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...
Grief can arise from loss, whether large-scale or small, and may not be easily removed once it takes hold. Because of grief’s obstinate nature, many approaches have been developed in order to handle the repressive, and often painful, effects it can have on people’s lives. One of those approaches is Elizabeth Kübler-Ross’s theory, The Five Stages of Grief. In Sierra Skye Gemma’s essay, “The Wrong Way”, she juxtaposes her own personal experiences with grief against Kübler-Ross’s hypothesis. Gemma uses her confessional, combined with empirical evidence that contradicts the Five Stages of Grief, to demonstrate that feelings of grief are unique to the individual; therefore, there is no right way to mourn.
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.
Kübler-Ross, Elisabeth and Kessler, David A. On Grief and Grieving: Finding the Meaning of Grief Through the Five Stages. New York: Scribner, 2005. Print.
The book, A Grief Observed by C. S. Lewis, (1961), was written from his journal he kept after the death Lewis’s wife, Joy Davidman in 1960. Lewis was a bachelor for almost 58 years before he married Joy Davidman Greshman in March of 1959. His wife had been diagnosed with cancer before he met her, however, they fell in love and spent their short time together before cancer took her life in 1960. A Grief Observed is C. S. Lewis’s chronicles of his personal observations and struggles that Lewis went through with the loss of his beloved wife. Below are some questions for added discussion and thought about the book.
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.
Sebold makes clear that these stages do not necessarily remain adamant, but that families coping with loss adhere to grief and loss in assorted ways. If readers confine their understanding of grief to coping and loss with death of a loved one, then the reader finds that they have trouble elucid...
Normal grief is characterized by waves of intense sadness, but the bereaved person is still capable of warm feelings. Most people experiencing normal grief do not meet the criteria for MDD and they usually don’t seek professional treatment anyway. However, those who suffer from MDD require early diagnosis and treatment. A study found that time spent in depression is a risk factor for suicide attempts (Sokero, 2005). In a National Public Radio interview, Sidney Zisook is quoted as saying: “I’d rather make the mistake of calling someone depressed who may not be depressed, than missing the diagnosis of depression, not treating it, and having that person kill themselves.” Therefore, early diagnosis and treatment of MDD is vital, regardless of what type of life event triggered the
One particular study in Sweden rated grief before the loss as being even more severe than that taking place after the loss. More than 40 percent of the women studied admitted that the pre-loss phase was more severe than the post-death experience. It is estimated that 22 to 75 percent of patients who are dying experience some clinical depression; however, depression is not clinically considered a normal part of the dying
There are many theories that examine the adolescent’s attempts to deal with grief; one such theory was developed by Moos.
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...
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
Worden’s theory (1996) involves four fundamental tasks of mourning that he believes must be completed for a person or family system to return to equilibrium and to successfully grieve a loss. These...
Death is something that many people have a hard concept grasping. The fact that a loved
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.