CBT for Grief: Examples, How It Works, & Effectiveness

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a form of therapy that focuses on building skills to change negative thoughts and behaviors to achieve more positive outcomes.² It was developed in the 1960s by a psychiatrist named Aaron Beck. When working with depressed patients, he discovered that people’s negative thoughts create cognitive distortions that were at the core of their depression. He recognized changing irrational or destructive thinking could have a positive outcome and help improve a person’s ability to cope with triggers of depression.

How Can CBT Help With Grief?

CBT for grief focuses on creating awareness of the negative thoughts a person has surrounding their grief. They can then begin to understand how these thoughts exacerbate their debilitating symptoms of grief. It emphasizes changing irrational negative thoughts into positive thinking.³ CBT also focuses on teaching the bereaved coping skills to deal with their grief in a healthier manner.

Here are some of the ways CBT can help with grief:

Coming to Terms With the Loss

CBT for grief helps the bereaved understand the messages they are giving to themselves about the death of a loved one. The act of talking about death is cathartic. In addition, therapists help them reframe their negative thought processes, which allows them to develop coping skills they can continue to utilize as they move through their grief. The goal is to move towards the acceptance stage of the loss and begin making adjustments in terms of a new normal.

Working Through Emotional Pain

Working through the grief associated with losing a loved one can be a deeply painful process. People are reluctant to directly address the death, fearing the emotional pain that will stem from these discussions. Therapy helps them to understand that the act of discussing their reactions and emotions is a way to help initiate their healing. Once the therapist understands the thought process and related behaviors that are causing negative outcomes they can begin the work of helping clients reframe these processes. This produces more positive results, a diminishing of the intensity of the emotional pain, and initiates thoughts about ways to adapt for the bereaved.

Adjusting to Life in the Present Moment

CBT is a therapeutic technique that keeps the client in the present moment. It teaches people to be aware of the current relationship between thoughts and behaviors at the moment they are happening. It is a rewiring process demanding that people address these issues as they occur. The goal is to build a new life with meaning and purpose after the death of a loved one.

Identifying Distortions in Thinking

When people are trying to come to terms with the death of a loved one, they are attempting to understand and make sense of the loss. Their reactions are based on their beliefs about death. They may tell themselves if circumstances were different or altered, a loved one would still be with them. They may struggle with an immense amount of guilt surrounding the grief, such as falsely believing they could have done something different and they could have stopped the death. The core of CBT is to help them recognize these thoughts are not based on reality and are causing unhealthy and unrealistic responses.

Cognitive Processing Therapy for Grief

Cognitive processing therapy (CPT) is a specific kind of CBT. It is often used as a type of treatment with people who have experienced a traumatic event. Therefore, CPT can be more beneficial than CBT for grief when an individual has experienced an especially traumatic loss.

The goal of treating people with CPT for grief is to remove the thought patterns and beliefs that interfere with the normal course of bereavement.⁴ Therapists with CPT training understand the dynamics, thought processes, and triggers associated with traumatic grief.

CBT for Grief Techniques

There are many different techniques used in CBT for grief, including cognitive restructuring, therapeutic exposure, and homework. All of the techniques focus on helping people learn the impact of rational and irrational messages people give themselves. It also helps them understand their identity in their world, their relationship with the deceased, and their relationships with others who remain in their lives.

Here are examples of  how CBT techniques are applied to grief:

• Cognitive restructuring: Cognitive restructuring is a therapeutic technique that helps people identify negative thought patterns. Therapy helps alter negative thought processes and reframe them, creating a positive result. For example, changing “If I had known he had heart problems, I would have taken him to the doctor, and he would still be alive.” to “he had no history of heart problems, so I could not have anticipated this.”
• Activity scheduling: Activity scheduling, or behavioral activation (BA), is based on the idea that creating opportunities for structured activities can help with the management of feelings of depression, sadness, and grief. For example, creating opportunities to socialize with others or exercising regularly.
• Therapeutic journaling: Journaling about one’s grief is a way to clarify and redefine emotions relating to loss and grief. Writing thoughts and feelings down can reveal negative thoughts and behavioral patterns. It also can reveal triggers for grief. Journaling can help to demonstrate coping mechanisms that are successful.
• Exposure: Exposure therapy is an aspect of CBT. It creates a safe place for people to face raw emotions, anxiety, and fears. It can be very effective with anxiety stemming from grief. Exposure shows worst-case fears can be overcome. For example, imagining how to cope on an upcoming anniversary shared with the person who has died.
• Guided Imagery: CBT grief experts describe guided imagery when treating grief as “the client briefly visualizes and tells the story of when they first became aware of a loved one’s death. The goal is to help the client come to terms with the loss by integrating the emotional processing with the rational knowledge the loved one has died.”⁵
• Homework Assignments: Homework helps clients to become more engaged and responsible for events and activities in their lives because of accountability. It helps to set personal goals. Homework also assists in establishing their relationship with the deceased and strengthens interpersonal relationships with others.

Can CBT Effectively Treat Grief?

A research study looking at the effectiveness of CBT in helping the bereaved found that CBT was an effective therapeutic technique. Furthermore, CBT significantly helps individuals heal from grief when compared to other therapies or no treatment.⁶

CBT can effectively treat grief in the following ways:

• It helps people understand the depth and reality of the loss of a loved one
• It helps clarify distorted thinking by replacing it with rational thoughts and behaviors
• It guides people into directly facing the pain that comes with grief and bereavement
• It helps people to clarify and build a new relationship with the person who has died
• It takes information gathered from these techniques to help an individual create a path forward to creating a new normal and finding a new purpose in their lives

How Quickly Does CBT for Grief Work?

The length of time CBT treatment for grief symptoms begins to work is connected to several factors. The closer the relationship, the deeper the grief may be felt. It also can be influenced by how sudden and traumatic the death was. Another factor is a person’s willingness to confront their emotions and do the necessary work with a therapist to try to understand and cope with their grief. Finally, if a person has a previous mental health history, it may lengthen the time needed for treatment.

Who Should Try CBT for Grief?

CBT treatment has proven to be very effective for people who are experiencing depression, post-traumatic stress disorder, panic disorder, anxiety, and social isolation in addition to their grief. Additionally, CBT is more effective for individuals who are no longer in the denial stage of grief, as they are often in shock or emotionally numb and may not be ready to begin CBT. It is important to note that young children or adolescents may not have the ability to integrate CBT concepts and may not benefit from CBT.

What to Expect During CBT for Grief Treatment

CBT for grief involves candidly discussing one’s feelings and following up on exercises outlined by the therapist. Especially in grief therapy, the person engaging in treatment needs to be prepared to face painful emotions. This is a short-term type of therapy, and the number of sessions depends on the individual needs of the person in treatment.

CBT for grief sessions involve:

• The therapist will work with the client to discuss current emotions and thoughts related to the loss of a loved one
• There will be an exploration of how those feelings and thoughts directly impact the behaviors of the client and how they are connected
• There will be homework exercises and in-person sessions to help clients identify thoughts and emotions that may not be realistic or are irrational
• The therapist will help the client reframe these thoughts and feelings with the goal of creating more realistic perspectives that evolve into positive outcomes
• Clients will practice these techniques and share results with the therapist
• Clients will be able to implement these skills on their own and use them to help cope with and minimize their symptoms related to grief in the future

How to Find a CBT Therapist for Grief

CBT for grief can be done in person or online. Many people prefer to work with a therapist in the office with an in-person therapeutic relationship. You can use an online therapist directory to find a therapist in your area. Just put in your zip code to find the therapist closest to you. Remember to confirm they have these areas of expertise. You also may want to ask about their philosophy of treatment and what they see as your treatment goals if you work together.

Online CBT therapy may be more convenient for some people in terms of setting up appointments. It can also be an alternative for someone who does not have transportation or the ability to get to a therapist’s office if it is not accessible. There may be differences in price between in-person and online therapy. Discuss these options with a potential therapist.

Other Treatment Options for Grief

CBT is only one of many treatment options for people who are experiencing grief. All grief therapies focus on managing emotions, adjusting to life without a loved one, and creating a new life with purpose. However, some therapies focus on the present, while other therapies look into past relationships and issues. It is important to find a type of therapy that feels like a good fit for you.

Other treatment options for grief include:

• Psychodynamic therapy:  Psychodynamic therapy links past experiences sometimes, going back to childhood with present behaviors and beliefs. Past relationships and experiences influence how grief is processed in the present, according to Sigmund Freud, its founder.
• Narrative therapy: Narrative therapy uses storytelling as a vehicle to process grief.
• It helps the storyteller clarify their own life story and feel more in control of their lives. It helps reveal their own life purpose, which helps heal from grief and loss.
• Group therapy: CBT group therapy is a popular treatment for grief. It offers comfort to group members and normalizes participants’ reactions to grief. The facilitator and group members help to recognize thoughts that may not be based on reality. Group therapy can be done in person or online.
• Complicated grief therapy: Some people find their grief becomes increasingly debilitating, and it may continue to linger. This is called complicated grief. Treatment is based on the idea that people have a need to attach to others and maintain close relationships. When this relationship is lost, treatment helps people get to a place of finally acknowledging and accepting the loss.
• Acceptance and commitment therapy (ACT): ACT looks at the painful emotions triggered by grief. It uses mindfulness techniques and helps people identify their own values and beliefs. This process helps the bereaved move into a place of acceptance and initiates healing after a loss.
• Ritual therapy: Ritual therapy helps the bereaved process their grief by identifying grief rituals they can do to honor the memory of a loved one. It helps create meaning in their lives. Examples of rituals are planting a memorial garden or creating a foundation in memory of a loved one.