Coping with Loss

Sue Schonberg, PhD, ABPP

Beck Institute Faculty

When individuals reflect on a feeling of loss, they often associate it with the death of a cherished friend or relative. While grief is one type of loss, there are many other types of losses people experience that elicit similar automatic thoughts, behaviors, and emotions. Sometimes people become stuck in unhelpful thinking and behavior that can prevent them from coping with their loss. This blog will explore a range of different types of losses, associated automatic thoughts and behaviors, and their shared commonalities.

Loss of a Person Through Death

The pain of loss through the death of a loved one or friend is universal. Grief is an expected response to a significant loss. Common reactions include profound sadness, daily thinking about the deceased person and wish that this loss hadn’t occurred. However, if grief persists beyond six months and creates significant and pervasive impairment to an individual’s functioning, the individual may be experiencing Prolonged Grief.

Loss of a Relationship

When individuals experience the loss of a relationship—either self-initiated or initiated by another person—sadness is a common emotional reaction. Individuals may also have unhelpful automatic thoughts about the breakup that can interfere with the healing process.

Examples might include:

• Blaming: “I could have made this relationship work somehow. I didn’t try hard enough.”
• Labeling: “I’m such a loser [for having a breakup].”
• Catastrophizing: “I’ll never meet another guy again,” or “I’ll never be able to trust someone again.”

Examples of maladaptive behaviors individuals might adopt include compulsive viewing of the ex-partner’s social media feed, avoidance of certain foods shared with the ex-partner, avoidance of places shared with the ex-partner, or displaying pictures of their ex-partner on their mobile phones or in their home.

Loss Due to a Medical Condition or Injury

An individual undergoing a mastectomy or hysterectomy will likely experience a sense of loss. In addition to the concrete loss of the body part, a woman may experience some degree of loss of her femininity as she once knew it or loss of future child-bearing options. An individual who had been an active runner and sustained an orthopedic injury that prevents them from running would likely also experience a sense of loss. 

Examples of maladaptive thoughts associated with loss due to a medical condition or injury include:

• Catastrophizing: “No one will find me physically attractive ever again.”
• All or Nothing Thinking: “I can’t exercise the way I used to. If I can’t lift weights, what’s the point in doing anything else?”
• Mindreading: “My running friends will ditch me– why would they want to remain friends with me if we can’t go on runs together?”

Examples of maladaptive behaviors might include avoidance of physical intimacy, refusal to consider alternative, lower impact exercise, or avoidance of one’s running partners. 

Loss of Safety

Individuals who experienced a life-threatening car accident can experience a sense of loss, even if all parties survived. The loss of feeling safe in the world and experiencing vulnerability can be extremely disturbing. Individuals may also feel a loss of safety in response to upsetting current events or volatility in one’s domestic and international political systems.

Individuals might experience automatic thoughts such as “I’ll never get into a car again” or “I’ll never feel safe in this country.” Their maladaptive core beliefs related to safety can also become activated (i.e. “The world is unsafe.”)

Associated maladaptive behaviors include avoidance of driving or avoidance of individuals with different political views despite interaction with these individuals being necessary for one’s job.

Loss of Pursuing One’s Dream

If an individual was laid off from their dream job, they may experience a sense of loss. Another individual might dream of starting a family, only to experience infertility. Examples of maladaptive thinking might include, “I’ll never get another job in this field,” or “If I can’t have a child, my life is meaningless.” Examples of maladaptive behavior might include refusing to apply for a new job or avoiding friends who have children.

What Are the Shared Commonalities of the Above Thinking Styles and Behaviors?

With all these losses, maladaptive thinking and behaviors can serve many functions. They can protect an individual from experiencing emotions deemed too painful or even intolerable. They can protect an individual from facing the uncertainty of their future by creating a false sense of control and invincibility. They can also insulate an individual from addressing painful core beliefs of being unlovable, incompetent, or defective. Unfortunately, the adoption of dysfunctional thinking or unhelpful behaviors can interfere with the healing process and are an important target for therapy.

The Role of Values in the Experience of Loss

Helping an individual identify their strengths and values respective to a specific type of loss can serve as a catalyst for meaningful and successful treatment. An individual who experienced the death of her husband might be encouraged to explore values related to the importance of family. Perhaps this client has been avoiding activities that she, her late husband, and their young children used to participate in together. Her values related to family can motivate her to re-engage in these activities, strengthening her bond with her children and helping the family heal.

An individual who experienced a breakup might be encouraged to explore values relating to friendship and helping others. They may decide to reach out to another friend who also experienced a recent breakup and offer support. An individual who avoids driving after a car accident might discuss his values related to achievement at work or school. His avoidance of driving may be incompatible with this value, as it may prevent him from participating in important meetings or class discussions. This value might serve as a catalyst in therapy to begin incremental exposure to his newly developed fear of driving.

Healthy Ways to Cope with Loss

When working with clients who have experienced loss, formation of a strong therapeutic relationship is critical, particularly if the client has become untrusting or avoidant of other people in the wake of their loss. Conceptualization should take into account the individual’s strengths and values, with an eye to how the individual’s values may interact with their experience of loss. Helping clients identify and evaluate inaccurate automatic thoughts about the loss can help them engage in helpful behaviors that can move them toward healing. Therapists should also normalize common emotions of sadness, jealousy, anger, and anxiety. The experience of loss of various types is universal, and CBT can effectively help individuals who have become stuck in the healing process.