biology, 42(3), 556-564.
Schnider, K. R., & Elhai, J. D. (2007). Coping Style Use Predicts Posttraumatic Stress and Complicated Grief Symptom Severity Among College Students Reporting a Traumatic Loss. Journal of Counseling Psychology, 54(3), 344–350.