Stuck in grief: The neuroscience and psychology of prolonged mourning
Grief is a natural response to loss but for some it can linger far beyond the typical timeframe, becoming what psychologists call prolonged grief disorder (PGD). Unlike typical grief, which diminishes in intensity over time, PGD is marked by persistent yearning, emotional numbness and difficulty moving forward. Recent advances in neuroscience and psychology provide insights into why some individuals become stuck in grief and how their brains and emotions differ.
The neurological basis of grief
Grief involves complex brain processes, particularly in regions associated with emotion regulation, memory and attachment. When someone dies, the brain must adapt to their absence: a process that involves restructuring predictive coding mechanisms.
Dr. Mary-Frances O’Connor, author of The Grieving Brain: The Surprising Science of How We Learn from Love and Loss, explains:
“Our brains are wired to anticipate the presence of loved ones. This predictive model is disrupted by loss, and grief reflects the process of recalibrating our expectations.”
For individuals with PGD this recalibration does not occur effectively. Neuroimaging studies reveal that the nucleus accumbens, a brain region associated with reward processing, remains highly active in people with prolonged grief. This area, which reinforces bonds with loved ones through feelings of connection and attachment, may keep the bereaved emotionally tethered to their loss.
The role of rumination in prolonged grief
A key psychological factor in being stuck in grief is rumination: the tendency to dwell on negative emotions and unanswerable questions, such as "Why did this happen?" or "What could I have done differently?"
A 2010 study published in Psychological Science by Stroebe found that individuals prone to rumination are more likely to develop prolonged grief symptoms. Rumination prevents emotional processing, trapping the bereaved in a cycle of despair and self-recrimination.
Dr. Margaret Stroebe, a leading grief researcher, emphasizes:
“Rumination perpetuates the sense of injustice and helplessness. Instead of adapting to the loss, the individual becomes entrenched in it, making it harder to envision a life beyond grief.”
Attachment styles and grief
Our attachment styles, the patterns of bonding formed in early childhood, also influence how we cope with loss. Those with insecure attachment styles (e.g. anxious or avoidant) are more vulnerable to prolonged grief. Anxiously attached individuals may struggle to let go, fearing abandonment, while avoidantly attached individuals may suppress their emotions, delaying healing.
A 2015 study in the Journal of Affective Disorders by Shear and colleagues revealed that insecure attachment is a significant predictor of prolonged grief disorder. The study suggests that unresolved attachment issues exacerbate the difficulty of adapting to life without the deceased.
Examples from literature and life
Joan Didion’s The Year of Magical Thinking provides a vivid example of being stuck in grief. After the sudden death of her husband, Didion found herself unable to throw away his shoes because she believed he might return. She described this as “magical thinking,” a hallmark of unresolved grief that reflects the brain’s struggle to accept reality. In A Grief Observed, C.S. Lewis recounts his anguish after losing his wife, describing a cycle of longing and disbelief: “Her absence is like the sky, spread over everything."
These literary accounts resonate with real-life experiences, highlighting how grief can permeate every aspect of existence when left unresolved.
Breaking free: psychological interventions
1. Cognitive Behavioral Therapy (CBT) - helps individuals challenge maladaptive thought patterns, such as guilt or rumination. A study published in JAMA Psychiatry found that CBT tailored for prolonged grief significantly reduced symptoms in 71% of participants.
2. Complicated Grief Therapy (CGT) - developed by Dr. Katherine Shear, CGT integrates elements of CBT with attachment theory. It focuses on helping individuals accept the reality of the loss while restoring their ability to find joy in life.
3. Mindfulness and Acceptance - practices like mindfulness encourage individuals to sit with their grief without judgment, facilitating emotional processing. Neuroimaging studies show that mindfulness increases activity in the prefrontal cortex, which regulates emotion and aids in moving forward.
4. Neuroscience-based coaching can help prolonged grief by leveraging techniques to rewire maladaptive neural patterns, such as those driving rumination and emotional dysregulation. It focuses on mindfulness, emotional regulation and cognitive reframing to foster resilience, acceptance, and adaptive processing of loss.
Hope in healing
Being stuck in grief can feel insurmountable, but understanding the underlying neuroscience and psychology offers a path forward. By addressing maladaptive brain processes, rumination and attachment issues, individuals can begin to navigate their grief in a healthier way. As Dr. O’Connor eloquently puts it:
“Grief is not a disorder or a weakness. It is a reflection of the depth of our love, and healing is not about forgetting but finding ways to live with what we’ve lost.”
I hope you found this short article interesting. If you’d like to connect and chat about your experience with grieving please reach out! With time, support and the right interventions, even the most profound grief can transform from a weight that burdens into a memory that honours.
