Grief and the Brain

Despite our innate feeling to avoid it, we will all experience grief at some, if not many, points in our lifetimes. As I ponder the global loss from the pandemic and those I've personally lost in the past few months, I feel compelled to explore the impacts of grief on the brain. 

Grief is a complex emotional state, incorporating many mental functions, including emotional processing, memory retrieval, processing of familiar faces, visual imagery, and autonomic regulation. 

Studies using fMRI with grieving people identify the areas of the brain that gets activated after a loss.

• Posterior cingulate cortex: upper limbic lobe controlling interrelated behaviors (e.g., memory, learning, emotion)

• Medial prefrontal cortex: important in arousal and motivation

• Dorsal anterior cingulate cortex:higher-level functions, such as attention allocation, reward anticipation, decision-making, ethics and morality, impulse control, and emotion

• Insula: integrates sensory and autonomic information from the viscera. It plays a role in certain language functions, as evidenced by aphasia in patients with some insular lesions. The insula processes aspects of pain and temperature sensation, and possibly taste.

• Amygdala: emotional processing center (both positive and negative emotions)

• Dorsolateral prefrontal cortex: involved in decision making and working memory

• Periaqueductal gray: Regulating autonomic function, motivated behavior, and behavioral responses to threats

• Anterior Cingulate: attention, rewards, decision-making, ethics and morality, impulse control, and emotion

• Nucleus Accumbens: within the hypothalamus that acts at the "reward circuit" of the brain

• Somatosensory Cortices: receives and processes sensory information from the entire body

An article by Mary-Frances O'Connor discusses the neuroscience and neuro-implications of grief and loss: 

• The "broken heat phenomenon" is real and can affect anyone who has a significant attachment to the loss of a loved one (not just a spouse that has recently passed).

  • Premorbid risk factors make some people more susceptible to takotsubo cardiomyopathy, an acute stress-induced heart condition involving left ventricular apical ballooning that mimics acute myocardial infarction.

  • Decreasing risk factors, such as hypertension and vascular disease for overall health in daily life, can help cardiovascular events.

• Grief will contribute to an increase in cortisol. Prolonged increased cortisol levels and chronic stress are related to increased risk of depression and poor emotion regulation.

• The research shows not everyone will react the same to the death of a loved one.

• Factors that can increase the risk of complicated grief, with adverse health implications for long term grief management include:

  • Rumination

  • Deliberate grief avoidance

  • Avoidance is a natural and adaptive response during grieving in small doses. However, high levels of deliberate avoidance of grief-related emotions may lead to prolonged activation of the suppressed thoughts and physiological arousal, poorer concentration and functioning on tasks at the moment, and prolonged likelihood of recurrent intrusive thoughts in the future. Rumination can also be a form of avoidance.

• Complicated grief is a risk factor for cognitive decline, and as with physical health, the effects seem to be driven by those with the most severe grief reactions.

• The baseline biological health and psychological states and baseline resilience will impact the outcome of experiencing grief long term and short term.
  

Here are 3 tips that we can use to improve our resilience when processing grief, both long term, and short term

1. Look through pictures or reflect on memories. Write down reflections in a journal. Capture thoughts in a memory jar, or contact a mutual friend or family memory to reminisce about your lost loved one. We engage our prefrontal cortex when we put our memories and reflections into words.

2. When we experience a loss, whether expected or unexpected, there are often unfulfilled hopes, dreams, regrets, and even resentments, and left unresolved. Consider writing a letter to that loved one. If needed, consider a small personal ceremony for the closer of those conversations.

3. When reflecting on your memories, appreciation, and reflections, NOTICE sensations in your body and connect to your breath.

I found this exploration of the neuro-implications of grief very comforting. For years I have felt my grief processing was not socially acceptable because of my tendency for introversion. Understanding we all experience grief differently and strategies to process my grief long and short term came me peace amid loss. 

The one book I understand I should recommend for everyone's must-read list regarding grief processing is

Option B: Facing Adversity, Building Resilience, and Finding Joy by Sheryl Sandberg and Adam Grant 

Resources and References:

1. O’Connor MF. Grief: A Brief History of Research on How Body, Mind, and Brain Adapt. Psychosom Med. 2019;81(8):731-738. doi:10.1097/PSY.0000000000000717

2. Merck Manual

3. https://drarielleschwartz.com/grief-grit-and-grace-dr-arielle-schwartz/#.YLanry1h3q1

Brain Changing = Life Changing. Live Beyond! 🧠