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The Grief Recovery Handbook, 20th Anniversary Expanded Edition

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The Grief Recovery Handbook, 20th Anniversary Expanded Edition

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The resource I would like to share with the class is The Grief Recovery Handbook, 20th Anniversary Expanded Edition: The Action Program for Moving Beyond Death, Divorce, and Other Losses, including Health, Career, and Faith, by John W. James and Russell Friedman. The Grief Recovery Handbook focuses on the work done by the authors at the Grief Recovery Institute.

This handbook is so helpful because it acknowledges many different types of loss. Their system helps give you skills to grieve tangible and symbolic losses. Here are some of the key takeaways from this book.

- "Since most of us have been socialized to attempt to resolve all issues with our intellect, grief remains a huge problem." (James & Friedman, 2009, p. 5).

- "Recovery means claiming your circumstances instead of your circumstances claiming you and your happiness." (James & Friedman, 2009, p. 6).

- The authors believe that the emotional stages of grief that someone who is dying goes through have been applied to other human emotions. "Grief, which follows death, divorce, and other losses, should not, however, be regarded in terms of stages." (James & Friedman, 2009, p. 11).

- "Grief is the entire range of naturally occurring human emotions that accompany loss" (James & Friedman, 2009, p. 47).

The activity in the book I found to be the most useful was the Relationship History Graph (James & Friedman, 2009, p. 115), where you create a timeline of your history with a person, place, or concept, such as a business. Everything positive goes on top of the timeline, and everything negative goes on the bottom. Then, you organize all of the events on the timeline into apologize, forgiveness, and significant emotional statements (James & Friedman, 2009, p. 136). Then, you write it out in a Grief Recovery Completion Letter (James & Friedman, 2009, p. 145).

I have used this process to help me grieve the passing of my grandmother, putting down two family dogs, losing my business, working through burnout, losing friendships, and my changing identity as an entrepreneur during COVID-19. This process has helped me identify effective ways to grieve my tangible and symbolic losses. I plan to use this resource with my clients who are experiencing their own losses and need support in grieving them.

Source

James, J. W., & Friedman, R. (2009). The Grief Recovery Handbook, 20th anniversary Expanded Edition: The Action Program for moving Beyond death, divorce, and other losses including health, career, and faith (20th Anniversary). William Morrow.

Nikole Stanfield

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The Action Program for Moving Beyond Death, Divorce, and Other Losses including Health, Career, and Faith

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I use TherapistAid for activities and worksheets for a lot of my substance use disorder groups so naturally I went there for a topical resource on grief. I found this childhood grief one apt for this week.

I like it, as it confirms my assumption about children. My brother and his wife are consistently "shielding" their daughter from "tough topics" like injuries and death, and I always assumed it was hurting her development as a human. (After all, life is just a series of losses!)

I've previously never thought about "grief" and "children" in the same sentence so I enjoyed this exercise. Overall, this is a great resource for folks that "baby" their kids, or just people in general, and could change a few minds and help the children heal faster and/or simply have a healthier relationship with loss.

Steven Schilling

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Childhood Grief: Guidelines for caregivers | Worksheet | Therapist Aid

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Speaking bluntly about death does not come naturally to most adults. Words like “dead” and “died” are rephrased and softened, becoming “passed…

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How Grief Affects Your Brain And What To Do About It 

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How Grief Affects Your Brain And What To Do About It 

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I have been at my Practicum/Internship site since January, which is the Neurofeedback Clinic of Northern Colorado. I was a former client years ago and neurofeedback was extremely helpful for me, and I also have heard all of the amazing benefits with current clients. I know that the brain is the “missing puzzle piece” when we think about counseling in general and especially when dealing with grief and loss. When looking for my WIKI resource, I wanted to make sure that it was in plain terms and relatable to everyone. This short Youtube video puts into perspective what is actually going on with the brain when we are dealing with grief and loss, some helpful tips in order to navigate this process, and everyone has their own individual time frame as to when they have navigated and processed their grief and loss. I really like the simplicity of this video and hope that it will be beneficial for others going through their own grief and loss.

Bridgette O'Boyle

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How Grief Affects Your Brain And What To Do About It | Better | NBC News

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First off, I love TED talks and any type of video that I can learn from and see different perspectives. In the video I shared, Jason B. Rosenthal speaks about his wife’s death and his journey through grief and loss. I really enjoy hearing other stories and their view on grief, this is probably why I have enjoyed the book Finding Meaning so much. Rosenthal stresses the end of life and how it impacts the future grieving process. I feel like this concept is something that I never fully grasped until I got to hear the many stories about how important our last few weeks can be compared to our entire lives. I believe in one of the documentary videos we watched in this class they also spoke on this thought and how important it was for one of the patients to have his grandchildren running around and around him during his hospice in home. Rosenthal expresses that although the memories during hospice in home were beautiful, they were also very hard to go through and he carries those images with him still. He also mentions that his ability to persevere was his wife telling him to move on before she passed, and essentially giving him permission. I also really liked how he mentions that so many people tell him that he’s doing so well with her death, but he explains that he is sad all of the time and he didn’t know if the despair would ever go away. He then lists multiple things in his life combined that has helped him feel better and how time is so important in grief because one day you will smile or laugh again and you wont even realize it.

Kimberly Harbaugh

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Jason B. Rosenthal: The journey through loss and grief | TED Talk

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In her brutally honest, ironically funny and widely read meditation on death, “You May Want to Marry My Husband,” the late author and filmmaker Amy Krouse Rosenthal gave her husband Jason very public permission to move on and find happiness. A year after her death, Jason offers candid insights on the often excruciating process of moving through and with loss -- as well as some quiet wisdom for anyone else experiencing life-changing grief.

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We don't "move on" from grief. We move forward with it

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We don't "move on" from grief. We move forward with it

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I can't remember how long ago I listened to author Nora McInerny's TED talk on grief, but it has stuck with me for many, many years. I think her TED talk helps normalize and reframe grief. It helped me understand what grief can look like for those who have lost someone very close to them (as I haven't yet).  I think this TED talk is great for those who are supporting someone in grief and for those who are grieving themselves. Plus, she's funny, making it fun to watch.

Allison Devault

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Nora McInerny: We don't "move on" from grief. We move forward with it

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In a talk that's by turns heartbreaking and hilarious, writer and podcaster Nora McInerny shares her hard-earned wisdom about life and death. Her candid approach to something that will, let's face it, affect us all, is as liberating as it is gut-wrenching. Most powerfully, she encourages us to shift how we approach grief.

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10 Grief Counseling Therapy Techniques & Interventions” by Jeremy Sutton, Ph.D.

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10 Grief Counseling Therapy Techniques & Interventions” by Jeremy Sutton, Ph.D.

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I really like this resource because it provides helpful definitions on grief processes (such as the four tasks of mourning), a video on three effective grief interventions, plenty of examples of the 10 techniques and interventions listed, as well as links to several other handouts relevant to helping clients work through their individual grief experiences. This resource, in my opinion, has a great variety of techniques and interventions that can be used for clients in various developmental stages as well as with clients from diverse and multicultural backgrounds.

Leanne Sanchez

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Unfortunately, grief is an inevitable, inescapable part of life.

We will all lose someone we love at some point in our life-most of us at many points-and the loss can often hit us harder than we expect.

If we feel really knocked off our feet or are struggling for a prolonged period of time, that may be a sign that we need some professional help to move on.

In this piece, we'll cover the basics of grief counseling/grief therapy and provide suggestions, tips, techniques, and exercises you can implement as a person in grieving, part of the support system for a person who is grieving, or as a mental health professional.

Before you read on, we thought you might like to download our 3 Positive Psychology Exercises for free. These science-based exercises will explore fundamental aspects of positive psychology including strengths, values and self-compassion and will give you the tools to enhance the wellbeing of your clients, students or employees.

What is Grief Counseling? A Definition of the Basics

Before we get into defining grief counseling, let's start with a definition of grief.

Grief is...

"... a reaction to any form of loss... [that] encompass a range of feelings from deep sadness to anger, and the process of adapting to a significant loss can vary dramatically from one person to another, depending on his or her background, beliefs, relationship to what was lost, and other factors."

(Mastrangelo & Wood, 2016)

Although you may be most familiar with the idea of grief as a response to the death of a loved one, the definition given here is broader: "... a reaction to any form of loss" (emphasis mine). Thus, grief is something that can be experienced in a wide range of situations, including the death of a loved one or a pet, the dissolution of a marriage, estrangement with a family member, or any other kind of significant loss.

Grief counseling is intended to help the client grieve in a healthy manner, to understand and cope with the emotions they experience, and to ultimately find a way to move on (Therapy Tribe, n.d.). This can be accomplished through existential therapy, individual therapy, group therapy, and/or family therapy (Mastrangelo & Wood, 2016).

You are probably already familiar with one model of grief: Elisabeth Kübler-Ross' popular "Five Stages of Grief" model. Although not much evidence has been found to support this model, it has stuck around in popular culture. The five stages are:

Although Kübler-Ross initially proposed that everyone moves through each of the five stages once and only once, she later acknowledged that some people may only experience two stages and that some people may revisit stages later in life (Mastrangelo & Wood, 2016).

Another popular model comes from J. W. Worden, who proposed that humans must undergo the "Four Tasks of Mourning" to heal:

1. To accept the reality of the loss

2. To work through the pain of grief

3. To adjust to life without the deceased

4. To maintain a connection to the deceased while moving on with life (Mastrangelo & Wood, 2016)

Although there are many unique theories and models of grieving with different stages and processes, generally all models agree that the following symptoms are common, whichever order they appear in:

Shock and disbelief, feeling numb, even denial that the loss occurred

Sadness, despair, loneliness, feeling empty

Guilt, regret, shame

Anger, feeling resentful

Anxiety, helplessness, insecurity, fear

Physical symptoms like fatigue, nausea, sickness, weight loss or gain, aches and pains, night sweats, heart palpitations, feeling faint or lightheaded, insomnia (Therapy Tribe, n.d.)

It's normal to experience these symptoms, but if you are experiencing them very intensely or for a long period of time after suffering the loss, you may want to look into grief counseling or grief therapy.

Grief Counseling and Grief Therapy: What's the Difference?

In general, the difference between counseling and therapy is merely one of semantics.

Both counseling and therapy use discussion between the client and the mental health professional to help the client address emotional, mental, or behavioral issues and solve problems.

However, the terms "counseling" and "therapy" are sometimes used in slightly different ways; counseling is more often used to refer to sessions focused on assisting clients who are dealing with everyday stressors and looking for ways to cope with normal issues and problems, while therapy is more frequently used to describe sessions in which clients are battling more difficult, more pervasive, and/or more chronic problems, like depression, anxiety, or addiction.

Thus, although grief counseling and grief therapy are basically the same thing, "grief counseling" may refer to the counseling that any individual might receive after losing a loved one, while "grief therapy" is more likely to refer to sessions that a client engages in when they are experiencing issues outside of the normal range of responses due to their grief.

For example, if a widow is simply struggling to cope with the loss of her husband, she may seek grief counseling; however, if she has lost her appetite and has had trouble sleeping for weeks, it may be a more serious problem that she seeks grief therapy for.

The Benefits of Grief Counseling

While grief counseling is not necessary for most people dealing with the loss of a loved one, there are some big potential benefits for those who are struggling more than usual (Mehta, 2013). If an individual was experiencing distress before the loss they suffered, or if their grief is chronic and interferes with normal functioning, grief counseling can help him or her to address their intense emotions and move on with the healing process.

Additionally, as with most forms of therapy, it is most effective if the individual voluntarily seeks it out.

Grief Counseling for Adults

If an individual does seek out grief counseling, this section describes what they can expect from their sessions.

The main goal of most grief counseling is to help the client integrate the reality of their loss into their life going forward, and helping them to maintain a healthy bond to the loved one they lost (Neimeyer, 2013). According to Dr. Robert A. Neimeyer, an active clinical psychologist and expert in grief therapy, there are two important first steps for working with a new client reeling from their loss:

1. Processing the Event Story of the Death
Clinicians working with a bereaved client will first encourage the client to engage in a healing re-telling of the loss. The clinician must create a safe space for the client to open up and build trust, so when the time comes to help the client rewrite the story of their loss, they are able to communicate effectively with the clinician.

2. Accessing the Back Story of the Relationship

In addition to hearing about the loss event itself, the clinician will also learn about the client's relationship with the loved one they lost. As Neimeyer says, "Death may end a life, but not necessarily a relationship." The clinician will guide the client through learning how to reconstruct their bond with their loved one rather than relinquishing it (Neimeyer, 2013).

Once you've got the basics covered, you can move on to some grief-specific techniques.

3 Techniques used in Grief Counseling

Three of the biggest things a good grief counselor can do for their client are to:

1. Let them talk about the deceased; ask them about the person, and allow them to speak about their lost loved one in a safe space.

2. Distinguish grief from trauma; if the client is struggling to get an image out of their head or experiencing flashbacks to the moment they learned of their loved one's death, they are experiencing trauma, which can keep them from working through their grief.

3. Deal with any guilt they are feeling and help them organize the grief; the client may feel guilty about what they did or didn't do while their loved one was alive, or they may feel guilty about not feeling "sad enough" or moving on while their loved one is dead. Encourage them to let go of the guilt and commit to living a life that will honor the deceased, even if that means forgetting about them for a little while (Tyrrell, n.d.).

Interventions and Strategies in Grief Therapy

Aside from the three important techniques listed above, there are many other more specific interventions and modified strategies that can be used to support a client in grief therapy.

For example, Dr. Alan D. Wolfelt developed the Companioning Model of Bereavement caregiving, in which the counselor or therapist acts as a companion and helper for the client. He is present for his client and observes their experience; however, "observe" in this context doesn't mean just watching, but bearing witness to their experience and to watch out for them.

Companioning is about...

Honoring the spirit, not focusing on the intellect.

Curiosity, not expertise.

Learning from others, not teaching them.

Walking alongside, not leading.

Being still, not frantic movement forward.

Discovering the gifts of sacred silence, not about filling every painful moment with words.

Listening with the heart, not analyzing with the head.

Bearing witness to the struggles of others, not directing them.

Being present to another person's pain, not taking away the pain.

Respecting disorder and confusion, not imposing order and logic.

Going to the wilderness of the soul with another human being, not thinking you are responsible for finding the way out (Wheeler-Roy & Amyot, 2004).

Following this model, the counselor or therapist will:

Listen in a supportive manner to the client's concerns.

Help disaster survivors recognize that, in most cases, their emotional reactions are natural, normal, and to be expected.

Assist survivors to reduce additional stress by organizing and prioritizing day-to-day and recovery-related tasks.

Help individuals to understand and recognize the wide range of reactions to trauma, such as numbness, frustration, confusion, anger, anxiety, sadness, and feelings of helplessness.

Assist individuals to draw on their own strengths and develop healthy coping mechanisms that permit them to gradually resume their pre-disaster (or pre-loss) level of functioning.

Sensitively and caringly help individuals to grieve their losses in their own unique ways.

Systematically draw upon an array of recovery resources for appropriate referrals (Wheeler-Roy & Amyot, 2004)

Dr. Kenneth Doka recommends encouraging clients to use rituals to connect with their loved one and carry on despite their grief. These four types of rituals can help:

1. Rituals of Continuity - These rituals establish that the lost loved one is still a part of the client's life, that the bond is still there.

2. Rituals of Transition - This type of ritual marks a significant change that has occurred in the grief response, such as cleaning out the room of the deceased or donating their belongings.

3. Rituals of Affirmation - In this ritual, the client can discharge any built-up regret by writing a letter or a poem to the deceased thanking them for their love and support.

4. Rituals of Intensification - These rituals connect group members and reinforce their common identity; a military unit may gather periodically to remember their fallen comrades or the survivors of an act of violence may revisit the site and place flowers or erect a memorial to those they lost (Wheeler-Roy & Amyot, 2004).

Smaller, everyday rituals can also be helpful for those grieving a loss; these are called Rituals to Commemorate, and include things like lighting a candle and thinking of the loved one, watching home videos or going through old pictures of the loved one, traveling to a place the loved one always wanted to visit, or visiting the burial site and leaving a tribute or symbolic item, like flowers or a balloon.

The mental health professional will not always encourage or apply the same techniques equally; there are a million different ways to grieve, and every healthy method of grieving is valid. However, there are two poles in grieving, with people falling anywhere on the spectrum between. The poles are "Intuitive Griever" and "Instrumental Griever."

The Intuitive Griever experiences feelings associated with their grief intensely and is open with expressions of their grief (e.g., crying, lamenting their loss). For them, successful strategies to cope with their grief involve facilitating their experience and expressing their feelings.

They may experience prolonged periods of confusion, inability to concentrate, disorganization, and disorientation, and they might also suffer from physical exhaustion and/or anxiety.

On the other hand, the Instrumental Griever is more prone to thoughts of grief than feelings of grief and is often reluctant to talk about their feelings. They prioritize mastery of themselves and their environment and find success in problem-solving strategies. They may experience brief periods of cognitive dysfunction, like confusion, forgetfulness, and obsessiveness, and they may have increased energy levels (Wheeler-Roy & Amyot, 2004).

Tips for Coping with Grief

In addition to the techniques and strategies listed above, counselors will likely also offer the following three tips for those who are grieving.

1. Do not grieve alone

It's vital that you stay connected with others during this time. Your support system may include your family, friends, leaders in your faith, a bereavement support group, and/or a licensed mental health professional to help you cope.

Your support system can help you:

Make the funeral arrangements or help you with new responsibilities.

Find peace and comfort through your faith's mourning rituals.

Share your grief with others who can relate.

Work through your difficult emotions in a safe setting.

2. Take good care of yourself

It can be easy to forget about our own needs when we are reeling from loss, but neglecting yourself won't help you effectively deal with your grief.

Remember to:

Do something creative to express your feelings (e.g., write something, paint, put together a scrapbook, or play a musical instrument).

Eat, sleep, and exercise to avoid adding physical fatigue to your emotional fatigue.

Be patient with yourself and allow yourself to feel whatever you feel.

Understand what triggers your grief and prepare for those triggers (e.g., plan to take a day or two off of work, let your friends and family know you'll need extra support, etc.).

3. Seek professional grief counseling

Not everyone will need the services of a counselor or therapist during their grieving period, but it can be very helpful for those who are really struggling. A qualified professional can help you understand the grief process and give you the tools you need to cope with your emotions (Therapy Tribe, n.d.).

While everyone grieves differently, these three tips are essential for anyone who must cope with a profound loss.

Grief Counseling in the Workplace

Whether the loss takes place at work or outside of the office, losing someone you work with can be tough to process. It's vital that the workplace leaders address grief in an appropriate way, or they risk the loss of morale, extended loss of productivity, and a generally negative attitude toward leadership.

Dr. Jerry Rothman offers the following suggestions to address grief in the workplace:

Before You Do Anything Else: Stop the Action

The very first step, that should be taken immediately following a death, is to call a halt to business as usual. Leaders should pause all nonessential activities and reschedule them to allow employees to process what has happened.

This may involve closing the business for a day or gathering all employees for a few hours to let them know what happened and address anything that needs addressing (e.g., safety concerns). Leaders should ensure that all employees are aware of the situation and leave with accurate information.

Focus on Feeling/Talking/Sharing

After the initial gathering to discuss what happened and make sure everyone is up to date, make some time for employees to gather and share their feelings. It is imperative to give employees a chance to work through their feelings and connect with their coworkers after a loss.

You may want to invite an external facilitator to lead a group discussion.

In larger organizations, this may need to be broken into several smaller groups; the important thing is that each employee gets a chance to share in a safe environment.

After every employee has had a chance to share, the organization can plan a larger ceremony or remembrance that includes the entire organization.

Use Differing Formats

Every individual grieves in their own way, and it's important to avoid imposing a specific type of grieving on anyone. Offer as many different formats of grief counseling or support as possible. Some people may not be comfortable sharing in a group and would benefit from speaking to someone one-on-one.

Others may find ceremonies and rituals comforting, while others may find them over-the-top or overly solemn. Try to offer support for a wide range of coping styles and strategies.

Create Ceremony/Rituals

Although some may not appreciate them, most people find some comfort in ceremonies and rituals. The ceremony could be something as simple as having everyone sign a card to the deceased's family, or it can be as big as planning a company-wide memorial service for the deceased.

If the loss is particularly significant to the workplace, periodic remembrances may be helpful as well.

Provide Many Opportunities

Some people take time to process their emotions before reaching out, and others may be in shock or denial for a period of time. Make sure to offer multiple opportunities across a longer time period instead of designating a single day or week as the time to grieve.

Give employees every opportunity you can to work through their feelings.

Utilize Diverse Helpers

Just as people grieve in many different ways, they always turn to a wide variety of people for support.

Some prefer to speak with loved ones, while others may want to sit down with a mental health professional.

Many people benefit from speaking with those in a position of authority in their organization or to a religious figure, like a pastor, priest, or rabbi. Still, others might be comfortable talking to a volunteer that they do not know, but have no desire to share their deepest thoughts and feelings with co-workers or managers.

Try to secure many different types of people as helpers for your employees as they grieve (Rothman, 2010).

At least some of these helpers should be mental health professionals external to the organization. They can provide objectivity and a promise of confidentiality for employees, allowing them to be honest and open (Lotich, 2017).

Grief Counseling for Children and Elementary Students

As difficult as grief counseling can be in the workplace, it can be even more difficult for children and their families. Special care must be taken when working with children to help them grieve in a healthy manner.

The Dougy Center (aka The National Center for Grieving Children & Families) offers these tips to help you guide a child through the grieving process:

1. Answer any questions they ask, even the hard ones about death. Give them honest answers that are appropriate for their age and development. Use concrete words like "died" or "killed" instead of "lost" or "passed away."

2. Give the child choices whenever possible. Let them decide how they want to say goodbye to the person, allow them to join in the funeral preparations and the service, and encourage them to work through their grief in whatever way works best for them.

3. Talk about and remember the person who died. Don't avoid talking about the deceased; bringing up the person they lost may help them to open up about their feelings. Remembering their loved one will help them see grief as a normal part of life and encourage them to focus on the good memories they have of the deceased.

4. Respect differences in grieving styles; children within the same family may have wildly different methods of coping, and that's okay. Let them work through it, however, is best for them.

5. Listen without judgment. Reflect what they say back to them, and ask them about their experience. Avoid telling them how they should or shouldn't think, feel, or behave in their grieving process.

6. Hold a memorial service and allow them to say goodbye. It will help them see how valued and important the deceased was to others and to know that it is okay to grieve. If they don't want to participate in the service, help them engage in their own service or ritual to say goodbye.

7. Take a break from grieving, and allow the child to take a break from grieving. Children may need more time than adults to smile, laugh, and have fun, and may even require it to heal (The Dougy Center, n.d.).

Following these tips will help you ensure that you are giving your child (or children) the love and support they need while coping with loss. If you are a mental health professional, remember to pass along this advice to the parents of grieving children, and apply the principles in your own practice.

How to Provide Grief Counseling in Hospice Care

Hospice care is one of the most emotionally exhausting fields to work in, as you are dealing with grief and loss every day. While there are some aspects of an expected loss that make it easier to cope with, that certainly doesn't mean it's easy.

VITAS Healthcare recommends the following techniques for providing support and assisting the bereaved with coping:

Create a helping environment by finding a quiet, private place to talk and projecting warmth, interest, and respect.

Use the past tense, use the deceased's name, and use words such as "death," "died," and "dead."

Begin the first encounter by asking the bereaved to tell you about the death.

Ask him or her about any funeral or memorial services.

Ask him or her about what has been happening since the death (e.g., how have things been with friends and family, is he/she able to talk openly about the deceased).

Ask the following questions to encourage them to reflect on their grief reaction:
o Some people have trouble eating or sleeping after they have lost someone they love. Are you eating okay?
o Are you getting out of the house and engaging in any former activities or hobbies?
o Is there anything bothering you in particular these days?

Ask about other difficult times in his/her life. Were these recent or in the past? How someone has responded to past losses can tell a great deal about how they are likely to adjust to the current loss.

Ask what coping skills he/she utilized in past crises; encourage him/her to utilize those same resources at this time.

Help them acknowledge their past accomplishments as a way to reestablish self-esteem.

Affirm their ability to survive their current loss.

Ask them about their relationship with the deceased.

Help them examine their special qualities and talents that endeared them to the deceased.

Most grief experts warn against making a drastic change too soon after the death of a loved one (examples include moving to a new home, getting into a new relationship). These premature changes are often viewed as an attempt to "run away" from the pain of grief.

Remind the survivor that it is normal to feel overwhelmed by the intensity of his/her feelings.

Help him/her identify feelings of loss and feel pain. Acknowledge that pain is a part of the grief experience, but reassure him/her the pain will not always be so intense.

Give him/her permission to cry.

Give him/her permission to feel relieved if he/she does.

Acknowledge that setbacks do happen and not to panic. Explain that it may feel like an emotional roller coaster at times, but that these are merely remnants of grief and not a signal that he/she is starting over again.

Grief is an exhausting process physically and emotionally, so it is important to encourage the bereaved to take extra care of themselves by eating balanced meals, drinking plenty of water, getting enough sleep, exercising regularly and limiting alcohol and other mind-altering drugs, as they can hinder the grief process.

Suggest that they be patient not only with themselves but with others who may not understand what they are feeling.

Remind them to have realistic expectations about how quickly they will heal from the pain of grief.

Encourage them to take one day at a time. At times, it might be easier to break the day into manageable increments.

Suggest that they start slowly to return to their normal routine by doing small customary chores such as shopping.

One grief therapist suggests that the bereaved set goals for themselves for six months at a time, picking two or three realistic goals and establishing a deadline to accomplish them. Setting goals provides security and a renewed control over one's life.

Doing small things for other people can also be helpful to someone who is grieving in that it takes attention off the bereaved and their pain for a while.

Reassure them that it is also OK to set limits with people and to say no.

Validate the survivor as they develop new skills and take on new roles.

Affirm their right to feel joy and hope and to eventually have another relationship, without viewing these as being disloyal to the deceased (VITAS Healthcare, n.d.)

Aside from this (long!) list of questions and discussion items, there are also some more specific techniques and strategies you can use, including:

Some bereaved feel the need, especially right after the death, to find out everything they can about the illness and/or circumstance of their loved one's death, and sometimes they want to review the medical records. This is normal and especially typical in a sudden death.

Encourage the use of symbols and "transitional objects" such as photos, audio or video tapes, articles of clothing or jewelry, or a collection that was special to the deceased.

Suggest writing a letter to the deceased or to God expressing his/her thoughts or feelings.

Suggest keeping a journal of the grief experience, or special thoughts, poems and remembrances.

Reading about grief often helps to normalize their grief experience. Bookstores, libraries, hospices and the Internet all have excellent grief resources.

Family members could put together a memory book that includes stories about family events, photos, poems, drawings, etc. They could also make a memory box, in which some special items are kept that can be shared with others or kept as a keepsake.

Suggest the use of artwork to express their grief feelings.

One grief therapist suggests that the bereaved person play out in his/her mind the "unfinished business" from the relationship with the deceased and try to come to a resolution. It is sometimes helpful to focus on what the survivor was able to do for the deceased instead of what they should have done.

The "empty chair" technique, where the bereaved person imagines the deceased and is encouraged to express whatever they need to say is another effective method for "unfinished business."

Role-play can be helpful when the bereaved face situations that are feared or that they feel awkward about - like starting a new relationship. Role play can build stronger coping skills (VITAS Healthcare, n.d.)

Supporting those grieving the loss of a loved one in hospice care has its own challenges, but it is generally similar to any other kind of grief therapy or counseling, in which the most important thing is to provide them with support, encouragement, and caring.

Coping with Miscarriage

As common as miscarriages are, they can still generate enormous feelings of loss and grief in expectant parents (and others heavily invested in the pregnancy, such as grandparents of the child lost).

It is absolutely normal to experience grief after a miscarriage, whenever it occurs in the pregnancy; however, recent research shows that around 15% of women who experience miscarriages suffer from more serious grief-related symptoms that may require the assistance of a qualified mental health professional (Leis-Newman, 2012).

If you are suffering from the symptoms below over a long period of time or to the point that you cannot function normally, you may want to look into counseling or therapy for your loss.

After a miscarriage, the sufferer may experience:

Depression

Numbness and disbelief

Anger

Guilt

Sadness

Difficulty concentrating

Fatigue

Trouble Sleeping

Loss of appetite

Frequent episodes of crying

Broken or suffering relationships with family or friends

Self-harm/suicidal attempts or actions (American Pregnancy Association, n.d.)

A common post-miscarriage grieving process may unfold in the following manner:

1. Shock or denial that the miscarriage happened.

2. Anger, guilt, and/or depression; feeling that it isn't fair, or asking "Why me?"

3. Acceptance of the reality of the miscarriage.

Getting to step three doesn't mean the grieving process is done, but it means you have accepted your situation and you now understand what you're dealing with; from here, it can get much, much better.

To help you along your grieving process, remember to:

Reach out to your loved ones for understanding, support, and comfort.

Seek counseling if you need it, and encourage your partner to seek counseling if he or she needs it; know that you are not alone.

Give yourself the time, space, and permission to grieve and remember what you have lost.

Set realistic goals for yourself, and focus on one thing at a time.

Allow yourself to feel both grief and joy; celebrating brief moments of joy does not dishonor your loss (American Pregnancy Association, n.d.).

While you are grieving your loss, it can be all too easy to focus on your own grief and ignore your partner's experience. This is dangerous to the health of your relationship and should be avoided at all costs. To help your relationship survive the grieving process, be sure to:

Be respectful and sensitive to your partner's needs, as they should be to yours.

Keep the communication lines open and share your thoughts and emotions with one another.

Accept the differences in coping styles and acknowledge the other's coping process as valid (American Pregnancy Association, n.d.).

Coping with a miscarriage is a heart-wrenching and difficult process, but know that you are not alone and there are tons of people out there who have suffered the same loss, and tons of support available.

Grief Counseling and Therapy for Pet Loss

The loss of a furry, four-legged loved one can also send us deep into grief. In our current society, pets are often treated as members of the family, and the loss of them can be almost as crippling as the loss of a human family member.

Counseling is available for coping with the loss of a pet, although you may find that your grief over losing a beloved pet is more suited to online support and support groups than to sessions with a mental health professional.

If you are struggling with the loss of a pet, check out the Rainbow Bridge website. It offers those grieving the death of a pet forums, chat rooms, suggestions and advice, an opportunity to memorialize the pet, and information on helping others, especially children, cope with the loss. You can find these resources here.

The Association for Pet Loss and Bereavement also offers many resources to help you deal with the loss of your pet, including access to professionals, information on training to become a pet bereavement counselor, chat rooms and forums, and memorials to lost pets. You can see these resources and more at their website.

Finally, the Best Friends organization has a page on pet loss and grief resources here that includes hotlines you can call to work through your grief, websites and webpages that can help, and recommended reading. Check out their page here.

However you choose to cope, remember that there is no shame in grieving the loss of a pet-they really can become members of the family, and it's never easy to lose a family member! If you feel you are struggling more than normal, don't be afraid to seek the help of a qualified mental health professional to guide you through the grieving process.

Group Grief Counseling and Retreats

If you or a client are dealing with prolonged grief, you might consider something a bit more intensive and social than individual counseling.

Group counseling and retreats may be just what you need to deal with your grief.

Group counseling, or group therapy, for grief can facilitate rapid recovery and help you find comfort in sharing with others, all under the guidance of a licensed mental health professional (Mastrangelo & Wood, 2016).

Usually, these groups are closed and limited to a certain number of group members, who stay in the group all the way to the end. They can take many different forms and focus on different specific losses; for instance, the Grief, Loss, & Transition Center offers the following group therapy options:

"Art in Grief" Therapy

Parent Loss

Suicide Loss

Spouse / Partner Loss

Trauma Information Group

Family Therapy

Grief support groups are groups that offer members support and understanding as they cope with their loss. They can be found in most large cities and towns around the world, and there are many different kinds of support groups with different areas of focus. For example, some support groups qualify as group counseling and are led by a mental health professional, while others may be more informal and led by a peer.

These are some of the other areas in which support groups can vary:

Attitude and culture

Structure

Attendance (good vs. spotty)

Consistent group vs. changing group

Focused on specific loss vs. general loss

Focused on advocacy and action vs. grief experience (Williams & Haley, 2017)

To reap any of the benefits of group counseling or support groups, you must be sure to find one that is a good fit for you. If you do, you might experience any or all of the following benefits:

Instillation of hope by seeing those farther along in the grieving process who are functioning and coping well.

The universality of grief in a support group reminds you that you are not alone; there are many others who experience grief as well.

Information and insight sharing can help you get helpful suggestions, good advice, and general understanding.

The opportunity to practice and receive altruism, which is healing in and of itself.

The group cohesiveness can help you feel that you belong, that you are accepted, and that your experience is valid (Williams & Haley, 2017).

However, grief support groups are not for everyone, and there are some pitfalls and disadvantages as well, including:

It can be overwhelming, especially when you are feeling vulnerable.

It can be discouraging to see others in the midst of their grief and leave you feeling hopeless.

They will likely not provide you with a therapy experience, especially if a peer is leading the group.

You might get bad information or bad advice from others in the group.

You may experience judgment from others, along with negativity and insensitivity.

There may be difficult people in the group who derail healing.

The culture of the group may be unhealthy or you may feel pressure to adopt beliefs you don't necessarily agree with (Williams & Haley, 2017).

If group therapy and support groups aren't intensive enough for you, you may want to try a grief retreat. These retreats offer you the opportunity to work through your grief over a long period of time, from a couple of days to a week or two. Some have schedules all attendees are expected to follow, while others are more self-directed, but they all give attendees a chance to connect with others who are grieving and talk with an expert in loss and grief.

If you are interested in a grief retreat, these are some of the resources you can use to find one that will suit you:

Retreat Finder website

STAR Foundation Upcoming Retreats

Camp Carousel Weeklong Retreat for Children, Teens, and Adults

Spark of Life Grief Recovery Retreats

Grief Counseling Resources: Books, Activities, and Worksheets (+ PDF)

If you're interested in learning more about grief counseling and techniques and resources you can use to guide your clients through the grieving process, this section is for you!

Some of the most popular books on grief counseling include:

Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner by J. William Worden (Amazon)

Techniques of Grief Therapy: Creative Practices for Counseling the Bereaved by Robert A. Neimeyer (Amazon)

The Grief Recovery Handbook: The Action Program for Moving Beyond Death, Divorce, and Other Losses including Health, Career, and Faith by John W. James and Russell Friedman (Amazon)

It's OK That You're Not OK: Meeting Grief and Loss in a Culture That Doesn't Understand by Megan Devine (Amazon)

Processing Through Grief: Guided Exercises to Understand Your Emotions and Recover from Loss by Stephanie Jose (Amazon)

There are also several activities, exercises, worksheets, and other resources you can put to good use with your clients, like:

Healing Activities for Grieving Children & Teens from Ryan's Heart - This PDF offers 13 exercises and activities for young children (3 to 12) and five for teens (13 to 19).

The Goodbye Letter - This worksheet is intended for children. Completing it will help them say their goodbyes to the deceased in a constructive manner.

Grief Sentence Completion - The Grief Sentence Completion worksheet allows children and teens to reflect on-and hopefully share-their feelings related to loss.

The Grieving Process Handout - This handout walks the reader through the normal grieving process and touches on the more unhealthy grieving process as well.

The Stages of Grief - This model is not the only model out there, but it is a popular one and refers to many stages or emotions that the bereaved experience. This handout outlines these stages.

My Stages of Grief - Although Kübler-Ross' five-stage model of grief is no longer considered the definitive model of grief, some clients may find it helpful to complete this worksheet on how they have progressed through the grieving process.

Remembering for Good Grief Workbook - This PDF is a 35-page workbook packed with information, suggestions, and exercises to help your client address his or her grief and heal.

Interventions for Prolonged Grief - This resource offers solution-focused techniques and strategies for helping your client deal with their loss and learn how to continue functioning.

A Take Home Message

This piece was a bit darker than the usual entries on this blog, but it's an important topic. We can get quite squeamish when the subject of death arises, but it is a natural part of life that we must all face at some point.

Likewise, grieving is a natural and virtually unavoidable part of life. You may never "get over" your grief, but you can learn to manage and cope with your grief and go on with your life.

Please let us know your thoughts in the comments section below. Have you used grief counseling before? How did it go? Have you counseled anyone through grief therapy? Are there are important tips or exercises we missed?

Thanks for reading!

We hope you found this article useful. Don't forget to download our 3 Positive Psychology Exercises for free.

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3 Grief Counseling Therapy Techniques & Interventions

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Unfortunately, grief is an inevitable, inescapable part of life. We will all lose someone we love at some point in our life-most of us at many points-and the loss can often hit us harder than we expect.

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"Bearing the Unbearable: Love, Loss, and the Heartbreaking Path of Grief" by Joanne Cacciatore, PhD

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"Bearing the Unbearable: Love, Loss, and the Heartbreaking Path of Grief" by Joanne Cacciatore, PhD

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I've been interested in Grief and Loss for a bit now, so I actually read the book "Bearing the Unbearable: Love, Loss, and the Heartbreaking Path of Grief" by Joanne Cacciatore, PhD over the summer. This book is composed of short chapters surrounding grief, mainly utilizing personal stories to convey her experience with grief. Being a trauma and bereavement professor, she has years of experience working with clients who have experienced grief and even speaks to her own experience with the loss of her daughter. This book allowed me to better understand ways in which grief impacts people, and how personalized the experience can be. She gives insight into different ways in which grief can be processed or explained to those trying to move through it. She tells a story about someone she worked with who ended up personifying their grief to better 'get to know' and understand the grief. My favorite chapter (which I'll include) speaks to a great way to explain coping with grief.

Jessica Mehring

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Hi everyone, For my resource, I chose to go with the What's Your Grief podcast. I found this site just through a Google search a while ago when looking for extra resources when working with my clients. This podcast really spoke to me because it offers so many episodes on different types of grief. Recently, I listened to one on pet loss and also how people within families grieve differently. I think my favorite thing about listening to these podcasts is that they feel very straightforward but caring and relatable. As their tagline says, this podcast offers no tilted heads, no soothing tones, just real-world grief talk, which as a resource is so valuable because it allows us to embrace the authenticity of what grief looks like for us and know we are not alone in the process. As well as the podcast, there is the website https://whatsyourgrief.com/, which offers resources for those grieving, those supporting, and grieving professionals.

Megan Sears

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In this podcast Eleanor Haley, MS and Litsa Williams, MA, LCSW-C, the mental health professionals behind the website and book ‘What’s Your Grief’, leave no stone unturned in demystifying the complicated and messy world of living life after loss. One digestible topic at a time, Haley and Williams distill topics ranging from grief theory to coping. Grievers and grief professionals alike will find their approach practical, relatable, informative and engaging. Grief is sad and confusing, but your grief support doesn’t have to be.

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The documentary "Pioneers of Hospice" was one which I was introduced to this summer while enrolled in an End-of-Life Doula certificate program through the University of Vermont. I feel it is a natural complement to comparable expositions such as Being Mortal. While much of this involves an exploration of the history of hospice care, it also provides valuable perspective on our changing conception of / approach to death, anticipatory grief, and the reality of unavoidable loss as mortal beings. When I viewed it, I felt a meaningful shift in my perspectives on this subject, and particularly in my sense of how I will approach clients facing the loss of their own life.

Chris Linn

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Breaking the Silence of Pregnancy Loss by Tanika Dillard

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Breaking the Silence of Pregnancy Loss by Tanika Dillard

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Beaking the Silence of Pregnancy Loss

I have worked with several women who were grieving numerous miscarriages.

One of them shared the below Ted Talk video with me helpful to her.
I appreciate Tanika's vulnerability, realism and positivty in this video.

I think speaking your loss is vital part of healing.  That's my biggest takeaway from this video and helping people through pregnancy loss.  To whom can you speak of this loss?  How can you name it?

Scott Slayback

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Breaking the Silence of Pregnancy Loss | Tanika Dillard | TEDxGreenville

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The book that I chose for this assignment is called “Prayer in the Night” by Tish Warren. This is a book that I would only recommend to clients who have disclosed their Christian faith which since I am providing services in Colorado Springs is more common than not. The book deals unflinchingly with the concept of loss, death, hopelessness, and fears that we are totally alone in the face of such existential experiences. The authenticity and vulnerability with which Tish Warren writes about this provides a palpable catharsis for those who are brushing up against similar themes in their own lives which is incredibly valuable to someone undergoing such incredibly difficult times. It also provides a framework of sorts for lament through faith as well as outlining that this need and this experience is not a modern invention but rather something that has lay at the heart of an ailing humanity for thousands of years. This book was invaluable to me during a horrific season of loss over the past two years, even though I did not consider myself a person of faith. There is so much gentlness and rawness in the words found on these pages. I highly recommend it.

Caleb Foust

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Prayer in the Night — Tish Harrison Warren

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The Science of Loss and Recovery with Mary-Frances O’Connor

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The Science of Loss and Recovery with Mary-Frances O’Connor

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I listened to this podcast when it came out in 2022 as it addressed some specific ways processing grief had shifted during the pandemic.  I lost my mom to COVID and while I was in the room when she passed on, many close family members were able to be on zoom.  That is a small part of this podcast.

The majority of the podcast discusses an approach to grief and grieving using neuroscience.  A couple of key take aways:

Grief is the feeling of loss that can be overwhelming

Grieving is the way that grief changes over time in frequency and intensity, but never fully goes away. It is a kind of learning that enables us to go through out the world so that we can feel the grief but also get what we want out of life.

There is never "getting over it" when it comes to grief, it changes you in a permanent way.  They use the analogy of "getting over your wedding day", that is an event that changes you forever eventho you don't necessarily celebrate it the same way over time.

She found through her research that progressive muscle relaxation specifically enabled people to process their grief effectively

The stages of grief as defined by  Elizabeth Kübler-Ross, aren't linear stages per se, but rather are phases that come and go in the form of waves that vary by frequency and amplitude.

Enjoy: https://www.happierapp.com/podcast/tph/mary-frances-oconnor-450

She has also written a book, that I have not read but colleagues at my practice have and highly recommend it: The Grieving Brain: The Surprising Science of How We Learn from Love and Loss

Mike Trimborn

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#450. The Science of Loss and Recovery | Mary-Frances O’Connor | Ten Percent Happier Podcast

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Very few of us will live a life without loss.

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Counseling Clients Near The End Of Life by James L. Werth, Jr.

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Counseling Clients Near The End Of Life by James L. Werth, Jr.

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As someone who is very interested in palliative care work with individuals who are dying as well as the loved ones and family systems around them, I found this book in our Theories textbook as one of the suggested readings for people who would like to work with people who are dying. My suggestion is the book, Counseling Clients Near The End Of Life by James L. Werth, Jr. I read this book as a way to further explore my interest in working with this population, and found it to be an extremely practical guide for working with folks who are dying as well as their grieving loved ones. This text provides case studies, explores ethical legal dilemmas of working with those near death, and advice on working with grieved families before and after their loved ones have passed. This book also dives into the auxiliary symptoms of folks anticipating their own death or the death of their loved ones and how to anticipate and work with those concurrent issues as they arise. Highly recommend for anyone who is hoping to work in palliative care in any capacity!

Taylor Arrogante-Reyes

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I found this book to be a well-written, sensitively presented, and important resource for those engaged in this critical area of work. Thank you, Dr. Werth, for making such a substantial contribution to this field.”--Journal of Palliative Care [This book

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Going with Grace: Simple, Knowledgeable, and Compassionate End of Life Planning, Training, and Support

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Going with Grace: Simple, Knowledgeable, and Compassionate End of Life Planning, Training, and Support

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From Going with Grace's website: “Our Mission: To relieve the burden created without proper end of life support, Going with Grace exists to support people as they answer the question “What must I do to be at peace with myself so that I may live presently and die gracefully?” and to support family members in completing the affairs of their loved one’s life after a death.”

Going with Grace is an educational and networking resource for end-of-life planning and death doula training. The website offers workbooks to help simplify the complex tasks required for people who are approaching the end of their life, or for people who are taking care of a loved one’s affairs. It also has a Death Doula Directory where you can look up local doulas for yourself or for clients who are wanting death-related support.

My partner went through the death doula training offered by Going with Grace a couple years ago and had a very positive experience. Going with Grace’s team consists of attorneys, caretakers, financial planners, and certified death doulas who all have extensive knowledge about end-of-life planning and support. Their death doula training is a really cool resource for anyone wanting to learn more about the practical aspects of supporting someone through grief and loss after a death!

Felix Barry

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ALUA ARTHUR, FOUNDER

Alua Arthur is a death doula, recovering attorney, and the founder of Going with Grace, a death doula training and end-of-life planning organization that exists to support people as they answer the question, "What must I do to be at peace with myself so that I may live presently and die gracefully?"

Going with Grace works to improve and redefine the end-of-life experience for people rooted in every community using the individual lived experience as the foundation. Learn More...

This end of life training course develops certified death doulas and end of life planners. In this unique 12 module online program, students will learn the major pillars of death care-emotional, practical, legal and spiritual.

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Our End of Life Planning services support you and your loved ones as you answer the question "What must I do to be at peace with myself so that I may die gracefully?" Our comprehensive consultations and Advance Planning Tool makes it simple to document your desires.

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Call us at (323) 641-3687 to book your end of life planning or death doula consultation.

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Alua Arthur is a death doula, recovering attorney, and the founder of Going with Grace, a death doula training and end-of-life planning organization that exists to support people as they answer the question, "What must I do to be at peace with myself so that I may live presently and die gracefully?"

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The Science & Process of Healing from Grief | Huberman Lab Podcast #74

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The Science & Process of Healing from Grief | Huberman Lab Podcast #74

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I've chosen to share Andrew Huberman's Podcast episode on Grief.

There is a great balance in Mr. Huberman's discussions between the biological functions of ourselves and the corresponding emotional and "human" elements of living.  In this episode the host explores some of the biological and neurological elements of grief and correlates the function of neuroplasticity in the grief process.  Two plus hours on the subject and, in my opinion, some very relevant ideas within the context of exploring and learning more about grief dynamics, bearing in mind we are all unique and will respond to loss in different ways.

Lance Jacobs

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Andrew Huberman:

Welcome to the Huberman Lab podcast, where we discuss science and science-based tools for everyday life.

Andrew Huberman:

I'm Andrew Huberman and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today, we are discussing grief. Grief is a natural emotion that most everybody experiences at some point in their life. However, grief is something that still mystifies most people. For instance, we often wonder why getting over the loss of somebody or a pet is so absolutely crushing. In some cases, it's obvious, because we had a very close relationship to that person or animal, but in other cases, it's bewildering, because somehow despite our best efforts, we are unable to reframe and shift our mind to the idea that the person or animal that at one point was here and so very present is now gone.

Andrew Huberman:

Today, we are going to discuss how we conceptualize grief, both at an emotional and at a logical level. I'm going to teach you about the neuroscience and the psychology of grief, and incredible findings that have been made in just a few key laboratories that point to the fact that we essentially map our experience of people in three dimensions.

Andrew Huberman:

I'll just give you a little hint of what those dimensions are. They relate to space, where people are; time, when people are - I'll explain what that means; and a dimension called closeness. And how those three dimensions of space, time, and closeness are what establish very close bonds with people, and are what require remapping, reorganization within our emotional framework and our logical framework, when we lose somebody for whatever reason.

Andrew Huberman:

Within that understanding, I'm confident that you will have greater insight into the grief process. And should you ever find yourself within the grief process, as I imagine most everyone will at some point, you'll be able to navigate that process in what psychologists and neuroscientists deem to be the most healthy way of going through grief. Indeed, moving through grief requires a specific form of neuroplasticity, a reordering of brain connections, and also the connections between the brain and body.

Andrew Huberman:

I'm going to teach you about all of that today, so you're going to learn a lot of scientific information. You will also learn a lot of tools that you can put in your kit of emotional, and, really, emotional-physical tools that will allow you to move through grief in this healthy way that I referred to earlier. I'll also point out some of the myths about grief. For instance, many of you have probably heard that there are designated stages of grief that everybody moves through. Turns out that recent research refutes that idea. There are different stages of grief, but not everybody experiences all of them, and hardly ever does somebody move through all of those linearly, meaning in the same order.

Andrew Huberman:

I also want to point out that for many of you that are not experiencing grief in this moment, there's an important scientific literature that teaches us that how we show up to grief, meaning our psychological and our biological state that we happen to be in when a loss occurs, strongly dictates whether or not we end up in what's called complicated or noncomplicated grief. And noncomplicated grief is a form of grief that is very prolonged and, in fact, often requires that people get substantial professional help.

Andrew Huberman:

So whether or not you're experiencing grief that's mild, moderate, or very intense right now, or whether or not you are not experiencing any grief at all, you're going to learn scientific information and tools that will help you navigate through this process that we call grief.

Andrew Huberman:

Before we begin, I'd like to emphasize that this podcast is separate from my teaching and research roles at Stanford. It is, however, part of my desire and effort to bring zero-cost-to-consumer information about science and science-related tools to the general public. In keeping with that theme, I'd like to thank the sponsors of today's podcast.

Andrew Huberman:

Okay, let's talk about grief. I just want to remind you that everybody at some point in their life experiences grief, either mild grief, moderate grief, or extreme grief. And it's somewhat obvious, but worth stating nonetheless, that how intense grief feels and how long it lasts scales with how close we were with somebody. And if you learn that the person who works at the coffee shop or that you see at the coffee shop on a regular basis happened to pass away or tragically get killed in a car accident, that can be quite upsetting. It can be somewhat disorienting to you, if you, for instance, just saw them yesterday or they seemed perfectly fine when you saw them last.

Andrew Huberman:

But of course, the grief that results from the loss of somebody to whom you have that level of attachment is far and away different than the level of grief that you would experience from the death of a very close loved one, a sibling, a parent; God forbid, a child. When that type of loss occurs, it's often the case that our entire relationship to life feels different. Places and things that at once brought us joy and laughter, now bring the opposite. They bring us intense feelings of sadness and loss.

Andrew Huberman:

Psychologists and neuroscientists distinguish between complicated grief and noncomplicated grief. They are very similar at the outset. One of the fundamental differences between them, however, is that complicated grief, which occurs in about one in 10 people, is a situation in which grief does not seem to resolve itself even after a prolonged period of time. Later in the episode, I'll point you to the actual tests that are used. I've provided links to those in the show note captions that will allow you to distinguish between complicated and noncomplicated grief. These arrive through the important research of the world-class grief researchers that are out there, and the psychologists that treat grief.

Andrew Huberman:

The important thing to point out is that grief is a process. Like any biological or psychological event, it has a beginning, a middle, and an end. And I do believe that being able to orient, in terms of where you are in that process, can be immensely beneficial. Not just for predicting how long it's going to last, but in order to conceptualize the person or animal that you lost in a way that allows you to best preserve their memory while maintaining your own functional capacity in life.

Andrew Huberman:

Along those lines, I want to point out that grief and depression, while they can feel quite similar in certain ways and have overlapping symptomology, loss of appetite, challenges sleeping, crying in the middle of the day for no apparent reason, et cetera they are distinctly different processes. The modern research teaches us, for instance, that grief rarely responds well to antidepressants, whereas depression can often respond well to antidepressants.

Andrew Huberman:

Everything we know and understand about grief is that it is a distinct psychological and physiological event in the brain and body from depression. Rather, perhaps the best way to think about grief is that it is actually a motivational state. It is a yearning, it is a desire for something. And somewhat surprisingly, it's not just a desire to have that person back or to have that animal back. You might think, "Well, that's crazy, of course it is."

Andrew Huberman:

But, of course, there are instances in which someone passing away or an animal passing away is actually providing relief for that person, because of where they happen to be in their life. Today, I'll teach you about grief as a motivational process, because grief as a motivational process really is the way that scientists and psychologists now conceptualize grief and the treatments for grief, so that people can move through them effectively.

Andrew Huberman:

As we wade into this important topic, I'd like to emphasize some of the common myths and misunderstandings about grief. Some of the myths and misunderstanding arrive from the beautiful work of Elisabeth Kübler-Ross, a psychologist who wrote the famous book "On Death and Dying." And I should emphasize that while Kübler-Ross was a real pioneer in establishing that there are indeed different stages of grief, the modern science, both psychology and neuroscience, point to the fact that not everybody experiences all of the stages that Kübler-Ross defined, nor do they move through those stages in a linear manner. Sometimes they're out of sequence.

Andrew Huberman:

I'll just highlight the five stages that Kübler-Ross illustrated, because some people really do experience all of them. Sometimes in the order I'll read them, but, again, oftentimes they don't. The different stages of grief, very quickly, are denial, anger, bargaining, depression, and acceptance. In the Kübler-Ross model, denial is always the first stage, and denial is just as it sounds, this disbelief. It cannot be. There's no way; a refusal to accept the new reality that the person or animal is gone.

Andrew Huberman:

The second stage, anger, is one in which the individual recognizes that the person is indeed gone or the animal is gone, but their body and their mind go into a motivated state. This is important; we're going to return to this idea of grief as a motivated state that involves action plans in more depth as we go further.

Andrew Huberman:

And then, the third stage is bargaining, what's sometimes called the negotiating phase. This idea that, "Well, if I had just done this," or, "If they had just done that," or, "If I'd called more." Or somehow refusing to accept the reality, so in a way, this can be blended with denial in thinking, "Well, if I just don't think about, it won't be real," this kind of thing. So, again, stages can be blended or braided together, because emotions are complex, right? Even though there are different stages to this process, they can sometimes be melded together.

Andrew Huberman:

The fourth stage of depression that Kübler-Ross described is one of "Why go on living? Why should I go on living? Why should I continue in this grief-stricken state that seems to deprive me of all the richness of life that I experienced when the person or animal was still here?" And then the fifth stage is acceptance. This internalization, not just cognitively, not just thinking, but emotionally that it's going to be okay, that not just "this too shall pass," but that it has passed.

Andrew Huberman:

So again, the five stages of grief that Kübler-Ross defined were immensely important as a critical parsing of the different stages that one could move through. But, unfortunately, those five stages were sort of taken to be gospel for a long time, and we now know, based on neuroimaging, based on more in-depth psychological evaluation, and, frankly, more researchers and clinicians moving into this area and observing that while much of what Kübler-Ross described does hold true, it's not always the case.

Andrew Huberman:

And in fact, the contour of the grief process actually has a lot of dimensions that are not encapsulated by those five stages. There's also a lot of variation depending on whether or not the loss is due to old age, disease, whether or not there was suffering prior or not, suicide or nonsuicide-type deaths and losses, and even grief about nondeath losses, a relationship breakup or something of that sort, or even homesickness and things of that sort.

Andrew Huberman:

So I do want to tip our hats to the incredible work of Elisabeth Kübler-Ross. By no means am I or do other researchers try and discount her incredible contributions, but I think nowadays we have a different and, frankly, a better understanding of what the grief process is like, and as a consequence, better tools to move through grief.

Andrew Huberman:

In order to really understand what grief is in your brain and body, and how to best navigate grief, I'd like you to do an experiment with me. For the next five minutes or so, I'd like you to at least try to discard of all prior notions of grief as just a state of sadness. I want to acknowledge that it is and does involve sadness, but for right now, let's think about grief as a motivational state, as a desire for something specific. In fact, I'd like you to think about grief as an attempt to reach out and get something that you very much want.

Andrew Huberman:

Imagine yourself extremely thirsty, for instance, on a very hot day, and a glass of water is right in front of you, and it's a beautiful, clean glass of water, and it's completely full, and you so badly want to drink that water. But no matter how intensely you want it, and no matter how hard you try and reach it, it always shifts just outside your reach. So if you can imagine that, even just a little bit, you are touching into the experience of grief.

Andrew Huberman:

How do I know this? Well, I know this because brain-imaging studies involving what's called functional magnetic resonance imaging, fMRI - in which you can evaluate which brain areas are more active than others according to blood flow, which correlates with neural activity and so forth - teach us that the brain areas that are associated with motivation and craving and pursuit are some of the primary brain areas and circuits that are activated in states of grief. I'd like to share an important paper with you, and it is one of the first to illustrate the fact that grief is not just a state of sadness and pain. It is indeed a state of yearning and desire of something that is just outside your reach, and unfortunately, will always be just outside your reach until you remap your relationship to that person or thing.

Andrew Huberman:

The title of this paper is posed first as a question, so that's why I'll read it as such. The title is "Craving love? Enduring grief activates brain's reward center," and the first author of this paper is Mary-Frances O'Connor. She's a professor of psychology at the University of Arizona, and one of the world leaders in the study of grief from a neuroscience perspective. With some luck, we'll get her here on the podcast as a guest.

Andrew Huberman:

Now, this paper has several important features. I'll just highlight a few. One of the features of this paper that's not surprising is they found that people who are in a state of grief are in a state of pain. That is, brain areas associated with pain, actual physical pain, are more active than in nongrieving individuals. However, they also found that people who are experiencing what's called complicated grief showed reward-related activity in a brain area called the nucleus accumbens. What is reward-related activity? Reward-related activity is activity of neurons that's associated with motivational states. And the nucleus accumbens is a brain center in which dopamine has the effect of creating a motivated state.

Andrew Huberman:

If ever you thought that dopamine was only associated with feeling good - you hear about dopamine hits - well, this paper and papers like it firmly tell us that dopamine is not about feeling good. Dopamine is about placing us into a state of desiring things and seeking things. This is true in addiction. This is true when we're hungry and we want to eat. This is true when we want to reproduce. This is true in every state in which we are reaching for something outside our immediate ability to give that thing to ourselves. This is very important to understand if you want to understand grief and how to move through grief.

Andrew Huberman:

Grief is not just about sadness. It is a state of sadness. Hence, the activation of brain areas associated with pain. And it is a state of desire and reaching for something. And for those of you that have experienced grief, I think that will resonate with you. In that understanding that grief is both a state of pain but also a state of wanting, and in the understanding that when we lose somebody, either because of breakup or because of death, or if an animal dies or gets taken away or is missing, that state of wanting and desire drives an activation state within us.

Andrew Huberman:

Now, the key thing to understand is that the activation of those reward centers and the involvement of dopamine puts us into an anticipatory state, a state of waiting for something to happen. It also puts us into a state of action or desiring action. Our body and our mind are what I like to refer to as center of mass forward. We are seeking how to resolve the craving, even if we know that is impossible.

Andrew Huberman:

Why do I say that? Well, we understand, also on the basis of brain-imaging studies and also some studies in animals that I'll describe in a moment, that in order to understand grief, we have to understand how attachments are represented in our brain. And it turns out that both attachments and the breaking of attachments in healthy ways are governed by three important, what we call, dimensions.

Andrew Huberman:

A dimension is just some feature of the world that's represented in our brain. So for instance, the color red doesn't exist in your brain. You happen to have cells, neurons in your eye that respond best to long wavelengths of light, and those long wavelengths of light happen to be what are reflected off things that are perceived as red. So in your mind, you have a notion of red. I know this is a little bit abstract, but you're not actually lighting up red neurons in your brain, and that's why you see red. You are lighting up neurons in your brain that represent the presence of red things in your environment.

Andrew Huberman:

Similarly, we have neurons and maps, or, we say, representations of other dimensions. We have dimensions of touch. We have dimensions of sound. And as I'll now teach you, we have three dimensions that define our relationship to people and animals and things. And when those people, animals, and things are within our immediate vicinity, or if we know how we could access them, if somebody's still alive, there's generally some way to access them, unless they're refusing to interact with us. Well, when we understand that, our motivational states can operate in a way that's logical. We know that, for instance, if we want to find our mother, brother, sister, significant other, dog, cat, parrot, et cetera we have to go through a certain set of steps.

Andrew Huberman:

What are those three dimensions? And how do they work? And that's what I'm going to teach you now. So at risk of sounding a little bit too reductionist, we are now going to describe your relationship to anything, everything, and anyone in these three dimensions. How can we do that? Why would we even want to do that? Why would we want to rob the complexity of relationships of their contour and their detail? Well, if we can understand the dimensions in which we map our relationship to people, animals, and things, then we can understand why it is that when those people, animals, or things are not accessible to us, why it hurts so much. And why it takes a certain amount of time in order to understand, if you will, or remap our association to them.

Andrew Huberman:

I promise that in grasping the information I'm about to give you, you will be able to better orient in the grief process, and you'll be able to move through it more effectively. The three dimensions of relating to someone or an animal or a thing are space, time, and closeness. And in order to illustrate each one and how they work together to support relationships and their involvement in the grieving process, I'm going to tell you about an experiment. This experiment was actually done.

Andrew Huberman:

The experiment involves putting people into a brain scanner that allows the researcher to evaluate brain activity in different areas, in fact, can look in a very nonbiased way, not make any predictions about which brain areas are going to be involved. And the experiment is the following: The person, I should say, the research subject, first sees images of things that reside at different distances from one another.

Andrew Huberman:

And when I say things, these are objects. So in one case, it's a beach or a parking lot with bowling balls set at different distances from one another. Their brain is imaged, and as their brain is imaged, they see different pictures of different scenes: the beach, the parking lot, et cetera bowling balls spaced in different ways, close together, far apart, regularly spaced, nonregularly spaced. When one does this sort of experiment, you see a lot of brain areas activated, not surprisingly, the visual cortex, the area of the brain that is responsible for creating visual perceptions, but also a brain area that seems uniquely tuned to the distance between you and the objects.

Andrew Huberman:

So whether or not the bowling balls are far away or close together from one another, and whether or not they're far away or close to you physically. So, literally, the distance between you and these objects. We'll refer to that measure, that dimension, as we call it, as proximity. Okay? Whether or not it's very close to you, high degree of proximity, or far away, low proximity, but it's simply physical space.

Andrew Huberman:

Then subjects listen to tones. Those tones also are spaced from one another. So it could be something as simple as my hand meeting the table top that I happen to be sitting in front of. So it's ... they image the brain. Of course, areas of the brain that are associated with auditory perception are active, not surprisingly. But as they evaluate different types of sounds and patterns of sounds, for instance, they can start to parse brain areas that seem uniquely tuned to the spacing of sounds, independent of what sounds are coming in. So whether or not it's musical notes or my hand hitting the table or human speech, they identify a brain region that is uniquely tuned.

Andrew Huberman:

That is, it becomes active specifically in response to changes in the spacing between sounds, much in the same way as they could identify brain regions that were only activated when there were changes in the distance between objects, such as the bowling balls that I used in the previous example. And then the subjects saw a different set of images. The images that they saw were of people and of faces, and some of the images that they saw were of people's faces right up close, and other images were of people at a distance, where you could see the whole body of the person.

Andrew Huberman:

Now, they also varied the emotional relationship to those people. That is they were able to get photographs from these research subjects' lives, so they could show them pictures of, for instance, their sister or some random person off the street. They could show them pictures of a parent or of a neighbor or of a celebrity that's well-known or of somebody that they didn't know at all. So they were able to vary both the position of the person, close or far, and they were able to vary the emotional distance to the person. Which is this dimension that I'm referring to as closeness, which is not physical closeness, but how attached or how well you know somebody.

Andrew Huberman:

Now, this is maybe sounding like a somewhat complicated experiment, but the takeaway from this experiment is exquisitely simple and exquisitely important. The result was that in all three conditions, changes in the physical spacing of these objects, changes in the temporal, that is the time spacing of these sounds, and changes in the emotional distance between the subject and different people, the same brain area was uniquely activated.

Andrew Huberman:

Now, that is an incredible thing to find, because what it suggests is that, yes, of course, there are brain areas that are associated with representation of visual objects. And that, yes, of course, there are brain areas associated with representation of different sounds. And, of course, there are brain areas associated with faces. We now know this. In fact, there's something called the fusiform face area, which is uniquely tuned to faces.

Andrew Huberman:

But at the same time, there is a unique brain region that is activated in all three of the conditions I described, that has to do with how far you are from somebody both in space, in time, and in terms of emotional closeness. And that brain area, it turns out, is a brain area called the inferior parietal lobule, the inferior parietal lobule.

Andrew Huberman:

Now, you don't need to know where the inferior parietal lobule is. In fact, you don't even need to know the name of this brain area. What you do need to know, however, if you want to understand grief and how to move through grief, is that your map of people is not a map of emotional closeness per se. It is a map of emotional closeness, what we call attachment, that is interwoven, that is braided in in a very intimate way with your map of where they are in physical space and where they are in time, when you saw them last, when you're likely to see them again. And if you were to want to see them, how much time it would take to reach them or for them to reach you.

Andrew Huberman:

Now, earlier I said that one of the key functions of our nervous system is to be able to make predictions. And so it's somewhat obvious, but nonetheless important to state and restate that one of the most powerful aspects of our attachments to people, animals, and things is our ability to predict what it would take to see them again. And when we are going to see them again.

Andrew Huberman:

In fact, we could say that our ability to locate someone or an animal or a thing in space and time, where they are and how long it would take for us to reach them or them to reach us, is a prediction of the requirements to engage in the attachment. In order to illustrate this at a little bit more depth, let's just do a fill-in-the-blank experiment. You can do this now in real time. I want you to think of somebody that you either rely on or that you care about very, very much. And I'll just allow you to fill in the blank on this sentence. If I want to see blank, the person or animal, I could see them within blank amount of time. If right now you wanted to see this person or animal or maybe even a thing, how long would it take you to reach them?

Andrew Huberman:

Could be a day, could be a second, could be there right next to you, all you'd have to do is turn your head. Now, answer this, if this person were to travel halfway around the world and land in their plane, I would expect to hear from them within blank minutes of them landing. Okay. The answers to this, of course, will differ. Now, I'd like you to answer this question: "If I'd like to find myself, it would take me X amount of time." And, of course, if you're listening to this and you're understanding it and you're of a rational mind, the answer to that should be zero seconds, instantaneous. You are always able to locate yourself in space and time, provided you are in the appropriate state of mind, meaning not asleep, for instance.

Andrew Huberman:

That last question might seem somewhat silly, but it's a fundamentally important one, because it illustrates the extremes at which we map our relationship to ourselves relative to other people and things. Now, if all of this sounds like a bunch of neuro psychobabble parsing of the obvious, I'd encourage you to suspend that belief for the moment. Because if you understand that all relationships are mapped in the brain and body through these three dimensions, space, time, and closeness, or proximity of space, proximity in time, and proximity of attachment, how close or rich or bonded you are to someone, well, if you can understand that, then it almost becomes obvious, or at least it becomes intuitive as to why after the loss of somebody, in particular a death or the loss of an animal, this map has to be reordered. Why? Because if we are attached to someone or an animal at a deep level, it is almost always on the basis of a lot of what we call episodic experience. A lot of episodic memories, memories of things that happened. Episodic memories are literally the conscious recollection of your experience of somebody or an animal or a thing. And within that memory, you have an understanding of what has happened with them in association to you, what's going on with them, where it happened, when it happened.

Andrew Huberman:

You have a rich knowledge database that we call implicit knowledge - you might not be aware of it all the time, but it's within you - of what this person is like and what they're doing in their life. When somebody is taken away from us, for whatever reason, episodic memories persist for some period of time, and they are still linked to our feelings of attachment. Grief is the process of uncoupling, unbraiding, and untangling that relationship between where people are in space, in time, and our attachment to them.

Andrew Huberman:

What I mean by this is when somebody or an animal or a thing is taken from us, either by decision or by death or by circumstance, well, in that case, our entire memory bank and our ability to predict where and when they will be, and therefore when we can feed our attachment to them again, that whole map is obliterated, except that the attachment itself has not been disrupted. Assuming that you are deeply attached to someone or an animal or a thing, that attachment persists, and the grief process is one in which you have to reorder your understanding of them in space and in time. This is very, very hard to do, and for some people, it's almost impossible to do, at least at the outset of grief. This in a very-

Andrew Huberman:

At least at the outset of grief. This in a very neurosciencey way explains this stage that Kübler-Ross described, which many, again, not all, but many people experience, which is one of denial. "How could it be? Why?" Well, when we have a rich catalog of experiences with somebody or of them, ideas about them and what they do, how they spend their day, what they do and don't do, where they do it, et cetera well, that memory bank is not just flushed out the moment that we learn that they're no longer with us. What happens is the brain continues to make these predictions that they will be in a certain place, or a certain time, that they'll be in a certain time zone, or they'll walk in the door any moment.

Andrew Huberman:

All of those predictions still hold. The neural activity continues. We call this reverberatory activity. That explains the yearning for and the desire to interact and yet it's just beyond our reach, because once they're gone, our brain still functions in a way, these neural circuits still function in a way that put us into an action state of seeking them, looking for them in the same location, expecting them to contact us at whatever frequency that we were used to hearing from them or that we could reach out to them and reliably get a response. It is immensely disorienting, in other words, to maintain a close attachment, and at the same time to not be able to make predictions about where that person, animal or thing is in space and time.

Andrew Huberman:

Now, if this seems somewhat abstract, I'm going to continue to flesh it out. Actually, right now, I'd like to flesh it out with a real-world example of grief and loss that comes to us from perhaps one of the greatest minds in human history and somebody who was intensely grounded in reality and logic, and, indeed, the physics of the world. The person I'm referring to is none other than the Nobel Prize-winning physicist Richard Feynman. Many of you are probably familiar with Richard Feynman, some of you perhaps are not. Richard Feynman was a Nobel Prize-winning physicist known for his thick New York accent.

Andrew Huberman:

He was actually not from Brooklyn, as many people think. He was actually from Far Rockaway in Long Island. Thick New York accent, very personable, exceptional teacher, brilliant mind, hence the Nobel Prize in physics. Also, a quite funny and amusing person, told great anecdotes, et cetera. Feynman had a childhood sweetheart who turned out to be his first wife, her name was Arline. It was well-known that Feynman was absolutely in love with her. He would talk about her all the time. She had a profound influence on him and his thinking and ultimately on his public education efforts later.

Andrew Huberman:

If you haven't already read books such as "Surely You're Joking, Mr. Feynman," or "What Do You Care What Other People Think?" I encourage you to do so. In fact that quote, "What do you care what other people think?" is actually a quote not of Feynman, but of his first wife, Arline, who sadly died at a very young age from tuberculosis. Why am I sharing Feynman's story of loss of his first bride? Well, the reason is Feynman continued to write letters to Arline for a long period of time. This is well-known only because after Feynman died, it was discovered that he kept an archive of letters to his deceased first wife.

Andrew Huberman:

Even though he did eventually marry and, in fact, had many relationships with many people, and I think was married twice more, maybe it was once, maybe it was twice, the intensity of his grief, but also his lack of ability to transition his mind to a place where he understood that Arline had died is one of the more profound examples of this inability to reconcile the logical world and the emotional world. I'm now going to read to you a letter that Feynman wrote to Arline. This was discovered after Feynman's death when they went through his desk and his belongings.

Andrew Huberman:

As I read this, you're going to hear some of the typical narrative of grief that is not unique to Feynman and his dead wife. But there are also some elements in there that I think you'll recognize as highlighting this disbelief and this dissociation between the reality of somebody's location in space and time and the emotional attachment that they hold for us, and therein lies the information about how to better navigate grief. So now I'm reading from the letter. This was a letter dated October 17th, 1946. It's not terribly long, but bear with me.

Andrew Huberman:

"Dear Arline, I adore you, Sweetheart. I know how much you like to hear that, but I don't only write it because you like it. I write it because it makes me warm all over inside to write it to you. It is such a terribly long time since I last wrote to you, almost two years, but I know you'll excuse me because you understand how I am, stubborn and realistic, and I thought there was no sense to writing. But now I know, my darling wife, that it is the right thing to do what I have delayed in doing and that I have done so much in the past. I wanted to tell you I love you. I want to love you. I will always love you."

Andrew Huberman:

So here we can hear the intense emotional attachment that clearly has persisted.

Andrew Huberman:

"I find it hard to understand in my mind what it means to love you after you are dead, but I still want to comfort and take care of you, and I want you to love me and care for me. I want to have problems to discuss with you. I want to do little projects with you. I never thought until just now that we can do that. What should we do? We started to learn to make clothes together or learn Chinese or getting a movie projector. Can't I do something now? No, I am alone without you and you were the idea woman and the general instigator of all our wild adventures.

Andrew Huberman:

"When you were sick, you worried because you could not give me something that you wanted and you thought I needed. You needn't have worried. Just as I told you then, there was no real need because I loved you in so many ways so much, and now it is clearly even more true. You can give me nothing now, yet I love you so that you stand in the way of my loving anything else. But I wanted you to stand there. You dead are so much better than anyone else alive."

Andrew Huberman:

So you can really appreciate the depth and intensity of the attachment; despite two years' time, it clearly has not waned. I'll read the final paragraph now.

Andrew Huberman:

"I know you'll assure me that I am foolish and that you want me to have full happiness and don't want to be in my way. I bet you are surprised that I don't even have a girlfriend except you, Sweetheart, after two years. But you can't help it, Darling, nor can I. I don't understand it for I've met many girls and very nice ones and I don't want to remain alone, but in two or three meetings, they all seem ashes. You only are left to me. You are real. My darling wife, I do adore you. I love my wife. My wife is dead. Rich. P.S., please excuse my not mailing this, but I don't know your new address."

Andrew Huberman:

So there's a lot contained in this letter. We could parse it line by line, but I think it's fair to say that clearly there's an immense attachment that's been maintained. So that's that dimension of closeness of attachment. Clearly, there's an understanding that she's dead. In fact, the last line of this love letter is "My wife is dead," right? He now moves her into the third person, in fact, in that final line. So he understands this, and yet he maintains the attachment. The very last portion of the letter, the P.S., the postscript, "I don't know your new address," right? Somewhat humorous in the typical vein of a Feynman writing or speech. He always had an intensely amusing and playful sense of humor, and yet there's something really contained in this. I don't think we're reading into this too much in that he doesn't know where to find her. He feels her as very real, and yet he doesn't know where to find her. He doesn't know her address. He obviously knows she's dead, so there's nowhere to mail it to.

Andrew Huberman:

The reason I shared this letter with you as opposed to one of the almost infinite number of other letters that have been written by poets and authors and scientists and everyday people is that it really encapsulates all three dimensions of attachment and grief. These notions of space, where is something or somebody? Time, this dimension of how long would it take me to reach them or for them to reach me? What would it take in terms of time to be reunited? Then that last dimension of closeness. The letter beautifully illustrates the fact that in grief, we maintain that sense of closeness, and yet we have to uncouple it from these other two dimensions, as we're referring to space and time.

Andrew Huberman:

So with this current understanding in mind, a few things start to become obvious and entirely normal to us, in the best and most healthy sense of the word normal. For instance, if you've lost somebody or an animal or even a thing that was vitally important to you, it should make perfect sense to you as to why you keep looking for that person. I recall this in my own life. I `had the unfortunate circumstance of ... my graduate advisor, who I was very close with, died quite young of breast cancer. Her daughter, she actually has two daughters, kept her cellphone and would occasionally call me. I had a quite close relationship to their family.

Andrew Huberman:

When it would come in, the number would pop up on my phone of not the daughter, but the name that showed up was of my graduate advisor. So for years after she died, my initial impulse when the phone would ring was, "Oh my goodness, she's calling." It was a reflexive excitement because I truly always enjoyed hearing from her. She was a wonderful, incredibly wonderful person, I should say. Similarly, when somebody passes away, we will find ourselves looking into a room expecting to see them there or expecting them to knock on the door any moment or to call on Sunday morning as it were.

Andrew Huberman:

Those expectations, those predictions that the brain is making, are entirely normal because they are based on that deep catalog of episodic memory that you maintain about that person. Again, the depth and richness of that catalog scaling, of course, in direct relation to how close you were with that person, right? Closer to somebody means more information about them. More information about them means your brain has a lot of implicit unconscious notions of when and where and how they show up.

Andrew Huberman:

So the fact that your brain and, indeed, sometimes your body reacts to the expectation that they'll be there is entirely normal. It's simply an activation of this map that involves closeness, space and time. Not surprisingly then, the reordering of that map that's required in order to move through the grieving process is going to involve some remapping. You, as the person grieving, have the opportunity to ask which node, as it's called, which element or dimension within that map are you going to focus on.

Andrew Huberman:

Some people really try hard to disengage with and remap their sense of emotional closeness to the person, that is it's so unbelievably overwhelming to them that the person is no longer accessible that they try and change their ideas about how close they really were. They try and change their emotional attachment to the person after they've died. Clearly in the example that I gave in the Feynman letter, that's not the case. The attachment seems indeed quite fixed and not going anywhere.

Andrew Huberman:

Psychologists and neuroscientists generally agree that the best way to approach moving through grief is actually to remap these dimensions while maintaining the close sense of attachment to the person by not in any way trying to undermine the intensity of the attachment or how important it was to you. So we'll now talk about how that process works and the different entry points, as they're called, to engaging in that process.

Andrew Huberman:

So one straightforward way to think about this state of mind and body that we call grief is that the idea that someone or an animal or a thing simply does not exist anymore is not something that the brain can easily conceptualize. The reason for that is that we, as beings that have a brain, and a brain as an organ that makes predictions tends to rely more on experience than knowledge. In other words, the knowledge that someone or an animal or a thing is gone, that it doesn't exist, at least not in the dimensionality that we were accustomed to relating to them in, is something that we can understand logically, but that emotionally is very hard to undo and from a memory perspective is very hard to undo.

Andrew Huberman:

So it's not just that we are in a state of emotional disbelief, it's that we have neurons, literally nerve cells and neural circuits, connections between nerve cells that are dedicated to this vast implicit knowledge of all the things we know about that person, animal or thing. Just because they are no longer in the dimensionality, meaning in the configuration, alive or present in our life, that they were before, doesn't eliminate those memories. Those memories persist.

Andrew Huberman:

So anytime we call to mind the person's name, or we call to mind things that remind us of them, or we suddenly feel the desire to engage with them, the memories, those episodic implicit memories, as they're called, all that menu and library of knowledge slams us straight in the face and pushes us into a mode of wanting to act in a way that's consistent with them still being here in the way that all that knowledge told us they were when we acquired it. That's a very long-winded way of saying that there's nothing wrong about the emotional state when we are in a state of grief. In fact, quite the opposite.

Andrew Huberman:

But there is something wrong about the memories because the memories are based on our prior knowledge of them and those memories actually do not apply to our current knowledge of them. Again, even though our brain is a prediction machine and it's a very good one, it's not perfect. In fact, it's far from perfect. So really, moving through grief is a process of understanding how relationships are mapped in the brain, space, time and closeness - also called attachment - understanding those three dimensions, understanding that they are closely linked, and then understanding that simply the knowledge that somebody or something or an animal isn't accessible to us does not allow us to discard of all the knowledge that we have.

Andrew Huberman:

As a consequence, our brain is constantly generating expectations of how to access them, even if we know that's completely irrational. Now, this should, I would hope, assist you in moving through grief. It's not a tool of the sort of like a switch that you can flip and suddenly not feel grief, but it does point to a specific set of mechanisms or a specific set of steps that you can engage in order to start to move through the grieving process in the most adaptive and effective way, and in a way that still holds in mind your close attachment to the person.

Andrew Huberman:

So let's talk about some of the tools for adaptively moving through grief. These are tools gleaned from the research psychology, the clinical psychology, and the neuroscience literature. So I've synthesized my understanding of those three literatures to provide the tools that I'm about to describe. The first one involves the acknowledgement and really the understanding that you don't want to disengage or dismantle your real attachment to someone, an animal or a thing. That's a real thing, and there is actually no adaptive reason to try and persuade yourself or numb yourself or somehow avoid the thinking of just how much they meant to you.

Andrew Huberman:

What is important, however, is that you make some effort to shift your mindset and your understanding of that person in a way that holds in mind that, yes indeed, the attachment is very real, and in some cases is very, very intense, but is now going to be uncoupled from the other two dimensions of the map, namely space and time. So again, just to make absolutely clear, there's no reason to try and convince yourself that you weren't actually that close to this person or them to you. There's no reason to try and reduce the intensity of that attachment.

Andrew Huberman:

To the contrary, you want to anchor yourself to that attachment, but you want to make sure that your thoughts about the person and your feelings about the person are not oriented toward, or in reference to, I should say, that map, that deep catalog of memories that you had. Now, this is not simply a fancy way of saying don't live in the past. This is saying you need to maintain your sense of attachment, but you need to start making predictions and understanding about how you're going to engage with that attachment, how you're going to feel those things without the expectation that things that once happen before are going to happen again.

Andrew Huberman:

So it's a complicated process, you can imagine, but you really want to hold and register two things at once. It's sort of like spinning two plates at once, and therefore it's going to feel like effort. One way to do this is to set aside a dedicated period of time of maybe five or 10, maybe even as much as 30 minutes, or depending on your capacity, 30 to 45 minutes, in which you are going to feel deeply into your closeness and your attachment to that person, animal or thing. But you are consciously going to try and prevent yourself from thinking about a couple of categories of things.

Andrew Huberman:

First of all, you want to actively try and disengage from any attempt to engage in what's called counterfactual thinking, the "what ifs." "What if I had called them a day earlier? What if they had taken a different route home? What if I had taken a different route home?" These counterfactual modes of thinking are an infinite landscape of possibility, and they are very closely tied to guilt. Guilt is an interesting emotion. We should probably do an entire episode about guilt. But guilt, as defined by psychologists and neuroscientists, is actually a way of assigning ourselves more agency, more capability of controlling reality than actually exists.

Andrew Huberman:

It's a very slippery slope. I want to be clear, it's not the case that guilt is never an appropriate response, but in the context of grieving, guilt is very precarious because in thinking, "I could have done this," or, "if I had only done that," you are essentially exploring an infinite landscape of things that you can never refute. You will never know that had you not gone down a different path or they had not taken a particular path in life that things would've turned out different, but you can't know that it would've worked as well, meaning you actually don't know that your what ifs are true, and you don't know that they're not true.

Andrew Huberman:

So as an infinite space, it's a very precarious one, and it will not allow you to uncouple that intense emotional attachment that I'm telling you is actually vital to hold onto from that catalog of episodic memory that you've established. In fact, it's going to strengthen those bonds. So in this dedicated five or 10 or 30, whatever period of time you can tolerate and maintain focus, the idea is to think about your attachment in a rich way and to perhaps even experience that in your brain and body.

Andrew Huberman:

I think if you're in a stage of grief, that actually will be fairly reflexive to do, but to try as much as possible to hold that grief in the present and to be connected to your immediate physical environment. So you want to orient yourself in current space and time rather than focus on memories or what you would've liked to see happen or the wish that they were still there, while at the same time thinking about the depth and richness of that attachment. This is obviously a tightrope walk, so to speak. It's an emotionally challenging and sometimes even will be experienced as a physically challenging tool or experience.

Andrew Huberman:

But in our understanding of how attachments and grief are represented in the brain, this can be an immensely beneficial practice because it is the first step, and indeed it represents many of the steps in the voyage from the initial shock of loss to our ability to hold in mind somebody or an animal or a thing in a way that still allows us to feel the depth and fullness of connection to them without feeling the yearning, that reaching for the glass of water, that unfortunately will never be resolved.

Andrew Huberman:

Keep in mind that as you embark on this process, it is entirely normal for your mind to flip into various states of expectation that they're suddenly going to be there. In fact, because of the closeness of these three dimensions in the map - space, time and attachment - it's entirely normal that when you start to think about your attachment to somebody or an animal or a thing, that you almost start to experience them as present in that environment. I'll share with you as somewhat bizarre, or it sounds bizarre to articulate out loud, but many of you perhaps will resonate with this.

Andrew Huberman:

For years after my graduate advisor died, I would get an experience of someone touching the back of my neck when I would think about her. That was not an experience I ever had with her, right? It was a professional relationship. I don't ever recall her touching in the back of my neck or me touching the back of my neck in her presence, at least not on a regular basis. So it was very perplexing to me. Then I encountered this incredible literature on grief, which said the following, "Grief in many ways is like a phantom limb." For those of you that aren't familiar, many people who experience amputation of a limb, either through surgery or accident or otherwise, will feel in a very genuine way that the limb is still present, even though when they look for the limb, it's not there.

Andrew Huberman:

So they can feel pain in limbs, they can feel the sensation of touch. There's some famous experiments from the neurologist, and my former colleague at University of California San Diego, who goes by his last name, Ramachandran; some people just call him Rama. He's an incredible scientist and has done a lot of really important work, in particular on phantom limb, among other things, and has done some beautiful experiments showing that people who have phantom limb pain or that are experiencing different sensations in their phantom limb, that can be very intrusive, much in the same way that expecting someone to walk through the door who you happen to know is deceased can be very intrusive.

Andrew Huberman:

Ramachandran has done beautiful experiments showing that if you give people what's called a mirror box - this is a box in which you insert an intact limb and there are some mirrors that give you the visual impression that the other limb is still present, and you move the intact limb, and you get a mirror image of the nonexistent, but nonetheless, visual image of the phantom limb moving - that you can resolve some of the pain of a limb that feels otherwise cramped up. In other words, the visual perception can reverse some of these phantom sensations.

Andrew Huberman:

In many ways, the phantom limb scenario and what I described about a sensation of being touched on the back of the neck, or this feeling that we have when we engage in the thinking and the emotions of our attachment to someone, an animal or a thing, is very much like a phantom limb, only it exists in the emotional space and it exists because it is reactivation of these maps about space, time and person. So if the process of moving through grief adaptively in a healthy way involves maintaining the attachment, but uncoupling that attachment from the space and time representation of that person, animal or thing that we had before, well then the question becomes, Where should we place our expectation of them, right?

Andrew Huberman:

Now, that of course, will vary from person to person. Some people with particular religious beliefs will indeed believe that the soul of the person, the molecules of the person, have been reordered and exist in some sort of either distributed domain, that they are in everything or they are in one location. I'm not here to speak to that one way or the other. There's no good experiment I know either to prove or disprove that, nor would I want to. It's not the job of science, frankly.

Andrew Huberman:

However, allowing ourselves to place notions of where that person, animal or thing is in their current new configuration, whatever that might be, ashes to ashes, dust to dust; or that the person's soul comes out of their body, these are all the different variations that people hear, or some people think, "Well, it's just molecules, and they disintegrate and are reordered and come up as the plants and the trees." Again, a near infinite number of possibilities, and it depends a lot on personal belief.

Andrew Huberman:

It is however essential that no matter what you believe, that you have some firm representation of where that person, animal or thing is so that you can plug it into this map, this three-dimensional map of space, time and attachment. The process of moving through grief can't simply be that we hold onto the attachment and we discard with any understanding of where they are in space and time. Actually, the letter that Feynman wrote to his deceased wife, Arline, again so beautifully and really poignantly illustrates the fact that he doesn't really know where to find her. On the one hand, he really understands that she's gone, and on the other hand, he understands that he still very much expects her to be there, that he would like to mail the letter.

Andrew Huberman:

But then of course, in this final somewhat humorous line, he doesn't know where to send the letter, he tells us. What's very clear and I think is very healthy is the fact that the emotional bond is still there, that that is maintained. So this tool, if you will, of dedicated blocks of time for really spending some effort, and it is indeed effort, to access the emotional connection while starting to uncouple the other nodes of the map, as it were, is something that is hard. You should expect it to be hard. But in terms of the options one has in order to deal with grief, it is indeed the most adaptive way to go about it.

Andrew Huberman:

You're not trying to avoid thinking about it. You're not engaging in this counterfactual thinking, the what if, what if, what if. You're not drowning it out with substances or delusion or with other ways of distracting yourself. So in that sense, it is truly adaptive. Now, of course, I don't want to imply that I'm a clinical psychologist. I'm certainly not. There is absolutely a place for working with a trained professional to move through grief, especially these situations, these one in 10 people who deal with what's called complicated grief or very prolonged grief. Those are somewhat different things, but in general point to the fact that there are people who have an exceptionally hard time moving through grief.

Andrew Huberman:

We'll talk about who those people are and ways to move through them with or without a professional to assist you. But nonetheless, we're starting to understand on the basis of neuroscience what some of the more adaptive and functional ways of moving through grief are. In order to really understand how a tool of the sort that we're describing ought to work and what it's designed to accomplish at a mechanistic level, I'd like to teach you about a very important aspect of your brain function that has everything to do with grief and the process of moving through grief, but has a lot to do with other aspects of our life experience as well.

Andrew Huberman:

Some of you are probably familiar with a brain area called the hippocampus. The hippocampus is a structure that's involved in the formation of new memories, but not the maintenance of memories. I discussed the hippocampus in detail in our episode on memory and our episode with our guest Dr. Wendy Suzuki from New York University, an expert on learning and memory. During those two discussions, I did not, however, touch into what the different cell types are in the hippocampus and the different roles they perform. It turns out that there are indeed different cell types in the hippocampus, and they perform very different roles that are absolutely central to the grief process.

Andrew Huberman:

We have cells in our hippocampus, meaning you have cells in your hippocampus - these cells are neurons, nerve cells - that fire anytime, and when we say fire, I should just remind you, I mean have electrical activity anytime that we enter a particular familiar location. So for instance, think about your bedroom and think about where the bed is. As you're doing that, these so-called place cells are firing, not necessarily to represent that it's a bed at that location, but to represent the location itself.

Andrew Huberman:

We also have neurons in our hippocampus, and elsewhere in our brain, I should say, that represent proximity. So, for instance, if you were to wake up in the middle of the night and walk into the kitchen. and it's somewhat dark. and you orient toward the sink to get yourself a glass of water or to the refrigerator to get yourself something to drink or to eat, as you get close to the sink or the refrigerator, there are neurons in your hippocampus that are going to start engaging electrical activity because you are in the mirror expected proximity of the sink or refrigerator and where they are, hence the word expected.

Andrew Huberman:

Now, that all seems fine and good. You've got neurons that represent where things are, and sort of goes without saying that those same neurons map to our emotional attachments. We generally know where to find our loved ones, even if they don't live with us, we generally know what city they're in. Even if they're traveling, we generally have a sense ...

PART 1 OF 3 ENDS [00:31:04]

Andrew Huberman:

We generally know what city they're in. Even if they're traveling, we generally have a sense of where they're traveling or the general area in which they're traveling. Place cells and proximity cells are involved in that kind of mapping and representations as well.

Andrew Huberman:

Now, there's a third kind of cell that's particularly important for the sort of tool that we were talking about earlier, that tool of holding on to the emotional attachment to somebody and yet trying to deliberately remap our understanding of where they are in space and time. That has to do with a category of cells called trace cells.

Andrew Huberman:

Trace cells were discovered by a number of laboratories. I think the most renowned of those is the Moser laboratory. The Mosers are a couple ... actually they were a couple. They're now, I think, amicably separated or divorced. That's not what this episode's about. If I have that wrong, forgive me, Edvard and Britt, are their names. Their relationship isn't what's important, except what is important is the work that they did together in one form or another, which was very important work establishing this category of cells in the, not just in the hippocampus, but in an area of the brain called the entorhinal cortex, that act as a sort of coordinate system to orient us in space and time.

Andrew Huberman:

Trace cells are activated when we expect something to be at a given location but it's not there. Experiments done in their laboratory and in other laboratories have shown that, for instance, if you give a rodent - or frankly, a person, an object that always resides at the same location, and we reach to it in order to access it ... let's say where your coffee maker is in the morning. I do a pour-over coffee. If I'm drinking coffee or maté, I'll do a pour-over. It's always more or less in the same location, and so there are place cells and proximity cells that relate to my being able to find that pour-over coffee cone thing.

Andrew Huberman:

However, if I were to go to that location and it wasn't there, the trace cells, these neurons in my hippocampus and entorhinal cortex and elsewhere - because again, these cells are connected by way of circuitry, by way of connections - those trace cells would fire. We could even call it a trace circuit. It's a circuit that has an expectation that something will be in a location, but when something is not at that location, this circuit becomes active. This is important because what we're talking about here is a neural circuit and a set of neurons that are responsible not for the presence of something, but the absence of something.

Andrew Huberman:

We have every reason to believe based on neuroimaging studies and studies in animal models that trace cells become very active in the immediate stage after the loss of a loved one. That the brain and our maps of the person, place, or thing that we know cognitively, we understand, we even believe they are gone, they are not accessible for whatever reason, death or otherwise - and yet we have neurons that are firing to reveal that absence to us. These neurons are closely associated with neurons that tell us where things ought to be.

Andrew Huberman:

So if you feel the expectation, or you sense that somebody should walk through the door any moment or call at any moment or be next to you when you wake up, and yet you cognitively understand that they won't, that there's no real reason why they should because they are indeed gone, you are not crazy. In fact, it's simply a reflection of the normal functioning of these trace cells and trace circuits.

Andrew Huberman:

Now I'd like to consider why two people, both who are intensely attached to a person that is no longer there, can experience the grief of the loss of that person in such different ways. This is often observed. You can have, God forbid, incredibly sadly, in cases where a child is lost, where both parents are grieving intensely, but one seems to feel it at an emotional depth and level that seems distinct from the other.

Andrew Huberman:

Now, of course, keep in mind that we never really know how other people are feeling. This is something actually that was raised in the episode where I interviewed a psychiatrist and researcher colleague of mine from Stanford, Karl Deisseroth, a psychiatrist. I heard him say once that we really don't know how other people feel. In fact, a lot of the times we don't even really know how we feel, or at least describing that is quite challenging with language often.

Andrew Huberman:

Indeed, that is the case. We don't really know how other people feel. There's no clear way of knowing that the expression someone else has, or whether or not they're crying or not, or their body language really represents how they feel inside, so that is important to keep in mind.

Andrew Huberman:

Nonetheless, there does seem to be a sort of a split among people, and, indeed, among animals as well, even within a species, in terms of how intensely they feel the yearning aspect of grief. It appears based on a number of different lines of evidence that that relates to this molecule that some of you have probably heard of, which is oxytocin.

Andrew Huberman:

Oxytocin is a hormone/peptide - a peptide just means a protein, generally a small protein, and a hormone is generally something that functions at numerous locations in the body to impact numerous organs and areas of the brain. A peptide can be a hormone and a hormone can be a peptide. They're not mutually exclusive. Oxytocin has a variety of roles in the brain and body. It's involved in milk letdown during lactation; it's involved in pair bonding, both in males and females; it's involved in bonding of parent to child and, indeed, between romantic partners, et cetera, et cetera.

Andrew Huberman:

Let's talk about some of the animal models that inform us about the potential roles of oxytocin in the grieving process. There's a species of animal called the prairie vole, and believe it or not, the prairie vole has been studied fairly extensively by neuroscience and psychology researchers. In fact, our former Director of the National Institutes of Mental Health, Tom Insel, his laboratory focused quite heavily on prairie voles.

Andrew Huberman:

Prairie voles are one species of animal. But depending on where they live, you find that some prairie voles are monogamous; that is, they mate with the same prairie vole for life, they raise litters of little prairie voles for life. Other prairie voles, generally that live in different locations in the wild, are nonmonogamous, sometimes called polygamous.

Andrew Huberman:

The neurochemical and circuit basis for this monogamy versus nonmonogamy are quite interesting. However, in the context of grief and attachment, the prairie voles have taught us a lot. They've taught us a lot through the following experiment.

Andrew Huberman:

You take two prairie voles that are coupled up, so these would be monogamous prairie voles that have established a couple-dom, I guess you would call that a prairie vole-dom anyway. Put them in a cage together. They mate together, they raise young together, and then you separate them. You literally put a physical barrier between the two of them, and you can evaluate how strongly one prairie vole will work to get access to the other prairie vole. This is sort of the Romeo and Juliet of prairie vole experiments.

Andrew Huberman:

What you observe is that the monogamous prairie voles will work very hard to get back to their mate, to get access to their mate. They will lever press, they'll even walk across a metal plate that they get an electrical shock. They'll work very, very hard. They will cross rivers and valleys, if you will. In the experimental context, that is.

Andrew Huberman:

The polygamous prairie voles - and again, we don't know if they're polyamorous. We don't know what they feel, right? We don't know if they're in love or if they're motivated simply for other things. But the nonmonogamous prairie voles will not work as hard to access a prairie vole partner. Now, you could argue that's because they expect that there will be other prairie vole partners, but even if they've never experienced another prairie vole partner, they won't work quite as hard to get back in connection with this other prairie vole, to mate or otherwise.

Andrew Huberman:

This turns out to be interesting when you start to explore the patterns of so-called oxytocin receptors in the brain. To make a long story short and to also bridge to the human literature, it turns out that the monogamous prairie voles have far more oxytocin receptors in this brain area that I mentioned earlier, the nucleus accumbens. Again, to remind you, the nucleus accumbens is the brain area associated with motivation, craving, and pursuit. So it's as if the monogamous prairie voles have a capacity to link the attachment circuitry and the molecules of attachment - in this case, oxytocin - to reward pathways and to motivational pathways.

Andrew Huberman:

Polygamous, or we should say nonmonogamous prairie voles, do as well. However, they have less oxytocin receptors. So in other words, nonmonogamous prairie voles seem to have less yearning for attachment overall, at least to a single individual prairie vole.

Andrew Huberman:

When we look at the human literature in terms of oxytocin receptor expression and brain imaging experiments and so on, what you find is the same. That people that experience intense grief and a deep yearning and a motivation to reconnect with the person, animal, or thing that is lost in many cases have heightened levels of oxytocin, specifically - or I should say oxytocin receptors, to be exact - specifically within the brain regions associated with craving and pursuit.

Andrew Huberman:

So for those of you that find yourself in this kind of stuck mode, this persistence of trying to reach into the past or wishful thinking, this counterfactual thinking, "If only, if only, if only," you don't necessarily want to pathologize that thinking. First of all, we should acknowledge that it's not necessarily adaptive. In fact, in the complete loss of somebody, or if somebody says they don't want anything to do with you ever again, by all means, if that's expressed clearly, then you need to accept that reality. But the yearning, the desire and the impulsivity, that kind of leaning in and at an almost reflexive way, to try and access that person again, to text them, to want to hear from them, could - and I have to highlight could - reflect the fact that you just so happen to have more oxytocin receptors or maybe more oxytocin overall in this brain area that's associated with motivation and pursuit. It does not necessarily mean that you are more capable of attachment than people who move through grief more quickly.

Andrew Huberman:

I should say that people move through grief at different rates, even if two people lost the same person or same animal. People move through this at different rates. Some of that is no doubt psychological, but some of it no doubt is also neurochemical and biological.

Andrew Huberman:

In sharing this with you, I hope it sheds some understanding and perhaps even some compassion for people who are moving through things more quickly or in a different way. Of course, it should also, I would hope, shed compassion and understanding for people that seem incapable of moving on, it's taking them far longer to move on.

Andrew Huberman:

Earlier we talked about complicated grief, noncomplicated grief and prolonged grief disorder. I should say that the precise divisions between these categories is not very precise. It takes a really trained expert to be able to identify whether or not somebody is in the prolonged grief disorder category, complicated, or noncomplicated grief. There's actually a set of questionnaires that I invite you to answer if you like. They were provided, or I should say I accessed them through a public site on Mary-Frances O'Connor's webpage. We'll put them in the show note captions. You actually can submit those answers in an anonymous way to a study that she's doing. She has several surveys - one for loss of a romantic relationship, other for loss due to death of somebody, and still another one that relates to home sickness. It's also available in several different languages. I'll provide a link to that website. It's very easy to download. There's no cost to that at all. You can contribute to the scientific data collection process if you like. I do believe that you get your scores back or an interpretation of your scores by participating there.

Andrew Huberman:

When Mary-Frances O'Connor hopefully comes on the podcast, she can tell us some more of the detail about separating out this prolonged grief disorder, complicated and uncomplicated grief. But in the meantime, it's very clear that people move through grief at different rates. As I mentioned just a moment ago, that this is entirely normal, probably has a basis in neurochemicals and hormones such as oxytocin. There are probably other reasons as well. In fact, we can assume with almost certainty that there are other reasons as well.

Andrew Huberman:

Nonetheless, I think it is really important to think about why some people might have a harder time moving through grief due to life circumstance, innate differences, and so on. There's a very nice set of studies, but one in particular, entitled "Catecholamine predictors of complicated grief outcomes." Here again, the first author is Mary-Frances O'Connor, reminding us that she's done so much important work in this area. This paper has several conclusions, but one of the key conclusions is that this particular category of molecules we call the catecholamines: the catecholamines include epinephrine, which is also adrenaline; norepinephrine, which is noradrenaline; and dopamine, which you've learned about before. Here, I'm just going to paraphrase, or I'll read directly, actually. What they found was that participants ... again, this is human subjects ... with the highest levels of epinephrine, of adrenaline, pretreatment had the highest levels of complicated grief symptoms posttreatment, and that could account for their baseline level of symptoms.

Andrew Huberman:

What this means is that people that have a lot of circulating adrenaline, we might even call these people who are, or typically reside at a higher level of autonomic arousal - we have an autonomic nervous system that dictates how calm or alert or stressed we happen to be just at baseline - people who tend to be more alert and anxious at baseline prior to any grief episode tend to have, or statistically on average we should say, are more likely to experience complicated grief and maybe even prolonged grief symptoms.

Andrew Huberman:

If you're somebody that is anticipating losing someone or an animal or a thing at some point, and I think that really means everybody, utilizing tools to adjust your epinephrine, your adrenaline levels down, has a number of important benefits - improving sleep, health metrics, et cetera. There are tools to do that. We have an episode on mastering stress that you can find at our website, hubermanlab.com. It has a lot of behavioral tools that are backed by science, some of work that was done in my laboratory, but certainly other laboratories as well that will allow you to control your autonomic nervous system both in real time and reduce the overall level of stress and even chronic activation of the so-called sympathetic arm or the autonomic nervous system, which is just fancy geek-speak for saying there are tools to help you be calm, not just for sake of navigating daily stress, but as this paper illustrates, for anticipating the fact that at some point you will lose somebody, an animal or a thing, and there is a way to move through that process that we call healthy normal grieving. Then there's the so-called complicated grief for prolonged grief disorders that reflect immense challenge in moving through grief at a reasonable rate.

Andrew Huberman:

So you can somewhat inoculate yourself against complicated or prolonged grief by reducing your resting levels of, or your preloss levels of epinephrine, of adrenaline. Again, there are excellent tools to do that. I won't review them here, for sake of time, but they're time-stamped and you can access those easily. Again, zero-cost tools.

Andrew Huberman:

Going back to this paper, "Catecholamine predictors of complicated grief treatment outcomes," should say that not only did participants with the highest levels of adrenaline have the highest levels of complicated grief symptoms posttreatment, but the predictive relationship between these two things, adrenaline and complicated grief, was not seen in depression. I find that incredibly interesting because it further separates depression from grieving and grieving from depression. A resounding theme again and again. Grieving is not depression and depression is not necessarily grieving. They can coexist, but they are separable as well and indeed reflect separate brain circuitries entirely.

Andrew Huberman:

The conclusion they draw is that the present study supports the hypothesis that catecholamine levels - again, epinephrine, dopamine, norepinephrine are the catecholamines - are affected by bereavement and in turn can affect the ability of those with complicated grief to benefit from psychotherapy.

Andrew Huberman:

What does all this mean? What this means is we can prepare ourselves to be in a better state to access, yes, access grief when it's appropriate, and, indeed, grief is the appropriate response when we lose someone, an animal or a thing that we are closely attached to. And yet to be able to move through that at a pace and in a way that is most adaptive for us. To just again highlight what adaptive means, it does not mean dissociating from the attachment to the person, animal, or thing.

Andrew Huberman:

I just want to pause for a second and mention why I keep repeating person, animal, or thing. I'm saying that because while grieving the loss of a person or a relationship with a person - doesn't have to be through death, of course, but death or otherwise - is something that we all can intuitively understand even if we haven't experienced it, we are capable of achieving great attachments to animals as well. While the loss of a thing, of an object, in no way, shape, or form approximates the loss of a person or an animal - I would never suggest that it does - it would also be naive and unfair of me or anyone else to suggest that things can't hold immense importance to us and that the loss of them can't feel quite significant and invoke the grieving process.

Andrew Huberman:

This isn't always about materialism. Sometimes it's purely about the sentimental attachment. For instance, the loss of a wedding ring or an engagement ring that was very meaningful to you; or an article of clothing or a painting; or even a small, seemingly important object to somebody else but something that held great meaning to you. Maybe a seashell that you collected with somebody on the beach and then somehow it gets lost, and it's the relationship with that person that's contained within that object for you as a representation within that object that's important. That's the reason why I keep saying person, animal, or thing. I think it's only fair to include things in that category, but of course with the understanding that they don't hold the absolute same magnitude as the loss of a being.

Andrew Huberman:

One thing that we ought to consider for a moment is whether or not the depth of attachment that you have to somebody predicts how long it will take for you to move through the loss of that person. We often hear this. Actually, I can remember some years ago, at the end of a relationship, a friend and colleague of mine saying, "For every year that you were together, it's going to take you one month to get over that person." I thought, "Where in the world do those data come from?" And this is what I call anecdata, or collective data where ... this is like phrases such as "absence makes the heart grow fonder." Indeed, sometimes absence can make the heart grow fonder, in the context of two living people or people in a loving relationship or even in the context of grief and loss. But of course, there's "absence makes the heart grow fonder," and then you also will hear "out of sight, out of mind." If you've been listening to this episode, clearly "out of sight" does not mean "out of mind" or out of emotional connection.

Andrew Huberman:

These sayings of well, "It takes x number of months for a number of years," or "Out of sight, out of mind," or "Absence makes the heart grow fonder," they really don't hold a lot of meaning, at least not for somebody like me who likes science. Because science is at least geared toward or aims towards establishing things in fact, not opinion, but also because science allows you to make predictions. It allows you to orient yourself in a process and make predictions and understand.

Andrew Huberman:

So what are we to think of people who seem very, very attached to somebody; they break up and they seem just crushed, devastated, but three weeks later they're in a new relationship and they seem perfectly fine? Or somebody whose spouse dies and then suddenly they're in a new relationship. I think there are rates of transition, if you will, that suggest some dysfunction, pathology, et cetera. But here we aren't in a position to judge, we're only in a position to speculate about this, and I think we can reasonably speculate that it sort of makes sense why someone who has an intense attachment to somebody might be able to form intense attachments generally, right? That they aren't restricted to one person, whereas other people who have an intense attachment to somebody might find themselves entirely incapable of moving on or it would take them a very long time. Hence, the lines in the Feynman letter to Arline about, he had met various other young women, they seemed perfectly nice and yet they were meaningless to him in the shadow of her memory, or we should say in the light of Arline's memory, or the memory of Arline, rather.

Andrew Huberman:

These dimensionalities of attachment, they cut in every direction. I don't think any well-trained psychologist or neuroscientist would ever say, "Oh, if you are somebody who becomes very attached, therefore it's very hard to move on." I think that could be true. It could also be that if you're somebody who has a great capacity for attachment, you have a great capacity for attachment overall. Neuroscience nor psychology is really in a position to judge certainly, but it's also not in a position to make those kinds of predictions. At least, the field as it stands right now of attachment and grieving can't really speak to why that's the case. That's my attempt to depathologize some of what we observe. Although I have to confess from a just sort of everyday stance that sometimes the rate in which people move out of attachments and grieving can be somewhat eerie.

Andrew Huberman:

I'd like to take a moment and explore this idea that allowing ourselves to really feel the attachment to somebody can accelerate or at least support adaptive transitioning through grief. There's a really wonderful study that on the face of it appears to be a what we call negative result. A negative result is when a hypothesis is posed and then turns out the hypothesis is not true. But as is the case with so many interesting scientific findings, often when there's a negative result, there's a more interesting result nested in that negative outcome.

Andrew Huberman:

This is the case in a particular paper I'll share with you now. There's a paper published in the journal Biological Psychology. Again, the title is posed as a question, which is "Emotional disclosure for whom? A study of vagal tone in bereavement." What this study explored was whether or not written disclosure of the emotional connection to somebody that was lost would be effective as a way for people to move through the grieving process.

Andrew Huberman:

The study also explored the so-called vagus nerve. The vagus nerve is an extensive nerve pathway that is bidirectional between brain and body, so brain to body and body to brain. It generally is associated with calming effects on our brain and body, although that's certainly not always the case. The way to think about it in terms of what we're going to talk about now is heart rate and heart rate variability.

Andrew Huberman:

In very simplistic terms, if your heart was just allowed to beat at its sort of default rate, that rate would be rather high because of the activation of the so-called sympathetic arm of the autonomic nervous system, the alertness component of the autonomic nervous system. The parasympathetic nervous system, as it's called, involves calming. We sometimes hear sympathetic is for stress or fight-or-flight. It's for a lot of other things as well, I should mention. It is not for sympathy. Sympa means together and it reflects the activity of a bunch of neurons being active at the same time or together, sympa. Whereas parasympathetic is often associated with rest-and-digest functions, or calming functions, although it is certainly involved in other things as well. So sympathetic nervous system drives alertness, panic, stress, et cetera; parasympathetic nervous system, meaning a distinct set of neurons, drive calming, falling asleep, digestion, sexual arousal, for that matter, and so on. So it's sort of like a seesaw of alertness and calm, alertness and calm, sympathetic and parasympathetic, back and forth.

Andrew Huberman:

The vagus nerve is generally associated with parasympathetic functions and has the capacity to slow down our heart rate, in particular by exhales. Just simply because of the movement of the diaphragm and its relationship to the heart and the thoracic cavity, exhales result in slowing down of the heart rate. This is what we call an increased vagal tone.

Andrew Huberman:

Let me explain for a moment, and actually here's a tool you can use not just in terms of navigating grief, but in terms of stress modulation, generally. We have a muscle called the diaphragm. When we inhale, whether or not it's through our mouth or nose, our diaphragm moves down. As a consequence, there is more space overall in the thoracic cavity. The heart gets a little bit bigger, believe it or not, volume-wise. Blood flows more slowly through that large volume, and there's a signal conveyed from the nervous system to the heart to speed the heart up. So inhales literally speed your heart up. When you exhale, the diaphragm moves up, and as a consequence, there's less space in the thoracic cavity. Heart gets a little bit smaller, the existing blood volume in the heart at that time moves more quickly through that small volume. A given amount of blood volume make the compartments in the heart smaller, and the blood moves more quickly through that volume. As a consequence, the nervous system sends a signal to the heart via the vagus and other pathways to slow the heart down. In other words, exhales slow the heart down.

Andrew Huberman:

That process, that relationship between inhale speeding the heart up and exhale slowing the heart down is something called respiratory sinus arrhythmia. Some people are able to engage respiratory sinus arrhythmia more naturally, more reflexively than others. You can actually train this by consciously thinking about slowing your heart rate while you exhale and consciously thinking about increasing your heart rate as you inhale. You can literally strengthen these pathways.

Andrew Huberman:

Now, respiratory sinus arrhythmia and the ability to slow your heart rate with exhales is one dimension of what's called vagal tone, or your ability to control your overall level of activation of alertness and stress with these vagus nerve pathways.

Andrew Huberman:

Vagal tone is something that varies from person to person. If you've trained up or you've thought about your relationship between breath and heart rate, you can improve vagal tone. Some people have very robust vagal tone without having done any training, other people have less of it, et cetera.

Andrew Huberman:

I'll just paraphrase from this paper and you'll see where this takes us in terms of navigating grief, because it's quite important. The vagus nerve provides inhibitory regulatory influence on the heart, allowing the heart rate to increase rapidly through vagal withdrawal - that means kind of coming off the brake of the parasympathetic nervous system, as in response to a stressor in one's environment. When you're stressed, you rarely take the opportunity, if it's an immediate stress or threat, to actively exhale, although that would be a great tool to use, and, in fact, we promote that tool in our mastering stress episode.

Andrew Huberman:

Vagal withdrawal usually co-occurs with an increase in sympathetic activation of the heart - you now know what that is - or is known as the fight-or-flight response. Vagal tone reflects the degree to which there is tonic, meaning ongoing, vagal influence on the heart. So when you have a high degree of vagal tone, it means that you are always activating that brake on your stress system, just at default. Some people just happen to do that more, other people need to practice long-exhale breathing in order to build up vagal tone, something that's very useful to do whether you're grieving or not.

Andrew Huberman:

Now, in this study, what they did is they had people, and I should say it was 35 participants, go through a writing exercise for a period of weeks. They actually wrote about three times per week. Then there was a follow-up at some period of time, and then again about a month later.

Andrew Huberman:

There were two different groups. One group was in the so-called written disclosure group. What they did is they, on day one, they would write about what happened when a loved one died. Indeed, they used people who had experienced real loss. They were asked to talk about and write about their deepest emotions and thoughts about it, memories of their loved one. Very intense stuff, if you think about it, if they're in the immediate period of having lost someone. Then they actually were asked to write a letter to the person that they lost. Again, a very intense exercise to go through if you did indeed lose somebody as these subjects had. Then of course there was the testing some period of time later, and I'll tell you what that testing involved.

Andrew Huberman:

The other group was a so-called control group where they were simply told to write about how they use their time - so an emotionally kind of empty writing exercise, if you will. They described what they would do today after they woke up, et cetera - no heavy emotional content and so on.

Andrew Huberman:

Now, as I mentioned earlier, the immediate results of this study were a negative result, meaning no effect. The disclosure ... we should say, the emotionally intense writing group and the control group did not differ at baseline on any symptom measures or psychological variables, they tell us. At least at face value, somewhat disappointingly, there really wasn't any kind of difference in outcome between the group that wrote about very emotional intense stuff versus nonemotionally intense.

Andrew Huberman:

Now, what I didn't tell you thus far is why they had them do this ...

PART 2 OF 3 ENDS [01:02:04]

Andrew Huberman:

Now what I didn't tell you thus far is why they had them do this exercise at all. They had them do this exercise, because many of the effective practices for moving through grief involve, as I mentioned earlier, getting close to and actually deliberately experiencing the attachment that one has to that person that was lost, not distracting oneself, not getting into this counterfactual thinking, the "what if, what if, what if," but rather thinking about, or in this case, writing about the real attachment. The initial idea was if people write about this attachment, that they're going to experience this attachment, and that will serve them in some or many ways in terms of moving through grief. And that wasn't what they found.

Andrew Huberman:

They found no difference between the two groups, until they explored who had higher vagal tone, who had a greater degree of so-called respiratory sinus arrhythmia. In other words, who was able to modulate their state using their breathing and their body? And what they discovered was that a subset of individuals who had a high degree of vagal tone seemed to get more benefit from this writing-type exercise. Now, this is one study and I would consider it fairly preliminary, with 35 subjects, although it's a study unto itself and I think a quite nice one.

Andrew Huberman:

And it really set the stage for a number of other studies that followed from this group and other groups, that really point to the fact that, yes, indeed, accessing these states of emotionality by writing or thinking about somebody is quite powerful in terms of engaging the bodily states and the mind states associated with the attachment. And that is very beneficial for moving through grief. That is very beneficial for sensing the attachment, and now it makes perfect sense as to why some people would benefit from that practice more than others, because some people are able to access more real somatic feelings of attachment by writing about the attachment, or by thinking about it, than others.

Andrew Huberman:

This brings us back to an earlier discussion we were having, where we were talking about how some people seem to move through things very quickly, or don't seem to be grieving constantly, and a spouse or a family member of that person might think, "Gosh, why aren't you upset? How is it that you can be functional and I'm not?" or "How is it that you can be functional?" There can even be fractures in families and relationships on the basis of differences in rates of grieving and so on. Well, some of this, again, probably relates to psychology and the different attachments that people had to the person, or animal or thing that was lost, but it no doubt also has to do with how much of a mind-body connection, how much vagal tone exists in the person when they suddenly found themselves in the grief episode.

Andrew Huberman:

This actually offers multiple opportunities. If you're somebody, for instance, who is grieving so intensely and so often that you're finding it immensely difficult to move through grief at a reasonable rate, and you might even say or find yourself diagnosed with prolonged grief disorder or with complicated grief syndrome in a way that's really impairing your adaptive functioning in life, well then it's not clear to me, at least by my read of the data, that you would want to engage in a lot of practices to increase the mind-body relationship and feeling so much of this attachment, because you're already feeling an immense amount of it.

Andrew Huberman:

Whereas other people who are feeling challenged in accessing the feelings of attachment, and perhaps not functioning well as a consequence of that, might find that practicing breathing in order to encourage respiratory sinus arrhythmia, again focusing on slowing your heart rate consciously while you exhale, and concentrating on increasing your heart rate as you inhale. Even just as a brief practice of even just one to three minutes or one to five minutes every once in a while or per day, that could be immensely beneficial in building this mind-body relationship.

Andrew Huberman:

Because again, what this paper really points to, and set off a number of other investigations related to, is that for those that can really feel the relationship between breathing heart rate, what we call vagal tone, well those people are going to be in a better position to move through grief, not because they are disengaging from the feelings of attachment, but because they are better able to access those feelings of attachment. What this relates to, of course, is that tripartite map, that three-part map that we talked about earlier, that representation of space: where things are, where the person is, where their belongings are, where their car is, where their bicycle is.

Andrew Huberman:

Time: when you were expecting to see them on a regular basis, when they would call, when they would come home from work, et cetera. And that third node, or that third dimension, of attachment, which is literally attachment and closeness - well, what we're talking about here is anchoring to that attachment and really feeling into that, but then disengaging from the space-and-time map that we call episodic memory, that menu of prior experiences that keeps us in many ways maladaptively in an expectation of what never can be again. Now I'd like to take a moment and consider some of the tools that you can access that support healthy transitioning through grief.

Andrew Huberman:

And these are tools distinct from that neural map, that space-time-closeness-attachment map that we were talking about before. Rather, it's important to remind ourselves that everything exists in a context of our baseline physiology. And I'm certainly not going to be the first or the last to tell you that everything in life, learning, relationships with people that are still around, our health in every way, immune system, et cetera function far better when we're sleeping really well and when we are generally awake during the daytime and asleep at night. I realize there are shift workers out there. people who are traveling and are jet lagged. First of all, thank you, shift workers. We rely on you.

Andrew Huberman:

We have an episode all about jet lag and shift work for you, and for trying to maintain the best possible mental and physical health in the face of ongoing shift work and jet lag. You can find that episode on our website, hubermanlab.com, lots of behavioral tools, some other tools as well. Nonetheless, human beings are diurnal. We were really designed to be awake mostly in the day and asleep at night. There are rare exceptions to this where people like to stay up late and sleep in late, but we are a diurnal species by way of our genetic wiring and our neural circuit wiring.

Andrew Huberman:

There's a particular feature to our diurnal, and diurnal meaning the opposite of nocturnal, our diurnal pattern of the release of a hormone called cortisol. Cortisol is a stress hormone, it's sometimes called, but cortisol has a lot of other effects, many of which are positive. Cortisol, for instance, protects us against infection. It can help us in terms of waking up in the morning. In fact, the pulse, as it's called, or the spike in cortisol early in the day is part of the reason we wake up. It's linked to our increase in temperature rhythms and can further increase our temperature, which leads to waking and so on. The typical pattern of cortisol in a healthy individual, and we really can say physically and emotionally healthy individual, is that cortisol is going to be somewhat high right around waking and then is going to be highest as it ever will be in the 24-hour period about 45 minutes postwaking, not exactly 45 minutes, but about 45 minutes. And then it will drop gradually, such that by about 4:00 p.m. in the afternoon, which is actually when body temperature tends to start to drop as well, cortisol tends to be very low, and then remains low in a healthy individual, such that at 9:00 p.m., it's very low. And throughout the night as we sleep, it's very low. In fact, spikes or pulses in 9:00 p.m. cortisol are a fairly reliable biomarker readout of certain forms of depression and chronic anxiety. This relates to the beautiful work of my colleagues at Stanford and Stanford School of Medicine, Dr. David Spiegel, who's been on this podcast, and Dr. Robert Sapolsky, who has also been on this podcast.

Andrew Huberman:

There's a very interesting paper exploring the relationship between cortisol rhythms and grieving, in particular complicated versus noncomplicated grieving. Again, complicated grieving being the form of grieving that reflects an immense challenge of people moving through the grieving process, such that it really needs to be dealt with, right? Again grieving is healthy, but complicated grieving is a prolonged grieving, and has other dimensions as well. Hence, the name "complicated." The title of this paper is "Diurnal cortisol in complicated and non-complicated grief: Slope differences across the day."

Andrew Huberman:

And the figure to orient to in this paper if you do decide to check it out, and we'll put a link to it, is figure one, which beautifully shows, or I should say very clearly shows, that in individuals that are experiencing complicated grief, there's the same general contour of high cortisol upon waking, even higher about 45 minutes after waking. And then a reduction in cortisol by 4:00 p.m., and even further reduction by 9:00 p.m. So, just as it were in a typical individual or somebody who is a noncomplicated grieving. However, when you compare the cortisol levels between people experiencing complicated grieving versus noncomplicated grieving, what you find is the 4:00 p.m. and 9:00 p.m. cortisol levels are significantly higher than they are in the noncomplicated grieving group.

Andrew Huberman:

This raises a very interesting idea and relates very closely to what we were talking about with vagal tone. You could imagine a situation in which people who are experiencing complicated grief have higher levels of afternoon and nighttime cortisol because they are in complicated grief, but you could also imagine the opposite, that they're experiencing complicated grief because of the fact that they have elevated cortisol. Now, it's very likely that it's bidirectional, that the answer isn't one or the other but both, that complicated grief changes patterns of cortisol, and that patterns of cortisol change the likelihood that one has complicated grief. That's the most logical interpretation of data like these.

Andrew Huberman:

However, when taken along with the data on vagal tone, that people who have a higher level of vagal tone are better able to navigate situations of the sort that we're talking about. And that some people perhaps have oxytocin receptors, or patterns of catecholamines or epinephrine that position them to be more likely to grieve in a particular way. We arrive at a scenario where it makes very good sense to think about modulating, that is controlling the foundation of your life in a way that establishes cortisol rhythms and sleep patterns, and patterns of autonomic arousal and catecholamine release, that position you to navigate the grief process in the best possible way.

Andrew Huberman:

If that was a complicated mouthful to digest, let me restate it in a simpler way. If you are somebody who is heading into grief, or is challenged with grief, complicated grief or otherwise, prolonged grief or otherwise, getting adequate sleep at night and establishing as normal a pattern of cortisol as possible is going to be very important. And there's a very simple, straightforward way to do this, and I apologize to the listeners of this podcast in advance if I sound like a repeating record, but the most powerful way to do this is to view sunlight very close to waking. It does not have to be right at sunrise. But when you get up in the morning, if the sun isn't out, please turn on as many bright lights as possible in your environment.

Andrew Huberman:

And then once the sun is out, try and get some bright sunlight in your eyes. Never look at any light so bright that it's painful to look at, sunlight or otherwise. If you live in an area of the world where there isn't a lot of sunlight, please keep in mind that sunlight coming through cloud cover is going to still be a very effective mechanism for establishing this cortisol rhythm. Why do I say this thing about sunlight over and over and over again? Well, having an early-day cortisol peak and a very low cortisol level late in the day, 4:00 p.m. and 9:00 p.m., is immensely beneficial. It reflects a properly regulated autonomic nervous system. It means being alert during the day, and your ability to sleep at night is tightly correlated to this viewing of sunlight in the morning.

Andrew Huberman:

If you have additional questions about this or these protocols, please see our mastering sleep episode, also at hubermanlab.com. But in brief, you don't want to wear sunglasses when you do this. You do not want to do this through a window, or a windshield. It is 50 times less effective, at least, because of filtering of the proper wavelengths. It is fine to wear eyeglasses, meaning corrective lenses or contacts, even if they have UV protection. Again, sunlight is best ten minutes to 30 minutes, depending on how bright it is outside and so on and so forth. I keep coming back to this protocol because, first of all, it is a zero-cost, but very effective way to regulate things like cortisol rhythms, melatonin rhythms, wakefulness during the day, ease of falling asleep at night and so on.

Andrew Huberman:

And second of all, because I want to emphasize this idea of modulation. There are processes in our brain and body which directly mediate some psychological effect or physiological effect, right? Dopamine is directly involved in motivation. If you're somebody who struggles with motivation, your dopamine system is likely to be dysregulated in some way, and there are behavioral tools and other tools to adjust that. We had an episode on dopamine, motivation and drive that talks extensively about those tools. However, the process of grief can't be distilled down to one molecule, one circuit, such that we can say, "Oh, you know, take this supplement or eat this diet, or exercise in the following way and you'll recover from grief more quickly."

Andrew Huberman:

It's simply not the case. It is the case however that proper sleep at night sets the foundation for the proper emotional tone to be able to navigate physical, psychological, and other types of challenges. And not incidentally, sleep at night, I should say sufficient duration and quality of sleep at night, is the way in which you engage neuroplasticity, the reordering of neural connections.

Andrew Huberman:

And everything we've been talking about today - about reordering of the maps in your mind, this tripartite three-part map of space, time and closeness - involves neuroplasticity, the reconfiguring of connections between neurons, strengthening certain pathways and not strengthening others, actively trying to disengage from the what if, this counterintuitive thinking, actively trying to disengage from the expectations that someone will be there. Although when you find yourself doing that, understanding why it's so reflexive and normal to do that. Actively trying to lean into the real attachment to somebody, animal or thing and yet, at the same time, not diluting yourself and undermining the whole process of grieving by trying to imagine that they are in fact still truly there, right?

Andrew Huberman:

It's a very narrow knife edge of a process, which is why it's so challenging. Regulating your cortisol rhythm through viewing sunlight early in the day, and I should also say avoiding bright lights from artificial sources in the evening, generally 10:00 p.m. to 4:00 a.m., but certainly in the evening, trying to dim lights in your immediate environment, trying to avoid bright screens, bright artificial lights as much as possible, and accessing that deep sleep. That's modulating it, setting an overall autonomic state, or an overall autonomic landscape would be the better way to describe it, that's going to allow you to sleep and get neuroplasticity, sleep and be in the best emotional state to navigate the grieving process.

Andrew Huberman:

Because it's only fair to say that the grieving process, as we're describing it is hard, and not just because it's emotionally hard - it's cognitively hard. You just think about what's required to move through grief properly, if you will. It's thinking about and actually physically experiencing the depth, the full depth of the attachment to the person. While at the same time, trying to uncouple from that rich menu, that catalog of episodic memories that can date back many, many years and have so much richness, so many predictions form on the basis of those episodic memories, and actively trying to distance ourselves from those memories by being very anchored in the fact that we are present.

Andrew Huberman:

We are the person alone in that room or, in some cases, with a bereavement group in that room, or with other people that are mourning the loss of that individual, animal or thing. And that knife edge of feeling the intense attachment while also disengaging from all the things that led to that attachment. Well, it's understandable why that would be so challenging. And it should also be understandable why positioning yourself to be able to do that in the best possible way requires proper sleep. What are the tools that we can think about using in terms of healthy adaptive moving through grief, trying to avoid complicated grief and prolonged grief disorders?

Andrew Huberman:

Realize that word disorder implies all sorts of things, but again, those are just naming categorizations that people come up with that I think fairly reflect the fact that some people have more challenge moving through grieving than others. And for some people, it can be very extended. I think the common misunderstanding is that proper grieving involves moving through something quickly. We're certainly not saying that. However, it is very clear that some people can get stuck, and that process of getting stuck, you should now understand, has a lot to do with maintaining or reactivating those episodic memories, those expectations of where somebody will be in space and time.

Andrew Huberman:

What can we say about the tools for moving through grief? Clearly, it's a value to dedicate some period of time, perhaps every day, perhaps every other day, depending on your capacity and schedule. These could be periods of time ranging anywhere from five to 45 minutes, maybe longer. These blocks of time would be appropriately described as rational grieving, right? Rational grieving is a clear acceptance of the new reality that the person, animal or thing no longer exists in the same space-time dimensionality that we knew them before, and yet holding onto and anchoring to the attachment that we had. This is, again, not an unhealthy anchoring to the attachment.

Andrew Huberman:

This is really anchoring to the depth and the intensity of the attachment that existed, as a way to, for lack of a better way to put it, push off from those episodic memories, to distance ourselves from them, because those episodic memories are the ones that lead us to look for the person in our current reality. And assuming this is a real and complete loss, those sorts of expectations are maladaptive. They do not serve us well. The second aspect of this is to understand that the node of the map, the component of the neural map that you're anchoring to, is a very real component of you. These are literally cells that represent the depth of attachment.

Andrew Huberman:

They are linked up with your emotional centers in the brain, and, indeed, they're linked up with your body. I think one of the things that comes up so often when people are grieving is, Why does it hurt so much. Well, that hurt is that yearning. It's that anticipation of action that you want to engage in, but some part of you at least knows that it leads nowhere. It's that reaching for that glass of water in a desert of thirst, and you know you can't have it. That's why it hurts so badly, because the systems of your brain and body are in a place of anticipation, of readiness. And given the activation of these brain-reward systems like the nucleus accumbens; given your now understanding of oxytocin being more enriched in the nucleus accumbens of some individuals, as opposed to others, it should make perfect sense as to why it's so painful in your body. We talked a moment ago about the importance of accessing quality sleep on a regular basis; gave you at least one tool to do that. There are, again, a rich array of tools to do that in the mastering sleep episode, and, again, highlighting the importance of sleep for not just emotion regulation and autonomic control, which is so vital, but also for making sure that neuroplasticity takes place. Because again, neuroplasticity is a two-part process.

Andrew Huberman:

There's the triggering of the plasticity, which in the case of the things we're talking about today, will be naturally activated by the practice of a dedicated focusing on the attachment, feeling the attachment to the person, maybe even writing about the attachment to the person as was described in that previous study, but also just ... the plasticity is triggered by the mere loss of that person, the intensity of that experience. But neuroplasticity, the literal rewiring of connections, occurs during deep sleep and in what I call non-sleep deep rest, or NSDR. And you can find NSDR scripts. These are short behavioral protocols that you do for 10 to 30 minutes at some point throughout the day, maybe even multiple times through day, that have been shown to accelerate neuroplasticity.

Andrew Huberman:

So, having such a practice can be very useful, and understand that it involves some cognitive work. We have to hold onto the attachment and imagine, and feel, as much as we can, the attachment, while also being extremely rationally grounded and trying to not try to hold onto the past, trying to not anticipate the person walking in the room. This is very hard because when we think about the attachment, the attachment tends to drag with it those episodic memories, that rich catalog of experiences. The expectation that they will walk in the room is perfectly natural. The hard cognitive work is to experience the deep emotional attachment. While at the same time, severing from or distancing ourselves from these expectations that they'll suddenly show up in our reality. When in fact, they won't.

Andrew Huberman:

And we talked about preparing ourselves for grief, right? If we have a loved one that's dying, or we anticipate that at some point, we are going to have a loss of some sort, could be death, could be a loss of another type, breakup, et cetera that we can prepare ourselves to grieve more adaptively by regulating the level of catecholamines, in particular epinephrine; that was well described in the study that I referred to earlier. And tools such as the one found in our mastering stress episode and tools of the sort that we talked about today, increasing that vagal tone by actively building up the relationship between exhales and slowing down of the heart rate, so-called respiratory sinus arrhythmia, those things could be very useful tools.

Andrew Huberman:

We can actually encourage our nervous system and build our nervous system, and build our mind to prepare for grief when it inevitably will come. Again, this is not about buffering ourselves from the realities of life. This is not about engaging from grief as a real and important process, and, indeed, it is a real and important process to engage in. Those that enter denial or try and distract themselves with substances, or thinking, or distracting of your behavior, substances or otherwise, won't move through grief as well, as adaptively as those who embrace a process of the sort that I'm describing here.

Andrew Huberman:

And of course, I want to restate again that even though grief and depression are now known to be fundamentally different, even though people move through the different stages of grief at different rates and sometimes skip stages, et cetera it is often important to access a trained professional psychologist or psychiatrist, or both, or bereavement group, or all of the above, in order to get the proper support for grieving. This is a podcast about science and science-based tools, but I absolutely want to emphasize that there are terrific resources out there that you can access. I don't say this in any kind of glib or pass-the-buck kind of way. There are wonderful trained therapists, bereavement groups, psychiatrists that are expert in navigating these sorts of things.

Andrew Huberman:

I like to think that the tools that we've talked about today would be not only compatible, but would be complementary to the sorts of approaches that they take. And as we think about this process of grief, as we all should at some point in our lives, because we all, indeed, will experience grief in one form or another, I would hope that the information that we discussed today would not only give you some tools, but hopefully give you a better understanding of not just the people that you've lost, or that you stand to lose, not just the animals that you've lost and stand to lose, but also give you a sense of why it is that the people who are still in your life and that you're attached to, the animals that are still in your life that you're attached to, have such profound meaning for you.

Andrew Huberman:

And I would encourage you to not lean away from, but rather to lean into the building of those episodic memories, to build up a richer and richer set of experiences and emotional attachments. Because while the process of grieving is in direct relation to how close we are attached to people, there are ways to move through it. And of course, it is the depth of our attachments and the number and the depth of meaning of experiences that we share with others and with animals that makes life so rich and worth living. I just want to take a moment and say thank you for being willing to explore this rather complicated and sometimes extremely challenging thing that we call grief from the perspective, or through the lens, of neuroscience and psychology.

Andrew Huberman:

I certainly learned a lot in exploring this literature. I also really look forward to hosting people like Dr. O'Connor on the podcast, and others on the podcast who've done such beautiful work in this area. I've put out the request, and hopefully they'll join us soon to further elaborate and teach us about this fundamental component of our lives. If you are learning from it or enjoying this podcast, please subscribe to us on YouTube. That's a terrific zero-cost way to support us. In addition, please subscribe to the podcast on Spotify and Apple. And at both Spotify and Apple, you can leave us up to a five-star review.

Andrew Huberman:

If you have comments and suggestions, feedback, or you'd like to see a particular guest on this podcast, please put those suggestions, comments, and feedback in the comments section on YouTube. In addition, please check out the sponsors mentioned at the beginning of today's podcast. That's the best way to support us. Not during today's episode, but on many previous episodes of the Huberman Lab podcast, we've discussed supplements. While supplements aren't necessary for everybody, many people derive tremendous benefit from them for things like easing and accelerating the transition time into sleep and getting better, deeper sleep, as well as things such as focus, et cetera.

Andrew Huberman:

We've partnered with Momentous supplements, because Momentous supplements first of all are extremely high quality. That's obviously important. Also, they ship internationally. We had heard from many of you that you were having trouble accessing some of the supplements that were described on the Huberman Lab podcast because you did not live in the U.S. Momentous ships both within the U.S. and abroad. And many of you have also requested that there be a single site where you could access all of the supplements that we've talked about on the Huberman Lab podcast. Right now at livemomentous.com/huberman, you can find a subset of the supplements that have been described on this podcast.

Andrew Huberman:

Again, all of the very highest quality, each single-ingredient supplements - that turns out to be very important if you're trying to develop the proper array of supplements for you. It's not helpful to have supplements that include many ingredients. So, we encourage Momentous to have single-ingredient supplements with dosages that allow you to build up from the minimal effective dose and so on, and the catalog of supplements they're going to add to that location, livemomentous.com/huberman, is going to expand in the weeks and months to come. And we expect that in fairly short amount of time, all of the supplements that we've described on the Huberman Lab podcast will be there.

Andrew Huberman:

If you're not already following Huberman Lab on Instagram and Twitter, I post science and science-related tools at Huberman Lab on Instagram, also at Huberman Lab on Twitter. Oftentimes, that material will overlap somewhat with the content covered on this podcast. But more often than not, what I'm covering on Instagram and Twitter is distinct from the information I cover on the Huberman Lab podcast. We also have a newsletter that has summaries of podcasts and points to specific protocols, and links that could be useful to you. That is the Neural Network Newsletter, and you can find it at Hubermanlab.com. Go to the menu, go to "newsletter." You can sign up simply by giving us your email.

Andrew Huberman:

We do not share your email with anybody else. Our privacy policy is there, and is made very clear. You can also see some newsletters of months' past. So, you can assess whether or not you really do want to sign up, although I like to think that you will. Again, zero cost, total privacy of your email account, and many people find those summaries and takeaway tools to be very useful in navigating these admittedly long podcast episodes. And last, but certainly not least, thank you for your interest in science.

PART 3 OF 3 ENDS [01:33:04]

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The Science & Process of Healing from Grief

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In this episode, I discuss grief and the challenges of processing losses of different kinds.

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Finding Joy in Grief: A Radical and Mindful Approach to Grieving | Sky Jarrett | TEDxMargueriteLake

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Finding Joy in Grief: A Radical and Mindful Approach to Grieving | Sky Jarrett | TEDxMargueriteLake

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For this Wiki Assignment, I am choosing the TED Talk, “Finding Joy in Grief: A Radical and Mindful Approach to Grieving” by Sky Jarrett. Sky opens up this TED talk by stating how grief and loss are inevitable experiences for all humans, and we will lose a lot of things that we love. Sky discusses different mindset shifts that we can utilize when we are at a place in our lives where grief is present. The first one being that grief exists beyond death and it is okay to grieve things we lose in our lives, because they are usually big losses. (loss of a relationship, loss of career, etc.) The second one that joy can still exist even when are grieving. Third one being that grief affects our whole body and causes physical ailments as well. Fourth is that there is no shame in grief, and we should never apologize for grieving. Five, there is no specific time period in which our grief must come to an end.  I think these mindset shifts can be really helpful for us and future clients because these categories relate to common misconceptions about grief. But once we acknowledge they are misconceptions, then we can no longer feel shame and understand the grieving process is complex and so many things can come out of this process. Being mindful allows us to identify what is related to grief, and if we ignore or reject it then we are doing ourselves a disservice. I really like this TED talk, and the radical side of what Sky was discussing. It made me think of the DBT skill of radical acceptance and how that skill could be helpful in grief. I am not accepting that I am okay with this by any means, but more accepting this is my reality and I am going to be faced with many challenges. Overall, I really think this was a great source and mindfulness can be really helpful in the face of grief.

Kaitlyn Owens

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Finding Joy in Grief: A Radical and Mindful Approach to Grieving | Sky Jarrett | TEDxMargueriteLake

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https://missed.org.au/ I chose ambiguous loss because I work with LGBTQ+ clients who have varying experiences with the ambiguous loss of family who do not accept their identity. I also have two friends whose loved ones have gone missing. I found two sites that I wanted to share about ambiguous loss.

Offers an introductory hour-long YouTube video talking about ambiguous loss and how it affects someone whose loved one has gone missing. Dr. Sarah Wayland discusses the effects of dealing with a missing person to what families found helpful in coping with the loss and their needs in dealing with police, and media. The site also offers a paid training course for professionals who want more training. It is based in Australia, but I found the information helpful.

Ruth Hyland

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What's Missing: Dr Sarah Wayland [BONUS]

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Dr. Pauline Boss pioneered the research on ambiguous loss, and has a website https://www.ambiguousloss.com/ filled with information and resources for learning about and dealing with ambiguous loss including interviews, presentations, podcasts, paid training for professionals, and links to her books.

Ruth Hyland

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Everyone experiences ambiguous loss if only from breaking up with someone, or having aging parents or kids leaving home. As we learn from the people who must cope with the more catastrophic situations of ambiguous loss, we learn how to tolerate the ambiguity in our more common losses in everyday li…

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Since I work with LGBTQ+ clients, I wanted to share my internship site’s website because it has links to so many resources to support LGBTQ+ people and their families. My hope is the information can help prevent ambiguous loss for children and their families who do not know how to deal with their child’s changing identity. https://www.flourishtherapy.org/resources

Ruth Hyland

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When I was a pre-teen, I attended a funeral with my family for someone from church that I had never met before or heard of. I oddly don't remember any details of the funeral or the individual's passing but I do remember one particular person's eulogy. The deceased person's teen son read the article I pasted below and I remember being completely struck and overly emotional when he read it. I was instantly shocked then quickly judgemental of this reaction because I didn't know anything about this person. The article is not credited with any author that I'm aware of and states,

“I'm old. What that means is that I've survived (so far) and a lot of people I've known and loved did not.

I've lost friends, best friends, acquaintances, co-workers, grandparents, mom, relatives, teachers, mentors, students, neighbors, and a host of other folks. I have no children, and I can't imagine the pain it must be to lose a child. But here's my two cents...

I wish I could say you get used to people dying. But I never did. I don't want to. It tears a hole through me whenever somebody I love dies, no matter the circumstances. But I don't want it to "not matter". I don't want it to be something that just passes. My scars are a testament to the love and the relationship that I had for and with that person. And if the scar is deep, so was the love. So be it.

Scars are a testament to life. Scars are a testament that I can love deeply and live deeply and be cut, or even gouged, and that I can heal and continue to live and continue to love. And the scar tissue is stronger than the original flesh ever was. Scars are a testament to life. Scars are only ugly to people who can't see.

As for grief, you'll find it comes in waves. When the ship is first wrecked, you're drowning, with wreckage all around you. Everything floating around you reminds you of the beauty and the magnificence of the ship that was, and is no more. And all you can do is float. You find some piece of the wreckage and you hang on for a while. Maybe it's some physical thing. Maybe it's a happy memory or a photograph. Maybe it's a person who is also floating. For a while, all you can do is float. Stay alive.

In the beginning, the waves are 100 feet tall and crash over you without mercy. They come 10 seconds apart and don't even give you time to catch your breath. All you can do is hang on and float. After a while, maybe weeks, maybe months, you'll find the waves are still 100 feet tall, but they come further apart. When they come, they still crash all over you and wipe you out. But in between, you can breathe, you can function. You never know what's going to trigger the grief. It might be a song, a picture, a street intersection, the smell of a cup of coffee. It can be just about anything...and the wave comes crashing. But in between waves, there is life.

Somewhere down the line, and it's different for everybody, you find that the waves are only 80 feet tall. Or 50 feet tall. And while they still come, they come further apart. You can see them coming. An anniversary, a birthday, or Christmas, or landing at O'Hare. You can see it coming, for the most part, and prepare yourself. And when it washes over you, you know that somehow you will, again, come out the other side. Soaking wet, sputtering, still hanging on to some tiny piece of the wreckage, but you'll come out.

Take it from an old guy. The waves never stop coming, and somehow you don't really want them to. But you learn that you'll survive them. And other waves will come. And you'll survive them too.

If you're lucky, you'll have lots of scars from lots of loves. And lots of shipwrecks.”

It's obviously very poetic but I think hearing these words from another kid around my age, at the time, was very powerful. And has stuck with me to this day almost 18 years later.

I proceeded through life not thinking much about this then one of my close friend's mom passed away and, somehow, this came back into my awareness. I sent this article to her and I don't think it changed anything major in her life but she said it was one of the more helpful supports she'd received throughout the shockwaves of losing her parent. It's not something I send out to everyone going through a grieving process but I think it's a great, short, encouraging perspective related to processing grief. I like that it's concise so it's something very accessible for all. It's strengths-based and sets the expectation that there are no expectations. Grief is hard. You don't ever totally get used to it and the real goal is to hope you don't ever get used to it. Grief is a testament to love and not something to fear but to expect and accept. Easier said then done.

Might not be everyone's cup of tea but this resource has certainly helped me when I've had the misfortune of losing someone close to me. And it's something I hope to offer to clients in the future--when appropriate.

Again, there's no cited author that I can find on the internet but I pulled this passage from a blog post that has very pretty imagery and somewhat average commentary. Enjoy.

Jacob Bergtrom

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Waves of Grief- An Old Man’s Words — Get rid of anxiety for good

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There was an old man’s response to the question, “My friend just died, I don’t know what to do.” that went viral on the internet. I read it right after Aria died, and it has stuck with me, so I wanted to share it with you.

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Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial

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Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: A randomized double-blind trial

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I have chosen to include an article about a study that used psilocybin to address depression and anxiety in patients with life-threatening cancer. This study included 51 cancer patients with depression and anxiety who were either givin two either low dose 1-3 mg/70kg or high dose 22-30 mg/70kg of psilocybin to address what I can summarize as anticipatory grief. The results of this study were that the high dose psilocybin group showed sustained reduction of anxiety and depression that came on rapidly with 79% showing clinically significant reduction in depression and 83% in anxiety sustained for 6 months. Some additional benefical aspects of using psilocybin in this setting that address anticipatory grief are some patients reported a more positive and accepting attitudes about death that were at times acompanied by mystical-type experiences and the experience helped to address existential distress about the terminal cancer diagnosis. While this study does not directly address how psilocybin could be used in combination with therapy to address anticipatory grief it does present itself as an interesting possibility for future work with grief.

Philip Benjamin

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10 Things Grieving Children Want You to Know

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10 Things Grieving Children Want You to Know

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Much of the work I currently do is in play therapy with children who have experienced trauma or abuse. Grief over divorce, an absent or addicted parent, or the loss of a member of the immediate family are frequent concerns in my practice. When working with the children, I feel there is just as much a role in preparing parents or primary caregivers for ways to help them throughout their week. My supervisor pointed out very early on that we see these children maybe an hour a week the rest of the time, we do not. I have found that incorporating caregivers provides more effective counseling experiences and facilitates continued improvement and growth for the family after services end. Additionally, most parents or caregivers want to know how they can help.

With that in mind, the resource I selected is something specific to the death of a friend, family member, or loved one. I believe this resource could be easily printed out and given to parents providing easy-to-follow tips for helping their child navigate the loss. I love that it highlights the significance of using clear, direct language at an age-appropriate level to inform children about the loss. It also emphasizes the need to allow children to be a part of rituals, services, and celebrating anniversaries, birthdays, etc., after the loss of a loved one. Sometimes, adults may leave children out of these types of events to protect them from pain but it is important to children just as it is for adults to have a grief process, rituals, and way to memorialize the loss and have the same opportunity to connect with others. It also provides them an opportunity to see how other trusted adults are grieving and coping with the loss. These young children look to their loved ones and caregivers for role modeling healthy behaviors, so it also reminds parents/caregivers of the need to allow children to see how they are grieving and to find healthy ways to do so.

Schneider, L. (n.d.). 10 things grieving children want you to know: Eluna Network. elunanetwork.org. https://elunanetwork.org/resources/10-things-greiving-children-want-you-to-know

Anna Woodword

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Ten Things Grieving Children Want You To Know

Tell them in age-appropriate and direct language

Ask them if they have any questions and clear up misconceptions

2. Children look to you as a role model for how people grieve:

Share your feelings with them as long as they are relieved of the task of having to "fix it"

Each child will grieve in their own unique way

They will grieve alone in an effort to shield you from their pain

3. Children want to talk about their person who died:

They need you to tolerate listening when they tell their story or share their feelings

They fear that they will forget their loved one

4. Children express their emotions through play and behaviors which may be problematic for you:

They can't always tolerate intense emotions or know how to talk about them

They might make decisions you don't agree with

They need to take breaks from their grief and engage in age appropriate activities.

5. Children need to know who would take care of them if you could not:

They may fear for your safety especially when you are apart
6. Children benefit from being included in mourning rituals:

Your child needs the opportunity to participate in ongoing rituals

Rituals aid in their understanding of death

7. They need you to help them feel safe:

Provide clear and consistent boundaries, limits and expectations

Give them room to safely interact with peers and adults outside of the family

8. They need to be taught coping strategies:

Include ways to comfort themselves in your absence
9. Children need to be included when making decisions:

About how to celebrate holidays, birthdays and anniversaries

About other family circumstances such moving or changing schools.

10. Children need you to take care of yourself: they will only adapt as well as you do.

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10 Things Grieving Children Want You to Know

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Ten Things Grieving Children Want You To Know Tell them in age-appropriate and direct language Ask them if they have any questions and clear up misconceptions 2.

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Konigsberg, R. D. (2011). The truth about grief: The myth of its five stages and the new science

of loss. Simon & Schuster.

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Konigsberg, R. D. (2011). The truth about grief: The myth of its five stages and the new science

of loss. Simon & Schuster.

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The Truth About Grief, by Ruth Davis Konigsberg is a resource that will challenge and even counter some of our popular ideas of grief, including Kubler-Ross’s 5 stages of grief.  The author not only challenges the concept behind stages of grief, but presents other, much more focused, research findings that can counter our presumptions and our therapeutic upbringing.

I chose this book for several reasons, not least of which was that my supervisor is promoting the 5 stage framework to me and I realized that there are some things missing in my view of grief, grieving, and the cultural and personal expectations both therapists and clients bring into the room regarding loss and grief.

Indeed, the author notes that there is actually a stigma against people that have “the ability to achieve an acceptable adjustment to someone’s death within a relatively short period of time.”

The author backs up the themes in the book with thorough review of research, and also mentions are related book, The Other Side of Sadness by George Bonnano.

References:

Konigsberg, R. D. (2011). The truth about grief: The myth of its five stages and the new science

of loss. Simon & Schuster.

Simon and Schuster Books (2010, December 24). Ruth Davis Konigsberg discusses The Truth

About Grief [Video]. YouTube. https://youtu.be/_AAgLNxEaV8?feature=shared

Konigsberg, R. D. (2011, January 29). New Ways to Think About Grief. Time Magazine, Jan. 24,

2011 issue. https://time.com/archive/6595176/new-ways-to-think-about-grief/

Dan Shorb

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The five stages of grief are so deeply imbedded in our culture that no American can escape them. Every time we experience loss-a personal or national one-we hear them recited: denial, anger, bargaining, depression, and acceptance. The stages are invoked to explain everything from how we will recover from the death of a loved one to a sudden environmental catastrophe or to the trading away of a basketball star. But the stunning fact is that there is no validity to the stages that were proposed by psychiatrist Elisabeth Kübler-Ross more than forty years ago. Ruth Davis Konigsberg shows how the five stages were based on no science but nonetheless became national myth. She explains that current research paints a completely different picture of how we actually grieve. It turns out people are pretty well programmed to get over loss. Grieving should not be a strictly regimented process, she argues; nor is the best remedy for pain always to examine it or express it at great length. The strength of Konigsberg's message is its liberating force: there is no manual to grieving; you can do it freestyle.

In The Truth About Grief,

In the course of clarifying our picture of grief, Konigsberg tells its history, revealing how social and cultural forces have shaped our approach to loss from the Gettysburg Address through 9/11. She examines how the American version of grief has spread to the rest of the world and contrasts it with the interpretations of other cultures-like the Chinese, who focus more on their bond with the deceased than on the emotional impact of bereavement. Konigsberg also offers a close look at Kübler-Ross herself: who she borrowed from to come up with her theory, and how she went from being a pioneering psychiatrist to a New Age healer who sought the guidance of two spirits named Salem and Pedro and declared that death did not exist.

Deeply researched and provocative, The Truth About Grief draws on history, culture, and science to upend our country's most entrenched beliefs about its most common experience.

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The Truth About Grief: The Myth of Its Five Stages and the New Science of Loss

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The Truth About Grief: The Myth of Its Five Stages and the New Science of Loss [Konigsberg, Ruth Davis] on Amazon.com. *FREE* shipping on qualifying offers. The Truth About Grief: The Myth of Its Five Stages and the New Science of Loss