The Science & Process of Healing from Grief

Conceptualizing Grief

• Grief is a natural emotion experienced by most people
• Can be mystifying and difficult to understand
• Loss of a person or pet can be crushing and hard to reframe
• Grief process varies depending on the closeness of the relationship

Neuroscience and Psychology of Grief

• Grief involves remapping and reorganization of emotional and logical frameworks
• Moving through grief requires neuroplasticity and reordering of brain connections
• Understanding the grief process can help navigate it in a healthy way

Myths About Grief

• Not everyone experiences the same stages of grief
• People do not always move through stages linearly

Complicated vs. Non-​​Complicated Grief

• Complicated grief: grief does not resolve itself after a prolonged period of time
• Non-​​complicated grief: grief resolves over time
• Occurs in about 1 in 10 people
• Psychological and biological state when loss occurs can impact whether grief is complicated or non-complicated

Navigating the Grief Process

• Understanding where one is in the grief process can be beneficial
• Grief has a beginning, middle, and end
• Links to tests for distinguishing between complicated and non-​​complicated grief provided in podcast show notes
  Grief and the Brain
• Grief and depression are distinctly different processes 
  • Grief rarely responds well to antidepressants, while depression often does
• Grief is a distinct psychological and physiological event in the brain and body 
  • Can be thought of as a motivational state, a yearning, a desire for something

Common Myths and Misunderstandings about Grief

• Elizabeth Kubler Ross’s five stages of grief: 
  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance
• Not everyone experiences all stages or moves through them in a linear manner
• Modern science shows that there are many dimensions to the grief process

Grief as a Motivational State

• Brain imaging studies show that grief activates brain areas associated with motivation, craving, and pursuit
• Grief involves both sadness and a state of wanting
• Activation of reward centers and involvement of dopamine puts us in an anticipatory state and a state of action or desiring action

Understanding Attachments in the Brain

• Attachments and the breaking of attachments are governed by three dimensions: 
  1. Representations of the world (e.g., color, touch, sound)
  2. Representations of people, animals, and things
  3. Representations of relationships and connections
     Three Dimensions of Relationships

• Space, time, and closeness

• Understanding these dimensions can help navigate the grief process

Experiment: Mapping Relationships in the Brain

• Subjects viewed images of objects at different distances 
  • Brain areas activated related to distance between objects
• Subjects listened to tones spaced at different intervals 
  • Brain areas activated related to spacing between sounds
• Subjects viewed images of people at different distances and with varying emotional closeness 
  • Brain areas activated related to physical and emotional distance

Results

• The same brain area, the inferior parietal lobule, was activated in all three conditions 
  • Suggests that relationships are mapped in the brain through space, time, and emotional closeness

Grief and Reordering Relationships

• Grief is the process of uncoupling and untangling the relationship between space, time, and attachment
• When someone or something is taken away, episodic memories persist, but the ability to predict where and when they will be is disrupted

• Understanding these dimensions can help individuals move through the grief process more effectively
  Grief and Loss

• Grief is a process of reordering understanding of someone in space and time 
  • Denial is a common stage in grief
  • The brain continues to make predictions about the deceased person’s presence
• Maintaining a close attachment while not being able to predict the person’s presence is disorienting
• Example: Richard Feynman’s letters to his deceased wife, Arlene 
  • Intense emotional attachment persisted despite her death
  • Struggled to reconcile the logical world and the emotional world
  • Maintained the attachment while trying to uncouple it from space and time

Normal Reactions to Grief

• Looking for the deceased person in familiar places
• Expecting them to call or show up at certain times
• These expectations are based on the deep catalog of episodic memory about the person 
  • The closer the relationship, the more information the brain has about them
  • The brain unconsciously makes predictions about when and where the person will show up
    Grieving Process and Remapping
• Grieving involves remapping the brain’s understanding of relationships 
  • Focus on which element or dimension within the map to concentrate on
• Maintaining close sense of attachment while remapping other dimensions 
  • Emotional disbelief and memory challenges
  • Brain relies more on experience than knowledge
  • Memories persist, even when the person or object is gone

Tools for Adaptively Moving Through Grief

• Acknowledge and understand the attachment without trying to disengage or dismantle it 
  • Shift mindset to uncouple attachment from space and time dimensions
• Set aside dedicated time to feel deeply into the closeness and attachment 
  • Consciously prevent engaging in counterfactual thinking (what ifs)
  • Hold grief in the present and connect to the immediate physical environment
• Tightrope walk between feeling the depth of attachment and not focusing on memories or wishes 
  • Beneficial practice for moving from initial shock of loss to holding connection without yearning

Grief as a Phantom Limb

• Normal for the mind to flip into states of expectation that the person or object will be there 
  • Can experience them as present in the environment when thinking about the attachment

• Grief can be similar to a phantom limb, where sensations or experiences are felt even when the person or object is gone
  Phantom Limb and Emotional Attachments

• >Phantom limb: people who experience amputation feel the limb is still present 
  • Can feel pain and sensation of touch in the missing limb
• Neurologist Ramachandran conducted experiments on phantom limb pain 
  • Using a mirror box, visual perception can reverse some phantom sensations
• Emotional attachments to people or things can be similar to phantom limb 
  • Reactivation of maps about space, time, and person

Moving Through Grief

• Process involves maintaining attachment but uncoupling it from space and time representation
• Essential to have a firm representation of where the person, animal, or thing is 
  • Plugging it into a 3D map of space, time, and attachment
• Adaptive ways to deal with grief: 
  • Not avoiding thinking about it
  • Not engaging in counterfactual thinking (what if)
  • Not drowning it out with substances or distractions

Hippocampus and Grief

• Hippocampus: brain structure involved in the formation of new memories
• Different cell types in the hippocampus perform different roles in the grief process 
  • Place cells: fire when we enter a familiar location
  • Proximity cells: fire when we are near an expected object or location
  • Trace cells: fire when we expect something to be at a given location, but it’s not there

Trace Cells and Grief

• Trace cells become active in the immediate stage after the loss of a loved one 
  • Responsible for the absence of something
  • Closely associated with neurons that tell us where things ought to be
    Grief and Attachment

• Grief is a normal response to the loss of a person, animal, or thing

• People experience grief differently, and the intensity of grief can vary
• The yearning aspect of grief may be related to oxytocin and its receptors in the brain

Oxytocin and Grief

• Oxytocin is a hormone peptide involved in bonding, lactation, and attachment
• Prairie voles have been studied to understand the role of oxytocin in attachment and grief
• Monogamous prairie voles have more oxytocin receptors in the nucleus accumbens, a brain area associated with motivation and craving
• Non-​​monogamous prairie voles have fewer oxytocin receptors and less yearning for attachment
• Humans with more oxytocin receptors in the nucleus accumbens may experience more intense grief and yearning

Moving Through Grief

• People move through grief at different rates, and this may be influenced by neurochemicals, hormones, and life circumstances
• Complicated grief, non-​​complicated grief, and prolonged grief disorder are different categories of grief
• Catecholamines, such as epinephrine (adrenaline), norepinephrine (noradrenaline), and dopamine, may also play a role in grief outcomes
• People with higher baseline levels of epinephrine may be more likely to experience complicated grief symptoms

• Utilizing tools to adjust adrenaline levels down may have benefits in improving sleep, health metrics, and managing grief
  Mastering Stress and Grieving

• Behavioral tools backed by science can help control the autonomic nervous system and reduce stress levels

• Reducing pre-​​loss levels of epinephrine (adrenaline) can help prevent complicated or prolonged grief
• Grieving is not depression, and depression is not necessarily grieving
• Depth of attachment to someone does not necessarily predict how long it will take to move through the loss
• Allowing oneself to feel the attachment can support adaptive transitioning through grief

Emotional Disclosure and Vagal Tone

• Study in Biological Psychology explored whether written disclosure of emotional connection to someone lost would be effective in moving through the grieving process
• Vagus nerve is a bi-​​directional nerve pathway between brain and body, associated with calming effects
• Sympathetic nervous system drives alertness, panic, stress
• Parasympathetic nervous system drives calming, falling asleep, digestion, sexual arousal
• Vagus nerve associated with parasympathetic functions and can slow down heart rate through exhales

Breathing and Heart Rate

• Inhales cause the diaphragm to move down, creating more space in the thoracic cavity, increasing heart volume, and speeding up the heart rate
• Exhales cause the diaphragm to move up, decreasing space in the thoracic cavity, decreasing heart volume, and slowing down the heart rate

• Controlling breathing can help manage stress and navigate grief
  Respiratory Sinus Arrhythmia and Vagal Tone

• Respiratory sinus arrhythmia: relationship between inhale speeding up the heart rate and exhale slowing it down 
  • Can be trained by consciously thinking about slowing heart rate while exhaling and increasing heart rate while inhaling
• Vagal tone: ability to control overall level of activation, alertness, and stress with vagus nerve pathways 
  • Varies from person to person
  • Can be improved through training and long exhale breathing

Grief and Vagal Tone

• Study with 35 participants: two groups, one writing about their emotions and thoughts about a loved one’s death, the other writing about their daily activities 
  • No immediate difference between the two groups in terms of psychological variables
  • However, those with higher vagal tone seemed to benefit more from the emotionally intense writing exercise
• Accessing emotional states by writing or thinking about a lost loved one can be powerful in engaging the bodily states and mind states associated with attachment 
  • Beneficial for moving through grief
• Differences in grieving rates may be due to psychological factors and the level of vagal tone in individuals

Tools for Healthy Grieving

• Sleep and maintaining a diurnal pattern (awake during the day, asleep at night) are crucial for overall mental and physical health
• Cortisol, a stress hormone, follows a diurnal pattern 
  • Important for maintaining a healthy stress response and navigating grief
• Practicing breathing exercises to encourage respiratory sinus arrhythmia can be beneficial for building the mind-​​body relationship and moving through grief 
  • Focus on slowing heart rate while exhaling and increasing heart rate while inhaling
    Cortisol and Grieving

• Cortisol has positive effects, such as protecting against infection and helping with waking up

• Healthy cortisol pattern: high upon waking, highest 45 minutes after waking, gradually drops throughout the day, low at night
• Spikes in nighttime cortisol can be a biomarker for depression and chronic anxiety
• Complicated grieving individuals have higher cortisol levels in the afternoon and nighttime compared to non-​​complicated grieving individuals 
  • This could be bidirectional: complicated grief changes cortisol patterns and cortisol patterns change the likelihood of complicated grief

Modulating Cortisol Rhythms and Sleep Patterns

• Establishing normal cortisol rhythms and sleep patterns can help navigate the grief process
• Viewing sunlight close to waking can help regulate cortisol rhythms and sleep patterns 
  • Sunlight exposure should be without sunglasses, not through a window or windshield, and can be done with corrective lenses or contacts
  • Duration: 10–30 minutes, depending on brightness
• Avoiding bright artificial lights in the evening can also help regulate cortisol rhythms and sleep patterns

Tools for Moving Through Grief

• Dedicate time for “rational grieving” — periods of time to focus on grieving and processing emotions 
  • Can range from 5 to 45 minutes or longer, depending on individual needs and schedules
• Proper sleep and regulated cortisol rhythms can help support emotional and cognitive processes during grieving

• Balancing the intense attachment to the lost individual while disengaging from episodic memories and expectations can be challenging, but is necessary for healthy grieving
  Rational Grieving and Neuroscience

• Rational grieving: clear acceptance of new reality without the person, animal, or thing
• Anchoring to the depth and intensity of the attachment
• Distancing ourselves from episodic memories that lead to maladaptive expectations 
• Neural map component representing attachment linked to emotional centers in the brain and body 
  • Painful yearning and anticipation of action that cannot be fulfilled
• Importance of quality sleep for emotion regulation, autonomic control, and neuroplasticity 
  • Tools for better sleep mentioned in the Mastering Sleep episode
  • Non-​​sleep deep rest (NSDR) scripts for accelerating neuroplasticity
• Cognitive work involved in experiencing deep emotional attachment while distancing from expectations
• Preparing for grief by regulating catecholamines and building up respiratory sinus arrhythmia
• Importance of seeking professional help and support during grieving
• Building deeper attachments and episodic memories to enrich life experiences