Grief is a unique & personal process that can involve stages like denial, anger, bargaining, depression & acceptance.
These stages are not linear & individuals may experience them differently or revisit stages over time.
Understanding & acknowledging one’s emotions during grief can facilitate healing & resilience.
Grief is an inevitable universal experience. Everyone will experience it at some point in their life, but not everyone is impacted by it in the same way (O’Connor, 2019; Bonanno, 2009).
That doesn’t mean that we can’t relate to each other’s grief. It just means that everyone has to discover their own way to move through it (Kübler-Ross & Kessler, 2004).
The stages of grief and how we understand them have evolved over the last few decades, according to Kübler-Ross and Kessler (2004).
This article explores the different stages of grief and even goes beyond the Kübler-Ross concept of five grief stages.
Before you continue reading, we thought you might like to download our five positive psychology tools for free. These science-based tools will help you move yourself or others through grief in a compassionate way.
Grief, simply put, is a person’s response to loss (Schoo et al., 2024). While much attention has been given to the emotional pain that comes with grief, it is important to acknowledge that grief goes beyond the emotional experiences (Hall, 2014).
“Grief can be defined as the response to the loss in all of its totality—including its physical, emotional, cognitive, behavioral, and spiritual dimensions.”
Hall, 2014, p. 7
Research has linked inflammation, rumination, and stress hormone levels to how people process loss (O’Connor, 2019). Some people process grief more easily than others.
Grief is not the same as depression, although depression can be a part of the grieving process (American Psychiatric Association, 2022). Grief is a multi-layered process that affects body and mind (O’Connor, 2019).
Manifestations of Grief
The infographic shows the most common physical, emotional, behavioral, and spiritual manifestations of grief.
Grief is easily misunderstood, and this image can help identify the physical, emotional, social, and spiritual manifestations of grief. In doing so, it aids in better understanding the nature of grief and different ways of grieving.
The difference is that the bereaved experiences predominant feelings of loss and emptiness, which are linked to memories and thoughts. Low mood and the inability to experience joy or pleasure are central to depression. They are not linked to memories. Instead, they are a general experience (Bahou, 2023).
Grief has an identifiable cause, while depression has various causes that are often interlinked (Peña-Vargas et al., 2021).
Even though depression is a stage of the grieving process, the bereaved doesn’t suffer from clinical depression, even though maladaptive grieving could turn into depression (Peña-Vargas et al., 2021; Bonanno, 2009).
Bereavement doesn’t have a set timeline, and everyone goes through it in their own way. Yet over time, its impact on the daily life of the bereaved lessens.
The 5 Stages of Grief: The Kübler-Ross Model Explained
The five stages of grief were first introduced in 1969 by Elisabeth Kübler-Ross in her book On Death and Dying.
Kübler-Ross (1969) originally developed the stages to describe the emotional journey of terminally ill patients. Since then, the model has evolved and been applied broadly to anyone experiencing any form of loss.
These stages are not a strict sequence that needs to be followed during grieving (Hall, 2014). Instead, they should be considered a helpful framework that brings language to the often confusing and difficult experience of grief (Kübler-Ross & Kessler, 2005).
Also, these stages are not specific to everyone, nor do they necessarily follow a chronological order. Individuals may experience the stages in a different order or even experience multiple at the same time, and sometimes some might experience the stages over again (Kübler-Ross & Kessler, 2005).
Denial
During the initial shock, denial functions as a protective buffer between the strong emotions and the mind. It helps the person experiencing loss to process the new, painful reality.
This isn’t about refusing to accept the new reality. Instead, it is a way for the individual to not become overwhelmed by the pain. Kessler (2019, p.1) describes this stage as “shock and disbelief that the loss has occurred.”
Anger
Anger is a common emotion that often surfaces when reality sets in during the healing process. It is a necessary, protective, and frequently misunderstood part of the grieving journey because it functions as a bridge between emotional numbness and deeper emotions (Kübler-Ross & Kessler, 2005). Anger provides the bereaved something to hold on to (LeDoux, 1996; Greenberg, 2002).
The sense of injustice, abandonment, sorrow, disappointment, longing, or powerlessness can be the trigger for anger (Harris & Winokuer, 2019). While navigating grief, the bereaved may direct their anger outward toward others, including therapists and other professionals (Harris & Winokuer, 2019).
Anger surfaces once the bereaved feels safe enough to know that they will probably survive whatever comes (Kübler-Ross & Kessler, 2004).
Bargaining
Bargaining is the stage of grief where the brain tries to cling to hope and the idea that death could be reversed. It is a psychological negotiation with fate, for some with God and others with themselves or their beliefs (Kübler-Ross & Kessler, 2005).
This process is not just an imaginative pleading. This stage is the brain’s attempt to restore predictability and coherence after the event. Emotionally charged memories activate the amygdala and can intensify mental ruminations — a characteristic of the bargaining stage (LeDoux, 1996).
Bargaining often occurs when cognitive and emotional systems are recalibrating to a new, overwhelming reality. This can provide a sense of agency in a situation that feels hopeless (O’Connor, 2019).
Not everyone goes through the bargaining stage or experiences prolonged distress. Ultimately, there is a wide variability in the process of grief (Bonanno et al., 2002; Bonanno 2009).
How do our brains handle grief? - Mary-Frances O'Connor
Depression
Depression is a companion to the heaviness of grief and the ability to be present. It is when the bereaved understands the finality of the loss as part of the lived experience.
It is important to make a distinction between clinical depression and depression as part of the grieving process. Depression here is not pathological. Instead, it is natural, appropriate, and often misunderstood by the people around the grieving (Kübler-Ross & Kessler, 2005).
Bonanno et al. (2002) observed in their study of bereavement that the symptoms of depression fluctuate and that they are not universal. When these symptoms appear, they are often profound and deeply embodied. Biologically, the process of grief slows down the nervous system and protects the body from overwhelm (O’Connor, 2019).
Prioritizing emotional regulation (Peña-Vargas et al., 2021) enables the bereaved to slowly create integrity instead of being overwhelmed with the full heaviness of the new reality (Kübler-Ross & Kessler, 2004).
Acceptance
Acceptance doesn’t mean that the person grieving is content with the loss. It merely describes the ability to recognize the new reality. “Acceptance is not about liking a situation. It’s about acknowledging all that has been lost and all that still remains” (Kübler-Ross & Kessler, 2004 p. 26).
Physiological acceptance expresses itself in the body’s ability to regulate itself again. Psychologically, the mind starts making space again for new experiences. And on a social level, the bereaved might start to reengage again, which might look different than before (Peña-Vargas et al., 2021).
On an emotional basis, acceptance can feel confusing at times. Guilt might follow happiness or moments of relief. Acceptance means making space for what can feel like conflicting emotions (Greenberg, 2002; LeDoux, 1996).
People who can recall happy memories during grief may experience relief from sadness and help during the acceptance stage (Bonanno & Keltner, 1997).
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The 6th Stage of Grief: Finding Meaning
The sixth stage of grief is a concept developed by Kessler (2019) based on Kübler-Ross’s five stages. It describes the transformative process of the bereavement journey.
In this stage, the bereaved starts to integrate the loss into their ongoing life by seeking and creating meaning based on the experience.
Finding meaning is about discovering ways the memory of a loved one and the influence this person had on the bereaved can continue to shape and impact their lives. Finding meaning doesn’t erase the grief; instead, it offers a way forward (Kessler, 2019). This allows the person who grieves to hold space for love and the pain of loss at the same time.
Finding meaning often starts with telling stories about the loved one (Kessler, 2019), but it can also entail revisiting the process of dying and whether it could have been preventable. This is no longer a way of trying to negotiate the death. Instead, it is about understanding and creating a story of the loss. It is also a topic that is not being talked about enough. For more on this, consider reading our article on post-traumatic growth.
How to find meaning after loss - David Kessler
Other Models & Theories
The five and six stages of grief demonstrate a framework that helps people going through grief to understand the patterns and processes that often emerge in bereavement.
Grief is nonlinear, and as explained, there is no prescribed single right way to grieve, which is why researchers and clinicians have developed several frameworks to offer language and structure to the complex experience of grief.
The 7 stages of grief
The seven stages of grief make up an expanded adaptation of the original five-stage model by Elisabeth Kübler-Ross. They include stages of shock and denial, pain and guilt, the upward turn, and reconstruction and working through, which expand on the original model to capture the early disbelief and numbness, the intense emotional pain, the gradual improvement, and the process of rebuilding after loss (Parkes & Prigerson, 2010).
Dual-process model
The dual-process model recognizes that grief involves two processes. On one side, the grieving person has to navigate through the feelings of loss (or loss-oriented stressors), and on the other, they focus on rebuilding life after loss (restoration-oriented stressors; Stroebe & Schut, 1999).
Loss-oriented stressors encompass emotional and psychological responses directly related to the loss, such as grief work, confronting and expressing complex emotions, and accepting the reality of the loss.
Restoration-oriented stressors include managing new responsibilities and engaging in new activities and relationships, as well as forming a new sense of self (Stroebe & Schut, 1999).
Central to this model is the concept of oscillation, which means that individuals move back and forth between the domains, which allows them to engage with grief while also finding relief from it. This dynamic process allows a healthy adjustment to the new situation by balancing emotions with the demands of daily life (Stroebe & Schut, 1999).
Tasks of mourning
This concept reframes grief as a dynamic process rather than a linear series of stages. According to Worden (2018), grief involves four core tasks that individuals may revisit in various sequences over time:
Accepting the reality of the loss
Accepting reality both intellectually and emotionally involves confronting the irreversible absence of the loved one through rituals, storytelling, and reminders that support cognitive and emotional integration (Hall, 2014; Kübler-Ross & Kessler, 2005).
Experiencing the pain of grief
Feel emotions fully, such as anger, sadness, guilt, and confusion, without avoidance. Emotional bypassing can complicate or prolong the grieving process (O’Connor, 2019; Peña-Vargas et al., 2021).
Adjusting to a world without the deceased
Adjust by taking on new roles, undergoing an internal transformation, and reexamining identity, beliefs, and meaning. This aligns with the biopsychosocial complexity of bereavement (Bonanno et al., 2002; Shoo et al., 2024).
Finding an enduring connection with the deceased
Integrate the memory and impact of the loved one into a reengaged life (Kessler, 2019; Harris & Winokuer, 2019).
Worden’s model emphasizes a compassionate, nonlinear, and human-centered approach to grief, acknowledging its personal and evolving nature.
Anticipatory grief
Anticipatory grief describes the grief before we grieve (Kübler-Ross & Kessler, 2005). It often occurs before an impending loss as a result of a terminal illness or the expected death of a loved one. This grief can impact both the person facing their own death and the person in the relationship.
Feelings such as sadness, anxiety, anger, guilt, and even physical symptoms such as lack of appetite and sleep disturbances can accompany it (Biscontini, 2023). This grief entails more than the anticipation of the loss. It can involve the loss of future experiences, the inevitability of the loss, and even the gradual decline of the loved one.
Research characterizes anticipatory grief by a heightened emotional response and a sense of being static in time, meaning planning for the future feels impossible (Lee, 2016).
Continuing bonds theory
Continuing bonds theory provides an interesting twist to research on bereavement. Unlike other models that describe detachment as a healthy sign of grieving, continuing bonds theory suggests that maintaining an ongoing relationship with the deceased is normal and part of the process (Klass et al., 1996).
This connection can look like cherishing memories, engaging in rituals, talking to the deceased, and integrating their values and wisdom into everyday life. These bonds of connection aren’t static; they change over time as the bereaved person’s life changes (Klass, 2006).
Generally, the internalized continuing connection to the deceased is associated with a positive adjustment, as long as the deceased is held in memory and meaning. On the other hand, external bonds such as hallucination may be linked to complicated grief (Field et al., 2005).
Complicated grief, also known as prolonged grief disorder or persistent complex bereavement disorder, is characterized by an intense and persistent state of mourning. It disrupts the person’s daily life and hinders emotional healing.
The risk for prolonged grief increases when the death of the loved one happens suddenly or under traumatic circumstances (Szuhany et al., 2021).
Symptoms of prolonged grief disorder (American Psychiatric Association, 2022) include:
Intense yearning or longing for the person who has died, even after a year
Constant thoughts or preoccupation with the deceased that make it hard to focus on the other parts of life
Ongoing emotional pain, such as deep sadness, anger, bitterness, or sorrow, that doesn’t ease over time
Feeling emotionally numb
Identity disruption, such as feeling like half a person
Marked sense of disbelief about the death
Avoidance of reminders that the person is dead
Intense emotional pain related to the death
Difficulty getting back into daily activities
Feeling that life is meaningless or empty
Intense loneliness
It is important to remember that for some, the process of grief is linear. For others, it can turn into complicated grief (Brown, 2021).
Supporting the Process in Therapy & Counseling
Supporting the grief process in therapy and counseling entails a therapeutic environment based on trust, empathy, and collaboration (Kramuschke et al., 2024).
This is because grief counseling involves more than addressing the immediate concerns or symptoms of a client. Paying attention to how clients express themselves and what they discuss, therapists and counselors can support people in better understanding their feelings and behavior (Newsom et al., 2017). This increases self-awareness and supports the process (Jordan & Neimeyer, 2003).
Effective therapy isn’t the same for everyone. Staying flexible and developing a collaborative process allows therapists to adjust the approach to fit each person’s unique grieving process (Jordan & Neimeyer, 2003).
17 Exercises For Grief & Bereavement
Apply these 17 Grief & Bereavement Exercises [PDF] to help others process difficult emotions, leverage self-compassion, and find balance following painful loss.
More Helpful Resources From PositivePsychology.com
At PositivePsychology.com we have a wide array of resources that will benefit you.
You might be interested in our article on the counseling process as a structured, collaborative conversation between a trained professional and individuals who are seeking support.
Because the process of grief can vary so widely, it is always beneficial to refresh your toolbox to ensure you stay flexible in your approach. Jeremy Sutton provides you with recommended tools in his article on counseling skills.
To assist your client with the grieving progress, you can give them this template. A Letter to a Loved One can be a therapeutic exercise to articulate unresolved emotions, express gratitude, and foster healing during the grieving process.
Emotions in Grieving is a helpful worksheet to support your client in exploring their emotions during the grief process.
To help your client gain deeper insight and understand when challenging moments arise, you might find this worksheet supportive: Grieving and Monitoring Difficult Times.
If you’re looking for more science-based ways to help others move through grief in a compassionate way, this collection contains 17 validated grief and bereavement exercises. Use them to help others find balance as they attempt to make sense of a life that has been irrevocably changed.
A Take-Home Message
Grief is a deeply personal experience that is universal and touches every life. Yet no two people grieve exactly the same way.
Over decades, research and clinical practice have shown that while models like the five stages of grief, the dual-process model, tasks of mourning, and continuing bonds theory offer helpful frameworks, there is no single right path through loss.
Grieving is nonlinear, shaped by individual, relational, and cultural factors, and may involve a wide range of emotions and challenges, including anticipatory and complicated grief (Hall, 2014).
Many equate grief with losing someone. However, grief can also manifest during various other experiences, such as job loss, breakups, divorce, and relocation (Bowlby, 1980; Brown, 2021).
Honoring the complex stages of grief, finding meaning in the process, maintaining connections, and allowing space for pain and growth allow the person grieving to move from grief to post-traumatic growth and healing (Karanci & Erdur-Baker, 2024).
There are commonly thought to be five stages of grief — denial, anger, bargaining, depression, and acceptance — as originally described by Elisabeth Kübler-Ross (1969). Several models expand her concept to seven stages. The five-stage model remains the most recognized one.
How long does the grieving process last?
The grieving process is unique, and there is no set timeline for how long the grieving process lasts. For some, it may take weeks or months, while for others, it may take years.
What are the most effective therapy techniques for grief?
Different people need different tools to cope with grief and to support their grieving processes. There is no one most effective technique for everyone.
References
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Bonanno, G. A., Wortman, C. B., Lehman, D. R., Tweed, R. G., Haring, M., Sonnega, J., Carr, D., & Nesse, R. M. (2002). Resilience to loss and chronic grief: A prospective study from pre-loss to 18 months post-loss. Journal of Personality and Social Psychology, 83(5), 1150–1164. https://doi.org/10.1037/0022-3514.83.5.1150
Bonanno, G. A. (2009). The other side of sadness: What the new science of bereavement tells us about life after loss. Basic Books.
Bonanno, G. A., & Keltner, D. (1997). Facial expressions of emotion and the course of conjugal bereavement. Journal of Abnormal Psychology, 106(1), 126–137. https://doi.org/10.1037/0021-843X.106.1.126
Bowlby, J. (1980). Attachment and loss: Vol. 3. Loss, sadness and depression. Basic Books.
Brown, B. (2021). Atlas of the heart. Vermilion.
Field, N. P., Gao, B., & Paderna, L. (2005). Continuing bonds in bereavement: An attachment theory-based perspective. Death Studies, 29(4), 277–299. https://doi.org/10.1080/07481180590923689
Greenberg, L. S. (2002). Emotion-focused therapy: Coaching clients to work through their feelings. American Psychological Association.
Hall, C. (2014). Bereavement theory: Recent developments in our understanding of grief and bereavement. Bereavement Care, 33(1), 7–12. https://doi.org/10.1080/02682621.2014.902610
Harris, D. L., & Winokuer, H. R. (2019). Working with emotions in the grief counseling process: Yours and the client’s. In Principles and practice of grief counseling (pp. 140–155). Springer Publishing Company.
Jordan, J. R., & Neimeyer, R. A. (2003). Does grief counseling work? Death Studies, 27(9), 765–786. https://doi.org/10.1080/713842360
Karanci, A. N., & Erdur-Baker, Ö. (2024). Prolonged grief, reconstruction of meaning, and posttraumatic growth. Turkish Journal of Trauma & Emergency Surgery, 30(1), 1–10.
Kessler, D. (2019). Finding meaning: The sixth stage of grief. Scribner.
Klass, D., Silverman, P. R., & Nickman, S. L. (Eds.). (1996). Continuing bonds: New understandings of grief. Taylor & Francis.
Kramuschke, M., Reinhardt, J., Dölemeyer, R., Kaiser, J., & Kersting, A. (2024). The change of working alliance and the association to treatment outcome in an internet-based therapy after pregnancy loss. BMC Psychology, 12(1), 254. https://doi.org/10.1186/s40359-024-01751-4
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Kübler-Ross, E., & Kessler, D. (2004). On grief and grieving: Finding the meaning of grief through the five stages of loss. Scribner.
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Lee, M. (2016). Using narrative approach for anticipatory grief among family caregivers. Annals of Geriatric Medicine and Research, 20(4), 168–172.
Newsom, C., Schut, H., Stroebe, M. S., Wilson, S., Birrell, J., Moerbeek, M., & Eisma, M. C. (2017). Effectiveness of bereavement counselling through a community-based organization: A naturalistic, controlled trial. Clinical Psychology & Psychotherapy, 24(6), O1512–O1523. https://doi.org/10.1002/cpp.2113
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About the author
Dr. Kinga Mnich is a globally-minded Executive Coach, Social Psychologist, and Speaker who helps high-achievers lead with confidence, clarity, and emotional intelligence. With over 15 years of experience across academia, social impact, and leadership development, she integrates science-backed strategies with mindfulness and somatic tools to create meaningful, lasting change. Kinga brings a rich multicultural perspective to her work.
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What our readers think
Brandon
on February 13, 2024 at 21:27
This is very insightful. I work in behavioral health and addiction treatment and this topic is important in recovery. Many people do not understand grief or how to cope and heal from it. In turn, this often leads to serious mental health and behavioral issues. I’ve learned through my work that grief is often the result of deep rooted trauma, which manifests as addiction. Thank you for your efforts on educating people to the importance of understanding grief.
I received an email from Seph with resources, articles on 13 Types of Grief, and the 10 Grief Counseling Therapy Techniques. Thank you, I will be trying them out. I am open to any other resources.
Dear Dr. Celestine,
I run a program for the VA, a weekly Zoom meeting group for Vietnam Veterans with PTSD. For this aging population this article is very relevant. Unfortunately they are not eager to read longer partly-scientific articles, however beneficial or relevant, but prefer talks, videos, etc. Do you know of any videos, TEDtalks, or other presentations which provide (even parts of) this information?
I am the founder and senior consultant of Optimum Practice Solutions. My focus is on providing organizational management tools and techniques as well as other solutions to support the veterinary and medical professions.
I write educational articles 3-4 times a month which are sent to my subscriber list via email. With a high rate of mental illness and suicide in veterinary medicine and the healthcare profession, I’d like to reprint this article with the author as a Guest in one of my upcoming articles. You’ll find me on LinkedIn https://www.linkedin.com/in/marylemalloy/
Let me know as soon as possible if I have your permission.
Thanks for your interest. Could you please send a few details about your organization, the purpose for which you’d like to republish this article, and the contact for your publishing manager via our contact form here, and we will be in touch 🙂
Thank you so much for the wonderful , detailed information. These resources help in supporting the clients. These kind of resources help the therapist to connect with the clients and help them in their journey.
Grief is an inevitable universal experience. Everyone will experience it at some point in their life, but not everyone is impacted by it in the same way (O’Connor, 2019; Bonanno, 2009).
The five stages of grief were first introduced in 1969 by Elisabeth Kübler-Ross in her book On Death and Dying.
Supporting the grief process in therapy and counseling entails a therapeutic environment based on trust, empathy, and collaboration (Kramuschke et al., 2024).
What our readers think
This is very insightful. I work in behavioral health and addiction treatment and this topic is important in recovery. Many people do not understand grief or how to cope and heal from it. In turn, this often leads to serious mental health and behavioral issues. I’ve learned through my work that grief is often the result of deep rooted trauma, which manifests as addiction. Thank you for your efforts on educating people to the importance of understanding grief.
I received an email from Seph with resources, articles on 13 Types of Grief, and the 10 Grief Counseling Therapy Techniques. Thank you, I will be trying them out. I am open to any other resources.
Dear Dr. Celestine,
I run a program for the VA, a weekly Zoom meeting group for Vietnam Veterans with PTSD. For this aging population this article is very relevant. Unfortunately they are not eager to read longer partly-scientific articles, however beneficial or relevant, but prefer talks, videos, etc. Do you know of any videos, TEDtalks, or other presentations which provide (even parts of) this information?
Thank you,
Jon
I am the founder and senior consultant of Optimum Practice Solutions. My focus is on providing organizational management tools and techniques as well as other solutions to support the veterinary and medical professions.
I write educational articles 3-4 times a month which are sent to my subscriber list via email. With a high rate of mental illness and suicide in veterinary medicine and the healthcare profession, I’d like to reprint this article with the author as a Guest in one of my upcoming articles. You’ll find me on LinkedIn https://www.linkedin.com/in/marylemalloy/
Let me know as soon as possible if I have your permission.
Hi Maryle,
Thanks for your interest. Could you please send a few details about your organization, the purpose for which you’d like to republish this article, and the contact for your publishing manager via our contact form here, and we will be in touch 🙂
Thank you.
– Nicole | Community Manager
Thank you so much for the wonderful , detailed information. These resources help in supporting the clients. These kind of resources help the therapist to connect with the clients and help them in their journey.