Sunday, June 1, 2014

Good Grief

Each and every one of us has been, or will be, faced with the loss of a loved one, and there's no "right" or "wrong" way to grieve. Fortunately, there are a small but growing number of psychologists who are interested in better describing the grief process, as well as identifying what works and what doesn't when it comes to coping with loss. Even more fortunately, last weekend I was in San Francisco for the annual meeting of the Association for Psychological Science. Among the many excellent research presentations I attended was one on "What Predicts Good Grief?" So from the front line of psychological science, I bring to you some of their insights.

First, Dr. Jason Holland presented data on assessment of grief-related stress. What he has found in developing this assessment is that the grief process hinges on two different psychological constructs: comprehensibility or "Why did this happen?," and re-establishing your footing in the world after the loss or "Where do I go from here?" Dr. Holland and his team have found that having difficulty comprehending the loss, or ruminating too much on the "Why did this happen?" takes away from figuring out how to re-establish your place in the world. Thus, he has found that not accepting the loss is related to increased thoughts of the loss and negative emotional responses to the loss over a longer period of time.

The second speaker was Dr. Anthony Papa, who discussed his research on whether other losses, like losing a job, are experienced similarly to the loss of a loved one or attachment figure. His studies demonstrated that losing "a role" in life may be the underlying psychological blow in the human grief response, hence the importance of re-establishing your footing from Dr. Holland's research.

The third speaker, Dr. Toni Bisconti studies the adjustment to widowhood from a developmental perspective. She reported that the most important finding from her extensive research is that the emotional response to the loss of a spouse does not improve linearly over time, but is rather quite volatile. Most people expect that a person who has lost a spouse would be devastated after the loss and then gradually improve over time. However, her innovative approaches to studying women after losing their husbands finds that ups and downs are the most common, and gradual improvement simply looks like longer periods of ups, and less intense downs. This is important for all of us who will have to help a friend or family member cope with the loss of a loved one by not perceiving mood or emotional lability as abnormal, but rather providing non-judgmental support and reassurance that there will be normally occurring ups and downs in the grieving process and improvement in "average mood" may only be apparent across months and years.

Another very interesting finding from her research was the role of support in helping widows overcome such a loss. In psychology we study different types of support people can provide one another. These often break down into emotional support (e.g., being a supportive listener and shoulder to cry on), and instrumental support (e.g., bringing over groceries and dinner). What Dr. Bisconti and her team has found is that receiving emotional support is the most important to "good grieving" during the first 6 months, while receiving instrumental support is the most important to "good grieving" after the first 6 months. I have thought about this for a few days now, and have settled onto the interpretation that instrumental support during the first 6 months after losing a spouse may interfere with the "re-establishing your footing in the world" process which is so important to successful coping with grief. What do you think?

Finally, the fourth speaker was Dr. George Bonanno, who is one of my favorite psychologists due to the breadth and innovation of his research on loss and resilience. In the context of the other speakers, Dr. Bonanno reminded the audience of the role of emotions as "context bound." By this he meant that all of our primary emotions (happiness, sadness, anger, fear, disgust, and surprise) are adaptive, but only in certain contexts. Specifically, he focused on anger, and theorized that anger, which serves the adaptive purpose of suggesting aggression or the willingness to protect yourself, is not adaptive in the context of grief and loss. Thus, he discussed that an individual's ability to enhance and suppress emotions, such as anger, for another's benefit is adaptive and therefore a predictor of "good grieving" (less depressive symptoms). So, in plain English, that means that individuals who are having difficulty with persistent anger following a loss may have more difficulty overcoming this experience over time. Finally, and consistent with the previous presenters, he discussed that widows who are not "forward-focused" are more likely to experience complicated grief.

In summary, these researchers' provided converging evidence that when faced with grief we should try or help our loved ones try to find their footing in the world following the loss, first by providing emotional support, finding ways to control anger related to the loss on favor of more adaptive emotions in that context, such as sadness or sharing happiness in memories, and accepting that emotional lability is part of the process. Luckily, Dr. Bonanno composed one of my favorite popular psychology books on the psychological processes that surround grief in The Other Side of Sadness, which I highly recommend for a little intellectual stimulation or even as a gift to a friend who is coping with loss.

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