The Stages and Emotional Impact of Grief

Grief is an intense emotional response to a significant loss. Though there are some general commonalities in the grief process across cultures, the specific experience is highly personal. Yet, despite individual differences, grief is essential as a mechanism of coping with and recovering from loss.

What Is Grief? 

Grief is a natural and normal response to loss. It is often described as sorrow, mourning, or emotional distress in response to a significant loss ^[1]. The American Psychological Association takes it a step further and describes grief as “anguish,” which includes many different symptoms ranging from dwelling on the past to separation anxiety and confusion ^[2].

In many cases, grief is a relatively short-term reaction to loss lasting six months or less ^[3]. Short and intense emotional responses (e.g., outbursts of crying, intense sadness, and longing) are prevalent in the days and weeks after the loss. However, the temporary psychological and physiological distress, disruption, and diminished functioning eventually give way to acceptance of the loss and a return to everyday life. This process can be described as normal grief or uncomplicated grief.

However, the grief process might take other forms, depending on the person and situation. Some of the most common types of grief reactions are summarized below:

• Anticipatory grief:  This type of grief is experienced before a significant loss. A family grieving the impending death of a loved one and imagining their burial is a good example of anticipatory grief ^[3].
• Acute grief: The immediate and overwhelming reaction to loss, such as a parent experiencing the emotional trauma of losing a child ^[1].
• Integrated grief: The experience of recalling the loss without the intense emotional reaction of acute grief. This type of grief might be best thought of as a transition period in which acceptance of the grief-causing loss is achieved, and the grieving person’s emotional wounds begin to heal ^[1].
• Complicated grief: Severe, intense, prolonged grief reaction marked by significant emotional pain and sorrow that can prevent someone from reengaging with their life. This type of grief typically involves a protracted experience of acute grief and often requires professional help to process ^[4]. Complicated grief may come in many forms (e.g., inhibited, delayed, distorted, and chronic), which are discussed in detail below ^[1].
• Prolonged, persistent, or complex grief: A diagnosable condition in the DSM-5 (persistent complex bereavement disorder) in which the grief experience continues for at least one year in adults and at least six months for children ^[1]. Like complicated grief, this kind of grief process can also be described as the inability to transition from acute to integrated grief ^[5].

Regardless of how the grieving process plays out, natural mourning is a typical response to loss; it’s the body and mind’s way of processing what’s happened and the mechanism by which we move on and accept the new reality.

How Grief is Processed

As noted earlier, each person grieves differently. For some, an outward expression of sadness, survivor’s guilt, anger, and other emotions might be completely normal. Yet, grief might be a more inward and private process for another.

Still, researchers have identified numerous commonalities in how to process grief that cut across racial, ethnic, gender, age, religious, and other demographic lines. Historically, Elisabeth Kübler-Ross’s five stages of grief have been the go-to model for describing how grief is processed. Her model explains it as follows ^[6]:

1. Denial: This stage is marked by a refusal to accept the loss.
2. Anger: Denial gives way to anger, which can be directed inwardly, outwardly, or toward a higher power for taking the person or thing.
3. Bargaining: Kübler-Ross posits that this step attempts to regain control and prevent or delay the loss (e.g., a child promising to behave well if their grandparents are allowed to live longer).
4. Depression: The depression stage occurs once a person realizes the loss is inescapable. Intense feelings of sadness and despair are joined by other typical signs of depression, such as social withdrawal, reduced joy in activities, sleep and appetite problems, and so forth.
5. Acceptance: This final stage occurs once a person acknowledges the loss, adjusts to the new reality, and begins to move on.

Over the years, this representation of the grief process has been criticized for being too rigid and linear. However, Kübler-Ross noted in 1974 that the stages never represented a linear process. Instead, she intended them to merely be a framework, saying that one can experience more than one stage at a time, skip some stages entirely, or not experience any of them ^[7]. 

Others have posited different explanations for the grief process in the intervening decades, including: 

Bowlby & Parkes’ Four Phases of Grief

Bowlby and Parkes based their Four Phases of Grief on Kübler-Ross’ model. However, Bowlby and Parkes made it very clear that their stages were not linear. Instead, you might skip stages, complete stage four, return to stage one again, and so forth. Their stages are as follows ^[6]:

• Shock and numbness: This often occurs immediately following a loss. People frequently shut down during this stage to survive the emotional shock.
• Yearning and searching: This is characterized by mixed feelings, such as confusion, anger, sadness, and anxiety. People in this stage long for what has been lost and search for ways to fill the void.
• Disorganization and despair: People in this stage might still feel despair and apathy. Likewise, this stage is often marked by disengagement and withdrawal from others.
• Reorganization and recovery: The heavy feelings of sadness and despair begin to lessen as positive memories of who or what was lost begin to increase.

Worden’s Model of Coping With Loss

Worden’s Four Basic Tasks in Adapting to Loss is an entirely different model. Rather than relying on stages, this model posits that people experiencing grief must complete four tasks. These tasks don’t necessarily occur in any order ^[6]:

• Accepting the reality of loss: This is often the first task grieving people take on. It culminates with being ready to move on and preparing for the impending loss.
• Experiencing pain or grief: This task involves many emotions, including confusion, anger, and sadness. This period of pain lasts until the grieving individual feels ready to move on.
• Adjusting to the environment:  Returning to a more normal routine (e.g., going back to work) after the focus of attention is no longer on the loss.
• Redirecting emotional energy: Repurposing one’s attention from the experience of loss to new activities and experiences that bring joy.

Wolfelt’s Companioning Approach to Grief

Another nonlinear grieving process model is Wolfelt’s companioning approach. Essentially, Wolfelt explains that grief is an integral part of healing. As such, it should not be avoided but experienced and shared with a companion.

This model has no stages or tasks to complete. Instead, Wolfelt describes a handful of experiential needs the bereaved should focus on, such as expressing grief, confronting loss, focusing on self-care, and exploring one’s new identity in the wake of the loss. A key component of this theory is that since grief recurs repeatedly, one must have a support system to grieve successfully ^[6].

Neimeyer’s Narrative and Constructivist Model of the Grieving Process

Neimeyer’s approach is unique in that it focuses on making meaning of the loss. The emotions one feels during the grieving process serve as guidelines for rebuilding meaning in life. In other words, one must reconstruct one’s identity into something new to heal.

According to Neimeyer, this is a highly social process. So, like Wolfelt’s approach, this model emphasizes the importance of a support system, such as family, friends, and the community. With a support system, grieving people reconstruct their lives, adapt to the loss, develop a new self-narrative, and eventually thrive again ^[6].

Dual Process Model of Grief

The Dual Process Model of coping with loss emphasizes typical processes of grieving, like experiencing intense sadness and constantly thinking of the loss, as well as restorative behaviors, like accepting one’s new role as an orphan after both parents pass away. These loss- and restoration-oriented processes, respectively, can oscillate back and forth.

As such, the Dual Process Model is not linear; instead, it recognizes that you may be overcome with loss-oriented feelings as time passes after a loss. Then, the next day, you may feel confident in your ability to move on, only to ruminate about the loss. This balance between confronting and avoiding grief may continue for months or years as one seeks to cope with a significant loss ^[8].

The above is not a complete list of all the stages of grief theories or models of grief and bereavement. However, it should provide a sufficient idea of prevailing notions of how we grieve, and how it is a deeply personal process that cannot fit into a single box.

Common Symptoms of Grief

Intense grief is often accompanied by a range of psychological, physiological, and behavioral symptoms ^[9]. These include: 

• Feeling numb or in shock at the initial news of the loss
• Overwhelming sadness regarding the loss
• Anger toward the person or thing that is no longer around
• Guilt for feeling angry or for things left unsaid
• Difficulty making decisions and staying focused
• Physical exhaustion from the outpouring of emotion and lack of sleep
• Restlessness or feeling on edge
• Loss of appetite
• Body aches, pains, and headaches
• Loneliness or social withdrawal

Again, this isn’t a complete list of all the possible symptoms one might experience when in grief. Moreover, these symptoms are not a blanket experience for everyone. Numerous factors might impact how one experiences grief, as discussed below.

Factors That Influence the Grief Process

Navigating loss is an experience that’s as different as the losses themselves. Multiple factors are at play, not least of which is the mental health history and the coping skills of the bereaved. However, one’s mental health is just one component of one’s ability to navigate the stages of grief successfully. Other factors that might affect the grief process include the following ^[10]:

• Cultural norms and religious beliefs
• The presence or absence of social support
• Age, gender, and personality characteristics
• The relationship to the lost (e.g., losing a direct relative might be more impactful than a colleague from work)
• Nature of the loss (e.g., an expected versus an unexpected death of a loved one)

The above factors influence how one might experience grief and how the grieving process is navigated. For example, someone with an extensive social support system might be able to better cope with the aftermath of a loss than someone who has few, if any, close family or friends. Likewise, older people tend to have better coping skills and may be able to navigate the grieving process more easily than children, adolescents, or young adults.

How Does Grief Impact Mental Health?

As previously discussed, grief often presents with a range of emotional symptoms. Among the most significant are its psychological effects, which can be intense and long-lasting. Feelings of distress, anger, and profound sadness are common, making the grieving process an emotional rollercoaster.

Grief can also have a lasting impact on mental health and overall well-being. Research shows that nearly half of all widows and widowers experience symptoms of depression within the first three months following the death of a spouse ^[11]. While the specific symptoms vary from person to person, the psychological impact of grief and depression may include:

• Sleeplessness
• Loss of appetite
• Feelings of hopelessness
• Difficulty concentrating or “mental fog”
• Physical fatigue or weakness
• Persistent feelings of worthlessness

In more severe cases, prolonged or intense grief may lead to suicidal thoughts or behaviors, underscoring the importance of early support and mental health intervention.

What Is Complicated Grief?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies complicated grief as persistent complex bereavement disorder, which is diagnosed when symptoms persist for at least 12 months ^[4]. A defining characteristic of this condition is that the severity of grief interferes with basic functioning, such as maintaining employment or academic responsibilities, preparing meals, attending to personal hygiene, and completing other everyday tasks. People experiencing complicated grief might also become preoccupied with the circumstances of their loss and be unable to make plans for their future ^[4].

The persistence of this disorder can be incredibly debilitating and demoralizing. Aside from the grief of losing someone or something significant, you may experience a sense of disbelief surrounding the loss or have a complete inability to accept the fact that the loss has occurred. Unfortunately, without treatment, persistent complex bereavement disorder can lead to an array of other problems, including suicidal thinking, increased risk of substance abuse, reduced immune functioning, and sleep disturbances, to name a few ^[12]. 

Furthermore, some people with complicated grief question their existence. In particular, they might struggle to find meaning after experiencing loss. These negative emotions can be overwhelming to the point of being debilitating and require professional intervention.

Therefore, compared to typical grief, complicated grief is longer-lasting, more intense, highly distressful, and can have adverse effects on more than one area of a person’s life. People who experience complicated grief are more likely to have other issues arise, too, such as depression, anxiety, substance abuse, and more intense physiological symptoms ^[10].

How to Cope with Grief

While grief can be an overwhelming and painful experience, several practical strategies can support the healing process. One of the most foundational approaches is prioritizing basic self-care. Getting adequate rest, maintaining a balanced diet, and engaging in regular physical activity can positively influence emotional and physical well-being.

Other helpful coping strategies include ^[4]:

• Avoiding alcohol and drugs, particularly when used as a means of numbing emotional pain.
• Seeking social support from trusted friends, family members, faith leaders, or grief support groups within the community.
• Engaging in enjoyable activities, such as walking a pet, spending time in nature, or visiting loved ones, can help restore a sense of normalcy.
• Openly expressing emotions by talking with someone trustworthy, such as a partner, sibling, or counselor.
• Reaching out to mental health professionals, including therapists, psychologists, and social workers, who can provide evidence-based approaches.

Some individuals also find comfort in books, while others benefit from journaling as a form of emotional release. There is no single “right” way to grieve; for many, a personalized combination of these techniques proves most effective in navigating loss and fostering recovery.

How to Support Someone Who Is Grieving

When someone is coping with loss, one of the most meaningful things others can do is simply offer their presence. Being emotionally available and listening without judgment or trying to “fix” the situation can provide immense comfort. Allowing the grieving individual to express their thoughts and feelings freely helps validate their experience. Often, a supportive presence, a listening ear, and a willingness to sit with them in their pain are more valuable than any advice. In many cases, knowing someone is there can offer reassurance and a sense of connection during an otherwise isolating time.

Other strategies you might rely on when supporting someone in the grief process include the following:

• Frequently check in. A call or text can mean the world to someone feeling alone.
• Provide practical assistance, like offering to go grocery shopping or driving the bereaved to appointments.
• Invite the bereaved to participate in an activity. It can be something as simple as a walk in the local park or a quick coffee at a nearby coffee shop.
• Respect their method of grieving. Some people prefer to grieve privately; others prefer a shared experience. Either way, be available for the bereaved without being pushy.
• Be in it for the long haul. While many people are available and offer help in the immediate aftermath of a loss, not nearly as many stay for long-term support.

When to Seek Professional Help

While grief is a natural response to loss, there are times when professional support may be necessary, particularly if the emotional burden becomes overwhelming. Individuals struggling to cope may benefit from speaking with a mental health professional, especially if grief begins to interfere with daily functioning. Local resources can often be found by searching online for “grief counselors near me” or by asking trusted friends or family members for referrals.

The level of professional intervention needed depends on the individual’s experience. Those going through typical grief may find relief through short-term counseling, while individuals experiencing complicated grief—a more intense and prolonged form—may require ongoing psychotherapy, sometimes extending six months or longer. Cognitive-behavioral therapy (CBT) that integrates grief-specific strategies has shown effectiveness in treating prolonged grief ^[10].

In some cases, antidepressant medication may be prescribed if grief symptoms develop into clinical depression. Research indicates that when paired with therapy, medication can significantly improve outcomes ^[10].

Other therapeutic approaches for grief include:

• Grief support groups: Provide emotional support and a sense of community for those coping with loss.
• Acceptance and Commitment Therapy (ACT): Helps individuals accept their grief, clarify personal values, and take meaningful action despite emotional pain.
• Interpersonal Therapy (IPT): Focuses on current relationships to explore grief-related challenges.
• Metacognitive Interpersonal Therapy (MIT): Helps individuals recognize and express grief-related emotions.
• Dynamic Interpersonal Therapy (DIT): Uses psychodynamic techniques and mentalization to deepen emotional insight.
• Traumatic grief therapy: Beneficial shortly after a loss, this approach focuses on emotional regulation, restoring daily routines, and normalizing grief responses.

Seeking help is not a sign of weakness but a proactive step toward healing, growth, and long-term emotional well-being.

Healing after Loss

Grief is a deeply personal and often overwhelming experience that affects every aspect of one’s well-being, emotionally, mentally, physically, and socially. While loss is a natural part of life, how individuals process and respond to it can significantly impact their health. Adopting a balanced lifestyle with proper nutrition, sleep, physical activity, social connection, and mindfulness can help build emotional resilience during grief.

It’s important to recognize when additional support is needed. Whether through short-term counseling, structured therapy, or community-based support groups, professional help can offer the tools and guidance necessary for navigating grief in a healthy, constructive way.

Everyone’s path to healing is different, but no one has to walk it alone. By understanding the effects of grief and integrating lifestyle strategies that promote wellness, individuals can gradually move toward healing, rediscover meaning, and regain a sense of balance and hope after loss.