1 00:00:02,640 --> 00:00:07,650 Thanks very much for joining us this morning for the latest in mental wellness sessions, 2 00:00:07,650 --> 00:00:12,870 which are brought to you by the Department of Experimental Psychology here at the University of Oxford. 3 00:00:12,870 --> 00:00:17,910 My name's Cathy Creswell and I'm really pleased to introduce this session. 4 00:00:17,910 --> 00:00:21,660 But just before we get started, I just want to mention a few things to you. 5 00:00:21,660 --> 00:00:27,090 First of all, just to say, we've now gotten quite a large series of webinars in this series, 6 00:00:27,090 --> 00:00:31,140 all on different topics relating to mental health and wellbeing, 7 00:00:31,140 --> 00:00:38,550 and all offering very practical advice based on sound scientific evidence by leading experts in the field. 8 00:00:38,550 --> 00:00:44,190 So please do have a look at the experimental psychology website and experimental psychology YouTube channel, 9 00:00:44,190 --> 00:00:50,550 where you can find all of those previous sessions, which I hope will be of interest and helpful for the next session. 10 00:00:50,550 --> 00:00:55,080 After today will be on the 27th of January at 10 o'clock in the morning, 11 00:00:55,080 --> 00:01:02,100 and that will be by Professor Paul Salkovskis talking about managing obsessive compulsive thoughts and behaviours. 12 00:01:02,100 --> 00:01:06,620 But now I'm delighted to introduce Dr Kirstin Smith to you 13 00:01:06,620 --> 00:01:13,140 who who will be talking about Coping with Grief after a Bereavement and custody is an MRC clinical scientist, 14 00:01:13,140 --> 00:01:20,790 fellow and a clinical psychologist in the Department of Experimental Psychology here and in the Oxford Centre for Anxiety Disorders and Trauma. 15 00:01:20,790 --> 00:01:24,570 And she's also a trustee and head of research for the charity The Lost Foundation, 16 00:01:24,570 --> 00:01:29,050 who provide free, facilitated group support to those who've lost loved ones to cancer. 17 00:01:29,050 --> 00:01:35,760 So she brings a huge wealth of experience and expertise on the topic that we're covering today. 18 00:01:35,760 --> 00:01:39,450 As you know, we're going to, first of all, have a talk from Kirstin, 19 00:01:39,450 --> 00:01:46,140 and then we'll open up to have a bit of a discussion based on the questions that have been submitted before the event today. 20 00:01:46,140 --> 00:01:49,530 And we were really pleased to receive a really large number of questions. 21 00:01:49,530 --> 00:01:56,070 So we've pulled out some of the key themes from those and we'll try to cover as much of that as possible. 22 00:01:56,070 --> 00:01:59,880 And just one last thing to say before I hand over to Kirsten, and that is that, of course, 23 00:01:59,880 --> 00:02:05,730 all of these sessions deal with topics that can be quite challenging for us as individuals. 24 00:02:05,730 --> 00:02:13,680 So we'll make sure that we we stop at 10:45 and we'd like to really encourage you to take a bit of time after the session. 25 00:02:13,680 --> 00:02:19,650 Give yourself a bit of space before you move on to your next activity in case any of the 26 00:02:19,650 --> 00:02:25,020 things that we talk about today may raise some difficult issues or feelings for you. 27 00:02:25,020 --> 00:02:28,410 So please do take some time, give yourself a bit of space. 28 00:02:28,410 --> 00:02:35,970 But without any further ado, I'm delighted to hand over to Dr. Kirsten Smith to talk to us about coping with grief after a bereavement. 29 00:02:35,970 --> 00:02:44,030 Thanks very much, Kirsten. Thank you, Cathy. OK. 30 00:02:44,030 --> 00:02:54,560 I'd like to start with a quick pop quiz. So I'm going to ask you to think about what is grief, according to film and TV. 31 00:02:54,560 --> 00:03:04,490 Here's a quick example. There are five stages to grief which are denial, anger, bargaining, depression and acceptance. 32 00:03:04,490 --> 00:03:15,320 And right now out there, they are all denying the fact that they're sad and that's hard and it's making them all angry. 33 00:03:15,320 --> 00:03:21,050 And it is my job to try to get them all the way through to acceptance. 34 00:03:21,050 --> 00:03:27,660 And if not acceptance, then just depression. If I can get them depressed then I'll have done my job. 35 00:03:27,660 --> 00:03:32,370 Now you look heard about the five stages model again and again. 36 00:03:32,370 --> 00:03:36,420 But what you might not know is that the stages of grief that they're talking 37 00:03:36,420 --> 00:03:41,850 about here were never actually formulated for bereavement researcher called 38 00:03:41,850 --> 00:03:47,940 Elisabeth Kubler-Ross proposed this model after working with clients with terminal cancer as a 39 00:03:47,940 --> 00:03:53,550 way of coming to terms with their own deaths. It was never intended to be applied to bereavement, 40 00:03:53,550 --> 00:03:59,010 and to date, there have been no empirical studies supporting its validity. 41 00:03:59,010 --> 00:04:05,560 So having said that, What do we in the research world understand grief to be? 42 00:04:05,560 --> 00:04:11,140 Well, strictly speaking, bereavement is the experience of the death of someone close to you. 43 00:04:11,140 --> 00:04:14,920 And grief is your response to that bereavement. 44 00:04:14,920 --> 00:04:22,000 Grief responses tend to be the most intense and distressing in the first six to 12 months after the loss. 45 00:04:22,000 --> 00:04:26,230 But what are these responses that I'm talking about? 46 00:04:26,230 --> 00:04:35,380 All of these pieces of art were either completed by artists who were grieving loved ones themselves or who I think were commenting on grief. 47 00:04:35,380 --> 00:04:40,570 And I've chosen these 10 because I think they map up quite well on to the experiences of grief that 48 00:04:40,570 --> 00:04:47,170 we understand from the literature as the symptoms of prolonged grief disorder or PGD for short. 49 00:04:47,170 --> 00:04:53,710 Now, I should say that each of these experiences are completely normal after bereavement, 50 00:04:53,710 --> 00:05:02,770 but it is the intensity and the chronicity of them that make them something that's worthy of specialist support. 51 00:05:02,770 --> 00:05:09,700 Persistent longing or yearning for the person who died is often the most commonly reported grief experience. 52 00:05:09,700 --> 00:05:16,840 And this was once described to me by a client. It's like losing your phone or your keys, but a million times more intense. 53 00:05:16,840 --> 00:05:25,790 It's this sense that you are missing something and your body is trying to encourage you to find it to instigate some kind of reunion. 54 00:05:25,790 --> 00:05:34,770 But obviously, in the case of bereavement, that's not possible. Preoccupation with thoughts or memories of the lost person. 55 00:05:34,770 --> 00:05:42,600 Now these can be frequently distracting and disturbing in nature and are often accompanied by very intense emotions. 56 00:05:42,600 --> 00:05:47,790 This piece on the slide was painted by Munch, depicting the moment of death of his sister, 57 00:05:47,790 --> 00:05:54,390 and he painted six different versions of this painting over a period of about 30 years or so, 58 00:05:54,390 --> 00:06:00,120 which suggests that he was particularly preoccupied by this memory in this image. 59 00:06:00,120 --> 00:06:09,540 In terms of the thoughts that someone might struggle with, it might be thoughts relating to things they wish they had or hadn't done before, 60 00:06:09,540 --> 00:06:16,810 during or after the loss or preoccupations with the way that life has changed since the loss. 61 00:06:16,810 --> 00:06:20,050 Memories might be traumatic, like the one shown on the slide, 62 00:06:20,050 --> 00:06:29,750 or they might be happy memories that now because the person has died are associated with pain and disbelief. 63 00:06:29,750 --> 00:06:38,720 It's common to feel confusion about your role in life after a significant bereavement or like a part of you has died or something's missing. 64 00:06:38,720 --> 00:06:44,240 A death can also come with the loss of a role such as being a partner, parent, 65 00:06:44,240 --> 00:06:51,530 carer, which can make it even more challenging to re-imagine yourself after a loss. 66 00:06:51,530 --> 00:06:59,420 I mentioned disbelief earlier, will shock, particularly after a sudden traumatic bereavement is another typical experience, 67 00:06:59,420 --> 00:07:05,750 and this sense of disbelief is something that we think gradually declines as we 68 00:07:05,750 --> 00:07:12,650 make sense of our loss and we process the death as something that is permanent. 69 00:07:12,650 --> 00:07:18,470 Avoidance of reminders can be external, like avoiding going somewhere that reminds you of the loss, 70 00:07:18,470 --> 00:07:22,850 such as hospitals or somewhere that you went with the person. 71 00:07:22,850 --> 00:07:34,080 Or it can also be internal, like avoiding thinking about or remembering the loss or even avoiding feelings that you might have about the loss. 72 00:07:34,080 --> 00:07:41,790 Intense emotional pain, whether that be sadness, anger, guilt, hopelessness, despair, 73 00:07:41,790 --> 00:07:50,130 these are all very common and appropriate after a significant loss too. this painting by Cramski was painted after the death of his two young sons. 74 00:07:50,130 --> 00:07:56,280 But this time it was more socially acceptable to paint women as the mourners rather than men. 75 00:07:56,280 --> 00:08:05,660 So he painted his wife in mourning instead of himself. Finding it difficult to move forward with life after death. 76 00:08:05,660 --> 00:08:14,210 This is a picture of Lucy, Lucian Freud's mother who fell into a deep depression after the death of her husband and at one point attempted suicide. 77 00:08:14,210 --> 00:08:19,670 We see this identity disruption and grief as being linked to the extent to which 78 00:08:19,670 --> 00:08:27,040 your sense of self is tied to the deceased person and the loss relationship. 79 00:08:27,040 --> 00:08:34,150 Finding that you feel numb or that you experienced a flattening of your emotions after the loss is also really common. 80 00:08:34,150 --> 00:08:41,680 And this piece of art actually shows the antithesis of this experience because these women featured are professional mourners who would 81 00:08:41,680 --> 00:08:53,140 be employed in some cultures to chant, sing, wail during a funeral as a way of honouring the deceased with the real outpouring of emotion. 82 00:08:53,140 --> 00:09:01,420 A sense that life is meaningless after the loss can make it very difficult to re-engage with pleasurable and meaningful activities, 83 00:09:01,420 --> 00:09:06,040 which in turn really doesn't help feelings of low mood and despair. 84 00:09:06,040 --> 00:09:10,390 Frida Kahlo suffered a number of pregnancy losses in her life and this painting is 85 00:09:10,390 --> 00:09:14,650 said to mark the point in which she knew that she would never become a mother. 86 00:09:14,650 --> 00:09:24,320 But it said that after this loss, she didn't turn into those feelings of meaninglessness, but rather dedicated her life to painting. 87 00:09:24,320 --> 00:09:30,700 And this last experience is the sense of being disconnected from others around you after a loss. 88 00:09:30,700 --> 00:09:35,630 Picasso painted the Old Guitarist after his close friend suicide and it started his 89 00:09:35,630 --> 00:09:40,880 blue period where he began to paint those that had been cast out by society. 90 00:09:40,880 --> 00:09:50,770 And some say that he saw himself as the old guitarist, perhaps because he'd become disconnected from others since his loss. 91 00:09:50,770 --> 00:09:57,250 So now we've covered what grief feels like and involves, let's think about why we grieve. 92 00:09:57,250 --> 00:10:06,010 Well, because it's an evolutionary response that is designed in our early life to keep us safe from harm. When we're born 93 00:10:06,010 --> 00:10:15,070 we need to keep moment at close so we can get fed and be protected from predators because essentially we're immobile and helpless by ourselves. 94 00:10:15,070 --> 00:10:25,000 Here's a clip demonstrating what happens. The baby is being soothed by mum's friends, and as soon as baby realises that it's been left by itself. 95 00:10:25,000 --> 00:10:33,910 Baby signals distress to restore proximity. And baby is then calmed down by mum's presence and soothed again. 96 00:10:33,910 --> 00:10:41,410 Now this process is called attachment, and it forms the building blocks for developing and maintaining relationship. 97 00:10:41,410 --> 00:10:50,110 We've been thought to be a form of separation distress that is brought on by attachment because when we attach to someone important, 98 00:10:50,110 --> 00:11:00,190 we get used to them being physically and emotionally available to us, and this understanding is emotionally stabilising for us. 99 00:11:00,190 --> 00:11:07,810 When someone dies, however, we need to then adapt our understanding of our relationship with them to as 100 00:11:07,810 --> 00:11:13,750 being one that's based on psychological proximity instead of physical proximity. 101 00:11:13,750 --> 00:11:24,530 What that means is we need to be able to find ways of feeling close to them, even in their absence, which of course, takes time and effort. 102 00:11:24,530 --> 00:11:30,090 But this is because, in the words of Colin Murray Park's grief and love are two sides of the same coin. 103 00:11:30,090 --> 00:11:38,900 You don't get one without the other. If we love deeply, we grieve deeply, and that makes grief a normal and appropriate response to loss. 104 00:11:38,900 --> 00:11:45,850 But not everybody grieves in the same way. What are the patterns of grief? 105 00:11:45,850 --> 00:11:54,370 This study was conducted by Bonano and colleagues using true prospective data, which is data that is collected before a death even happens. 106 00:11:54,370 --> 00:12:03,010 So you have a data point before the death was even a possibility. Three years pre loss and then you have six months post loss and 18 months post loss. 107 00:12:03,010 --> 00:12:09,400 We have three groups that are labelled here on the slide. Chronic grief, recovery and resilience. 108 00:12:09,400 --> 00:12:13,570 I should say that this is actually depression that they're measuring, not strictly grief. 109 00:12:13,570 --> 00:12:20,830 But let's look at the orange lines first, which are grouped together here as chronic grief because they don't seem to change much over time. 110 00:12:20,830 --> 00:12:26,770 They start quite high and quite high. And the same with the resilience groups which are purple here. 111 00:12:26,770 --> 00:12:28,600 Not much change over time. 112 00:12:28,600 --> 00:12:38,110 Generally quite low in their depression scores, the recovery group is the black line and they start high and then in the six to 18 months after loss, 113 00:12:38,110 --> 00:12:47,330 they come back down to the same level of the resilient group. So you just have these two data points, then you think this is a pattern. 114 00:12:47,330 --> 00:12:51,770 Some people don't experience much depression after a loss, and this stays low over time, 115 00:12:51,770 --> 00:12:56,510 while others experience more depression and they stay depressed or they recover. 116 00:12:56,510 --> 00:13:03,360 Well, no. Here's what happens when you include the pre loss data point. 117 00:13:03,360 --> 00:13:12,660 We see that the two orange lines differ in that one was actually depressed before the loss and remain depressed throughout the course of the study, 118 00:13:12,660 --> 00:13:16,620 while for the other it looks like the loss triggered their depression. 119 00:13:16,620 --> 00:13:23,790 The other interesting one is the purple lines that without the pre loss data, it looked like they were both resilient. 120 00:13:23,790 --> 00:13:30,870 But actually one of them was depressed before the loss and the death brought about recovery from their depression. 121 00:13:30,870 --> 00:13:39,450 This group tends to be people who were carers or people who were in a bad relationship. 122 00:13:39,450 --> 00:13:47,880 We did a study looking specifically at grief, and we observed a similar pattern resilience, recovery and chronic grief too. 123 00:13:47,880 --> 00:13:57,510 And what you might notice from this slide and the slide before is that on the whole, there isn't a pattern that represents delayed grief, 124 00:13:57,510 --> 00:14:03,390 which is where you start off resilient and sometime later you see a large increase in your grief. 125 00:14:03,390 --> 00:14:06,480 We don't typically see this pattern in the literature. 126 00:14:06,480 --> 00:14:13,110 There may be the odd case here and there, but on the whole, this is not a consistent pattern of responding. 127 00:14:13,110 --> 00:14:21,840 A few of you asked questions about being worried about if you're coping OK, now, does that mean that you should expect it to hit you later? 128 00:14:21,840 --> 00:14:31,080 Well, not necessarily. We do see resurgences of acute grief around important time markers like anniversaries, birthdays, 129 00:14:31,080 --> 00:14:35,280 if you're really overwhelmed or stressed at work or things like that. 130 00:14:35,280 --> 00:14:43,450 But these resurgences tend to be short lived and they can return to baseline after the event has passed. 131 00:14:43,450 --> 00:14:48,580 Researchers who are interested in treatment developments are asking themselves, 132 00:14:48,580 --> 00:14:54,130 how do we distinguish between individuals who adapt to loss and those who don't? 133 00:14:54,130 --> 00:15:02,340 So how are the people in orange different from the people in purple? 134 00:15:02,340 --> 00:15:09,400 These are some of the factors that are thought to be key in keeping grief stuck - avoidance rumination, 135 00:15:09,400 --> 00:15:17,190 unprocessed memories, social disconnection and negative beliefs about yourself, the world and others. 136 00:15:17,190 --> 00:15:23,280 And we don't target grief in therapy because grief is not a problem to be solved. 137 00:15:23,280 --> 00:15:32,730 It's a natural and appropriate response to loss. So our aim and therapy is to make it possible for grief to be felt, processed, 138 00:15:32,730 --> 00:15:39,030 tolerated, by removing any obstacles that get in the way of making that possible. 139 00:15:39,030 --> 00:15:43,620 A variety of psychological treatment protocols have been found to be effective in treating 140 00:15:43,620 --> 00:15:48,900 prolonged grief disorder and randomised controlled trials and all in one way or another 141 00:15:48,900 --> 00:15:57,510 aim to target some or all of these factors. But what I'm going to do now is I'm going to attempt to give you some bite size suggestions 142 00:15:57,510 --> 00:16:03,420 that you can try at home to overcome each of these potential grief obstacles after loss. 143 00:16:03,420 --> 00:16:12,870 However, if you are struggling with any of these, you may benefit from working through your grief with a specialist, counsellor or psychologist. 144 00:16:12,870 --> 00:16:17,840 And I'll mention some resources at the end that may be of use. 145 00:16:17,840 --> 00:16:20,350 Let's start with avoidance. 146 00:16:20,350 --> 00:16:28,930 So, as I mentioned before, avoidance can be external reminders of grief or internal experiences like false memories, emotions. 147 00:16:28,930 --> 00:16:36,220 And the thing about avoidance is that it prevents your brain and your body from learning that you can cope with a certain stimulus. 148 00:16:36,220 --> 00:16:41,920 When I mentioned before The grieving process involves the revising of your understanding 149 00:16:41,920 --> 00:16:48,070 of your relationship with someone as being emotionally and physically available to you, 150 00:16:48,070 --> 00:16:53,830 into one in which they're psychologically close to you without their physical presence. 151 00:16:53,830 --> 00:16:57,730 It's thought that this process, unfortunately, 152 00:16:57,730 --> 00:17:09,790 is only possible through repeatedly emotionally tolerating your body's attempts to reunite with that person who died. 153 00:17:09,790 --> 00:17:14,980 And what this means is that in situations where you get that pang of grief, 154 00:17:14,980 --> 00:17:20,980 you don't immediately run in the other direction or avoid that situation, but rather sit with your reaction 155 00:17:20,980 --> 00:17:26,490 even if that feels really, really challenging. And avoidance, 156 00:17:26,490 --> 00:17:35,520 it can get in the way of any new learning about coping, and it can block grief from adapting over time, 157 00:17:35,520 --> 00:17:46,140 but I want to throw a bit of a caveat in here because grief adaptation is often about balance and tackling avoidance will be possible in some days. 158 00:17:46,140 --> 00:17:54,960 But taking time away from grief and ensuring that you concentrate on activities don't also trigger grief is also an important part of adaptation. 159 00:17:54,960 --> 00:18:00,110 So it's about balance. How do we overcome avoidance? 160 00:18:00,110 --> 00:18:04,990 Well, gradually go to that place that you've been avoiding. 161 00:18:04,990 --> 00:18:08,420 They take someone with you if it helps you be there. 162 00:18:08,420 --> 00:18:15,560 Some people find it hard to engage in any activity that the person who died would have liked or would have been involved in. 163 00:18:15,560 --> 00:18:23,450 For example, a mother who doesn't eat sweets anymore after losing her son, even though she enjoys them. 164 00:18:23,450 --> 00:18:29,300 Because if he's not around to be able to enjoy them, why should she be allowed to enjoy them? 165 00:18:29,300 --> 00:18:39,080 And in that sort of scenario, it might be helpful to focus on the activity as an opportunity for connection with the person who died, 166 00:18:39,080 --> 00:18:44,850 as opposed to focussing on the feelings of loss that they're not there to do it with you. 167 00:18:44,850 --> 00:18:52,850 And for both of these suggestions, it's important to acknowledge and expect grief to surface when you go into that situation 168 00:18:52,850 --> 00:18:56,360 when you try that activity and let it come. 169 00:18:56,360 --> 00:19:06,950 Then make sure to plan something afterwards that's either distracting or relaxing for you to help bring yourself that. 170 00:19:06,950 --> 00:19:15,140 Rumination, if the dwelling or the chewing over the loss, its negative consequences, and how it could have been prevented. 171 00:19:15,140 --> 00:19:19,940 Thoughts are cyclical in nature and they have no clear answers. 172 00:19:19,940 --> 00:19:24,800 They often include why statements like, Why did this have to stop and why me? 173 00:19:24,800 --> 00:19:29,870 Why then? And importantly, they don't serve to move the story on. 174 00:19:29,870 --> 00:19:38,350 They don't give you any extra information, and they only really serve to trigger negative emotions. 175 00:19:38,350 --> 00:19:43,770 With rumination the key is to support your triggers to rumination. 176 00:19:43,770 --> 00:19:51,930 When does it happen, when you're alone, a particular time of day, when you're tired or overwhelmed? 177 00:19:51,930 --> 00:19:58,650 If you know what your triggers are, you can actively plan to do something differently in those times. 178 00:19:58,650 --> 00:20:03,810 Have a friend over. Get more sleep. Get some exercise. 179 00:20:03,810 --> 00:20:12,840 Now, if you do notice yourself ruminating, one thing that can help is to give your a rumination and name - my whirlpool thoughts. 180 00:20:12,840 --> 00:20:19,710 The hamster wheel, my spaghetti thoughts. Remind yourself that these go nowhere. 181 00:20:19,710 --> 00:20:27,270 You can even picture something in your mind like a stop sign to signal to yourself that you are interrupting your rumination. 182 00:20:27,270 --> 00:20:31,950 Next, gently refocus your attention on the present moment, 183 00:20:31,950 --> 00:20:33,990 the task at hand. 184 00:20:33,990 --> 00:20:46,010 And if you are not doing anything before the rumination started, now would be a good time to pick up a book or go for a walk or watch TV. 185 00:20:46,010 --> 00:20:48,590 The next block is unprocessed memories, 186 00:20:48,590 --> 00:20:56,390 and these can be memories that were traumatic at the time and are coming back to you now and triggering pain and grief, 187 00:20:56,390 --> 00:21:05,030 or it can be pleasant memories that become tied with the knowledge of the loss and also trigger pain. 188 00:21:05,030 --> 00:21:10,790 These can feel as though the loss is happening again or as though it's just happened, 189 00:21:10,790 --> 00:21:21,730 and this can contradict the sense of permanence of the death, which can throw feelings of real disbelief and confusion. 190 00:21:21,730 --> 00:21:27,670 One method of processing loss memories is retelling the story of the loss. 191 00:21:27,670 --> 00:21:37,840 This can be done verbally or written down. And when you do this, focus on how you felt at the time and include in your loss story, 192 00:21:37,840 --> 00:21:43,630 is there anything that you know now to be true is different from what you thought then? 193 00:21:43,630 --> 00:21:49,540 For example, did you think the person who died was in pain and suffering? 194 00:21:49,540 --> 00:21:57,550 But now you know that they're no longer in pain and they're no longer suffering. Add what you know now to your loss story. 195 00:21:57,550 --> 00:22:08,700 Another thing you can try is memory transformation. Ask yourself, in what ways are you better off from having known this person who died? 196 00:22:08,700 --> 00:22:15,310 What qualities that you are grateful for do you carry because of them? 197 00:22:15,310 --> 00:22:24,670 While focussing on these qualities, does an image come to mind that represents this person essence or the quality that they gave you. 198 00:22:24,670 --> 00:22:32,910 Some people find it helpful to bring this image to mind in response to unpleasant memories. 199 00:22:32,910 --> 00:22:42,510 Social disconnection is linked to avoidance and is often perpetuated by our societal discomfort with discussing grief and painful feelings. 200 00:22:42,510 --> 00:22:49,050 People are often worried about being judged negatively about their grief, and as a result 201 00:22:49,050 --> 00:22:56,590 they don't share their feelings with others and end up feeling very socially disconnected. 202 00:22:56,590 --> 00:23:01,300 So for this, I recommend finding supporters who can give you what you need. 203 00:23:01,300 --> 00:23:04,270 Now, this may not be one perfect friend or family member. 204 00:23:04,270 --> 00:23:13,720 There is rarely one person who can meet all of our support needs, but take some time to figure out what it is that will be most beneficial for you. 205 00:23:13,720 --> 00:23:19,540 Do you need a listener, someone who's going to pick you up and tell you that you're doing great? 206 00:23:19,540 --> 00:23:27,400 Do you need someone to help you with practical things or to figure out a solution to a particular problem? 207 00:23:27,400 --> 00:23:34,000 Once you have a list of these potential supporters, the next step is to plan your approach. 208 00:23:34,000 --> 00:23:40,210 What this means is thinking about how you are going to ask for exactly what you need. 209 00:23:40,210 --> 00:23:46,480 People love to be given a roadmap on how to support their bereaved friends and family members. 210 00:23:46,480 --> 00:23:51,460 Grief is a delicate thing, and instead of offering help, 211 00:23:51,460 --> 00:23:57,220 a lot of people wait to be asked or what they'll do is they say, Let me know if you need anything. 212 00:23:57,220 --> 00:24:04,750 And if you can be explicit with what you would like, then that means you're more likely to get what you need and 213 00:24:04,750 --> 00:24:10,270 it takes the pressure off your supporters and working out what would be best. 214 00:24:10,270 --> 00:24:16,240 Then all that's left to do is reach out. Now I know that this is easier said than done. 215 00:24:16,240 --> 00:24:22,870 This might be the hardest part. It's extra hard to reach out when you are in a rough place. 216 00:24:22,870 --> 00:24:30,470 We kind of see it as our gift to others, that I'll keep my pain in my suffering to myself so that I don't have to burden others with it. 217 00:24:30,470 --> 00:24:39,250 However, I think most of us would say that if the tables were turned, we would want our loved ones to reach out to us if they were struggling. 218 00:24:39,250 --> 00:24:42,340 So just bear that in mind. 219 00:24:42,340 --> 00:24:52,360 Lastly, negative beliefs about the self, the world and others can develop for the first time after a loss or be exacerbated by it. 220 00:24:52,360 --> 00:25:01,100 These are often excessively harsh in nature and make it really difficult to tackle the first four blocks that I've mentioned. 221 00:25:01,100 --> 00:25:10,040 So how best to overcome these? Well, one of the most effective methods is by putting our thoughts to the test, being willing to be proved right, 222 00:25:10,040 --> 00:25:13,790 but also being open enough to being proved wrong. 223 00:25:13,790 --> 00:25:21,050 For example, if I believe that nobody wants to hear about my grief and because of that, I choose not to open up to anyone. 224 00:25:21,050 --> 00:25:23,780 I might climb what's called the behavioural experiment, 225 00:25:23,780 --> 00:25:32,090 where I make a prediction about what might happen if I were to open up to someone, who I think will change the subject, who 226 00:25:32,090 --> 00:25:36,040 I think they'll just ignore it. Will they walk away? 227 00:25:36,040 --> 00:25:41,150 Will will they laugh at me? I then rate my belief in my prediction. 228 00:25:41,150 --> 00:25:45,830 Do I think it's 50 percent likely to come true? I think it's 100 percent likely. 229 00:25:45,830 --> 00:25:51,080 Whatever that may be, you noted down and then you carry out your experiment. 230 00:25:51,080 --> 00:25:56,930 I might reach out to a friend and ask if we can put a little bit of time to talk about my grief, 231 00:25:56,930 --> 00:26:03,110 and maybe I'll let them know that I just need them to listen. And then I observe what happens. 232 00:26:03,110 --> 00:26:08,530 Often our predictions are not as accurate as we think. 233 00:26:08,530 --> 00:26:15,850 Next, some of these beliefs are easily testable, some take a little bit more thinking. 234 00:26:15,850 --> 00:26:21,970 For example, if I were to think that my life is ruined and I'll never feel happy again, 235 00:26:21,970 --> 00:26:29,350 the only way to test that out is by actively engaging in activities that I think 236 00:26:29,350 --> 00:26:34,240 at one time, or may still again make me happy or give me a sense of meaning, 237 00:26:34,240 --> 00:26:41,460 if I try nothing and there's no way, I'll be able to test out my belief and it will persist uncontested. 238 00:26:41,460 --> 00:26:47,180 One other thing to try is asking others for their input. 239 00:26:47,180 --> 00:26:53,930 For example, if you did something in the course of your loss that you're not feeling guilty or regretful about, 240 00:26:53,930 --> 00:26:58,580 you might ask others what they might have done in a similar situation. In therapy 241 00:26:58,580 --> 00:27:01,190 we use anonymous surveys to get this information, 242 00:27:01,190 --> 00:27:09,350 so you might ask friend canvass opinion for people you don't know if you feel if you don't feel comfortable asking your own network about it. 243 00:27:09,350 --> 00:27:18,890 We often judge ourselves more harshly and with significant hindsight bias than we would others. 244 00:27:18,890 --> 00:27:26,390 Finally, I'd like to dedicate this talk to my good friend Stu, who died by suicide in April of this year. 245 00:27:26,390 --> 00:27:32,870 I have reluctantly become a member of the traumatic grief club and I just wanted to let you all know 246 00:27:32,870 --> 00:27:38,780 that I used all of the tools that I talk to you about today in the aftermath of his death and even now. 247 00:27:38,780 --> 00:27:46,630 And they do help to cope with the heaviness of grief. 248 00:27:46,630 --> 00:27:55,030 Finally, here are some of the work that's informed this talk, and I'll finish up by sharing some resources that are all free at the point of access 249 00:27:55,030 --> 00:28:05,660 if you're struggling with grief and are in need of some support. And also, if you are interested in any book recommendations, 250 00:28:05,660 --> 00:28:11,720 here are some books that I recommend for adults and for teenagers and children who are grieving. 251 00:28:11,720 --> 00:28:14,250 Thank you for listening. 252 00:28:14,250 --> 00:28:22,230 Thanks very much indeed, Kirsten, and we'll certainly circulate your recommendations to people who've joined the session after the event as well. 253 00:28:22,230 --> 00:28:27,060 So if people are hurrying to scribble down any of these things, please don't worry. 254 00:28:27,060 --> 00:28:31,560 And of course, the talk is available on YouTube is being live streamed now, 255 00:28:31,560 --> 00:28:37,200 but will be available afterwards as well so people can go back if they want to follow up for any further information. 256 00:28:37,200 --> 00:28:42,720 But thanks ever so much, Kirsten, for a really wonderful talk. We had lots of questions 257 00:28:42,720 --> 00:28:46,020 as we mentioned before and some of which you've picked up on in your talk, 258 00:28:46,020 --> 00:28:53,010 but it'd be great to go back to some of them a bit more and pick up on some of those issues have bit more discussion about them. 259 00:28:53,010 --> 00:28:59,640 I suppose one of the things we had quite a lot of questions about was this question of what is normal grief? 260 00:28:59,640 --> 00:29:05,280 And you clearly did talk about that before you talked about, you know, particular intense period initially, 261 00:29:05,280 --> 00:29:12,850 but also the very different trajectories that people's depression symptoms can follow after a bereavement. 262 00:29:12,850 --> 00:29:15,330 And you also talked about some of the things that can be problematic. 263 00:29:15,330 --> 00:29:21,300 And I suppose one of the things I was wondering is in relation to this question of what's normal. 264 00:29:21,300 --> 00:29:23,910 You know, you talked about avoidance being problematic. 265 00:29:23,910 --> 00:29:33,630 So I wondered if people might be thinking, OK, so how do I know if I or someone else is avoiding, or whether they really are fine and getting on ok? 266 00:29:33,630 --> 00:29:43,470 Because this question of, you know, that I seem to be okay or my partner seems to be fine and getting on, 267 00:29:43,470 --> 00:29:49,330 you know, getting along quite well is, is that right? I know it was a big concern for quite a lot of people. 268 00:29:49,330 --> 00:29:55,270 Yeah, I mean, I think it's. You know, to be clear, like prolonged grief, 269 00:29:55,270 --> 00:29:59,230 like any of the mental health problems is really about do you have severe and 270 00:29:59,230 --> 00:30:04,690 distressing symptoms that are interfering with your ability to engage in work, 271 00:30:04,690 --> 00:30:12,520 social activities, daily life. The the diagnostic classifications for people in grief disorders 272 00:30:12,520 --> 00:30:20,410 is if your stroke still really struggling after a period of six to 12 months, then you should have access to support. 273 00:30:20,410 --> 00:30:25,760 I don't think they're really saying, you know, they're not trying to pathologise normal reactions. 274 00:30:25,760 --> 00:30:33,610 They're just saying we as a society need to put in place support systems for individuals who will be struggling after this period. 275 00:30:33,610 --> 00:30:42,100 And that is a very small minority of people who are bereaved. The vast majority of people are resilient in the face of loss. 276 00:30:42,100 --> 00:30:46,810 And I think that what you were saying about avoidance, 277 00:30:46,810 --> 00:30:55,150 how do you know if you know you're avoiding too much or too little, that's really about 278 00:30:55,150 --> 00:31:01,060 Do I find my grief interfering with an area of my life that I would like to be different? 279 00:31:01,060 --> 00:31:11,430 If you find actually your life is somewhat unaffected or, you know, it's not interfering in a huge way, I wouldn't worry about it, really. 280 00:31:11,430 --> 00:31:22,090 The adaptation to grief is about approaching grief at times and processing it, but also spending time doing other activities, 281 00:31:22,090 --> 00:31:26,950 you know, focussing your attention away from grief, focussing on new relationships. 282 00:31:26,950 --> 00:31:30,100 And that's completely normal, too. It's just, I guess, 283 00:31:30,100 --> 00:31:37,800 if you find yourself focussing on grief to a disabling amount that you might want to think a little bit more about it. 284 00:31:37,800 --> 00:31:47,400 Thank you. And you obviously gave a number of tips about how to try to address factors that might be causing that to happen, 285 00:31:47,400 --> 00:31:53,640 and we certainly had a lot of questions about how to cope with the symptoms associated with grief - sadness, 286 00:31:53,640 --> 00:32:00,540 lack of motivation, problems of concentration, sleep in unpleasant dreams, et cetera. 287 00:32:00,540 --> 00:32:09,310 And I mean, I just want to highlight to people that we obviously do have a number of other sessions that may be useful in relation to these topics. 288 00:32:09,310 --> 00:32:16,070 So we've had previous sessions on low moods, on managing paranoia, on sleep, and other things. 289 00:32:16,070 --> 00:32:22,470 So please do have a look at those. But, Kirstenm I didn't know if you wanted to add anything further about what people can do, 290 00:32:22,470 --> 00:32:29,220 you know, maybe even in the in the short term about managing those symptoms. 291 00:32:29,220 --> 00:32:36,900 I mean, I think for most, for most people, just going about your day to day life and seeking support from your informal networks or your friends, 292 00:32:36,900 --> 00:32:42,290 your family, making space for your grief, that will be enough to help you adapt to your loss. 293 00:32:42,290 --> 00:32:49,330 And you know, as we grow up, we detach from our parents and attach to others. 294 00:32:49,330 --> 00:32:55,620 So it is a process that we're equipped for. But after a loss, I think it's especially important to really focus on the basics. 295 00:32:55,620 --> 00:33:02,400 So good sleep, good nutrition, spending time outdoors, exercise, self-care, self kindness, 296 00:33:02,400 --> 00:33:09,290 and they all go a long way into making grief more manageable to carry because it is a heavy thing. 297 00:33:09,290 --> 00:33:16,770 I think just really upping the ante in terms of taking care of yourself is what's really needed in the aftermath. 298 00:33:16,770 --> 00:33:22,260 Thank you. And we also had a lot of questions which were really about, which we're interested 299 00:33:22,260 --> 00:33:26,790 in your reflections on the context of the death or the circumstances of the loss. 300 00:33:26,790 --> 00:33:34,920 So for example, if a death was very sudden or or somebody witnessed the death or in the context of suicide or where 301 00:33:34,920 --> 00:33:41,010 relationships may be difficult or all the bereaved person was estranged from the person who died, 302 00:33:41,010 --> 00:33:47,190 and lots of people reflected on feelings of guilt, self-blame, anger in these sort of contexts. 303 00:33:47,190 --> 00:33:51,060 So it would be really interesting to hear your thoughts about, you know, 304 00:33:51,060 --> 00:33:57,810 the impact of those sort of contextual factors and what people might be able to do in those circumstances. 305 00:33:57,810 --> 00:34:09,450 Yeah. So particularly when a death is sudden, bereaved individuals that often don't have the time to ready a support network and they're 306 00:34:09,450 --> 00:34:16,770 often not already in contact with services that might be able to provide support like hospice and palliative care settings. 307 00:34:16,770 --> 00:34:25,240 And this delay may mean that sudden death prove higher risk or with respect to long term consequences for loss. 308 00:34:25,240 --> 00:34:33,210 And there is literature to suggest that if you are bereaved by suicide, then you yourself are at greater risk of suicide and mental health problems. 309 00:34:33,210 --> 00:34:42,840 Similarly, if you have lost multiple people or you witnessed extreme distress and the terminal illness of your loved one, 310 00:34:42,840 --> 00:34:46,350 these all seem to increase the impact of loss. 311 00:34:46,350 --> 00:34:49,530 But converse to that, I guess, 312 00:34:49,530 --> 00:35:00,480 and having a so-called good death where your loved one was able to get appropriate medical care and their pain and distress was adequately managed. 313 00:35:00,480 --> 00:35:03,690 They seem to be associated with better outcomes. 314 00:35:03,690 --> 00:35:14,220 But the fact is for treatment and these loss types will be the same as the ones that I mentioned in the talk because they they transcend loss. 315 00:35:14,220 --> 00:35:24,330 But the emphasis will be different. So for example, if you lose someone to suicide, guilt and self-blame are often prominent features of your grief, 316 00:35:24,330 --> 00:35:30,510 as well as the stigma and shame that's also more of an issue with suicide death than other kinds of death. 317 00:35:30,510 --> 00:35:39,210 So any therapeutic work would focus on these types of negative beliefs that might be more pronounced in that particular kind of loss. 318 00:35:39,210 --> 00:35:42,900 And in relation to the same topic, various people talk about anger, 319 00:35:42,900 --> 00:35:51,330 which I think can be a very difficult emotion to feel in at that time and then adds to further feelings of guilt and blame, 320 00:35:51,330 --> 00:35:56,760 you know, either anger at the person who died or anger about others in the social network. 321 00:35:56,760 --> 00:36:00,150 I don't know if you have any comments on that. Yeah, I mean, 322 00:36:00,150 --> 00:36:09,060 one of the things that we do when we're working with people in anger is getting them to think about the impact this anger is having for them. 323 00:36:09,060 --> 00:36:13,530 You know, their anger is is totally justified 324 00:36:13,530 --> 00:36:20,040 most of the time, and it's more about thinking, OK, is, is there something that I can do? 325 00:36:20,040 --> 00:36:26,380 Is the anger actually only hurting me? Or is there something that I can actually do to express that anger? 326 00:36:26,380 --> 00:36:34,570 So sometimes we ask people to write an anger letter to the person that they are angry with, and that might be services 327 00:36:34,570 --> 00:36:42,030 in the case of COVID, government. And it's just a way of processing those feelings and coming to terms with them. 328 00:36:42,030 --> 00:36:46,020 And then, you know, after that, the person's still angry that we can ask them, 329 00:36:46,020 --> 00:36:51,930 Is there something else that you want to do or maybe is that is is it time to think about turning the anger down 330 00:36:51,930 --> 00:37:00,190 a little bit so that you're not the one that's left with the negative consequences that are burning through your body? 331 00:37:00,190 --> 00:37:11,170 Thank you. And we had a lot of questions about how to best support others that are grieving so I'd be really keen to hear your advice on that? 332 00:37:11,170 --> 00:37:18,340 Yeah. So I guess in the talk, I covered social disconnection from the bereaved person's perspective and thinking 333 00:37:18,340 --> 00:37:24,160 about what they could do to overcome their sense of being disconnected from others. 334 00:37:24,160 --> 00:37:26,920 But really, in an ideal world, 335 00:37:26,920 --> 00:37:35,500 they wouldn't have to do any of that because they'd have a network that was emotionally receptive and ready and distress tolerant and compassionate. 336 00:37:35,500 --> 00:37:42,080 And they basically wouldn't need to reach out because they'd have all of that support at their fingertips when they needed it. 337 00:37:42,080 --> 00:37:47,140 But that doesn't seem to be the case at all for most bereaved people. 338 00:37:47,140 --> 00:37:55,180 I think a lot of people who are not affected by loss, even if someone close to them is, 339 00:37:55,180 --> 00:38:00,400 their life moves on and it's not something that they hold in mind for particularly long time. 340 00:38:00,400 --> 00:38:07,690 I know that there are some hospices out there who contact bereaved family members after a period of about three months, 341 00:38:07,690 --> 00:38:12,910 with the letter saying, You know, this is usually the time that your networks stop asking you if you're OK, 342 00:38:12,910 --> 00:38:17,050 so we're contacting you to say, Do you need help? Are you all right? 343 00:38:17,050 --> 00:38:23,890 And so for those of you out there who are wondering how to support your friends and family members who are grieving, 344 00:38:23,890 --> 00:38:28,750 I would say keep checking in and keep making it OK for them to talk about their grief, 345 00:38:28,750 --> 00:38:33,250 keep offering the space to discuss it even if they don't use it. 346 00:38:33,250 --> 00:38:39,730 And in the aftermath of my recent loss, lots of my friends contacted me immediately afterwards ask how I was doing. 347 00:38:39,730 --> 00:38:47,800 But in the reality immediately afterwards, I only wanted to speak to people who were involved in the loss, who loved Stu and who were devastated by it. 348 00:38:47,800 --> 00:38:52,990 And it was only a little bit later that I opened up to a sort of wider circle of friends. 349 00:38:52,990 --> 00:38:59,710 But even me who works in bereavement and has for 10 years, and all of my friends are very much aware of that. 350 00:38:59,710 --> 00:39:03,790 There's maybe two or three people who still ask me about it even now, 351 00:39:03,790 --> 00:39:09,520 and lots of my people who are considered to be really good friends haven't asked me about it at all. 352 00:39:09,520 --> 00:39:15,310 So I do think people are very uncomfortable with grief, and I would say, 353 00:39:15,310 --> 00:39:21,100 just try and be mindful that even though your life has moved on, the people who are very close to the loss, 354 00:39:21,100 --> 00:39:23,980 it may still be very much at the forefront of their minds, 355 00:39:23,980 --> 00:39:29,920 and they may really benefit from having someone show an interest or just asking them about their grief. 356 00:39:29,920 --> 00:39:36,190 And then the next thing I would say about that is if you are going to reach out and offer support to someone, 357 00:39:36,190 --> 00:39:41,020 try not to shy away from the pain and don't offer advice unless you're asked for 358 00:39:41,020 --> 00:39:48,700 it and, for platitudes like time is a healer or everything happens for a reason. 359 00:39:48,700 --> 00:39:54,760 It's it's obviously incredibly hard to see the people that you care about in pain. 360 00:39:54,760 --> 00:40:00,880 And our gut instinct is to do everything, to use all the tools in our arsenal to try and take that pain away. 361 00:40:00,880 --> 00:40:05,440 But you actually can't because it's unfixable and the worst thing has already happened. 362 00:40:05,440 --> 00:40:09,130 So the best that you can do is going to be there for support. 363 00:40:09,130 --> 00:40:15,400 And if you can't be someone's emotional rock because not everybody's built that way, you know, 364 00:40:15,400 --> 00:40:21,880 send them a frozen meal or food box or card or, you know, something that might just lighten their load a little bit. 365 00:40:21,880 --> 00:40:25,390 So that would be my advice. Thank you. 366 00:40:25,390 --> 00:40:31,180 I mean, I suppose, as well as other people who weren't connected to the loss themselves, you know, their lives carrying on, 367 00:40:31,180 --> 00:40:35,770 I suppose there is often also that worry about getting it wrong or raising it at 368 00:40:35,770 --> 00:40:40,210 a time when the person actually had managed to distract themselves for a while. 369 00:40:40,210 --> 00:40:45,640 And, you know, and raising it at a time when people didn't really want to think about it. 370 00:40:45,640 --> 00:40:49,510 And I think that worry about getting it wrong and making life more difficult for 371 00:40:49,510 --> 00:40:54,210 someone who is already having such a difficult time is probably quite a major barrier. 372 00:40:54,210 --> 00:40:58,100 And I don't know. I think what you've already said is all really helpful in that way. 373 00:40:58,100 --> 00:41:02,920 If there's anything it adds about, if people are worrying about that specifically. 374 00:41:02,920 --> 00:41:09,910 Yeah, I mean, just to normalise that because I think that is a huge worry that actually prevents a lot of people from reaching out. 375 00:41:09,910 --> 00:41:15,040 And I don't want to bring them down if they're in a different place mentally right now. 376 00:41:15,040 --> 00:41:23,800 So I just won't say anything. But in my experience with all of the people that I've worked with who are bereaved, you're not going to bring them down. 377 00:41:23,800 --> 00:41:28,810 Like if they if you bring it up, they will tell you if they don't want to talk about it. 378 00:41:28,810 --> 00:41:38,590 But nine times out of 10, I would say people really appreciate it being acknowledged and people appreciate the opportunity to 379 00:41:38,590 --> 00:41:44,590 talk about the person who died because they are often thinking about it a lot more than we realise. 380 00:41:44,590 --> 00:41:49,360 Thank thanks very much. Just one very final question. I suppose we've been we've been talking about bereavement, 381 00:41:49,360 --> 00:41:53,920 but there were questions also about to what extent what we've discussed today would apply to 382 00:41:53,920 --> 00:41:58,750 other loss events and I suppose particularly thinking about the sort of tips that you gave. 383 00:41:58,750 --> 00:42:04,760 And to what extent people might be able to apply those to other sorts of loss situations. 384 00:42:04,760 --> 00:42:13,340 Yeah. Well, there has been one study that looked at the experience of yearning, which is central to grief. 385 00:42:13,340 --> 00:42:23,180 And they found that yearning was correlated with neural activation in the reward pathways of the brain and people who had prolonged grief. 386 00:42:23,180 --> 00:42:27,860 And they also found this same kind of activation in people who'd gone through 387 00:42:27,860 --> 00:42:33,030 relationship break-ups when the individual was still kind of protesting the death. 388 00:42:33,030 --> 00:42:35,150 And when I mentioned before about this, 389 00:42:35,150 --> 00:42:42,650 this model of healthy coping where you oscillate between focussing on the grief and then spending time away from the grief, 390 00:42:42,650 --> 00:42:55,350 focussing on other activities that are surrounded on rebuilding your life, I guess, this model has been applied to intense feelings of homesickness. 391 00:42:55,350 --> 00:43:05,400 And so I think we can learn a lot from bereavement research about how we cope with other kinds of losses like relationship break-up and homesickness. 392 00:43:05,400 --> 00:43:13,470 Thanks very much. And thank you very much indeed, Kirsten, for a really fantastic session, I'm sure will be extremely helpful to a lot of people. 393 00:43:13,470 --> 00:43:15,030 And just before we wrap up, 394 00:43:15,030 --> 00:43:22,530 but just like to thank everyone again for joining us this morning and just remind you to take a bit of time before you go on to your next activity. 395 00:43:22,530 --> 00:43:29,550 Give yourself a bit of space. Go for a walk, have a cup of tea, whatever whatever works best for you. 396 00:43:29,550 --> 00:43:37,980 And also just reminder that our next session will be on the 27th of January and we'll be focussing on obsessive compulsive thoughts and behaviours. 397 00:43:37,980 --> 00:43:41,310 As we said, we will share the resources that Kirsten mentioned, 398 00:43:41,310 --> 00:43:48,930 but also we will send an email with a link to everybody tomorrow, and that link is also now in the chat. 399 00:43:48,930 --> 00:43:50,760 So please do give us your feedback. 400 00:43:50,760 --> 00:43:58,440 We do look at it very carefully and use it for thinking about and planning future sessions, so please do share your thoughts with us. 401 00:43:58,440 --> 00:44:04,470 But just I'd just like to once again say thanks very much to Dr. Kirsten Smith for a really wonderful session, 402 00:44:04,470 --> 00:44:08,430 and thank you all for joining us this morning. And we hope to see you all again soon. 403 00:44:08,430 --> 00:44:15,085 Thank you.