How Do Coping Strategies Affect Grief, PTSD and Depression After Losing a Loved One?

What you need to know

• Unhelpful coping strategies like avoidance and rumination play a key role in maintaining symptoms of prolonged grief, PTSD and depression after losing a loved one
• How people remember the loss and their negative thoughts about it predict these unhelpful coping strategies
• Targeting unhelpful coping in therapy may help reduce symptoms of prolonged grief, PTSD and depression after bereavement
• Different types of coping strategies may be important to focus on depending on whether someone is experiencing primarily grief, PTSD or depression symptoms

How we cope with loss affects our mental health

Losing a loved one is one of the most difficult experiences in life. While grief is a normal response to loss, some people develop prolonged and intense grief reactions that impair their daily functioning. Others may develop posttraumatic stress disorder (PTSD) or depression after a bereavement. But why do some people struggle more than others after a loss?

New research provides insight into the cognitive and behavioral factors that may maintain symptoms of prolonged grief, PTSD and depression following bereavement. The study found that unhelpful ways of coping with the loss play a key role in perpetuating these mental health difficulties.

The study

Researchers followed 275 bereaved adults over an 18-month period, assessing them at 3 time points:

1. 0-6 months after the loss
2. 6-12 months after the loss
3. 12-18 months after the loss

At the first assessment, participants completed measures of:

• Loss-related memory characteristics (e.g. how vivid, intrusive or distressing memories of the loss were)
• Negative thoughts and beliefs about the loss (e.g. “I’ll never be happy again”)

At the second assessment, participants reported on their use of different coping strategies.

At the final assessment, symptoms of prolonged grief disorder, PTSD and depression were measured.

The researchers then used advanced statistical techniques to examine how these factors were related over time.

Key findings

The study found that unhelpful coping strategies acted as a mediator between initial memory characteristics/negative thoughts and later symptoms. In other words:

1. How people remembered the loss and the negative thoughts they had about it predicted their use of unhelpful coping strategies 6 months later

2. These unhelpful coping strategies then predicted symptoms of prolonged grief, PTSD and depression another 6 months later

Importantly, the effect of memory characteristics and negative thoughts on later symptoms was fully explained by unhelpful coping. This suggests that coping strategies play a crucial role in maintaining mental health difficulties after bereavement.

Types of unhelpful coping

The study looked at four main types of unhelpful coping strategies:

1. Avoidance - Staying away from reminders of the loss

2. Proximity seeking - Excessive efforts to feel close to the deceased

3. Loss rumination - Repetitive thoughts about the loss and its consequences

4. Injustice rumination - Dwelling on the unfairness of the loss

For prolonged grief symptoms, all four types of coping strategies were found to play a role. For PTSD symptoms, avoidance, proximity seeking and loss rumination were most important. For depression symptoms, avoidance and loss rumination had the strongest effects.

Implications for treatment

These findings have important implications for helping people who are struggling after bereavement. They suggest that:

• Assessing and targeting unhelpful coping strategies may be crucial for reducing symptoms of prolonged grief, PTSD and depression

• Different types of coping strategies may need to be addressed depending on someone’s primary symptoms

• Helping people process memories of the loss and modify negative thoughts about it may reduce unhelpful coping

• Interventions that directly target avoidance, excessive proximity seeking, and rumination are likely to be beneficial

Some evidence-based techniques that may help reduce unhelpful coping include:

• Gradual exposure to avoided reminders of the loss
• Identifying and challenging negative thoughts about the loss
• Scheduling positive activities to counter avoidance
• Practicing mindfulness to reduce rumination
• Finding healthy ways to maintain a connection to the deceased

Limitations and future directions

While this study provides valuable insights, it’s important to note some limitations:

• The sample was predominantly female and Caucasian, so findings may not generalize to all populations

• All measures were self-reported rather than clinician-administered

• The study focused on grief-specific measures, which may have contributed to stronger effects for prolonged grief than PTSD or depression

Future research could address these limitations by:

• Including more diverse samples
• Using clinical interviews to assess symptoms
• Incorporating measures specific to PTSD and depression

Additionally, studies that experimentally manipulate coping strategies could provide stronger evidence for their causal role in maintaining symptoms.

Conclusions

• Unhelpful coping strategies play a key role in maintaining mental health difficulties after bereavement
• How people remember the loss and their thoughts about it predict these unhelpful coping strategies
• Targeting unhelpful coping in therapy may help reduce symptoms of prolonged grief, PTSD and depression
• Different coping strategies may need to be addressed depending on someone’s primary symptoms

This research enhances our understanding of why some people struggle more than others after losing a loved one. It highlights unhelpful coping as an important target for assessment and intervention. For those experiencing prolonged and impairing grief reactions, PTSD or depression following a loss, seeking professional help to address unhelpful coping patterns may be beneficial.