59 caregivers of terminally ill spouses,

One study (1) of 248 caregivers of terminally ill Cancer patients investigated the presence of predeath complicated Grief and its correlates. Results revealed the following variables associated with higher levels of predeath complicated grief: 
Age younger than 60 years.
Lack of perceived available social support.
History of depression and current depression.
Lower income.
Pessimistic thinking.
Severity of stressful life events.


Of these correlates, pessimistic thinking and severity of stressful life events were independent predictors of predeath complicated grief.


Other research has focused on predictors of outcomes such as symptoms of depression and overall negative health consequences. Three categories of variables have been investigated:
Situational (e.g., circumstances of the death).
Personal (e.g., personality characteristics, gender).
Interpersonal context (e.g., social support, kinship).


Most research has focused on spousal/partner loss and is not uniquely focused on death via cancer.


Situational: Expected or Unexpected Death


Although theory suggests that a sudden, unexpected loss should lead to more difficult grief, empirical findings have been mixed. The impact of an unexpected loss seems to be moderated by self-esteem and perceived control: Bereaved persons with low self-esteem and/or a sense that life is uncontrollable seem to suffer more Depression and somatic complaints after an unexpected death than do bereaved persons with higher self-esteem and/or a sense of control.


Personal: Personality Characteristics


Attachment theory has suggested that the nature of one's earliest attachments (typically with parents) predicts how one would react to loss. Bereaved persons with secure attachment styles would be least likely to experience complicated grief, while those with either insecure styles or anxious-ambivalent styles would be most likely to experience negative outcomes.


In a study of 59 caregivers of terminally ill spouses, the nature of their attachment styles and marital quality were evaluated. Results showed that caregivers with insecure attachment styles or in marriages that were "security-increasing" were more likely to experience symptoms of complicated grief.Persons with a tendency toward "ruminative coping," a pattern of excessively focusing on one's symptoms of distress, have also been shown to experience extended depression after a loss.


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Grief and Grieving - Symptoms

Your experience of Grief is likely to be different from another person's. Similarly, you will probably grieve somewhat differently each time you experience a significant loss. Your reaction to loss is influenced by the relationship you had with the lost person and by your general coping style, personality, and life experiences. How you express grief is influenced in part by the cultural, religious, and social rules of your community.

Grief is expressed physically, emotionally, socially, and spiritually.

• Physical expressions of grief often include crying and sighing, headaches, loss of appetite, difficulty sleeping, weakness,fatigue, feelings of heaviness, aches, pains, and other stress-related ailments.
• Emotional expressions of grief include feelings of sadness and yearning. But feelings of worry,anxiety, frustration, anger, or guilt are also normal.
• Social expressions of grief may include feeling detached from others, isolating yourself from social contact, and behaving in ways that are not normal for you.
• Spiritual expressions of grief may include questioning the reason for your loss, the purpose of pain and suffering, the purpose of life, and the meaning of death. After a death, your greving process is influenced by how you view death..

Grief can cause prolonged and serious symptoms:

 including depression , anxiety, suicidal  thoughts and actions, physical illness, and PTSD.

Intense grief can bring on unusual experiences. After a death, you may have vivid dreams about your loved one, develop his or her behaviors or mannerisms, or see or hear your loved one. If you feel fearful or stressed by any of these experiences, talk to your doctor and a  mental health (Dr. Losito) professional or clergy person experienced in grief counseling

Age and emotional development influence the way a person grieves a death.

• Children younger than age 7 usually perceive death as separation. They may feel abandoned and scared. And they may fear being alone or leaving people they love. Grieving young children may not want to sleep alone at night, or they may refuse to go to day care or school. Children under age 7 usually are not able to verbally express their feelings. Instead, they tend to act out their feelings through behaviors, such as refusing to obey adults, having temper tantrums, or role-playing their lives in pretend play. Children younger than age 2 may refuse to talk. And they may be generally irritable. Children between the ages of 2 and 5 may develop eating, sleeping, or toileting and bed-wetting problems.
• Children between the ages of 7 and 12 often perceive death as a threat to their personal safety. They tend to fear that they will die also and may try to protect themselves from death. While some grieving children want to stay close to someone they think can protect them, others withdraw. Some children try to be very brave or behave extremely well. Others behave terribly. A grieving child may have problems concentrating on schoolwork, following directions, and doing daily tasks. Children in this age group need to be reassured that they are not responsible for the death they are grieving.
• TEENS perceive death much like adults do. But they may express their feelings in dramatic or unexpected ways. For example, they may join a religious group that defines death in a way that calms their feelings. They may try to defy death by participating in dangerous activities, such as reckless driving, Smoking cigarettes, drinking alcohol, taking illegal DRUGS, or having unprotected SEX. Like adults, preteens and teens can have suicidal thoughts when grieving. Warning signs of suicide in children and teens may include preoccupation with death or suicide or giving away belongings.

Grief: When Major Loss Challenges Your Beliefs

A major loss can challenge your sense of certainty in your belief system and religious faith. You may find yourself examining many of your values and beliefs, including the purpose of life, death, suffering, and whether there is a higher power. Alternately, you may gain comfort, courage, and hope from your religious beliefs during this time.

It is important to distinguish between religion and spirituality.

• Religion is a system of faith and worship of a divine being. There are many different types of religions. All religions have certain beliefs, practices, and rituals.
• Spirituality is one's personal connection with and questions about the deepest meanings or powers governing life. Some people express their spirituality through their religion. Others may have a system of values and beliefs that does not include worship of a divine being.

There are some ways you can help yourself when you are questioning the purpose of life, death, and suffering.

• Be clear about your feelings. Are you feeling unsure about your religious belief system? Are you angry because you have different beliefs from those of your religion? Are you feeling empty because you do not have a belief system that answers your questions?
• Allow yourself the right to question. You may feel uncomfortable when you have questions that do not seem to have answers. Give yourself permission to say, "I don't have the answer for that right now," or "I don't know why this happened." Saying this instead of making up an answer or giving someone else's answer is often the first step in discovering what you truly believe.
• Talk with someone you trust. Talk with someone who will listen to your concerns and will not try to answer your questions for you. If you talk about it, what is bothering you may become more clear and you may find the answers you are looking for.
• Find a way to handle the feelings that arise. Are you angry with a higher power? Do you want to make a deal with a higher power as a way to avoid further distress and sadness? Are you frustrated with your feelings of helplessness? Do you feel guilty? It is important to recognize your feelings and handle them in the way that helps you resolve them.
• Find answers to your questions about religious beliefs. If you are confused about a specific religious belief, ask someone who knows the answer. Talk with a clergy person. Read religious books or texts.
• List your sources of spiritual (or religious) comfort or practices. What gives you comfort in times of questioning? Do you feel the need to be alone or with other people? Are there practices in your religion that you have not done in some time and would like to try again? If needed, talk with someone who can help you list and do some of the things you choose to do.

If you or someone you know is having trouble addressing religious or spiritual questions that arise while in a bereaved state, talk with a clergy person or a licensed counselor, social worker, or Dr. Losito, Ph.D, Pastoral counseling, which combines the spiritual expertise of a member of the clergy with the skills of a licensed counselor, may be helpful. You can also ask your local librarian to recommend books that can help address your spiritual questions.

My Own Bereavement

My father died at noon on my Birthday when I was 36years old, so I can understand why people grieve during the Holy Season;  Although, my father had been ill for few years, I felt the bizarre combination of shock, loss, and relief. I even felt joy because he was finally out of pain and with Jesus. During the next few months, those emotions constantly bounced around inside of me until I felt like my mind was playing the old children’s game of Fruit; consequently, I was not able to look at a French Fry in the Face for many months. 

Basket Turn Over. One day, I was able to feel joyful, the next, I grieved, the next I felt totally lost.

Late on that Christmas afternoon, I returned to my apartment. When I opened the door I heard joyful voices singing, “We Wish You a Merry Christmas!” In my haste, I had left the Christmas music playing. The colorful lights on our tree were cheerfully twinkling, seeming to mock my father’s death. “How could anybody die on Christmas day?” I asked myself. Everything felt surreal. I felt a little crazy, but later I learned that my feelings were the normal responses to shock and grief.

Until my father died, I had not experienced the death of anyone close to me. I had no idea how to bear grief. I decided to ignore my grief and pretend that my father was still alive until the very next Christmas. That sounds a little crazy, but I know now that it was the only way I could temporarily cope. I had to finally face the loss of my father and learn how to bear grief. In fact, that very next Christmas continued to face this Holy Day could not be same from previous Christmases.  Christmas was the Holy Day my Father provided a sense of care and concern to all. Now this had to be restructured to something completely all new. 

Your grief

I know that many people are experiencing loss at this time of year, especially. For example, you may have been divorced since the last Christmas or one of your sons or daughters may be at war or a friendship may have been broken over the last year. Perhaps it’s health problems that have robbed you of many activities that were common to your life before this year or someone you love may have died.

Grief is an experience that is common to everyone. Nobody who has ever lived on this earth has been able to avoid it, but it often comes to us when we least expect it. We can easily be overwhelmed and stuck in grief for years, if we do not have some understanding of it.

Getting Through Grief

Since my father died, I have learned three things that have helped me deal with grief.

1. Grief usually comes in waves, which lasts about 20 to 30 minutes.

The body cannot sustain such strong grieving for much longer than that. After my father died, I had been afraid that such strong grief would just consume me. I feared that my grief would drag me down into a dark hole and I would never be able to come out again.

When I found out that the waves had a limit, I felt safe to let go, to cry, or talk or write my feelings down. In the months that followed, the grief waves also came less and less. I learned that the Holy Spirit is the God of all comfort (2 Cor.1:1-3) and I learned to ask Him to enter those grief waves with me. He did and He brought comfort. The grief hurt, but I wasn’t nearly as afraid.

2. Emotions don’t know time and space.

Memories are stimulated through the senses. For example, you may hear a familiar song that takes you emotionally back to a very sad place. The smell of potpourri may cause you to think of familiar previous family rituals that can no longer occur. The sight of a Christmas ornament can remind you of people who are no longer alive.

A few years after my father died, an uncle came to visit us. As I hugged him, I smelled Old Spice cologne, which had been my father’s favorite. Suddenly, I felt like a helpless 36 year-old whose heart had just been broken. I didn’t know how to come forward emotionally and I got stuck in a miserable emotional state that Christmas.

Now I remind myself to pay attention to my senses before each holiday season begins. I begin to say to myself, “That was then and this is now.” I learned to pause between the stimuli and my response. I began to practice enjoying what I have “now,” rather than automatically letting myself move emotionally backward in my mind. I have learned to celebrate the season for what it is “right now” in my life, remembering the birth of Jesus, counting the ways His birth has brought blessings and joy into my life.

This was a discipline that I had to practice and, year by year, this process has helped me live in the present.

3. Confine and assign time to your feelings

We don’t need to ignore our feelings altogether, but it’s helpful to deliberately make a time and place for them.

I began to set aside a period of time to think about my father. Sometimes I wrote about him in a journal. Other times I talked about him to my children, sometimes I lit a Christmas candle and gave thanks for him. I also looked through a scrapbook of my childhood. However, I placed a time limit on my grief and nostalgia.

I had to exercise my will to do this, making a decision to invest most of my energy into the family members who were still with me, serving friends and strangers who had needs. I invested my energy more and more into serving than grieving, and creating new memories, rather than looking back.

Years from now, you may find yourself writing or telling your grief story. Your pain will be less, because you will have experienced the Lord’s comfort. You will have also practiced the process of grieving. You will know that every day is a new day. Every day will train you to help others in grief, just as our Lord promised.

There’s no doubt that the holidays can be a sad time for those of us who are experiencing loss. But with God’s strength and grace, He can help us make it through the sadness finding peace and healing that is found in Him –The Prince of Peace. Jesus continues to seek and find us at Christmas, bringing hope to our hurting hearts.  

Dr. Nicholas Losito, Ph.D, CISM,  is the Clinical Director of Hand of  Compassion. He is available for further consults and support during the Christmas season and right through into the New Year. 

Coping With Grief at Christmas

Christmas are a time for fellowship and friendship with those you love. However, for many bereaved families, it is also the time of year when they remember the ones in lives who have died. How one handles this grief depends on many factors:

• Relationship to person who died
• Time since loved one's passing
• How many living family members and friends will join in holiday festivities
• What stage of grief is the bereaved person is in

Once these factors are identified, the bereaved can decide what would be best in dealing with grief at Christmas. There are many ways this can be done including honoring the loved one lost or creating new family traditions.

Grieve

It's OK to be sad when you miss someone you love. It's only natural to feel the grief and heartache associated with being alone. When you start feeling overwhelmed by the holidays:

• Spend some time alone, reading your bereavement cards or letters from others about the person who died
• Go to the cemetery or other resting place
• Write a letter to the person who died
• Seek Dr. Losito if the grief is too overwhelming to handle alone
• Share memories of the person with whoever will listen

Hold a Memorial Service

On Christmas Eve or Christmas Day, hold a special graveside Memorial Services honoring the person who died. This will give everyone a chance to connect with their feelings about the deceased person. Activities to include in the memorial service are:

• Singing a few special holiday songs
• Reading a few favorite Bible passages or poems
• A photographic slide show at the Christmas celebration
• Placing favorite flowers or grave blanket on the headstone
• Have a special Mass or religious service held in the deceased person's memory

Create New Family Traditions

Grief at Christmas can be eased by changing family traditions that normally would make you sad. If it is a parent  you grieve, then make your holiday festivities different than what they were when he or she was alive. Change the location of the celebration or just do things different if that is what you prefer. If it was a child who dies, consider including him or her in your celebration:

• Put up a stocking with the child's name on it
• Add the child's name to Christmas cards in a way that makes you and your family feel comfortable
• Place flowers or toys at the child's resting place
• Make a toy donation in his or her name
• Buy a special angel ornament to add to your tree

Take a Year Off

There is no rule that says you have to celebrate Christmas with your family and friends. If your grief is so fresh or overwhelming, take a year off. Spend the day watching your favorite movies alone if that is what you want to do. You don't have to put a Christmas tree or send out holiday cards. If anyone asks, tell them you needed some time for yourself this year and hope to be back into the festivities next year. Instead of celebrating, you can:

• Volunteer at a food kitchen
• Spend time at your favorite spot meditating or reflecting
• Take a long walk
• Spend time with an elderly neighbor or one who is alone on Christmas
• Create your own support group and invite others over who are suffering through the same kind of loss.

A Final Thought

Christmas is exactly what you make of it. It can be a joyous time of year or it can leave you feeling sad and lonely. Remember, don't do anything that makes you uncomfortable -- you are the one grieving and need time to do that.

Blue Christmas: 6 Tips for Coping with Grief During the Holidays The rest of the world seems overjoyed with holiday spirit and yet you just want to get in bed and pull the covers over your head. You’re grieving. Perhaps your loss was quite recent or maybe it occurred years ago. All you know is that you dread this time of year and cannot wait for it to be over. While the holidays are definitely a challenge for grievers, using these 6 strategies will help you feel a little less blue. Talk about your Loved One – Don’t be afraid to mention your loved one when you’re at a party or with friends and family. Often people are reluctant to mention the deceased because they are afraid to ‘upset’ you. They don’t realize that your loved one is always on your mind and that it’s healthy to reminisce. Be the one to share memories and to encourage conversation. Express your Feelings – Holding in pent up emotion is not healthy. If you want to cry, let yourself cry. If you need to express anger, write in a journal. Try creative arts to express the many feelings you’re experiencing. Use on-line sites to connect with other grievers and talk about your feelings. Letting yourself feel the pain and then finding expression for that pain is an important aspect to healing. Light a Candle – Light a memorial candle at the holiday dinner table to honor the light of your loved one. Remember that although their physical form has gone, they are very much still a part of your life. Hold that love close to your heart and remember that your life has been enriched by their love. Shop and Share – A frequent sadness for grievers is not being able to shop for their loved one. Try going shopping for things that you might have purchased for your dear one and then donating those items to a homeless shelter, a hospital, or a charity. Cut Yourself Slack – Be extremely gentle and kind to yourself. If you don’t feel like going to a party, don’t go. If you don’t want to send cards, then don’t send them. Do the absolute minimum necessary for you to celebrate the holidays. Grieving is exhausting and you simply won’t have extra energy to expend. When possible, ask friends and neighbors to help you with tasks that feel overwhelming. Try to do your shopping on-line. Set your bar low and give yourself permission to take it easy. Simple Pleasures – Even if your heart is broken, you can look for simple pleasures to savor. See if you can find one tiny thing each day for which you can be grateful. Notice your health, your loved ones who are still living, even small sensory pleasures like tastes, smells, and sounds. Try shining the focus of your attention on small things in your life that bring you some happiness. Using these tips will help ease you through the holidays. Remember that grieving is one of the most universal of all experiences – you are not alone.

The rest of the world seems overjoyed with holiday spirit and yet you just want to get in bed and pull the covers over your head.  You’re grieving.  Perhaps your loss was quite recent or maybe it occurred years ago.  All you know is that you dread this time of year and cannot wait for it to be over.

While the holidays are definitely a challenge for grievers, using these 6 strategies will help you feel a little less blue.

Talk about your Loved One – Don’t be afraid to mention your loved one when you’re at a party or with friends and family.  Often people are reluctant to mention the deceased because they are afraid to ‘upset’ you.  They don’t realize that your loved one is always on your mind and that it’s healthy to reminisce.  Be the one to share memories and to encourage conversation.

Express your Feelings – Holding in pent up emotion is not healthy.  If you want to cry, let yourself cry.  If you need to express anger, write in a journal.  Try creative arts to express the many feelings you’re experiencing.  Use on-line sites to connect with other grievers and talk about your feelings.  Letting yourself feel the pain and then finding expression for that pain is an important aspect to healing.

Light a Candle – Light a memorial candle at the holiday dinner table to honor the light of your loved one.  Remember that although their physical form has gone, they are very much still a part of your life.  Hold that love close to your heart and remember that your life has been enriched by their love.

Shop and Share – A frequent sadness for grievers is not being able to shop for their loved one.  Try going shopping for things that you might have purchased for your dear one and then donating those items to a homeless shelter, a hospital, or a charity.

Cut Yourself Slack – Be extremely gentle and kind to yourself.  If you don’t feel like going to a party, don’t go.  If you don’t want to send cards, then don’t send them.  Do the absolute minimum necessary for you to celebrate the holidays.  Grieving is exhausting and you simply won’t have extra energy to expend.  When possible, ask friends and neighbors to help you with tasks that feel overwhelming.  Try to do your shopping on-line.  Set your bar low and give yourself permission to take it easy.

Simple Pleasures – Even if your heart is broken, you can look for simple pleasures to savor.  See if you can find one tiny thing each day for which you can be grateful.  Notice your health, your loved ones who are still living, even small sensory pleasures like tastes, smells, and sounds.  Try shining the focus of your attention on small things in your life that bring you some happiness.

Using these tips will help ease you through the holidays.  Remember that grieving is one of the most universal of all experiences – you are not alone.

Grief Is the Last Act of Love !