Thanks very much for joining us this morning for the latest in mental wellness sessions,
which are brought to you by the Department of Experimental Psychology here at the University of Oxford.
My name's Cathy Creswell and I'm really pleased to introduce this session.
But just before we get started, I just want to mention a few things to you.
First of all, just to say, we've now gotten quite a large series of webinars in this series,
all on different topics relating to mental health and wellbeing,
and all offering very practical advice based on sound scientific evidence by leading experts in the field.
So please do have a look at the experimental psychology website and experimental psychology YouTube channel,
where you can find all of those previous sessions, which I hope will be of interest and helpful for the next session.
After today will be on the 27th of January at 10 o'clock in the morning,
and that will be by Professor Paul Salkovskis talking about managing obsessive compulsive thoughts and behaviours.
But now I'm delighted to introduce Dr Kirstin Smith to you
who who will be talking about Coping with Grief after a Bereavement and custody is an MRC clinical scientist,
fellow and a clinical psychologist in the Department of Experimental Psychology here and in the Oxford Centre for Anxiety Disorders and Trauma.
And she's also a trustee and head of research for the charity The Lost Foundation,
who provide free, facilitated group support to those who've lost loved ones to cancer.
So she brings a huge wealth of experience and expertise on the topic that we're covering today.
As you know, we're going to, first of all, have a talk from Kirstin,
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.
And we were really pleased to receive a really large number of questions.
So we've pulled out some of the key themes from those and we'll try to cover as much of that as possible.
And just one last thing to say before I hand over to Kirsten, and that is that, of course,
all of these sessions deal with topics that can be quite challenging for us as individuals.
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.
Give yourself a bit of space before you move on to your next activity in case any of the
things that we talk about today may raise some difficult issues or feelings for you.
So please do take some time, give yourself a bit of space.
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.
Thanks very much, Kirsten. Thank you, Cathy. OK.
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.
Here's a quick example. There are five stages to grief which are denial, anger, bargaining, depression and acceptance.
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.
And it is my job to try to get them all the way through to acceptance.
And if not acceptance, then just depression. If I can get them depressed then I'll have done my job.
Now you look heard about the five stages model again and again.
But what you might not know is that the stages of grief that they're talking
about here were never actually formulated for bereavement researcher called
Elisabeth Kubler-Ross proposed this model after working with clients with terminal cancer as a
way of coming to terms with their own deaths. It was never intended to be applied to bereavement,
and to date, there have been no empirical studies supporting its validity.
So having said that, What do we in the research world understand grief to be?
Well, strictly speaking, bereavement is the experience of the death of someone close to you.
And grief is your response to that bereavement.
Grief responses tend to be the most intense and distressing in the first six to 12 months after the loss.
But what are these responses that I'm talking about?
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.
And I've chosen these 10 because I think they map up quite well on to the experiences of grief that
we understand from the literature as the symptoms of prolonged grief disorder or PGD for short.
Now, I should say that each of these experiences are completely normal after bereavement,
but it is the intensity and the chronicity of them that make them something that's worthy of specialist support.
Persistent longing or yearning for the person who died is often the most commonly reported grief experience.
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.
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.
But obviously, in the case of bereavement, that's not possible. Preoccupation with thoughts or memories of the lost person.
Now these can be frequently distracting and disturbing in nature and are often accompanied by very intense emotions.
This piece on the slide was painted by Munch, depicting the moment of death of his sister,
and he painted six different versions of this painting over a period of about 30 years or so,
which suggests that he was particularly preoccupied by this memory in this image.
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,
during or after the loss or preoccupations with the way that life has changed since the loss.
Memories might be traumatic, like the one shown on the slide,
or they might be happy memories that now because the person has died are associated with pain and disbelief.
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.
A death can also come with the loss of a role such as being a partner, parent,
carer, which can make it even more challenging to re-imagine yourself after a loss.
I mentioned disbelief earlier, will shock, particularly after a sudden traumatic bereavement is another typical experience,
and this sense of disbelief is something that we think gradually declines as we
make sense of our loss and we process the death as something that is permanent.
Avoidance of reminders can be external, like avoiding going somewhere that reminds you of the loss,
such as hospitals or somewhere that you went with the person.
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.
Intense emotional pain, whether that be sadness, anger, guilt, hopelessness, despair,
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.
But this time it was more socially acceptable to paint women as the mourners rather than men.
So he painted his wife in mourning instead of himself. Finding it difficult to move forward with life after death.
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.
We see this identity disruption and grief as being linked to the extent to which
your sense of self is tied to the deceased person and the loss relationship.
Finding that you feel numb or that you experienced a flattening of your emotions after the loss is also really common.
And this piece of art actually shows the antithesis of this experience because these women featured are professional mourners who would
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.
A sense that life is meaningless after the loss can make it very difficult to re-engage with pleasurable and meaningful activities,
which in turn really doesn't help feelings of low mood and despair.
Frida Kahlo suffered a number of pregnancy losses in her life and this painting is
said to mark the point in which she knew that she would never become a mother.
But it said that after this loss, she didn't turn into those feelings of meaninglessness, but rather dedicated her life to painting.
And this last experience is the sense of being disconnected from others around you after a loss.
Picasso painted the Old Guitarist after his close friend suicide and it started his
blue period where he began to paint those that had been cast out by society.
And some say that he saw himself as the old guitarist, perhaps because he'd become disconnected from others since his loss.
So now we've covered what grief feels like and involves, let's think about why we grieve.
Well, because it's an evolutionary response that is designed in our early life to keep us safe from harm. When we're born
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.
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.
Baby signals distress to restore proximity. And baby is then calmed down by mum's presence and soothed again.
Now this process is called attachment, and it forms the building blocks for developing and maintaining relationship.
We've been thought to be a form of separation distress that is brought on by attachment because when we attach to someone important,
we get used to them being physically and emotionally available to us, and this understanding is emotionally stabilising for us.
When someone dies, however, we need to then adapt our understanding of our relationship with them to as
being one that's based on psychological proximity instead of physical proximity.
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.
But this is because, in the words of Colin Murray Park's grief and love are two sides of the same coin.
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.
But not everybody grieves in the same way. What are the patterns of grief?
This study was conducted by Bonano and colleagues using true prospective data, which is data that is collected before a death even happens.
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.
We have three groups that are labelled here on the slide. Chronic grief, recovery and resilience.
I should say that this is actually depression that they're measuring, not strictly grief.
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.
They start quite high and quite high. And the same with the resilience groups which are purple here.
Not much change over time.
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,
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.
Some people don't experience much depression after a loss, and this stays low over time,
while others experience more depression and they stay depressed or they recover.
Well, no. Here's what happens when you include the pre loss data point.
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,
while for the other it looks like the loss triggered their depression.
The other interesting one is the purple lines that without the pre loss data, it looked like they were both resilient.
But actually one of them was depressed before the loss and the death brought about recovery from their depression.
This group tends to be people who were carers or people who were in a bad relationship.
We did a study looking specifically at grief, and we observed a similar pattern resilience, recovery and chronic grief too.
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,
which is where you start off resilient and sometime later you see a large increase in your grief.
We don't typically see this pattern in the literature.
There may be the odd case here and there, but on the whole, this is not a consistent pattern of responding.
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?
Well, not necessarily. We do see resurgences of acute grief around important time markers like anniversaries, birthdays,
if you're really overwhelmed or stressed at work or things like that.
But these resurgences tend to be short lived and they can return to baseline after the event has passed.
Researchers who are interested in treatment developments are asking themselves,
how do we distinguish between individuals who adapt to loss and those who don't?
So how are the people in orange different from the people in purple?
These are some of the factors that are thought to be key in keeping grief stuck - avoidance rumination,
unprocessed memories, social disconnection and negative beliefs about yourself, the world and others.
And we don't target grief in therapy because grief is not a problem to be solved.
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,
tolerated, by removing any obstacles that get in the way of making that possible.
A variety of psychological treatment protocols have been found to be effective in treating
prolonged grief disorder and randomised controlled trials and all in one way or another
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
that you can try at home to overcome each of these potential grief obstacles after loss.
However, if you are struggling with any of these, you may benefit from working through your grief with a specialist, counsellor or psychologist.
And I'll mention some resources at the end that may be of use.
Let's start with avoidance.
So, as I mentioned before, avoidance can be external reminders of grief or internal experiences like false memories, emotions.
And the thing about avoidance is that it prevents your brain and your body from learning that you can cope with a certain stimulus.
When I mentioned before The grieving process involves the revising of your understanding
of your relationship with someone as being emotionally and physically available to you,
into one in which they're psychologically close to you without their physical presence.
It's thought that this process, unfortunately,
is only possible through repeatedly emotionally tolerating your body's attempts to reunite with that person who died.
And what this means is that in situations where you get that pang of grief,
you don't immediately run in the other direction or avoid that situation, but rather sit with your reaction
even if that feels really, really challenging. And avoidance,
it can get in the way of any new learning about coping, and it can block grief from adapting over time,
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.
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.
So it's about balance. How do we overcome avoidance?
Well, gradually go to that place that you've been avoiding.
They take someone with you if it helps you be there.
Some people find it hard to engage in any activity that the person who died would have liked or would have been involved in.
For example, a mother who doesn't eat sweets anymore after losing her son, even though she enjoys them.
Because if he's not around to be able to enjoy them, why should she be allowed to enjoy them?
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,
as opposed to focussing on the feelings of loss that they're not there to do it with you.
And for both of these suggestions, it's important to acknowledge and expect grief to surface when you go into that situation
when you try that activity and let it come.
Then make sure to plan something afterwards that's either distracting or relaxing for you to help bring yourself that.
Rumination, if the dwelling or the chewing over the loss, its negative consequences, and how it could have been prevented.
Thoughts are cyclical in nature and they have no clear answers.
They often include why statements like, Why did this have to stop and why me?
Why then? And importantly, they don't serve to move the story on.
They don't give you any extra information, and they only really serve to trigger negative emotions.
With rumination the key is to support your triggers to rumination.
When does it happen, when you're alone, a particular time of day, when you're tired or overwhelmed?
If you know what your triggers are, you can actively plan to do something differently in those times.
Have a friend over. Get more sleep. Get some exercise.
Now, if you do notice yourself ruminating, one thing that can help is to give your a rumination and name - my whirlpool thoughts.
The hamster wheel, my spaghetti thoughts. Remind yourself that these go nowhere.
You can even picture something in your mind like a stop sign to signal to yourself that you are interrupting your rumination.
Next, gently refocus your attention on the present moment,
the task at hand.
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.
The next block is unprocessed memories,
and these can be memories that were traumatic at the time and are coming back to you now and triggering pain and grief,
or it can be pleasant memories that become tied with the knowledge of the loss and also trigger pain.
These can feel as though the loss is happening again or as though it's just happened,
and this can contradict the sense of permanence of the death, which can throw feelings of real disbelief and confusion.
One method of processing loss memories is retelling the story of the loss.
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,
is there anything that you know now to be true is different from what you thought then?
For example, did you think the person who died was in pain and suffering?
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.
Another thing you can try is memory transformation. Ask yourself, in what ways are you better off from having known this person who died?
What qualities that you are grateful for do you carry because of them?
While focussing on these qualities, does an image come to mind that represents this person essence or the quality that they gave you.
Some people find it helpful to bring this image to mind in response to unpleasant memories.
Social disconnection is linked to avoidance and is often perpetuated by our societal discomfort with discussing grief and painful feelings.
People are often worried about being judged negatively about their grief, and as a result
they don't share their feelings with others and end up feeling very socially disconnected.
So for this, I recommend finding supporters who can give you what you need.
Now, this may not be one perfect friend or family member.
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.
Do you need a listener, someone who's going to pick you up and tell you that you're doing great?
Do you need someone to help you with practical things or to figure out a solution to a particular problem?
Once you have a list of these potential supporters, the next step is to plan your approach.
What this means is thinking about how you are going to ask for exactly what you need.
People love to be given a roadmap on how to support their bereaved friends and family members.
Grief is a delicate thing, and instead of offering help,
a lot of people wait to be asked or what they'll do is they say, Let me know if you need anything.
And if you can be explicit with what you would like, then that means you're more likely to get what you need and
it takes the pressure off your supporters and working out what would be best.
Then all that's left to do is reach out. Now I know that this is easier said than done.
This might be the hardest part. It's extra hard to reach out when you are in a rough place.
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.
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.
So just bear that in mind.
Lastly, negative beliefs about the self, the world and others can develop for the first time after a loss or be exacerbated by it.
These are often excessively harsh in nature and make it really difficult to tackle the first four blocks that I've mentioned.
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,
but also being open enough to being proved wrong.
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.
I might climb what's called the behavioural experiment,
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
I think they'll just ignore it. Will they walk away?
Will will they laugh at me? I then rate my belief in my prediction.
Do I think it's 50 percent likely to come true? I think it's 100 percent likely.
Whatever that may be, you noted down and then you carry out your experiment.
I might reach out to a friend and ask if we can put a little bit of time to talk about my grief,
and maybe I'll let them know that I just need them to listen. And then I observe what happens.
Often our predictions are not as accurate as we think.
Next, some of these beliefs are easily testable, some take a little bit more thinking.
For example, if I were to think that my life is ruined and I'll never feel happy again,
the only way to test that out is by actively engaging in activities that I think
at one time, or may still again make me happy or give me a sense of meaning,
if I try nothing and there's no way, I'll be able to test out my belief and it will persist uncontested.
One other thing to try is asking others for their input.
For example, if you did something in the course of your loss that you're not feeling guilty or regretful about,
you might ask others what they might have done in a similar situation. In therapy
we use anonymous surveys to get this information,
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.
We often judge ourselves more harshly and with significant hindsight bias than we would others.
Finally, I'd like to dedicate this talk to my good friend Stu, who died by suicide in April of this year.
I have reluctantly become a member of the traumatic grief club and I just wanted to let you all know
that I used all of the tools that I talk to you about today in the aftermath of his death and even now.
And they do help to cope with the heaviness of grief.
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
if you're struggling with grief and are in need of some support. And also, if you are interested in any book recommendations,
here are some books that I recommend for adults and for teenagers and children who are grieving.
Thank you for listening.
Thanks very much indeed, Kirsten, and we'll certainly circulate your recommendations to people who've joined the session after the event as well.
So if people are hurrying to scribble down any of these things, please don't worry.
And of course, the talk is available on YouTube is being live streamed now,
but will be available afterwards as well so people can go back if they want to follow up for any further information.
But thanks ever so much, Kirsten, for a really wonderful talk. We had lots of questions
as we mentioned before and some of which you've picked up on in your talk,
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.
I suppose one of the things we had quite a lot of questions about was this question of what is normal grief?
And you clearly did talk about that before you talked about, you know, particular intense period initially,
but also the very different trajectories that people's depression symptoms can follow after a bereavement.
And you also talked about some of the things that can be problematic.
And I suppose one of the things I was wondering is in relation to this question of what's normal.
You know, you talked about avoidance being problematic.
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?
Because this question of, you know, that I seem to be okay or my partner seems to be fine and getting on,
you know, getting along quite well is, is that right? I know it was a big concern for quite a lot of people.
Yeah, I mean, I think it's. You know, to be clear, like prolonged grief,
like any of the mental health problems is really about do you have severe and
distressing symptoms that are interfering with your ability to engage in work,
social activities, daily life. The the diagnostic classifications for people in grief disorders
is if your stroke still really struggling after a period of six to 12 months, then you should have access to support.
I don't think they're really saying, you know, they're not trying to pathologise normal reactions.
They're just saying we as a society need to put in place support systems for individuals who will be struggling after this period.
And that is a very small minority of people who are bereaved. The vast majority of people are resilient in the face of loss.
And I think that what you were saying about avoidance,
how do you know if you know you're avoiding too much or too little, that's really about
Do I find my grief interfering with an area of my life that I would like to be different?
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.
The adaptation to grief is about approaching grief at times and processing it, but also spending time doing other activities,
you know, focussing your attention away from grief, focussing on new relationships.
And that's completely normal, too. It's just, I guess,
if you find yourself focussing on grief to a disabling amount that you might want to think a little bit more about it.
Thank you. And you obviously gave a number of tips about how to try to address factors that might be causing that to happen,
and we certainly had a lot of questions about how to cope with the symptoms associated with grief - sadness,
lack of motivation, problems of concentration, sleep in unpleasant dreams, et cetera.
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.
So we've had previous sessions on low moods, on managing paranoia, on sleep, and other things.
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,
you know, maybe even in the in the short term about managing those symptoms.
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,
your family, making space for your grief, that will be enough to help you adapt to your loss.
And you know, as we grow up, we detach from our parents and attach to others.
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.
So good sleep, good nutrition, spending time outdoors, exercise, self-care, self kindness,
and they all go a long way into making grief more manageable to carry because it is a heavy thing.
I think just really upping the ante in terms of taking care of yourself is what's really needed in the aftermath.
Thank you. And we also had a lot of questions which were really about, which we're interested
in your reflections on the context of the death or the circumstances of the loss.
So for example, if a death was very sudden or or somebody witnessed the death or in the context of suicide or where
relationships may be difficult or all the bereaved person was estranged from the person who died,
and lots of people reflected on feelings of guilt, self-blame, anger in these sort of contexts.
So it would be really interesting to hear your thoughts about, you know,
the impact of those sort of contextual factors and what people might be able to do in those circumstances.
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
often not already in contact with services that might be able to provide support like hospice and palliative care settings.
And this delay may mean that sudden death prove higher risk or with respect to long term consequences for loss.
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.
Similarly, if you have lost multiple people or you witnessed extreme distress and the terminal illness of your loved one,
these all seem to increase the impact of loss.
But converse to that, I guess,
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.
They seem to be associated with better outcomes.
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.
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,
as well as the stigma and shame that's also more of an issue with suicide death than other kinds of death.
So any therapeutic work would focus on these types of negative beliefs that might be more pronounced in that particular kind of loss.
And in relation to the same topic, various people talk about anger,
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,
you know, either anger at the person who died or anger about others in the social network.
I don't know if you have any comments on that. Yeah, I mean,
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.
You know, their anger is is totally justified
most of the time, and it's more about thinking, OK, is, is there something that I can do?
Is the anger actually only hurting me? Or is there something that I can actually do to express that anger?
So sometimes we ask people to write an anger letter to the person that they are angry with, and that might be services
in the case of COVID, government. And it's just a way of processing those feelings and coming to terms with them.
And then, you know, after that, the person's still angry that we can ask them,
Is there something else that you want to do or maybe is that is is it time to think about turning the anger down
a little bit so that you're not the one that's left with the negative consequences that are burning through your body?
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?
Yeah. So I guess in the talk, I covered social disconnection from the bereaved person's perspective and thinking
about what they could do to overcome their sense of being disconnected from others.
But really, in an ideal world,
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.
And they basically wouldn't need to reach out because they'd have all of that support at their fingertips when they needed it.
But that doesn't seem to be the case at all for most bereaved people.
I think a lot of people who are not affected by loss, even if someone close to them is,
their life moves on and it's not something that they hold in mind for particularly long time.
I know that there are some hospices out there who contact bereaved family members after a period of about three months,
with the letter saying, You know, this is usually the time that your networks stop asking you if you're OK,
so we're contacting you to say, Do you need help? Are you all right?
And so for those of you out there who are wondering how to support your friends and family members who are grieving,
I would say keep checking in and keep making it OK for them to talk about their grief,
keep offering the space to discuss it even if they don't use it.
And in the aftermath of my recent loss, lots of my friends contacted me immediately afterwards ask how I was doing.
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.
And it was only a little bit later that I opened up to a sort of wider circle of friends.
But even me who works in bereavement and has for 10 years, and all of my friends are very much aware of that.
There's maybe two or three people who still ask me about it even now,
and lots of my people who are considered to be really good friends haven't asked me about it at all.
So I do think people are very uncomfortable with grief, and I would say,
just try and be mindful that even though your life has moved on, the people who are very close to the loss,
it may still be very much at the forefront of their minds,
and they may really benefit from having someone show an interest or just asking them about their grief.
And then the next thing I would say about that is if you are going to reach out and offer support to someone,
try not to shy away from the pain and don't offer advice unless you're asked for
it and, for platitudes like time is a healer or everything happens for a reason.
It's it's obviously incredibly hard to see the people that you care about in pain.
And our gut instinct is to do everything, to use all the tools in our arsenal to try and take that pain away.
But you actually can't because it's unfixable and the worst thing has already happened.
So the best that you can do is going to be there for support.
And if you can't be someone's emotional rock because not everybody's built that way, you know,
send them a frozen meal or food box or card or, you know, something that might just lighten their load a little bit.
So that would be my advice. Thank you.
I mean, I suppose, as well as other people who weren't connected to the loss themselves, you know, their lives carrying on,
I suppose there is often also that worry about getting it wrong or raising it at
a time when the person actually had managed to distract themselves for a while.
And, you know, and raising it at a time when people didn't really want to think about it.
And I think that worry about getting it wrong and making life more difficult for
someone who is already having such a difficult time is probably quite a major barrier.
And I don't know. I think what you've already said is all really helpful in that way.
If there's anything it adds about, if people are worrying about that specifically.
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.
And I don't want to bring them down if they're in a different place mentally right now.
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.
Like if they if you bring it up, they will tell you if they don't want to talk about it.
But nine times out of 10, I would say people really appreciate it being acknowledged and people appreciate the opportunity to
talk about the person who died because they are often thinking about it a lot more than we realise.
Thank thanks very much. Just one very final question. I suppose we've been we've been talking about bereavement,
but there were questions also about to what extent what we've discussed today would apply to
other loss events and I suppose particularly thinking about the sort of tips that you gave.
And to what extent people might be able to apply those to other sorts of loss situations.
Yeah. Well, there has been one study that looked at the experience of yearning, which is central to grief.
And they found that yearning was correlated with neural activation in the reward pathways of the brain and people who had prolonged grief.
And they also found this same kind of activation in people who'd gone through
relationship break-ups when the individual was still kind of protesting the death.
And when I mentioned before about this,
this model of healthy coping where you oscillate between focussing on the grief and then spending time away from the grief,
focussing on other activities that are surrounded on rebuilding your life, I guess, this model has been applied to intense feelings of homesickness.
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.
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.
And just before we wrap up,
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.
Give yourself a bit of space. Go for a walk, have a cup of tea, whatever whatever works best for you.
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.
As we said, we will share the resources that Kirsten mentioned,
but also we will send an email with a link to everybody tomorrow, and that link is also now in the chat.
So please do give us your feedback.
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.
But just I'd just like to once again say thanks very much to Dr. Kirsten Smith for a really wonderful session,
and thank you all for joining us this morning. And we hope to see you all again soon.
Thank you.