The COVID pandemic has resulted in significant losses. More than 585,000 people in the United States have died. Thousands of Americans are grieving the loss of loved ones and countless others have lost close relationships, jobs, and normalcy that life used to have.

On Memorial Day, Americans pause to honor those brave men and women who have served in the armed forces and given their lives. It’s also a time when people remember loved ones who have gone before them.

Grief is defined as a feeling of deep sorrow and emotional pain associated with losing something important. Reactions to loss and grief are widespread and can include shock or disbelief, anger and irritability, and symptoms of depression. You may feel hopeless or withdrawn from friends and family. Grief can also make it hard to sleep and concentrate.

Grief, when not recognized or allowed to be felt, can lead to more serious issues including depression and anxiety, explains UCHealth behavioral health therapist Rachel Slick.

“An important concept when coping with grief and loss, especially during a pandemic, is to acknowledge that it is hard,” Slick said. “Allow yourself to feel whatever surfaces. The grieving process is complicated and can be confusing. There are moments of happiness and reminiscing that are often immediately followed by sadness or guilt. All of it is normal. Permit yourself to notice those feelings. The only way to get through grief is to go through grief.”

UCHealth Today talked to Slick to gain insight into the grieving process, help those who are grieving, and provide strategies to help you.

What are common reactions to grief?

Common grief reactions include shock or disbelief, anger, irritability, and sometimes symptoms of depression. This can include withdrawing from social activities, feeling hopeless, experiencing sleep difficulties, or having a hard time concentrating.

How do sadness and grief differ?

Grief involves sadness. Feeling sad tends to accompany grief. The difference is that grief can typically be attributed to a specific trigger or loss, while sadness and depression do not always have a specific cause.

Are others feeling grief because of this pandemic?

“I have worked with multiple patients who have lost loved ones during the pandemic and were unable to spend time with them in their final months, days, or hours,” Slick said. “That incites a feeling of loneliness on top of the existing grieving process.

“The grieving process is inherently lonely, as it can often feel like no one thoroughly understands your pain or your experience. The restrictions associated with the pandemic have added an additional layer of isolation.”

People also experience grief when they lose something significant, like a job, financial security, or a sense of identity. Slick said she also has heard from patients who experienced an abrupt lifestyle change when the pandemic hit, which caused similar reactions to grieving a loss of a loved one.

“There are elements of shock, anger, and depression at play,” she said.

What are the stages of grief and loss?

There are researched models of grief that suggest that grief happens in stages: some indicate five, nine, or even 12 stages of grief.

“Regardless of the specific number of stages of grief and loss, the concept is the same: there are different waves of emotion that happen over time as one copes with a loss,” Slick said.

“The idea that there are ‘stages’ somewhat implies that we move through the stages like a checklist as if we can cross one emotion off the list when we have ‘finished’ with it.”

This is misleading, she said.

“Grief does not follow a perfect timeline. The emotions associated with grief – commonly recognized as denial, anger, bargaining, depression, and acceptance – tend to fluctuate, come and go, and change over time. Everyone copes with grief at a different pace. While it is comforting to know what feelings can be expected, it is inaccurate to believe that it follows a predictable timeline.”

What is the Kubler-Ross grief cycle?

The Kubler-Ross grief cycle is often referred to in therapy and grief counseling, Slick said. The author, Elisabeth Kubler-Ross, initially wrote her book about the stages of grief from the perspective of a terminally ill patient, not from someone grieving a loss.

The stages of grief can be somewhat adapted to an individual experiencing grief. They are:

Denial/shock – experiencing difficulty believing that the news is true, feeling convinced there has been a mistake, not thoroughly grasping that this person is gone.

Anger – realizing the extent of the loss, feeling upset that you must adjust to a new reality in this person’s absence, feeling like this is not fair, often looking to blame others for the loss.

Bargaining – often looks like trying to negotiate with a higher power if that is what you believe. “If you bring this person back, I promise I will do x, y, z.” Not everyone experiences this stage of grief. It varies based on individuals and their beliefs.

Depression – characterized by withdrawing from activities or interactions, an inability to experience joy or pleasure, a sense of hopelessness.

Acceptance – not necessarily feeling “okay” that your loved one died, but acknowledging that your loved one died and you are still allowed to be okay and to continue living. It looks like adopting a new sense of normal. It does not mean that you will never experience any of the other stages of grief again, or that you won’t have a tough day. It means the good days tend to outnumber the tougher days.

What are some strategies for dealing with loss and grief?

“The strategies specific to this pandemic loss look very similar to the strategies we use to cope with this pandemic in general: Don’t neglect basic self-care,” Slick said.

• Eat enough throughout the day.
• Drink enough water.
• Take your medications as prescribed.
• Get sufficient rest.
• Go to the doctor when you need to.
• Interact with another human on some level, even if virtually.

“Simply having a phone call or a video chat on the calendar can improve our mood and give us something to look forward to,” she said. “It also holds us accountable; we are less likely to skip the event if we treat it like a scheduled appointment on the calendar.”

How do you get over loss?

“I would argue that there is no ‘getting over’ loss,” Slick said. “There is no box we get to check at the end of the process that indicates that we have healed entirely.”

She said that as time passes, there will be more distance between where we are in the present and when the loss happened. A person will move closer to “acceptance,” but that doesn’t necessarily mean that those other feelings associated with grief – sadness, shock, guilt – go away entirely.

How do I live after the loss of a loved one?

“One day at a time. By meeting your basic needs one day at a time, you can continue taking care of yourself while you create distance between where you are now and when the loss occurred.”

Taking care of yourself is boring, she reiterated, but important: drink water, eat food, sleep, engage in physical activity, and interact with someone who cares about you (even virtually). Go to doctor appointments when you need to, take medications as prescribed.

“Permit yourself to feel everything that surfaces: denial, anger, fear, sadness. And eventually, permit yourself to have a good day too,” she said. “You are allowed to have a happy mood without feeling like you have forgotten your loved one.”

Other suggestions:

• Try writing a letter to the person you’ve lost to express anything you may have left unsaid. You never have to read it again if you don’t want to.
• Consider doing something special to acknowledge your loved one during the holidays, on their birthday, or on any other significant date. By acknowledging that it is not just another day, you may prevent yourself from feeling surprised by the grief that will likely surface on that date.
• Communicate your needs. If you want to be left alone, kindly let your friends and family members know that you need space. If you want to talk about your loved one, talk with someone. Talk with someone who knew this person and share memories and stories.
• When in doubt, reach out. Talk to a medical professional or a mental health provider. Grief is a heavy thing to carry by yourself. Some people are honored to come alongside you. Even though no one has the perfect thing to say, it is sometimes nice to have someone next to you while you go through this process.

Can grief make you sick? Can I get depression, anxiety or other issues from grief? What are the physical symptoms of grief?

The effects of grief can impact both mind and body, Slick explained.

“Grief can cause feelings of exhaustion, hopelessness, anhedonia (a lack of ability to feel pleasure), and even forgetfulness – these symptoms mirror depressive symptoms,” she said. “Experiencing grief can make it difficult to take care of our basic needs which can subsequently cause physical health issues.”

Grief can also cause anxiety symptoms as a byproduct. If the loss was especially unexpected or tragic, a person may feel increased worry surrounding those circumstances. For example, a death from a car accident may cause a fear of driving or death from COVID-19 may increase the fear of leaving the house.

Do young children and adolescents show grief differently than adults?

The duration and intensity of grief are different for everyone, from children to adolescents to adults, but it is a natural reaction at any age. People across the lifespan often struggle to articulate their feelings in perfect words, so we typically see grief expressed through behaviors, Slick explained.

“It is commonly conveyed as anger or irritability,” she said. “Sometimes in children, we may see grief expressed through the way they play. If they have imaginary friends or are playing with toys, we may hear comments about their missed loved one or about a funeral.”

In children, like adults, Slick said that she tends to see their psychological distress manifests as physical symptoms.

“In children, we see more frequent headaches or stomachaches and sleep disturbance. In younger children, we may see behavioral regressions, like wetting the bed after being potty trained or sucking their thumb after having stopped this habit. “

How does grief change you as a person?

Any time an individual experiences grief or loss it shapes them as a person. It can have short-term and potentially long-term impacts on physical health, as mentioned above. Those impacts can be lessened by addressing grief and coping healthily.

It can also build resilience – the capacity to recover from adversity. It can foster empathy – the ability to understand and share the feelings of someone else.

Why does grief hurt so much?

Grief hurts at the beginning because it is an abrupt change. Anytime a person is forced to change their lifestyle or habits, it causes stress. Grief hurts sometimes for many months or years because as time passes, there will always be more opportunities to miss the person we lost – more opportunities to endure those stages of grief again. There are anniversaries, birthdays, milestone events that can cause emotions just like the ones felt at the initial loss. This does not mean that someone isn’t healing. 

How to support someone who is going through grief? Are there words of comfort for grief?

It can be difficult to know the “perfect” thing to say when supporting someone who is experiencing grief. Sometimes the most comforting thing to do is simply be present with that person, allow them to feel their emotions and express them, give them a safe space to cry or get mad. Sometimes when people reminisce about their loved one it can bring smiles and laughter and this is often followed quickly by tears, confusion, anger. Try to remove the pressure to say the perfect thing and simply let them know you are there for them during those swings of emotions.

You can use phrases to validate their emotions, such as: “There is no right or wrong way to deal with this” or “You are allowed to feel everything that you feel.”

Other tangible ways to help include assisting with seemingly simple tasks that the person may find difficult to accomplish during the initial periods of grief: grocery shopping or preparing meals, walking their dog, navigating the logistics of the funeral services.

Try to find a balance between allowing this person some space to experience grief alone, without abandoning them. If you have immediate concerns about their safety, always trust your intuition and show up. If you do not feel comfortable showing up in person, you can call for the local crisis response team to check on them in their home or you can call the non-emergent police line for a welfare check.

Visit https://coloradocrisisservices.org/ for Colorado crisis services.

What is grief counseling? What are the goals of grief counseling?

Grief counseling is therapy specific to coping with grief and loss. The goal is not to “get over” the loss, but rather to have a supportive space to grieve. The therapist serves as a neutral listener, someone to talk to that will validate your emotions. Some goals of grief counseling are to verbally process the experience and hardship, as well as learning strategies to cope with it healthily.

If you or someone you know is looking for a grief counselor, visit https://www.uchealth.org/services/behavioral-health/