How Help Someone with Complicated Bereavement: Fostering Understanding and Seeking Treatment

When someone you love can’t get past their grief, you may feel helpless, confused, and frustrated. By exploring the neurological underpinnings of complicated bereavement and the risk factors for this painful condition, you can gain greater insight into what your loved one is experiencing and understand why comprehensive treatment is necessary to help them heal.

Death is a natural part of life, something that we will all both witness and experience. The grief that we feel after the death of a loved one can be profoundly painful and significantly impact our emotional stability immediate aftermath of our loss. In acute stages of grief, it can feel as if we will never be whole again. With time, however, most of us are able to move past intense feelings of loss. Our pain lifts and emotional tranquility is restored. This does not mean that we do not miss the person we have lost; it means that we have completed the natural grieving process and integrated our loss in a healthy way.

Sometimes, however, grief doesn’t end. An estimated 15% of bereaved people experience complicated bereavement, a condition in which acute grief persists for more than 6 months. Their life comes to revolve around their yearning for their loved one; they may be unable to experience joy, believe life has no meaning, feel unrelenting sadness or guilt, and are often plagued by intrusive thoughts. In order to avoid the most painful of triggers they may avoid anything that reminds them of the person they lost, including people, places, and situations.

Witnessing someone you love experience complicated bereavement can be deeply troubling. You may feel confused about why they are stuck in their loss and unsure about how to support them when the normal rules of grief don’t seem to apply. But their grief does not need to be permanent and by developing a better understanding of this phenomenon you can learn how to help someone with complicated bereavement.

The Neurological Underpinnings of Complicated Bereavement

Christina lost her husband to a massive stroke on their 30th wedding anniversary. He was only 50 years old, and Christina’s pain was unbearable. She cried constantly and, even as the weeks turned into months, her pain remained as raw as it was the moment she found him lying unconscious on the basement floor. “I couldn’t get past it. I couldn’t not think about it. Every time I started to, the memory of it would suddenly hit me like it was happening all over again.”

This sense of being trapped within acute grief is typical of people experiencing complicated bereavement. So why does this happen? Why are some people able to process grief in a healthy way while others are not? The answer appears to lie in the way complicated bereavement acts on the brain.

In 2008, researchers at UCLA used brain imaging technology to investigate differences in brain activity between people with complicated bereavement and those with healthy experiences of grief. The study showed that for those with complicated bereavement, reminders of the their loved one activates neural reward activity in the brain. “The idea is that when our loved ones are alive, we get a rewarding cue from seeing them or things that remind us of them,” says Dr. Mary-Frances O’Connor, lead author of the study. “After the loved one dies, those who adapt to the loss stop getting this neural reward. But those who don’t adapt continue to crave it, because each time they do see a cue, they still get that neural reward.”

In some ways, this cycle of reward-seeking is not unlike that experienced in addiction. Of course, this does not mean that complicated grief is intentional; the craving of neural rewards is an involuntary phenomena that strips your loved one of the ability to move beyond a place of loss. “It’s as if the brain were saying, ‘Yes I’m anticipating seeing this person’ and yet ‘I am not getting to see this person,’” Dr. O’Connor explains. “The mismatch is very painful.”

Risk Factors for Complicated Bereavement

Although Dr. O’Connor’s research offers invaluable insight into the neurological processes attendant to complicated bereavement, further study is necessary to more fully understand why neural rewards are triggered in some by not others. In the future, researchers may uncover biomarkers that can help clinicians better identify who is at risk for complicated bereavement to facilitate early intervention and lessen suffering. However, even today we know that there are experiential and psychological risk factors that increase a person’s likelihood of experiencing complicated bereavement, including:

  • Unexpected or violent death: The unexpected death, such as death from an unknown illness or accident, of a loved one means that survivors have not had the opportunity to emotionally prepare for loss. Rather, survivors are thrown into loss suddenly and they may not have the inner resources to cope. Violent death, such as murder or suicide, can also profoundly disrupt the natural grieving process.
  • Death of a child: Losing a child is one of the most painful experiences a person can have and the sense of grief is often intensely powerful and prolonged. It is possible that the brains of parents are particularly primed to experience neural rewards from reminders of their children and that outliving a child contradicts our sense of natural order.
  • Lack of a social support system: Social support is a fundamental element of healthy emotional functioning and the absence of such support can leave your loved one isolated within their suffering. This is particularly true if the deceased served as their primary source of social contact. Without trusted family and family to imbue your loved one with a sense of belonging or the opportunity to process their grief in a supportive environment, they may be less likely to move through that grief.
  • The presence of a mental health disorder, substance use disorder, or childhood trauma: People who have a mental health disorder such as depression, anxiety, or post-traumatic stress disorder (PTSD), a substance use disorder, or who have experienced childhood trauma may be particularly vulnerable to complicated bereavement due to diminished ability to process distress in healthy ways. Complicated bereavement may also augment symptoms of mental health disorders and act as a trigger for substance abuse.

It is important to remember, of course, that complicated grief may be experienced even by people without any of these risk factors.

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How to Help Someone With Complicated Bereavement

Complicated grief is both harrowing in and of itself and is associated with higher rates of suicide, serious illness, and social dysfunction. As such, it is vital that your loved one seeks treatment as early as possible in order to allow them to process their grief in healthy ways and restore emotional and behavioral harmony. The best thing you can do to help someone with complicated bereavement is to encourage them to connect with a comprehensive treatment program that can provided the specialized care needed to heal from this painful condition. Often, residential treatment is needed in order to ensure your loved one is safe and create rapid recovery.

A residential treatment program provides a warm, inclusive space in which your loved one can focus fully on healing. Surrounded by compassionate clinicians and peers, they will be able to participate in a range of evidence-based treatment modalities designed with their unique needs in mind, including individual psychotherapy and group therapies in which they can safely explore their experience of loss, receive social support, learn healthy coping mechanisms, and process any unresolved issues that may be hindering the recovery process. Ideally, the program you choose should offer programs specifically focused on grief and loss in which your loved one can grieve openly and know that they are not alone as they develop a renewed sense of purpose. By participating in a broad spectrum of targeted therapies, your loved one can break through the cycle of craving and begin to imagine life beyond grief. Treatment must also address any pre-existing mental health disorders, substance use disorders, or childhood trauma in order to facilitate complete healing.

For some, the initial suggestion of treatment may be perceived as a demand that they “get over” their loss and they may fear that healing is an act of betrayal. It is important to remind them that while healthy grief is an expression of love, complicated bereavement is pain without purpose. Healing does not diminish the depth of affection for their lost loved one, but is a way of honoring both themselves and the person they lost. They will always carry the memories of their loved one, but they can do so with joy rather than sorrow as they begin to participate in living once again.

Bridges to Recovery offers comprehensive treatment for people struggling with mental health disorders as well as co-occurring substance use disorders. Contact us to learn more about our renowned Los Angeles and San Diego-based programs and how we can help you or your loved one start on the path to lasting wellness.