Stuck in prolonged grief? How to navigate loss that lingers
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If you’ve experienced the loss of a loved one, you’re likely familiar with the devastating feeling of grief. Grief is a natural response to death, but for some people, the intense pain of loss doesn't follow the typical healing trajectory.
Instead of gradually lessening over time, the grief remains at the same crushing intensity for months, or even years. This condition, known as prolonged grief, affects approximately 7-15% of people who experience loss.
What is prolonged grief?
When the normal grieving process becomes “stuck” you might experience prolonged grief. In typical grief, people initially experience intense pain (they might not be able to sleep or eat, and thoughts of their loved one consume their days). But most people gradually go on to have moments where they're not thinking about the person who died. These moments grow from minutes to hours, until they catch themselves laughing and enjoying an afternoon.
But with prolonged grief, this natural progression doesn't happen. The grief maintains its initial intensity without the normal trajectory of healing. You can feel as consumed by your loss months or years later as you were in the immediate aftermath.
Who is most at risk?
Prolonged grief is more likely to occur in certain circumstances:
- Sudden, unexpected deaths (accidents, suicides, or catastrophes)
- The loss of a child — one of the most common situations for prolonged grief to develop
- People with pre-existing mental health challenges
Parents who lose a child, particularly in sudden circumstances like accidents or suicide, face the highest risk of developing prolonged grief.
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Learn three powerful metacognitive therapy steps to stop the worry cycle, reduce anxiety, and feel calmer in everyday life.
The common symptoms
Prolonged grief can feel similar to depression, but it has distinct characteristics, including:
- Intense and persistent longing for the deceased person
- Excessive focus on the person who died, even after a lot of time has passed
- Difficulty accepting that the person is dead
- Trouble finding meaning in life
- Feeling like you've lost part of yourself
- Anger and bitterness
- Sleep difficulties and functional impairment
- Social withdrawal from relationships and daily activities
While they share some similarities, there’s important differences between prolonged grief and depression. Depression generally involves negative thoughts and feelings of worthlessness or self-loathing, while prolonged grief centres around the intense longing and focus on the person you’ve lost. People with prolonged grief don't usually experience the self-focus we commonly see in depression — their pain is focused entirely on their loss.
The role of metacognitions in prolonged grief
Metacognitive Therapy focuses on the thoughts people have about their thoughts (their 'metacognitions”), which can keep people trapped in cycles of rumination and pain. These thoughts can be categorized into “positive” and “negative” metacognitions, both of which can prolong rumination.
Positive metacognitions that maintain their grief and suffering:
- 'I need to keep thinking about them to honour their memory'
- “My grief shows how much I loved them'
- 'If I move on with my life, it means I didn't love them'
- 'I need to process what happened by thinking about it over and over'
- 'I must stay connected to my pain to stay connected to them'
- 'Healing means losing my bond with the person who died'
These beliefs create a lot of resistance to letting go of grief, even if your grief is causing you to suffer tremendously. Grief becomes the tool to maintain connection and demonstrate love.
Negative metacognitions that increase fear and distress:
- 'I'm going crazy'
- 'Normal people don't think about death this much'
- 'If I don't stop these thoughts, I'll never function again'
- 'There's something wrong with me — I should be over this by now'
- 'These intrusive memories mean I'm weak or broken”
These beliefs can lead to desperate attempts to control or push away thoughts and feelings, which typically backfire.
Hypervigilance and checking behaviours
Some people develop compulsive patterns around their grief, constantly monitoring their grief symptoms and emotional state. They might be hypervigilant about signs they’re forgetting their loved one, scanning for any signs that they’re “moving on”. Many spend a great deal of time analyzing every memory to ensure they remember it correctly.
Many people withdraw from social connections and daily activities because they feel these things don't matter or are too difficult. Therapy helps people gradually re-engage with life while still honouring their loss.
The Metacognitive Therapy approach
Metacognitive Therapy helps people recognize that these well-intentioned efforts to honour their loved one may actually be keeping them stuck in a constant state of grief.
Metacognitive therapists help people examine and challenge their beliefs about grief and love, exploring questions like:
- 'Is constant remembering and thinking the only way to show love?'
- 'What would your loved one have wanted for you?'
- 'If the situation were reversed, would you want them to stop living their life?'
- 'Can you love someone even when you're not thinking about them constantly?'
Most people recognize that they can love someone even when they weren't actively thinking about them, helping them separate love from constant rumination.
You can think of grief like a physical wound — it naturally heals when we don't constantly pick at it. Ask yourself: 'Are you picking at your wound by constantly focusing on your grief? What are the pros and cons of keeping the wound open?'
Detached Mindfulness and structured grieving
Rather than trying to eliminate grief entirely (which isn’t an achievable goal) Metacognitive Therapy helps people to:
- Practice detached mindfulness outside of designated grief times
- Set aside specific periods for active grieving to reduce the time you spend ruminating (typically 1-2 hours per day initially, compared to the 8-12 hours many people spend consumed by grief.) You don't have to use this time, but it's there if you need it.
- Engage more fully in life during non-grieving times
- Allow the natural grief process to unfold without constant interference
Moving forward while honouring love
The goal of Metacognitive Therapy for prolonged grief isn't to 'get over' the loss or stop loving the person who died. Instead, it's about finding ways to carry that love forward without being trapped in perpetual suffering.
You’ll discover that there are many ways to maintain connection with a loved one beyond constant rumination: through memories shared at appropriate times, through living in ways that would make the person proud, and through carrying forward the positive impact that person had on their life.
Healing doesn't mean forgetting or loving less. It means allowing the natural grief process to unfold so that love can remain while you fully engage with life again.
If you recognize yourself in this description of prolonged grief, know that effective help is available, and Metacognitive Therapy has shown significant promise in helping people move through prolonged grief.
