Grief and ACT

What is grief?

Grief is a deep emotional response to loss, particularly the loss of a loved one however it can include many types of loss. It can manifest in various ways, including sadness, anger, confusion, and even relief. Grief is a personal and unique experience; everyone processes it differently, influenced by factors such as the nature of the loss, individual coping mechanisms, and cultural background.

Key aspects of grief often include:

• Feelings of sorrow, despair, guilt, or anger.
• Changes in sleep, appetite, and energy levels.
• Difficulty concentrating or making decisions.
• Withdrawal from friends and family or changes in relationships.

It can be a complex and ongoing process, and although there is never a set timeline, sometimes, individuals can find themselves stuck in grief and unable to move forward with their lives. Such stuckness can arise from various factors, including:

• Traumatic or unexpected circumstances surrounding the death
• Over-reliance on emotional numbing strategies (e.g. through substance use)
• Emotions such as regret, guilt, or shame
• Difficulty accessing appropriate support
• The complexity or strain of the relationship with the deceased
• Previous bad experiences of loss
• Other difficult life circumstances happening at the same time” (eg a death leading to severe financial and/or housing difficulties)

Seeking support through friends, family, or professional therapy can be helpful in navigating grief.

Types of grief

It’s important to note that it can be easy to talk about grief as a thing, rather than a set of behaviours that we carry out. Viewed this way, we can see grief as:

Grief is frequently described as having many different types and categories. Just like diagnostic categories, there may be some utility in being aware of these descriptions, but it is important to hold them lightly, as there is limited research evidence supporting these distinctions and it is difficult to capture the complexity of human experiences related to loss. However, a practitioner may find it useful to be aware of some of the different ways grief can appear.  Here are some of the common descriptions:

• Anticipatory grief: Grief experienced before an impending loss, often seen in terminal illness situations. Individuals often start processing emotions before the actual loss occurs.
• Problematic grief: Prolonged and intense grief that interferes with daily functioning. It might involve persistent yearning, difficulty moving on, and intense sorrow. Symptoms include feelings of emptiness, avoidance of reminders, and difficulty accepting the loss.
• Delayed grief: Grief that is postponed, often due to circumstances that make it difficult to process the loss immediately. Feelings may resurface later, sometimes triggered by new losses or reminders.
• Disenfranchised grief: This type of grief may not be openly acknowledged or socially supported, for example the loss of a pet, a miscarriage, or the death of an ex-partner. This leaves individuals feeling isolated or invalidated in their grief.
• Collective grief: Grief experienced by a group or community, often in response to a shared loss, such as the loss of a public figure, a disaster, national tragedy, or cultural event.
• Chronic grief: A prolonged form of grief that persists for an extended period, often characterised by ongoing very high levels of distress and difficulty moving forward.
• Masked grief: Grief that is not recognised or expressed, often leading to physical symptoms or behavioural changes instead of emotional acknowledgment. This may present as anger, fatigue, or anxiety without the individual identifying these feelings as grief.

Core characteristics of grief

People have sometimes talked about grief as a sequence of stages we go through (e.g. denial, anger etc etc), but nowadays most people accept that it’s much more of an individual response. While these are common expressions of grief, most people don’t experience these stages linearly and so nowadays it is more important to recognise grief as a personal journey. In the case of complicated or stuck grief, an individualised treatment plan is required to navigate it effectively and this is where therapy can be extremely useful.

Grief presents in many ways and can be characterised by a range of emotional, physical, cognitive, and social symptoms. Here are some core characteristics:

Emotional

• Sadness: A profound sense of loss and sorrow.
• Anger: Frustration or resentment towards the situation, others, or even oneself.
• Guilt: Feelings of regret or self-blame about the loss.
• Anxiety: Worry about the future or the fear of further loss.
• Relief: Sometimes, especially in cases of prolonged suffering, there can be feelings of relief.

Physical

• Fatigue: A sense of exhaustion or lack of energy.
• Sleep disturbances: Insomnia or oversleeping.
• Appetite changes: Loss of appetite or overeating.
• Physical pain: Headaches, stomach aches, or other unexplained aches.

Cognitive

• Difficulty concentrating: Trouble focusing on tasks or making decisions.
• Intrusive thoughts: Recurrent memories or thoughts about the loss.
• Confusion: Feeling disoriented or having trouble processing information.

Social

• Withdrawal: Pulling away from friends and family.
• Isolation: A desire to be alone or difficulty engaging in social activities.
• Changes in relationships: Strain or shifts in dynamics with loved ones.

Behavioural

• Avoidance: Steering clear of reminders of the loss.
• Crying spells: Sudden and intense bouts of crying.
• Restlessness: A sense of agitation or inability to relax.

Using ACT in grief support

Acceptance and commitment therapy (ACT) can be a valuable approach for individuals dealing with grief.

Here are some examples of how ACT can support someone through the grieving process:

• Emotional acceptance: ACT encourages individuals to accept their feelings of grief rather than avoiding or suppressing them. Acknowledging emotions like sadness, anger, or guilt can help in processing the loss. Mindfulness techniques promote being present with one’s thoughts and feelings without judgment, allowing individuals to experience grief without becoming overwhelmed.
• Cognitive defusion: Strategies that help individuals distance themselves from unhelpful thoughts associated with grief can reduce the power those thoughts have over emotions and behaviours.
• Values clarification: Grief can shift a person’s perspective on what matters most. ACT helps individuals clarify their values, guiding them to live in alignment with these values and providing a sense of purpose and direction during a time of confusion and pain.
• Engagement in life: Individuals are encouraged to take small steps towards re-engagement with life, whether through social activities, hobbies, or new experiences that honour their loved one’s memory.
• Self-compassion: ACT emphasises treating oneself with kindness and understanding. Acknowledging that grief is a normal and shared human experience can alleviate feelings of isolation. Through ACT, individuals learn skills that help them cope with distress, nurturing resilience as they navigate their grief journey.

ACT provides a framework that helps individuals embrace their grief, understand their emotional responses, and take meaningful steps towards healing. By focusing on acceptance, commitment to values, and mindful living, those experiencing grief can find a path forward that can honour and accept their feelings while also promoting well-being and encouraging personal growth.

For individuals:

If you need support in managing grief and would like to speak to an ACT trained therapist, please visit our psychological therapy page to learn more.

For professionals:

If you would like to learn more about how ACT can support people with anxiety take a look at our ACT training courses. Our resources are also a great place for additional tools and insight, plus take a look at a guest blog from Dr Ray Owen, “What would they think?”: how grief models can show up as actions in therapy sessions.