Dual process model of coping

Last updated April 08, 2024

The dual process model of coping is a model for coping with grief developed by Margaret Stroebe and Henk Schut. This model seeks to address shortcomings of prior models of coping, and provide a framework that better represents the natural variation in coping experience on a day to day basis.^[1]^[2]

The authors came up with a dual process model to better represent human grief. They explain that coping with bereavement, a state of loss, can be a combination of accepting loss and confronting life changes that can be experienced simultaneously. This model suggests that healthy coping is done through the oscillation between this acceptance and confrontation.^[1]^[2] It informs on how the combination of healthy emotional catharsis and changing perspective can be a good and healthy process to cope.^[3] Being able to confront the situation and also deal with everyday life events allows the person to live their lives with desired states of stability in a subjective post-loss world in which bereaved persons find themselves (Parkes, 1993)^{[ full citation needed ]}.

Coping

Bereavement and the adjective 'bereaved' are derived from a verb, 'reave', which means "to despoil, rob, or forcibly deprive" according to the Oxford English Dictionary . Thus, a bereaved person is one who has been deprived, robbed, plundered, or stripped of someone or something that they valued. Reaction to this state or impact of loss is called grief. According to Lazarus and Folkman (1984),^{[ full citation needed ]} coping strategies are the "constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing on or exceeding the resources of the person".

People vary in the ways they grieve and in the ways they cope. But acknowledging it and allowing themselves to go through the motions will allow them to cope in a healthy way. To cope with the loss, the person requires to relearn the world around them and simultaneously make a multifaceted transition from loving in presence to loving in absence (Attig, 2001).^{[ full citation needed ]} A healthy relocation of the deceased internally and maintaining a healthy dynamic connectedness/relationship is observed to provide solace to the grieving, but the weightage differed in pluralistic cultural settings. Grievers will go through times of extreme sadness and also times where they are numb to what has happened.^[4]

Lack of appropriate coping can bring many ailments to a person, mental and physical.^[5] Healthy coping is achieved when the bereaved person is enabled to go forward with healthy, productive living by effortfully developing "new normals" to guide that living which is characterized by lesser stressful demands compared to the initial phase of grief. There are multiple ways to facilitate healthy coping and grieving. For instance, spirituality has been identified as a potential factor that could help facilitate healthy coping strategies and reduce the likelihood of developing complicated grief.^[6]^[7]

Greenblatt has reviewed spousal mourning as being essential for transition. He describes four phases of mourning: the initial reaction of shock, numbness, denial and disbelief; followed by pining, yearning, depression then in a healthy environment resolution phase begins with emancipation from the loved one and readjustment to the new environment.^[8]

In the dual process model, healthy coping can be understood as finding a proper balance between the loss oriented and restoration oriented process, ensuring that an individual has ample time to both acknowledge and process their grief while simultaneously finding distractions and new meaning.^[1]

Dual process model

Loss oriented

The loss oriented process focuses on coping with bereavement, the loss itself, recognizing it and accepting it. In this process a person may express feelings of grief with all the losses that occur from losing their loved one.^[1] There will be many changes from work to family and friendships. There might also be demographic changes and even economic ones. Loss oriented coping has been identified as an especially important aspect of early-stage bereavement, and depending on how an individual copes can significantly impact future adjustment.^[1] It has also been identified that ruminating on feelings of loss might lead to distorted, complicated or prolonged grief.^[7]

The loss oriented process will bring on a lot of yearning, irritability, despair, anxiety and depression. During this process they are only concentrated on their pain that this loss has caused. Lack or denial of early adaptive acknowledgement that they will no longer speak to deceased or see them again might instigate compulsive and self-destructive behaviors. People attached with the deceased have to reconfigure their identity as an autonomous being. These processes in a non-resilient griever can appear overwhelming, and associated guilt can be exported over friends and family in an assumptive effort which might affect interpersonal relationships.^[9]

In the context of disaster related losses or anticipated losses, such as climate change related losses, there is evidence that engaging with these emotional experiences in order to make meaning of them is a necessary step. Research indicates that without this process of reflecting on emotional experiences, it is not possible to transform them into more adaptive expressions, leading to poor mental health.^[10]

Restoration oriented

In restoration-oriented process, an individual will tackle issues tangentially related to their loss, and will engage in activities that can help distract from grief and facilitate adjustment to a post-loss life.^[2] These include focusing on the new roles in their post loss reality and responsibilities in lives. The restoration-oriented process incorporates endurance through reconstruction of perspective by taking over grief; grieving thoughts are adjusted adaptively by creating new meanings with the deceased.

The restoration process is a confrontation process that allows the person to adjust to a world without the deceased. People in this process can feel subjective oscillations of pride and grief related stressors in the avoidance mentalization. This process allows the person to live their daily life as a changed individual without being consumed by the grieving they are facing.^[11]^[12] William Worden calls this the four tasks of grief.^[13] Therese A. Rando calls the letting go process as emancipation from bondage due to the strength required for change and recovery.^{[ citation needed ]}

Again, in the context of disaster related losses or anticipated losses due to climate change, the process of reflecting on and making meaning of emotional experiences leads to growth in resilience, psychological flexibility, increased community engagement and greater solidarity. It is the emotional processing component of this grief that supports the action and restoration that occurs in responses to these losses.^[14]

Oscillation

Addressing limitations of other models of grief, such as the five stages of grief, the authors designed the dual process model of coping to help depict a more accurate experience of grief and bereavement in everyday life. This model is based on the idea that individuals will contend with multiple stressors following a significant loss, and will not be able to deal with one isolated issue at a time.^[1] Bereaved individuals may even experience gaps and fluctuations in the amount of grief they experience daily.^[2]

The role of oscillation in the dual process model is to suggest that grieving individuals will regularly transition between the loss oriented and restoration oriented process.^[2] Jennifer Fiore, in a 2019 systematic review, describes this process of oscillation as an element of the dual process model of coping that is crucial for an individual to cope with their loss in a healthy manner. Oscillation between these two processes allows for an individual to address two distinct areas of life post-loss that are foundational for healthy coping.^[1]

While understood to be an essential part of the dual process model, oscillation is also not fully understood by present research. Fiore's 2019 systematic review acknowledged that there is currently no consensus about the optimal balance between loss oriented and restoration oriented coping.^[1] However, it is generally understood that an individual will prioritize the loss-oriented process early into the grieving process, and will gradually prioritize the restoration-oriented process more as time progresses.^[2]

Oscillation has also been observed to be influenced by culture and individual characteristics. Different cultural norms and personal preferences may guide individuals to prioritize one type of process over another, making oscillation a dynamic aspect of the dual process model.^[2]

Conclusion

The dual process model of coping takes into consideration that most will have multiple stressful life events while they are coping with bereavement. Their lives will continue and so will the problems associated with it, confounded by the newfound loss that an individual may be contending with. There will be many situations that will take them away from grieving, necessitating a balance between coming to terms with one's loss, while simultaneously tending to establishing new social aspects of life that transcend their grief.^[1] These situations can either benefit them or affect them negatively if they allow them to. Being aware and prepared to change can allow them to continue and deal with post-loss life events.^[2]

Related Research Articles

Grief is the response to the loss of something deemed important, particularly to the loss of someone or some living thing that has died, to which a bond or affection was formed. Although conventionally focused on the emotional response to loss, grief also has physical, cognitive, behavioral, social, cultural, spiritual and philosophical dimensions. While the terms are often used interchangeably, bereavement refers to the state of loss, while grief is the reaction to that loss.

According to the model of the five stages of grief, those experiencing grief go through five emotions: denial, anger, bargaining, depression and acceptance. Although it is in common use, studies have not confirmed these stages, and the model has been criticized as outdated as well as unhelpful in explaining the grieving process.

Coping refers to conscious strategies used to reduce unpleasant emotions. Coping strategies can be cognitions or behaviors and can be individual or social. To cope is to deal with and overcome struggles and difficulties in life. It is a way for people to maintain their mental and emotional well-being. Everybody has ways of handling difficult events that occur in life, and that is what it means to cope. Coping can be healthy and productive, or destructive and unhealthy. It is recommended that an individual cope in ways that will be beneficial and healthy. "Managing your stress well can help you feel better physically and psychologically and it can impact your ability to perform your best."

Death education is education about death that focuses on the human and emotional aspects of death. Though it may include teaching on the biological aspects of death, teaching about coping with grief is a primary focus. The scientific study of death is known as thanatology. Thanatology stems from the Greek word thanatos, meaning death, and ology meaning a science or organized body of knowledge. A specialist in this field is a thanatologist.

The loss of a pet or an animal to which one has become emotionally bonded oftentimes results in grief which can be comparable with the death of a human loved one, or even greater, depending on the individual. The death can be felt more intensely when the owner has made a decision to end the pet's life through euthanasia. While there is strong evidence that animals can feel such loss for other animals, this article focuses on human feelings, when an animal is lost, dies or otherwise is departed.

Disenfranchised grief is a term coined by Dr. Kenneth J. Doka in 1989. This concept describes the fact that some forms of grief are not acknowledged on a personal or societal level in modern day Eurocentric culture. For example, those around you may not view your loss as a significant loss, and they may think you don’t have the right to grieve. They might not like how you may or may not be expressing your grief, and thus they may feel uncomfortable, or judgmental. This is not a conscious way of thinking for most individuals, as it is deeply engrained in our psyche. This can be extremely isolating, and push you to question the depth of your grief and the loss you’ve experienced. This concept is viewed as a ”type of grief”, but it more so can be viewed as a "side effect" of grief. This also is not only applicable to grief in the case of death, but also the many other forms of grief. There are few support systems, rituals, traditions, or institutions such as bereavement leave available to those experiencing grief and loss.

Anticipatory grief refers to a feeling of grief occurring before an impending loss. Typically, the impending loss is the death of someone close due to illness. This can be experienced by dying individuals themselves and can also be felt due to non-death-related losses like a scheduled mastectomy, pending divorce, company downsizing, or war.

A broken heart is a metaphor for the intense emotional stress or pain one feels at experiencing great loss or deep longing. The concept is cross-cultural, often cited with reference to unreciprocated or lost love.

Grief counseling is a form of psychotherapy that aims to help people cope with the physical, emotional, social, spiritual, and cognitive responses to loss. These experiences are commonly thought to be brought on by a loved person's death, but may more broadly be understood as shaped by any significant life-altering loss.

<span class="mw-page-title-main">Judi's House</span>

Judi’s House is a community-based nonprofit bereavement center for children and families with the vision that no child should be alone in grief.

An online memorial is a virtual space created on the Internet for the purpose of remembering, celebrating, or commemorating those who have died. An online memorial may be a one-page HTML webpage document giving the name of the deceased and a few words of tribute, an extensive information source, or be part of a social media platform where users can add their own words and photos.

<span class="mw-page-title-main">George Bonanno</span>

George A. Bonanno is a professor of clinical psychology at Teachers College, Columbia University, U.S. He is responsible for introducing the controversial idea of resilience to the study of loss and trauma. He is known as a pioneering researcher in the field of bereavement and trauma. The New York Times on February 15, 2011, stated that the current science of bereavement has been "driven primarily" by Bonanno. Scientific American summarized a main finding of his work, "The ability to rebound remains the norm throughout adult life." Bonanno has been honored with several major awards for his work.

Prolonged grief disorder (PGD), also known as complicated grief (CG), traumatic grief (TG) and persistent complex bereavement disorder (PCBD) in the DSM-5, is a mental disorder consisting of a distinct set of symptoms following the death of a family member or close friend. People with PGD are preoccupied by grief and feelings of loss to the point of clinically significant distress and impairment, which can manifest in a variety of symptoms including depression, emotional pain, emotional numbness, loneliness, identity disturbance and difficulty in managing interpersonal relationships. Difficulty accepting the loss is also common, which can present as rumination about the death, a strong desire for reunion with the departed, or disbelief that the death occurred. PGD is estimated to be experienced by about 10 percent of bereaved survivors, although rates vary substantially depending on populations sampled and definitions used.

Ambiguous loss is a loss that occurs without a significant likelihood of reaching emotional closure or a clear understanding. This kind of loss leaves a person searching for answers, and thus complicates and delays the process of grieving, and often results in unresolved grief. Some examples are infertility, termination of pregnancy, disappearance of a family member, death of an ex-spouse, and a family member being physically alive but in a state of cognitive decline due to Alzheimer's disease or dementia. An ambiguous loss can be categorized into two types of loss: physical or psychological. Physical loss and psychological loss differ in terms of what is being grieved for, the loss of the physical body, or the psychological mind. Experiencing an ambiguous loss can lead to personal questions, such as, "Am I still married to my missing spouse?," or "Am I still a child to a parent who no longer remembers me?". Since the grief process in an ambiguous loss is halted, it is harder to cope or move on to acceptance from the type of loss experienced. There are various types of grief that can occur due to the type of ambiguity experienced and corresponding therapy techniques to address the certain types of grief. The overall goal of therapy to cope with ambiguous loss is to overcome the trauma associated with it and restore resilience.

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References

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↑ Zheng, Yongqiang; Cotton, Anna Cox; He, Longtao; Wuest, Leslie Grace (2021-08-01). "Spirituality-Integrated Interventions for Caregivers of Patients with Terminal Illness: A Systematic Review of Quantitative Outcomes". Journal of Religion and Health. 60 (4): 2939–2959. doi:10.1007/s10943-021-01221-w. ISSN 1573-6571.
1 2 Mason, Tina M.; Tofthagen, Cindy S.; Buck, Harleah G. (2020-04-02). "Complicated Grief: Risk Factors, Protective Factors, and Interventions". Journal of Social Work in End-of-Life & Palliative Care. 16 (2): 151–174. doi:10.1080/15524256.2020.1745726. ISSN 1552-4256.
↑ Greenblatt, M. (1978-01-01). "The grieving spouse". American Journal of Psychiatry. 135 (1): 43–47. doi:10.1176/ajp.135.1.43. ISSN 0002-953X. PMID 337812.
↑ Fasse, Léonor; Zech, Emmanuelle (2015). "The Dual Process Model of Coping with Bereavement in the test of the subjective experiences of bereaved spouses. An interpretative phenomenological analysis". OMEGA: Journal of Death and Dying. 74 (2): 212–238. doi:10.1177/0030222815598668. S2CID 145779481 – via ResearchGate.
↑ Kieft, J.; Bendell, J (2021). "The responsibility of communicating difficult truths about climate influenced societal disruption and collapse: an introduction to psychological research". Institute for Leadership and Sustainability (IFLAS) Occasional Papers. 7: 1–39.
↑ Bennett, Kate M.; Gibbons, Kerry; MacKenzie-Smith, Suzanna (2010-12-01). "Loss and Restoration in Later Life: An Examination of Dual Process Model of Coping with Bereavement". OMEGA - Journal of Death and Dying. 61 (4): 315–332. doi:10.2190/OM.61.4.d. PMID 21058612. S2CID 7474544.
↑ Jeffreys, J. Shep (2004-12-30). Helping Grieving People: A Handbook for Care Providers. Routledge. p. 46. ISBN 978-1-135-94138-3.
↑ Worden, J. William (2009). Grief counseling and grief therapy : a handbook for the mental health practitioner (4th ed.). New York, NY: Springer Pub. Co. ISBN 978-0826101204. OCLC 307513848.
↑ Kieft, J.; Bendell, J (2021). "The responsibility of communicating difficult truths about climate influenced societal disruption and collapse: an introduction to psychological research". Institute for Leadership and Sustainability (IFLAS) Occasional Papers. 7: 1–39.