Bereavement is the period of grief and mourning after a death. When you grieve, it's part of the normal process of reacting to a loss. You may experience grief as a mental, physical, social or emotional reaction. Mental reactions can include anger, guilt, anxiety, sadness and despair. Physical reactions can include sleeping problems, changes in appetite, physical problems or illness.

How long bereavement lasts can depend on how close you were to the person who died, if the person's death was expected and other factors. Friends, family and faith may be sources of support. Grief counseling or grief therapy is also helpful to some people.

Key Points

• There are three types of grief: anticipatory, normal or common, and complicated.
  • Anticipatory grief occurs before death.
  • Anticipatory grief does not affect everyone.
  • Normal or common grief begins soon after a loss and symptoms go away over time.
  • Normal grief is different from major depression.
  • Complicated grief lasts longer than normal grief.

There are three types of grief: anticipatory, normal or common, and complicated.

Anticipatory grief occurs before death.

Anticipatory grief is grief that occurs leading up to a death. It may be felt by the person dying or person's family. When a patient experiences distress, pain, and medical complications, it can add to anticipatory grief. Anticipatory grief is different from grief that occurs after the death.

Anticipatory grief does not affect everyone.

Research has shown that about one in four patients with incurable cancer feels anticipatory grief. Anticipatory grief is less likely to occur when the patient and family accept death. Talking with someone who is trained in grief and bereavement may help patients and their family come to terms with impending death.

Normal or common grief begins soon after a loss and symptoms go away over time.

Normal grief occurs in most people who have experienced a loss. During normal grief, the bereaved person accepts the loss and continues with daily activities even though it is hard to do. Common emotional reactions include:

• Emotional numbness, shock, disbelief, or denial. These often occur right after the death, especially if the death was not expected.
• Anxiety over being separated from the loved one. The bereaved may wish to bring the person back and become lost in thoughts of the deceased. Images of death may occur often in the person’s thoughts.
• Distress that leads to crying; sighing; having dreams, illusions, and hallucinations of the deceased; and looking for places or things that were shared with the deceased.
• Anger.
• Periods of sadness, loss of sleep, loss of appetite, fatigue, guilt, and loss of interest in life.

Grief bursts or pangs are short periods (20-30 minutes) of very intense distress. These bursts are caused by reminders of the deceased person, such as during holidays, the anniversary of the loved one’s death, or when giving away items that belonged to the person. At other times they seem to happen for no reason.

In normal grief, symptoms will occur less often and will feel less severe as time passes. Recovery time will vary with each person. For most bereaved people, symptoms lessen between 6 months and 2 years after the loss. Although many bereaved people have similar responses as they cope with their losses, there is no typical grief response.

Normal grief is different from major depression.

When a person grieves they can have symptoms that overlap with major depression, such as sleep problems, feelings of guilt, repeated thoughts, and lack of interest. Normal grief is different from major depression in the following ways:

• Painful feelings come and go instead of being constant.
• There are feelings of emptiness rather than sadness or not feeling pleasure.
• People have good self-esteem and do not feel worthless or badly about themselves.
• If there are thoughts of suicide, they are focused on the deceased person, such as a wish to join them in death, instead of thoughts about oneself.

A bereaved person can be diagnosed with major depression if they have symptoms that occur outside of the normal grief process.

Complicated grief lasts longer than normal grief.

Complicated grief is when symptoms don't improve and last for a long period of time, cause extreme distress, affect multiple areas of their lives, and decrease the ability to take part in daily activities.

After loss, there is no specific way to grieve that is right or wrong. There's not a normal length of time to grieve either. Learn about common grief reactions and how to recognize if you would benefit from treatment for grief.

Common Grief Reactions

After loss, there is no specific way of grieving that is right or wrong, and there is not a "normal" length of time to grieve. While everyone experiences grief differently, there are many common grief reactions:

• Physiologically, grief may disrupt sleep patterns, cause changes in stress hormones and health, and lead to physical symptoms such as weakness, trouble breathing, restlessness and immune system changes.
• Emotionally, strong feelings of sadness, loneliness, fear, anxiety or resentment and anger can occur. Some people who are in mourning may feel a sense of guilt when they start to re-engage in activities and relationships, as if they are somehow betraying the person who died.
• Mentally, the bereaved person may have trouble accepting the loss, difficulty concentrating and making decisions, changes to their sense of identity or the belief that their future is disrupted. They may sometimes avoid thinking about the loss, while at other times they may be unable to stop thinking about it. They may find themselves making special efforts to include the person's memory in their life. They may fear forgetting the person who died, or fear losing fond memories of their time with that person.
• Socially, the bereaved person may experience loneliness, boredom, social withdrawal, lack of confidence, emotional sensitivity (or feeling "overemotional"), self-consciousness, as well as difficulties developing new relationships.

While these reactions are common after the loss of someone close, the extent to which they occur depends upon many factors. The nature of the relationship with the deceased, the grieving person's personality style and typical coping strategies and the environment in which the person works or lives can all play a role. Some people do not appear to need to grieve as deeply as others, even for those they most love. In addition, the bereaved can sometimes feel as much relief as sorrow, especially when the person who died had been suffering or in pain.

The Course of Grief

The amount of time a person grieves will depend on many factors, including the circumstances of the death, the nature of their relationship to the deceased and their own personal needs. The popular "stage theory," in which grief passes through five stages—denial, anger, bargaining, depression, and acceptance—may be appealing in that it makes it seem that loss can be controlled. However, research suggests that grief doesn't follow a set of stages. It's a more complicated, ongoing process that comes in waves.

As time goes by, the intensity of grief may lessen, but the person may still have periods when they feel intense emotions. Over time the cycle widens, with a gradual return to a more balanced state. Intense emotions tend to come and go. A 35-year study found that for some, grief fades only gradually, after many years have passed. Reflective thoughts and memories happen less frequently over time, but they may not stop completely, and many bereaved individuals maintain the sense of having an internal ongoing relationship with the person who died.

Prolonged or Complicated Grief

Approximately 10% of the population (or 1 out of every 10 people) experiences a prolonged, impairing reaction when they are grieving. This is called prolonged or complicated grief. This type of grief reaction is sometimes a combination of posttraumatic stress reactions and separation distress. It can include:

• Yearning or longing for the deceased
• A feeling that life is unbearable
• Preoccupation with or difficulty accepting the death
• Intrusive, disturbing images, a sense of hopelessness
• A wish to die to join the deceased
• Avoidance of reminders of the death

The person may feel guilty about their behavior toward the deceased in life, or for living when the deceased person is not. They may feel that they caused or contributed to the death, that they should have prevented the death or that they should have been the one who died.

Complicated grief can be accompanied by:

• Emotional numbness
• Difficulty planning the future
• Loss of identity
• Feeling the future is cut short
• Retreat from others
• Anger and guilt over not having more typical grief reactions

If these reactions linger for months, cause significant distress or interfere with functioning, mental health treatment can help.

When you are grieving a loss, you also need to take care of yourself. Although not everyone experiences grief the same way, there are things you can do to support self-care. Learn some tips that are shown to reduce grief over time to help care for yourself.

There are many ways to take care of yourself when you are grieving. Many factors will influence your choice of self-care strategies, such as the amount of time since the death, your background and personality, your relationship with the person who died, and competing demands in the wake of the death. Grieving a death resulting from a disaster or public health crisis presents its own challenges. Here are a few strategies that have been noted by others to mitigate or reduce grief over time. Not all of them are necessary or appropriate for everyone, but they may provide some possible options for self-care.

Social Connectedness

Giving and getting social support, as well as feeling that you belong, are important for coping and wellbeing. Here are some ways to connect with others you trust while you are grieving:

Talk with those who bring comfort when you feel up to it

Not everyone feels comfortable talking openly about personal losses. We all make our own choices about when, where, with whom, and whether we want to express our feelings. In public health or disaster contexts, the option to gather or mourn in a traditional way may be limited and can make reaching out even more difficult. Even with such potential obstacles, consider making the effort to talk with those you feel most comfortable with, because evidence suggests that opening up about loss can improve mental and physical health. Talking can also help you understand your own emotions and feel understood, rather than alone or isolated.

Reach out to those who have been through similar situations

The most helpful support often comes from people who have suffered similar losses. Instead of saying, "I'm sorry for your loss," they might validate what you're experiencing and let you know how they got through it. Just being in touch with them may feel comforting. Seeing how they've endured may give you hope or help you to feel less alone. They may not have to say many words, but you still feel understood by the kinship of shared or similar experiences.

Be clear and authentic when others reach out to you

You can make better connections by being authentic or true to yourself. For instance, if you automatically answer the question "How are you?" with, "Fine," it doesn't encourage those you're close with to ask further questions. In order to get better support you could say something like, "I'm not fine, but I appreciate you asking and it's nice to be able to be honest about that with you." If you don't feel ready to talk more just then, let them know the best times and ways to reach out, and what is most helpful. If it feels right, you can also tell them that it's okay for them to ask you questions or talk about how they feel too.

Adjusting Self-Talk

Being flexible in what you expect of yourself while grieving can help you accept the loss you feel and move toward feeling better. Here are some ways to take better care of yourself during times of grief:

Be kind to yourself

Grief can take a toll on our energy and ability to function. Be patient with yourself and adjust your expectations about what you are able to accomplish each day. You may not be able to control when emotions arise. Grief tends to come in waves, sometimes when least expected. Make time and space for the feelings when you can, to help you process the experience. Then realize that there are moments when the pain temporarily eases up. No matter how sad you feel, another break will eventually come. It can help you regain a sense of control.

Realize that there is no standard way to grieve

Grief can be complicated, especially after a sudden, unexpected loss, the shock of the death can cause you to feel numb and delay or interfere with grieving. It's important to not also feel bad about yourself for not "feeling" something like what you or your family would expect. Just let your reactions follow at their own pace. But remember, most people who have lived through loss say that the sadness or despair do decrease with time.

Adjust beliefs and thoughts that don't serve you

Some people get stuck in beliefs that may fit most of the time but don't serve all the time. For instance, you may define friendship by what you can offer, such as advice, support, or practical help, but you may need to change this pattern when grieving. Try reframing your belief to one of "friendship isn't only what you can give, it"s what you're able to receive." By connecting with others, you can potentially feel better sooner, as well as be able to give back to others going through similar situations in the future.

Strong feelings and thoughts are common following sudden loss, especially when a person is overwhelmed or trying to regain control by blaming themselves or others. But this can prolong the grieving process. Here are some common thoughts that occur with grief, along with some potentially more helpful thoughts:

• "I will always feel this awful," can become something like: "I often feel this awful, but over time it might just be sometimes." Or, "There are people I can talk who might help me feel better."
• "I should have done something to prevent this," can become something like: "I did the best I could under the circumstances, with what I knew at the time."
• "It should have been me," can become something like: "All I can do now is live the present moment as it is," or, "That choice belongs to a higher power."

Focus on making meaning or gaining a broader view

One way to do this is to find ways to honor the loss. Once the initial shock of the loss begins to decrease, many bereaved people pay tribute to their loved ones by creating some way to honor the person. They also find ways to help them feel connected to the person who has died. Engaging in these processes can give life continued meaning and allow you to live in a way that honors and reaffirms your relationship. It can also help you begin to live more fully, or to live as you believe the other person would want you to live.

Accepting that loss is inevitable—we will all die someday—may also help offset the pain with a broader perspective. A religious, spiritual or philosophical perspective can also help you gain a broader view, as well as a sense that you or your loved ones are looked after. It may also help you feel that you have a connection to something much larger than yourself, or to a universal human experience.

Focus on healing

If you continue to struggle with daily activities or feel high levels of distress from grief, post-traumatic symptoms, or depression, there are experts who can help. Consider talking to someone who focuses on complicated or prolonged grief. There are evidence-based treatments that can help you learn to correct unhelpful thoughts and beliefs, find positive coping strategies, and gain meaning from the loss. Treatment can help you find ways to honor and maintain positive memories of those you lost, work towards accepting the death, manage emotions like anger or avoidance, resume normal day-to-day life, and look forward to a better future.

It is not always clear how to help someone manage grief. You may have to make choices about how to offer support to someone after a loss. Learn about factors that may affect your options and some ways you can be there for someone who is grieving.

Strategies for Offering Support

When you reach out to help someone who is grieving a loss, a number of things can affect your choices. These factors can include the amount of time that has passed since the loss, your personality, the grieving person's personality, the nature of your relationship, your past experiences, and the amount of time and energy you may have to be of support. Supporting someone who is grieving a death resulting from a disaster or public health crisis presents its own challenges, perhaps making it difficult to physically be together. Here are a few strategies that may be helpful:

Let the person know you are there for them

Sometimes friends, family, and coworkers can disappear after a loss. They may not know what to say, worry they will say the wrong thing or overstep, fear causing more pain, feel somehow guilty about the death, or fear they can't do enough to make the grieving person feel better. Some people may see a person drowning in sorrow and then worry that they will be dragged under too. Don't let these doubts and fears get in the way of reaching out to let the person know you care. Even people who have endured the worst suffering often can benefit from an expression of caring, or from practical assistance, being included in activities, or a simple conversation.

Know what is most helpful

Two things people in pain commonly want to know are that they're not "crazy" to feel the way they do, and that they have support. Those who are grieving don't expect you to "fix" their pain but do need to know that you are with them in their suffering. You can say something like, "I know you have to be hurting, and maybe you don't know what will happen next, and neither do I. But you won't go through this alone. I will be there with you."

Particularly if you are not close to the person, it may be tempting to quickly say, "I'm sorry for your loss," or offer platitudes—or common statements—like, "It's going to be okay," which can leave a person wondering, "How do you know it is going to be okay?" of saying, "You will get through this," which may be hard for the person to believe under the circumstances, let them know that you're in it with them, by saying something like, "We're here for you, whatever you need." Or you can send text messages, emails or cards with the message: "You are not alone," "I'm thinking of you," or, "We're here for you."

A survey of people who were grieving studied what they felt was helpful and what was not, particularly soon after a loss. Helpful support included direct expressions of empathy, willingness to talk about the deceased (including saying their name), offers of practical support, asking about the impact of the death, and acknowledgement of the difficulty of the situation. Less appreciated were a casual or passive attitude, statements that the death was in any way for the best or acceptable (e.g., "It was their time to go," "It's God's will"), avoiding talking about the death or the person who died, and assumptions that the bereaved person was strong and could get through grief period. If the grieving person expresses these thoughts, you can respectfully acknowledge the feeling or thought, but don't begin with statements like these yourself.

Be sincerely interested and caring

Be an "opener." Openers are people who ask questions and listen to the answers without judging. They are naturally curious and enjoy learning about and feeling connected to others. In helping others through grief, the most effective openers don't always have to be the closest of friends. Openers can make a big difference in times of crisis, especially for those who are normally reserved, or worried about being a "burden" on others by starting conversations about their feelings.

When asking questions, it's important to convey sincere interest or your questions may come across as insincere. Simply asking, with real feeling, "How are you today?" shows that you are aware that a person may be struggling to get through their day. It also shows understanding that the most intense levels of grief might not be constant or permanent.

Offer empathy

If you do not feel comfortable asking questions or starting a conversation with the grieving person, you could send a text message with something simple like, "I know I can't possibly know what you're going through, but I'm here for you. I've been thinking about you." Offer empathy with the message that the person is not alone. If you have been through a similar loss, you might let the person know, without sharing too much of your own story at first but offering to talk more if it would help.

Offer a menu of options for support

Rather than making assumptions about whether the person wants to talk, offer a menu of options and see if they take any of them. Simply showing up can make a huge difference. Say, "I'm here if you ever want to talk—now, later, even in the middle of the night. Whatever would help you." You can let the person know that if they need you, they can call any time. Just knowing it's an option may be enough for the person to feel better, even if they never take you up on the offer.

Often, you might sincerely ask, "Is there anything I can do?" but the person does not have an answer. The question may make the person feel as if they should know what they need, even if they don't. Or, they might know of things that would be helpful but feel that it would be too much to ask of you. It may be more helpful for you to offer some practical or supportive action. Rather than offering to do "anything," offer to do something specific—like mowing the lawn, picking up family, holding the person's hand, or bringing food. Or you can just make the choice to do something for the person but give them some measure of control in the process. Specific acts help because instead of trying to fix the problem, they free up the person to have more time to grieve in their own way.

Most importantly, show up over and over, and make it clear that you will be there when the person needs you.

Be genuine and reliable

Grieving can come in waves and last a long time. Continue to check in with the person regularly. Make it clear that you truly want to help, so they don't feel like a burden. Convey the message, "I'm checking in because I care about you. I just want to let you know that I'm here." Or find ways to spend time with them without the need for talking. Caring for someone in this way means that when they are hurting, you cannot imagine being anywhere else.

Many who are grieving find that they really appreciate contact months later, when most interest has dropped off. This is especially true on anniversaries, birthdays, or holidays that remind them of their loss. A text, call, card, or email can be a much-needed reminder that even over time, they are not alone.

As the worst of the grief fades, the person may feel the need to restore balance in their friendships, so they don't feel one-sided. They may want those close to them to know they are there to help carry their troubles too. Make sure you allow this shift and let them offer help or assistance in other ways, so that they benefit from feeling like they have something to contribute to the friendship.

Be sensitive to unique factors that affect the person

There's no one way to grieve and there's no one way to comfort. And what helps a person one day might not help that person the next day. When someone is suffering, instead of following the Golden Rule, follow the Platinum Rule, which is: treat others as they want to be treated. The person who is grieving may worry about stigma and feel less able to talk openly as a result. They may experience anger, lower functioning, or illness. Try to avoid judgment. Take your cues from the person and respond with understanding or action that meets their needs.

Help challenge the person

Some people might need to be reminded that, though grieving, they still need to set and achieve goals at work, school, or in other areas of their lives. Challenging someone could backfire, but if you know the person well enough, encouragement like this might provide a needed jolt of confidence. A gentle reminder that they could fail by failing to try may help. You may also challenge them to reach out for more formal help from a mental health professional, mentor, or clergy member, if they are experiencing a significant amount of emotional pain or struggling to function for an extended period of time.

As people grow older, they may lose significant people in their lives, including spouses and cherished friends. Or, they may have to move away from home or give up favorite activities. A doctor who knows about your losses is better able to understand how you are feeling. He or she can make suggestions that may be helpful to you.

Although it is normal to mourn when you have a loss, later life does not have to be a time of ongoing sadness. If you feel sad all the time or for more than a few weeks, let your doctor know. Also, tell your doctor about symptoms such as lack of energy, poor appetite, trouble sleeping, or little interest in life. These could be signs of depression, which is a medical condition.

Depression is a common problem among older adults, but it is NOT a normal part of aging. Depression may be common, especially when people experience losses, but it is also treatable. It should not be considered normal at any age. Let your doctor know about your feelings and ask about treatment.

During COVID-19, keeping physical distance from others to prevent the spread of the disease has been challenging for everyone. Older adults are at greater risk of COVID-19, but it is critically important for them to stay connected to others. If you are feeling isolated or lonely a lot of the time due to COVID-19, you may want to tell your doctor or health professional. Learn more about how to stay connected if you are experiencing loneliness and social isolation.

Sometimes people find grief counseling makes it easier to work through their sorrow. Regular talk therapy with a grief counselor or therapist can help people learn to accept a death and, in time, start a new life.

There are also support groups where grieving people help each other. These groups can be specialized—parents who have lost children or people who have lost spouses, for example—or they can be for anyone learning to manage grief. Check with religious groups, local hospitals, nursing homes, funeral homes, or your doctor to find support groups in your area.

An essential part of hospice is providing grief counseling, called bereavement support, to the family of someone who was under their care. You can also ask hospice workers for bereavement support, even if hospice was not used before the death.

Remember to take good care of yourself. You might know that grief affects how you feel emotionally, but you may not realize that it can also have physical effects. The stress of the death and your grief could even make you sick. Eat well, exercise, get enough sleep, and get back to doing things you used to enjoy, like going to the movies, walking, or reading. Accept offers of help or companionship from friends and family. It’s good for you and for them.

If you have children, remember that they are grieving, too. It will take time for the whole family to adjust to life without your spouse. You may find that your relationship with your children and their relationships with each other have changed. Open, honest communication is important.

Mourning takes time. It’s common to have roller coaster emotions for a while.

Let major decisions wait, if possible.

Try to delay major life decisions until you are feeling better. You don’t want to decide to make a big change, like selling your home or leaving your job, when you are grieving and perhaps not thinking clearly.

Everyone goes through tough times in life. But many things can help you survive—and even thrive—during stressful periods. There’s no one-size-fits-all approach. Learning healthy ways to cope and how to draw from resources in your community can help you build resilience.

“Resilience is the extent to which we can bounce back from adverse events, cope with stress, or succeed in the face of adversity,” says Dr. Cindy Bergeman, a psychology professor at the University of Notre Dame.

You’re not born with resilience. “It’s not something you either have or don’t have,” says Dr. Alexandra Burt, a child development expert at Michigan State University.

“Resilience is a process in which many factors—including family, community, and cultural practices—interact. It boosts wellness and protects you from risks to your well-being. For many people, these risks are compounded by hardship and discrimination,” adds Dr. Lisa Wexler, who studies suicide prevention at the University of Michigan.

Researchers are studying what helps people become more resilient. Creating healthy habits and taking care of yourself can help. And so can family, friends, and your connection to community and culture.

Finding Your Strengths

Stress can cause wear and tear on the body and brain. Chronic stress has been linked to an increased risk of many health conditions. These include heart disease, high blood pressure, depression, and anxiety.

Many stressful situations can’t easily be changed by one person. And some—such as parenting or a challenging job—can be things you want to do, even if they’re taxing.

But resilience isn’t just about eliminating stress. It’s also about tapping into your strengths. Researchers call these protective factors. “They can buffer stress or directly promote well-being—and sometimes even do both,” Wexler says.

Your strengths include those of your neighborhood and community. Different cultures have developed different ways to help people cope. The ceremonies, teachings, and cultural practices that are meaningful to you can help, Wexler says.

Other protective factors involve nurturing your body. “Being able to manage your stress is key to what underlies resilience. And a healthy body is going to deal with stress much better,” says Bergeman.

Other tools are emotional, like expressing your feelings rather than bottling them up, she explains. Looking at problems from different angles can help, too.

“Can you see a difficulty in a more positive way?” Bergeman asks. “For example, you can look at a stressful situation as a growth opportunity instead of thinking of it as a threat. Ask yourself: What can I learn from this situation?”

Meeting your own needs also makes a difference. “We’re often so busy trying to take care of other people that we don’t do good self-care. I encourage people to do something that they enjoy every single day. Many people feel guilty about that. But it really helps us replenish our emotional reserves, just like a meal fills our physical reserves,” says Bergeman.

In times of stress, self-care can be the opposite of selfish. Adults who take time for themselves can better help nurture resilience in children, says Burt. “One of the best things any parent can do for their child is to be well and healthy themselves. That makes it a lot easier for you to provide the support your child needs.”

Tapping Into Resources

Another part of resilience is about using the resources available to you. More and more, researchers are understanding that resilience doesn’t happen in a vacuum.

“The presence of resilience in a person is related to the supports around them,” Burt says. For example, she and her team found that growing up in a very impoverished neighborhood can change the way a child’s brain develops. But when adults in the community work together to support and monitor neighborhood children, it helps protect the children’s brains despite their circumstances. “A child can be resilient because they have these resilience-promoting things around them,” Burt explains.

Supportive adults don’t have to be a parent or relative, Burt says, though they often are. Some kids don’t have supportive families.

“That supportive person can also be a teacher, or someone else who’s important to them. Just one person who they really feel has their back,” she says.

Wexler is part of the NIH-funded Alaska Native Collaborative Hub for Research on Resilience (ANCHRR). This is a group of researchers working with local community leaders. They are studying which cultural strengths help protect Alaska Native young people from suicide.

Many protective factors for these young adults come from their community’s culture. “Access to cultural resources combined with the ability to use them is what helps lower suicide risk,” says Dr. James Allen from the University of Minnesota.

ANCHRR is also looking at how the cultural and spiritual practices that Alaska Native communities harness work to protect youth against the suicide and other risks they face.

Choosing Your Tools

The tools that best help you offset stress can differ from situation to situation, says Bergeman.

“Sometimes you have a stressor where you need to take action and solve the problem. But for other types of stressors, maybe you need emotional support,” she says. “A way to think about resilience may be: How do you match what you need with the kinds of tools that you have?”

In a way, practice makes perfect, Bergeman says. Keep tabs on what felt helpful to you during stressful times. Ask yourself: How did you deal with it? Did you choose a healthy strategy? How might other people have helped you deal with it?

“That can prepare you for the next experience that may be more difficult,” Bergeman says.

Building Resilience

Nurturing your body, brain, and social connections can help you bounce back from stress.

• Develop healthy physical habits. Healthy eating, physical activity, and regular sleep can improve your physical and mental health.
• Take time for yourself. Make taking care of yourself part of your daily routine. Take time to notice the good moments or do something that you enjoy, like reading a book or listening to music.
• Look at problems from different angles. Think of challenging situations as growth opportunities. Try to see the positive side of things. Learn from your mistakes and don’t dwell on them.
• Practice gratitude. Take time to note things to be thankful for each day.
• Explore your beliefs about the meaning and purpose of life. Think about how to guide your life by the principles that are important to you.
• Tap into your social connections and community. Surround yourself with positive, healthy people. Ask friends, family, or trusted members of your community for information or assistance when you need it. Look for cultural practices that you feel help in times of stress.
• Get help for mental health and substance use disorders. Talk with a health care professional if you’re having trouble coping. Or call SAMHSA’s free national helpline at 1-800-662-HELP. If you or someone you know is thinking about suicide, you can call the National Suicide Prevention Lifeline at 1-800-273-TALK. You can also text “HOME” to the Crisis Text Line at 741741.

Losing someone you love can change your world. You miss the person who has died and want them back. You may feel sad, alone, or even angry. You might have trouble concentrating or sleeping. If you were a busy caregiver, you might feel lost when you’re suddenly faced with lots of unscheduled time. These feelings are normal. There’s no right or wrong way to mourn. Scientists have been studying how we process grief and are learning more about healthy ways to cope with loss.

The death of a loved one can affect how you feel, how you act, and what you think. Together, these reactions are called grief. It’s a natural response to loss. Grieving doesn’t mean that you have to feel certain emotions. People can grieve in very different ways.

Cultural beliefs and traditions can influence how someone expresses grief and mourns. For example, in some cultures, grief is expressed quietly and privately. In others, it can be loud and out in the open. Culture also shapes how long family members are expected to grieve.

“People often believe they should feel a certain way,” says Dr. Wendy Lichtenthal, a psychologist at Memorial Sloan-Kettering Cancer Center. “But such ‘shoulds’ can lead to feeling badly about feeling badly. It’s hugely important to give yourself permission to grieve and allow yourself to feel whatever you are feeling. People can be quite hard on themselves and critical of what they are feeling. Be compassionate and kind to yourself.”

Adapting to Loss

Experts say you should let yourself grieve in your own way and time. People have unique ways of expressing emotions. For example, some might express their feelings by doing things rather than talking about them. They may feel better going on a walk or swimming, or by doing something creative like writing or painting. For others, it may be more helpful to talk with family and friends about the person who’s gone, or with a counselor.

“Though people don’t often associate them with grief, laughing and smiling are also healthy responses to loss and can be protective,” explains Dr. George Bonanno, who studies how people cope with loss and trauma at Columbia University. He has found that people who express flexibility in their emotions often cope well with loss and are healthier over time.

“It’s not about whether you should express or suppress emotion, but that you can do this when the situation calls for it,” he says. For instance, a person with emotional flexibility can show positive feelings, like joy, when sharing a happy memory of the person they lost and then switch to expressing sadness or anger when recalling more negative memories, like an argument with that person.

Grief is a process of letting go and learning to accept and live with loss. The amount of time it takes to do this varies with each person. “Usually people experience a strong acute grief reaction when someone dies and at the same time they begin the gradual process of adapting to the loss,” explains psychiatrist Dr. M. Katherine Shear at Columbia University. “To adapt to a loss, a person needs to accept its finality and understand what it means to them. They also have to find a way to re-envision their life with possibilities for happiness and for honoring their enduring connection to the person who died.”

Researchers like Lichtenthal have found that finding meaning in life after loss can help you adapt. Connecting to those things that are most important, including the relationship with the person who died, can help you co-exist with the pain of grief.

Types of Grief

About 10% of bereaved people experience complicated grief, a condition that makes it harder for some people to adapt to the loss of a loved one. People with this prolonged, intense grief tend to get caught up in certain kinds of thinking, says Shear, who studies complicated grief. They may think the death did not have to happen or happen in the way that it did. They also might judge their grief—questioning if it’s too little or too much—and focus on avoiding reminders of the loss.

“It can be very discouraging to experience complicated grief, but it’s important not to be judgmental about your grief and not to let other people judge you,” Shear explains.

Shear and her research team created and tested a specialized therapy for complicated grief in three NIH-funded studies. The therapy aimed to help people identify the thoughts, feelings, and actions that can get in the way of adapting to loss. They also focused on strengthening one’s natural process of adapting to loss. The studies showed that 70% of people taking part in the therapy reported improved symptoms. In comparison, only 30% of people who received the standard treatment for depression had improved symptoms.

You may begin to feel the loss of your loved one even before their death. This is called anticipatory grief. It’s common among people who are long-term caregivers. You might feel sad about the changes you are going through and the losses you are going to have. Some studies have found that when patients, doctors, and family members directly address the prospect of death before the loss happens, it helps survivors cope after the death.

Life Beyond Loss

NIH-funded scientists continue to study different aspects of the grieving process. They hope their findings will suggest new ways to help people cope with the loss of a loved one.

Although the death of a loved one can feel overwhelming, many people make it through the grieving process with the support of family and friends. Take care of yourself, accept offers of help from those around you, and be sure to get counseling if you need it.

“We believe grief is a form of love and it needs to find a place in your life after you lose someone close,” Shear says. “If you are having trouble moving forward in your own life, you may need professional help. Please don’t lose hope. We have some good ways to help you.”

Coping With Loss

• Take care of yourself. Try to exercise regularly, eat healthy food, and get enough sleep. Avoid habits that can put your health at risk, like drinking too much alcohol or smoking.
• Talk with caring friends. Let others know if you need to talk.
• Try not to make any major changes right away. It’s a good idea to wait for a while before making big decisions, like moving or changing jobs.
• Join a grief support group in person or online. It might help to talk with others who are also grieving. Check with your local hospice, hospitals, religious communities, and government agencies to find a group in your area.
• Consider professional support. Sometimes talking to a counselor about your grief can help.
• Talk to your doctor. Be sure to let your healthcare provider know if you’re having trouble with everyday activities, like getting dressed, sleeping, or fixing meals.
• Be patient with yourself. Mourning takes time. It’s common to feel a mix of emotions for a while.