Grief is a unique & personal process that can involve stages like denialangerbargainingdepression & acceptance.
These stages are not linear & individuals may experience them differently or revisit stages over time.
Understanding & acknowledging one’s emotions during grief can facilitate healing & resilience.
Grief is an inevitable universal experience. Everyone will experience it at some point in their lifebut not everyone is impacted by it in the same way (O’Connor2019; Bonanno2009).
That doesn’t mean that we can’t relate to each other’s grief. It just means that everyone has to discover their own way to move through it (Kübler-Ross & Kessler2004).
The stages of grief and how we understand them have evolved over the last few decadesaccording to Kübler-Ross and Kessler (2004).
This article explores the different stages of grief and even goes beyond the Kübler-Ross concept of five grief stages.
Before you continue readingwe thought you might like to download our five positive psychology tools for free. These science-based tools will help you move yourself or others through grief in a compassionate way.
Griefsimply putis a person’s response to loss (Schoo et al.2024). While much attention has been given to the emotional pain that comes with griefit is important to acknowledge that grief goes beyond the emotional experiences (Hall2014).
“Grief can be defined as the response to the loss in all of its totality—including its physicalemotionalcognitivebehavioraland spiritual dimensions.”
Hall2014p. 7
Research has linked inflammationruminationand stress hormone levels to how people process loss (O’Connor2019). Some people process grief more easily than others.
Grief is not the same as depressionalthough depression can be a part of the grieving process (American Psychiatric Association2022). Grief is a multi-layered process that affects body and mind (O’Connor2019).
Manifestations of Grief
The infographic shows the most common physicalemotionalbehavioraland spiritual manifestations of grief.
Grief is easily misunderstoodand this image can help identify the physicalemotionalsocialand spiritual manifestations of grief. In doing soit aids in better understanding the nature of grief and different ways of grieving.
The difference is that the bereaved experiences predominant feelings of loss and emptinesswhich are linked to memories and thoughts. Low mood and the inability to experience joy or pleasure are central to depression. They are not linked to memories. Insteadthey are a general experience (Bahou2023).
Grief has an identifiable causewhile depression has various causes that are often interlinked (Peña-Vargas et al.2021).
Even though depression is a stage of the grieving processthe bereaved doesn’t suffer from clinical depressioneven though maladaptive grieving could turn into depression (Peña-Vargas et al.2021; Bonanno2009).
Bereavement doesn’t have a set timelineand everyone goes through it in their own way. Yet over timeits impact on the daily life of the bereaved lessens.
The 5 Stages of Grief: The Kübler-Ross Model Explained
The five stages of grief were first introduced in 1969 by Elisabeth Kübler-Ross in her book On Death and Dying.
Kübler-Ross (1969) originally developed the stages to describe the emotional journey of terminally ill patients. Since thenthe model has evolved and been applied broadly to anyone experiencing any form of loss.
These stages are not a strict sequence that needs to be followed during grieving (Hall2014). Insteadthey should be considered a helpful framework that brings language to the often confusing and difficult experience of grief (Kübler-Ross & Kessler2005).
Alsothese stages are not specific to everyonenor do they necessarily follow a chronological order. Individuals may experience the stages in a different order or even experience multiple at the same timeand sometimes some might experience the stages over again (Kübler-Ross & Kessler2005).
Denial
During the initial shockdenial functions as a protective buffer between the strong emotions and the mind. It helps the person experiencing loss to process the newpainful reality.
This isn’t about refusing to accept the new reality. Insteadit is a way for the individual to not become overwhelmed by the pain. Kessler (2019p.1) describes this stage as “shock and disbelief that the loss has occurred.”
Anger
Anger is a common emotion that often surfaces when reality sets in during the healing process. It is a necessaryprotectiveand frequently misunderstood part of the grieving journey because it functions as a bridge between emotional numbness and deeper emotions (Kübler-Ross & Kessler2005). Anger provides the bereaved something to hold on to (LeDoux1996; Greenberg2002).
The sense of injusticeabandonmentsorrowdisappointmentlongingor powerlessness can be the trigger for anger (Harris & Winokuer2019). While navigating griefthe bereaved may direct their anger outward toward othersincluding therapists and other professionals (Harris & Winokuer2019).
Anger surfaces once the bereaved feels safe enough to know that they will probably survive whatever comes (Kübler-Ross & Kessler2004).
Bargaining
Bargaining is the stage of grief where the brain tries to cling to hope and the idea that death could be reversed. It is a psychological negotiation with fatefor some with God and others with themselves or their beliefs (Kübler-Ross & Kessler2005).
This process is not just an imaginative pleading. This stage is the brain’s attempt to restore predictability and coherence after the event. Emotionally charged memories activate the amygdala and can intensify mental ruminations — a characteristic of the bargaining stage (LeDoux1996).
Bargaining often occurs when cognitive and emotional systems are recalibrating to a newoverwhelming reality. This can provide a sense of agency in a situation that feels hopeless (O’Connor2019).
Not everyone goes through the bargaining stage or experiences prolonged distress. Ultimatelythere is a wide variability in the process of grief (Bonanno et al.2002; Bonanno 2009).
How do our brains handle grief? - Mary-Frances O'Connor
Depression
Depression is a companion to the heaviness of grief and the ability to be present. It is when the bereaved understands the finality of the loss as part of the lived experience.
It is important to make a distinction between clinical depression and depression as part of the grieving process. Depression here is not pathological. Insteadit is naturalappropriateand often misunderstood by the people around the grieving (Kübler-Ross & Kessler2005).
Bonanno et al. (2002) observed in their study of bereavement that the symptoms of depression fluctuate and that they are not universal. When these symptoms appearthey are often profound and deeply embodied. Biologicallythe process of grief slows down the nervous system and protects the body from overwhelm (O’Connor2019).
Prioritizing emotional regulation (Peña-Vargas et al.2021) enables the bereaved to slowly create integrity instead of being overwhelmed with the full heaviness of the new reality (Kübler-Ross & Kessler2004).
Acceptance
Acceptance doesn’t mean that the person grieving is content with the loss. It merely describes the ability to recognize the new reality. “Acceptance is not about liking a situation. It’s about acknowledging all that has been lost and all that still remains” (Kübler-Ross & Kessler2004 p. 26).
Physiological acceptance expresses itself in the body’s ability to regulate itself again. Psychologicallythe mind starts making space again for new experiences. And on a social levelthe bereaved might start to reengage againwhich might look different than before (Peña-Vargas et al.2021).
On an emotional basisacceptance can feel confusing at times. Guilt might follow happiness or moments of relief. Acceptance means making space for what can feel like conflicting emotions (Greenberg2002; LeDoux1996).
People who can recall happy memories during grief may experience relief from sadness and help during the acceptance stage (Bonanno & Keltner1997).
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The 6th Stage of Grief: Finding Meaning
The sixth stage of grief is a concept developed by Kessler (2019) based on Kübler-Ross’s five stages. It describes the transformative process of the bereavement journey.
In this stagethe bereaved starts to integrate the loss into their ongoing life by seeking and creating meaning based on the experience.
Finding meaning is about discovering ways the memory of a loved one and the influence this person had on the bereaved can continue to shape and impact their lives. Finding meaning doesn’t erase the grief; insteadit offers a way forward (Kessler2019). This allows the person who grieves to hold space for love and the pain of loss at the same time.
Finding meaning often starts with telling stories about the loved one (Kessler2019)but it can also entail revisiting the process of dying and whether it could have been preventable. This is no longer a way of trying to negotiate the death. Insteadit is about understanding and creating a story of the loss. It is also a topic that is not being talked about enough. For more on thisconsider reading our article on post-traumatic growth.
How to find meaning after loss - David Kessler
Other Models & Theories
The five and six stages of grief demonstrate a framework that helps people going through grief to understand the patterns and processes that often emerge in bereavement.
Grief is nonlinearand as explainedthere is no prescribed single right way to grievewhich is why researchers and clinicians have developed several frameworks to offer language and structure to the complex experience of grief.
The 7 stages of grief
The seven stages of grief make up an expanded adaptation of the original five-stage model by Elisabeth Kübler-Ross. They include stages of shock and denialpain and guiltthe upward turnand reconstruction and working throughwhich expand on the original model to capture the early disbelief and numbnessthe intense emotional painthe gradual improvementand the process of rebuilding after loss (Parkes & Prigerson2010).
Dual-process model
The dual-process model recognizes that grief involves two processes. On one sidethe grieving person has to navigate through the feelings of loss (or loss-oriented stressors)and on the otherthey focus on rebuilding life after loss (restoration-oriented stressors; Stroebe & Schut1999).
Loss-oriented stressors encompass emotional and psychological responses directly related to the losssuch as grief workconfronting and expressing complex emotionsand accepting the reality of the loss.
Restoration-oriented stressors include managing new responsibilities and engaging in new activities and relationshipsas well as forming a new sense of self (Stroebe & Schut1999).
Central to this model is the concept of oscillationwhich means that individuals move back and forth between the domainswhich allows them to engage with grief while also finding relief from it. This dynamic process allows a healthy adjustment to the new situation by balancing emotions with the demands of daily life (Stroebe & Schut1999).
Tasks of mourning
This concept reframes grief as a dynamic process rather than a linear series of stages. According to Worden (2018)grief involves four core tasks that individuals may revisit in various sequences over time:
Accepting the reality of the loss
Accepting reality both intellectually and emotionally involves confronting the irreversible absence of the loved one through ritualsstorytellingand reminders that support cognitive and emotional integration (Hall2014; Kübler-Ross & Kessler2005).
Experiencing the pain of grief
Feel emotions fullysuch as angersadnessguiltand confusionwithout avoidance. Emotional bypassing can complicate or prolong the grieving process (O’Connor2019; Peña-Vargas et al.2021).
Adjusting to a world without the deceased
Adjust by taking on new rolesundergoing an internal transformationand reexamining identitybeliefsand meaning. This aligns with the biopsychosocial complexity of bereavement (Bonanno et al.2002; Shoo et al.2024).
Finding an enduring connection with the deceased
Integrate the memory and impact of the loved one into a reengaged life (Kessler2019; Harris & Winokuer2019).
Worden’s model emphasizes a compassionatenonlinearand human-centered approach to griefacknowledging its personal and evolving nature.
Anticipatory grief
Anticipatory grief describes the grief before we grieve (Kübler-Ross & Kessler2005). It often occurs before an impending loss as a result of a terminal illness or the expected death of a loved one. This grief can impact both the person facing their own death and the person in the relationship.
Feelings such as sadnessanxietyangerguiltand even physical symptoms such as lack of appetite and sleep disturbances can accompany it (Biscontini2023). This grief entails more than the anticipation of the loss. It can involve the loss of future experiencesthe inevitability of the lossand even the gradual decline of the loved one.
Research characterizes anticipatory grief by a heightened emotional response and a sense of being static in timemeaning planning for the future feels impossible (Lee2016).
Continuing bonds theory
Continuing bonds theory provides an interesting twist to research on bereavement. Unlike other models that describe detachment as a healthy sign of grievingcontinuing bonds theory suggests that maintaining an ongoing relationship with the deceased is normal and part of the process (Klass et al.1996).
This connection can look like cherishing memoriesengaging in ritualstalking to the deceasedand integrating their values and wisdom into everyday life. These bonds of connection aren’t static; they change over time as the bereaved person’s life changes (Klass2006).
Generallythe internalized continuing connection to the deceased is associated with a positive adjustmentas long as the deceased is held in memory and meaning. On the other handexternal bonds such as hallucination may be linked to complicated grief (Field et al.2005).
Complicated griefalso known as prolonged grief disorder or persistent complex bereavement disorderis characterized by an intense and persistent state of mourning. It disrupts the person’s daily life and hinders emotional healing.
The risk for prolonged grief increases when the death of the loved one happens suddenly or under traumatic circumstances (Szuhany et al.2021).
Symptoms of prolonged grief disorder (American Psychiatric Association2022) include:
Intense yearning or longing for the person who has diedeven after a year
Constant thoughts or preoccupation with the deceased that make it hard to focus on the other parts of life
Ongoing emotional painsuch as deep sadnessangerbitternessor sorrowthat doesn’t ease over time
Feeling emotionally numb
Identity disruptionsuch as feeling like half a person
Marked sense of disbelief about the death
Avoidance of reminders that the person is dead
Intense emotional pain related to the death
Difficulty getting back into daily activities
Feeling that life is meaningless or empty
Intense loneliness
It is important to remember that for somethe process of grief is linear. For othersit can turn into complicated grief (Brown2021).
Supporting the Process in Therapy & Counseling
Supporting the grief process in therapy and counseling entails a therapeutic environment based on trustempathyand collaboration (Kramuschke et al.2024).
This is because grief counseling involves more than addressing the immediate concerns or symptoms of a client. Paying attention to how clients express themselves and what they discusstherapists and counselors can support people in better understanding their feelings and behavior (Newsom et al.2017). This increases self-awareness and supports the process (Jordan & Neimeyer2003).
Effective therapy isn’t the same for everyone. Staying flexible and developing a collaborative process allows therapists to adjust the approach to fit each person’s unique grieving process (Jordan & Neimeyer2003).
17 Exercises For Grief & Bereavement
Apply these 17 Grief & Bereavement Exercises [PDF] to help others process difficult emotionsleverage self-compassionand find balance following painful loss.
More Helpful Resources From PositivePsychology.com
At PositivePsychology.com we have a wide array of resources that will benefit you.
You might be interested in our article on the counseling process as a structuredcollaborative conversation between a trained professional and individuals who are seeking support.
Because the process of grief can vary so widelyit is always beneficial to refresh your toolbox to ensure you stay flexible in your approach. Jeremy Sutton provides you with recommended tools in his article on counseling skills.
To assist your client with the grieving progressyou can give them this template. A Letter to a Loved One can be a therapeutic exercise to articulate unresolved emotionsexpress gratitudeand foster healing during the grieving process.
Emotions in Grieving is a helpful worksheet to support your client in exploring their emotions during the grief process.
To help your client gain deeper insight and understand when challenging moments ariseyou might find this worksheet supportive: Grieving and Monitoring Difficult Times.
If you’re looking for more science-based ways to help others move through grief in a compassionate waythis collection contains 17 validated grief and bereavement exercises. Use them to help others find balance as they attempt to make sense of a life that has been irrevocably changed.
A Take-Home Message
Grief is a deeply personal experience that is universal and touches every life. Yet no two people grieve exactly the same way.
Over decadesresearch and clinical practice have shown that while models like the five stages of griefthe dual-process modeltasks of mourningand continuing bonds theory offer helpful frameworksthere is no single right path through loss.
Grieving is nonlinearshaped by individualrelationaland cultural factorsand may involve a wide range of emotions and challengesincluding anticipatory and complicated grief (Hall2014).
Many equate grief with losing someone. Howevergrief can also manifest during various other experiencessuch as job lossbreakupsdivorceand relocation (Bowlby1980; Brown2021).
Honoring the complex stages of grieffinding meaning in the processmaintaining connectionsand allowing space for pain and growth allow the person grieving to move from grief to post-traumatic growth and healing (Karanci & Erdur-Baker2024).
There are commonly thought to be five stages of grief — denialangerbargainingdepressionand acceptance — as originally described by Elisabeth Kübler-Ross (1969). Several models expand her concept to seven stages. The five-stage model remains the most recognized one.
How long does the grieving process last?
The grieving process is uniqueand there is no set timeline for how long the grieving process lasts. For someit may take weeks or monthswhile for othersit may take years.
What are the most effective therapy techniques for grief?
Different people need different tools to cope with grief and to support their grieving processes. There is no one most effective technique for everyone.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disordersfifth editiontext revision (DSM-5-TR). American Psychiatric Association Publishing. https://www.psychiatry.org/psychiatrists/practice/dsm
BonannoG. A.WortmanC. B.LehmanD. R.TweedR. G.HaringM.SonnegaJ.CarrD.& NesseR. M. (2002). Resilience to loss and chronic grief: A prospective study from pre-loss to 18 months post-loss. Journal of Personality and Social Psychology83(5)1150–1164. https://doi.org/10.1037/0022-3514.83.5.1150
BonannoG. A. (2009). The other side of sadness: What the new science of bereavement tells us about life after loss. Basic Books.
BonannoG. A.& KeltnerD. (1997). Facial expressions of emotion and the course of conjugal bereavement. Journal of Abnormal Psychology106(1)126–137. https://doi.org/10.1037/0021-843X.106.1.126
BowlbyJ. (1980). Attachment and loss: Vol. 3. Losssadness and depression. Basic Books.
BrownB. (2021). Atlas of the heart. Vermilion.
FieldN. P.GaoB.& PadernaL. (2005). Continuing bonds in bereavement: An attachment theory-based perspective. Death Studies29(4)277–299. https://doi.org/10.1080/07481180590923689
GreenbergL. S. (2002). Emotion-focused therapy: Coaching clients to work through their feelings. American Psychological Association.
HarrisD. L.& WinokuerH. R. (2019). Working with emotions in the grief counseling process: Yours and the client’s. In Principles and practice of grief counseling (pp. 140–155). Springer Publishing Company.
KlassD.SilvermanP. R.& NickmanS. L. (Eds.). (1996). Continuing bonds: New understandings of grief. Taylor & Francis.
KramuschkeM.ReinhardtJ.DölemeyerR.KaiserJ.& KerstingA. (2024). The change of working alliance and the association to treatment outcome in an internet-based therapy after pregnancy loss. BMC Psychology12(1)254. https://doi.org/10.1186/s40359-024-01751-4
Kübler-RossE. (1969). On death and dying. The Macmillan Company
Kübler-RossE.& KesslerD. (2004). On grief and grieving: Finding the meaning of grief through the five stages of loss. Scribner.
Kübler-RossE.& KesslerD. (2005). On grief and grieving: Finding the meaning of grief through the five stages of loss. Simon and Schuster.
LeDouxJ. E. (1996). The emotional brain: The mysterious underpinnings of emotional life. Simon & Schuster.
LeeM. (2016). Using narrative approach for anticipatory grief among family caregivers. Annals of Geriatric Medicine and Research20(4)168–172.
NewsomC.SchutH.StroebeM. S.WilsonS.BirrellJ.MoerbeekM.& EismaM. C. (2017). Effectiveness of bereavement counselling through a community-based organization: A naturalisticcontrolled trial. Clinical Psychology & Psychotherapy24(6)O1512–O1523. https://doi.org/10.1002/cpp.2113
ParkesC. M.& PrigersonH. G. (2010). Bereavement: Studies of grief in adult life (4th ed.). Routledge.
Peña-VargasC.Colón-FrancoE.& Aponte-ParesG. (2021). A biopsychosocial approach to griefdepressionand the role of emotional regulation. International Journal of Environmental Research and Public Health18(16)8362.
StroebeM.& SchutH. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies23(3)197–224. https://doi.org/10.1080/074811899201046
SzuhanyK. L.MalgaroliM.MironC. D.& SimonN. M. (2021). The risk for prolonged grief increases with sudden or traumatic deaths. Journal of Grief Studies15(3)45–58.
WordenJ. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner (5th ed.). Springer Publishing Company.
About the author
Dr. Kinga Mnich is a globally-minded Executive CoachSocial Psychologistand Speaker who helps high-achievers lead with confidenceclarityand emotional intelligence. With over 15 years of experience across academiasocial impactand leadership developmentshe integrates science-backed strategies with mindfulness and somatic tools to create meaningfullasting change. Kinga brings a rich multicultural perspective to her work.
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What our readers think
Brandon
on February 132024 at 21:27
This is very insightful. I work in behavioral health and addiction treatment and this topic is important in recovery. Many people do not understand grief or how to cope and heal from it. In turnthis often leads to serious mental health and behavioral issues. I’ve learned through my work that grief is often the result of deep rooted traumawhich manifests as addiction. Thank you for your efforts on educating people to the importance of understanding grief.
I received an email from Seph with resourcesarticles on 13 Types of Griefand the 10 Grief Counseling Therapy Techniques. Thank youI will be trying them out. I am open to any other resources.
Dear Dr. Celestine,
I run a program for the VAa weekly Zoom meeting group for Vietnam Veterans with PTSD. For this aging population this article is very relevant. Unfortunately they are not eager to read longer partly-scientific articleshowever beneficial or relevantbut prefer talksvideosetc. Do you know of any videos TEDtalksor other presentations which provide (even parts of) this information?
I am the founder and senior consultant of Optimum Practice Solutions. My focus is on providing organizational management tools and techniques as well as other solutions to support the veterinary and medical professions.
I write educational articles 3-4 times a month which are sent to my subscriber list via email. With a high rate of mental illness and suicide in veterinary medicine and the healthcare professionI’d like to reprint this article with the author as a Guest in one of my upcoming articles. You’ll find me on LinkedIn https://www.linkedin.com/in/marylemalloy/
Let me know as soon as possible if I have your permission.
Thanks for your interest. Could you please send a few details about your organizationthe purpose for which you’d like to republish this articleand the contact for your publishing manager via our contact form hereand we will be in touch 🙂
Thank you so much for the wonderful detailed information. These resources help in supporting the clients. These kind of resources help the therapist to connect with the clients and help them in their journey.
Grief is an inevitable universal experience. Everyone will experience it at some point in their lifebut not everyone is impacted by it in the same way (O’Connor2019; Bonanno2009).
The five stages of grief were first introduced in 1969 by Elisabeth Kübler-Ross in her book On Death and Dying.
Supporting the grief process in therapy and counseling entails a therapeutic environment based on trustempathyand collaboration (Kramuschke et al.2024).
What our readers think
This is very insightful. I work in behavioral health and addiction treatment and this topic is important in recovery. Many people do not understand grief or how to cope and heal from it. In turnthis often leads to serious mental health and behavioral issues. I’ve learned through my work that grief is often the result of deep rooted traumawhich manifests as addiction. Thank you for your efforts on educating people to the importance of understanding grief.
I received an email from Seph with resourcesarticles on 13 Types of Griefand the 10 Grief Counseling Therapy Techniques. Thank youI will be trying them out. I am open to any other resources.
Dear Dr. Celestine,
I run a program for the VAa weekly Zoom meeting group for Vietnam Veterans with PTSD. For this aging population this article is very relevant. Unfortunately they are not eager to read longer partly-scientific articleshowever beneficial or relevantbut prefer talksvideosetc. Do you know of any videos TEDtalksor other presentations which provide (even parts of) this information?
Thank you,
Jon
I am the founder and senior consultant of Optimum Practice Solutions. My focus is on providing organizational management tools and techniques as well as other solutions to support the veterinary and medical professions.
I write educational articles 3-4 times a month which are sent to my subscriber list via email. With a high rate of mental illness and suicide in veterinary medicine and the healthcare professionI’d like to reprint this article with the author as a Guest in one of my upcoming articles. You’ll find me on LinkedIn https://www.linkedin.com/in/marylemalloy/
Let me know as soon as possible if I have your permission.
Hi Maryle,
Thanks for your interest. Could you please send a few details about your organizationthe purpose for which you’d like to republish this articleand the contact for your publishing manager via our contact form hereand we will be in touch 🙂
Thank you.
– Nicole | Community Manager
Thank you so much for the wonderful detailed information. These resources help in supporting the clients. These kind of resources help the therapist to connect with the clients and help them in their journey.