Grief is the experience of coping with loss.

Most of us think of grief as happening in the

painful period following the death of a loved one. But grief can accompany any event
that disrupts or challenges our sense of normalcy or ourselves. This includes the loss of
connections that define us.

You may grieve the loss of:

 A friend, family member, partner or pet.

 A marriage, friendship or another form of kinship.
 Your home, neighborhood or community.
 Your job or career.
 Financial stability.
 A dream or goal.
 Good health.
 Your youth.
 Fertility.

Grief can manifest in various ways, affecting your emotions, body, and behavior:

Emotional symptoms include waves of different emotions such as sadness, anger, and
lack of joy, often leading to confusion and conflicting feelings.

Physical symptoms may include fatigue, headaches, nausea, upset stomach, heart
palpitations, muscle or joint pain, and changes in appetite and sleep patterns.

Behavioral changes may involve difficulty concentrating, making decisions, feeling

hopeless, and focusing on the loss to the extent that other responsibilities become
challenging to manage.
According to Association for Behavioral and Cognitive Therapies (ABCT) 2019
Complicated grief affects between 2% to 3% of the population worldwide and 7% to 10% of bereaved
people.

The American Psychological Association (APA) defines grief as lasting from six months
to two years. Symptoms gradually improve as time passes.

It’s important to remember that grief doesn’t fit into neat boxes or timelines. Everyone’s
grief and grieving timelines are different.

Complicated grief

In real-time, all grief is complex. In certain circumstances; however, grief can evolve into
something even more complex — complicated or prolonged grief. Complicated or
prolonged grief often involves especially challenging circumstances or extreme
symptoms that interfere with daily life over a long period.

In Almas's case, her experience exemplifies elements of complicated grief:

1. Almas's grief is complicated by the discovery of her husband's secret life. undisclosed marriages
and left her with financial debt creates a sense of shock and disbelief, which complicates her
ability to come to terms with his death.

2. Prolonged and Intense Symptoms: Almas exhibits a range of symptoms associated with
complicated grief, including persistent yearning for the deceased, intense crying spells,
debilitating loneliness, and difficulty engaging in daily activities.

3. Almas's inability to find peace and her overwhelming separation anxiety are indicative of the
depth of her emotional pain and the complexity of her grief.

4. Interference with Daily Functioning: Almas's grief symptoms significantly interfere with her
ability to function in her daily life. For instance, her poor sleep, anhedonia, social withdrawal,
and difficulty maintaining a routine all point to the disruptive impact of her grief on her day-to-
day functioning. This level of impairment is characteristic of complicated grief

5. Co-occurring Medical Conditions: Almas's battle with Stage 4 ovarian cancer adds an additional
layer of complexity to her grief. The physical symptoms associated with her cancer, such as
fatigue and anorexia, may exacerbate her emotional distress and complicate her ability to cope
with the loss of her husband

2. Review the manifestations of adaptive/maladaptive grief identified in this

scenario?
Adaptive Manifestations of Grief:

1. Acknowledgment of Emotions: Almas displays adaptive grief by acknowledging her emotions

and seeking therapy to address her complicated grief symptoms. This proactive approach
demonstrates a willingness to confront her feelings and work towards healing.
2. Seeking Support: By seeking therapy at a psychology clinic, Almas demonstrates an adaptive
response to her grief. Seeking professional help and support from mental health professionals is
an important step in processing grief and finding healthy coping mechanisms.
3. Desire for Healing and Understanding: Almas's stated goals for therapy, such as finding peace
and figuring out her identity in the aftermath of her husband's death, reflect a desire for healing
 4. and understanding. This willingness to engage in self-exploration and personal growth is
indicative of adaptive grieving.

Maladaptive Manifestations of Grief:

1. Rumination and Intrusive Thoughts: Almas experiences ruminative thoughts regarding her
deceased husband, particularly regarding the discovery of his secret life. These intrusive
thoughts and rumination may contribute to her prolonged and intense grieving process,
suggesting maladaptive coping mechanisms.
2. Social Withdrawal: Almas's withdrawal from social interactions and difficulties engaging in
activities of daily living indicate maladaptive grieving behaviors. Isolating oneself and
withdrawing from social support can exacerbate feelings of loneliness and prolong the grieving
process.
3. Physical Symptoms and Impact on Health: Almas's physical symptoms, such as fatigue, anorexia,
and hair loss, may be exacerbated by her grief and underlying medical condition. Maladaptive
grieving can negatively impact one's physical health, leading to somatic symptoms and
decreased overall well-being.
4. Struggles with Acceptance and Adjustment: Almas's difficulty accepting her husband's death,
compounded by the discovery of his secret life and financial deceit, suggests maladaptive
grieving. The inability to come to terms with the loss and adjust to the new reality can prolong
the grieving process and hinder emotional healing.

Overall, while Almas demonstrates some adaptive responses to her grief by seeking therapy and
expressing a desire for healing, she also exhibits maladaptive manifestations such as rumination, social
withdrawal, and struggles with acceptance. Addressing these maladaptive coping mechanisms and
providing support to facilitate adaptive grieving will be crucial in her therapeutic journey towards healing
and recovery.

3. Discuss how to break the bad news and what are different models or protocols for breaking bad
news?

Breaking bad news is a delicate and challenging task that requires sensitivity, empathy, and clear
communication.

SPIKES Protocol:

1. Setting: Choose an appropriate setting that is private, comfortable, and free from distractions.
2. Perception: Assess the patient's understanding and perception of their condition to do the
conversation accordingly.
3. Invitation: Ask the patient how much information they would like to receive and if they would
like someone to be present during the discussion.
 4. Knowledge: Provide clear and honest information about the diagnosis, prognosis, and treatment
options, using simple and understandable language.
5. Emotions: Acknowledge and validate the patient’s emotions, expressing empathy and providing
support.
6. Strategy and Summary: Collaborate with the patient to develop a plan moving forward,
summarize key points, and address any questions or concerns.

ABCDE Protocol:

1. Advance preparation: Prepare yourself mentally and emotionally before delivering the news.
2. Build a therapeutic environment: Ensure the setting is conducive to open communication and
emotional support.
3. Communicate well: Use clear and compassionate language to deliver the news, providing
information gradually and checking for understanding.
4. Deal with patient and family reactions: Acknowledge and validate the patient's and family's
emotions, offering support and reassurance.
5. Encourage emotions and validate: Encourage expression of emotions, validate their feelings, and
offer coping strategies and resources.

NURSE Protocol:

1. Name: Begin by addressing the patient by name and introducing yourself.

2. Understand: Assess the patient's understanding of their condition and their preferences for
receiving information.
3. Respect: Respect the patient's autonomy and involve them in decision-making.
4. Support: Provide emotional support and empathetic responses throughout the conversation.
5. Explore emotions: Encourage the patient to express their emotions and validate their feelings.

Breaking Bad News Model by Buckman:

1. Setting: Choose an appropriate setting and ensure privacy.

2. Warning shot: Prepare the patient for bad news by signaling that difficult information is
forthcoming.
3. Delivering the news: Use clear and direct language to convey the diagnosis, prognosis, and
treatment options.
4. Responding to patient's feelings: Acknowledge and validate the patient's emotions, expressing
empathy and providing support.
5. Strategy and summary: Collaborate with the patient to develop a plan moving forward and
summarize key points.

4.Deliberate the stages of grieving?

Elisabeth Kubler-Ross Five Stages of Grief:

Denial: The initial stage involves denying the reality of the loss as a defense mechanism to
protect oneself from overwhelming emotions. It's a natural response to shock and disbelief.
 Anger: As denial begins to fade, individuals may experience intense feelings of anger and
resentment. This anger can be directed towards oneself, others, or even the deceased for
causing the loss.

Bargaining: In this stage, individuals may attempt to negotiate or make deals to reverse the loss.
They may engage in "if only" statements or bargaining with a higher power in hopes of finding a
way to prevent or undo the loss.

Depression: Depression sets in as individuals confront the full weight of the loss and its
implications. Feelings of sadness, despair, and loneliness become prominent as they come to
terms with the reality of their situation.

Acceptance: The final stage involves accepting the reality of the loss and integrating it into one's
life. Acceptance does not mean forgetting or moving on from the loss but rather finding a sense
of peace and resolution in the face of it.

5. Examine the factors affected her grief (psychological, social, physical)?

In examining the factors affecting Almas's grief, it's crucial to consider various psychological, social, and
physical aspects of her experience:

Psychological Factors:
Discovery of Husband's Secret Life: The revelation that her husband had a secret life and
undisclosed marriages significantly impacts Almas's psychological well-being. This betrayal of
trust and loss of the perceived integrity of her relationship exacerbates her feelings of grief,
anger, and confusion.
Complicated Grief Symptoms: Almas's experience of complicated grief, characterized by
persistent yearning, sadness, and difficulty engaging in daily activities, reflects the psychological
toll of her loss. These symptoms may be further intensified by the concurrent challenges she
faces, such as her own health issues and past traumatic experiences.
Rumination and Intrusive Thoughts: Almas's tendency to ruminate on her husband's betrayal
and the circumstances surrounding his death contributes to her psychological distress. Intrusive
thoughts and feelings of guilt, anger, and regret may dominate her cognitive processes, making it
difficult for her to find peace and acceptance.

Social Factors:
Isolation and Loneliness: Almas's grief is compounded by feelings of isolation and loneliness, as
she struggles to connect with others and maintain her social support network. The loss of her
husband, coupled with the shock of discovering his secret life, may lead to withdrawal from
social interactions and a sense of alienation from friends and family.
Financial Stress: The discovery that her husband left her with financial debt adds another layer
of stress and social strain to Almas's grief. Financial worries and uncertainties about her future
financial stability may exacerbate her emotional distress and further isolate her from social
support systems.
Loss of Identity and Roles: The loss of her husband and the subsequent revelations about his
past challenge Almas's sense of identity and social roles. She may struggle to redefine herself in
the absence of her husband's companionship and support, leading to feelings of confusion,
disorientation, and social withdrawal.

Physical Factors:
Health Issues: Almas's battle with Stage 4 ovarian cancer and the physical symptoms associated
with her illness and chemotherapy regimen significantly impact her grief experience. Fatigue,
nausea, hair loss, and other somatic symptoms may exacerbate her emotional distress and
complicate her ability to cope with the loss of her husband.
Impact of Illness on Coping: Almas's own health issues and medical treatments may affect her
ability to cope with her grief. Physical discomfort, pain, and limitations imposed by her illness
may interfere with her ability to engage in therapeutic activities, seek social support, or
participate in activities that bring her comfort and solace

6. Discuss in detail the ways to facilitate Almas through any model like Grief Model/
Cycle including the concept of resilience?
Facilitating Almas through the grief process, incorporating concepts from various grief models
such as the Grief Cycle, and emphasizing resilience involves a holistic approach that addresses
her emotional, psychological, social, and physical needs. Here's a detailed discussion on ways to
support Almas:

Acknowledging and Validating Emotions:

Encourage Almas to express her emotions openly and validate her feelings without judgment.
This involves creating a safe and supportive environment where she feels comfortable discussing
her grief-related thoughts and feelings.
Utilize active listening techniques to demonstrate empathy and understanding. Reflecting back
her emotions and experiences can help Almas feel heard and validated in her grief journey.

Educating about the Grief Process:

Provide psychoeducation about the stages of grief, whether using the Grief Cycle or other
models, to help Almas understand that her emotions and reactions are normal and part of the
grieving process.
Discuss the concept of resilience, emphasizing that while grief can be challenging, individuals
have the capacity to adapt and grow from their experiences of loss. Highlight examples of
resilience in others who have navigated similar challenges.

Encouraging Self-Expression and Coping Strategies:

Encourage Almas to find healthy outlets for expressing her grief, such as journaling, art therapy,
or participating in support groups. Engaging in activities that promote self-expression and
creativity can help Almas process her emotions and find meaning in her loss.
Teach coping strategies such as mindfulness, relaxation techniques, and deep breathing exercises
to help Almas manage stress and anxiety associated with her grief and health issues.

Promoting Social Support:

Facilitate connections with supportive individuals, such as friends, family members, or support
groups, who can provide emotional support and companionship during Almas's grieving process.
Encourage Almas to lean on her social support network for practical assistance with daily tasks,
errands, and appointments, especially considering her health issues and the financial strain she
may be facing.

Addressing Practical Needs:

Assist Almas in addressing practical concerns related to her husband's financial deceit, such as
financial planning, debt management, and accessing resources for financial assistance or legal
advice.
Coordinate with healthcare professionals to ensure Almas receives comprehensive care for her
Stage 4 ovarian cancer, including symptom management, palliative care, and psychosocial
support.

Fostering Meaning-Making and Growth:

Encourage Almas to explore ways to find meaning in her loss and identify sources of post-
traumatic growth. This may involve reflecting on her personal values, strengths, and spiritual
beliefs, and how they can guide her through her grief journey.
Support Almas in setting realistic goals and aspirations for the future, helping her envision a life
that incorporates her experiences of loss while also embracing opportunities for personal growth
and fulfillment.

Building Resilience:
Emphasize the concept of resilience as a dynamic process of adaptation and growth in the face
of adversity. Encourage Almas to draw upon her internal and external resources, such as coping
skills, social support, and personal strengths, to navigate the challenges of grief and illness.
Help Almas identify ways to cultivate resilience, such as fostering optimism, practicing gratitude,
maintaining a sense of purpose, and seeking meaning in her experiences of loss and adversity.