Many people think of grief as a single instance or very short period of pain or sadness in reaction to a loss. However, the term grieving refers to the entire emotional process of coping with a loss. And at the holidays, grief over the loss of a family member or a friend can be especially pronounced.

"Grief reactions often return with renewed intensity at anniversaries and other occasions," said Gerg Inger Ringdal, PhD, an expert on grief and bereavement at the Norwegian University of Science and Technology in Trondheim, Norway. Ringdal said during this time bereaved persons must pass back and forth many times between different grief reactions such as longing and despair before coming to a final phase in the process.

Normal grieving allows a person to let a loved one go and continue with his or her life in a healthy way.

"Athough grieving is painful, it is important that those who have suffered a loss be allowed to express their grief, and that they be supported throughout the process," said Joy L. Fincannon Carter, RN, MS, a psychiatric clinical nurse specialist and an American Cancer Society (ACS) medical editor.

Each person's way of grieving for a loved one will be different, Carter said. The length and intensity of the emotions people experience will also vary from person to person.

"It is normal for people to feel better for a period of time, only to become sad again soon afterward," said Carter, who co-authored Couples Confronting Cancer, Keeping Your Relationship Strong.

Sometimes, people wonder how long the grieving process will last for them, and when they can expect to experience some relief, Carter said.

Researchers have studied grief to better understand the ways that people work through a loss and eventually accept it. Several phases, or emotional states, are experienced while grieving.

The first phase involves a period of shock or numbness. This phase is often followed by a period of emotional upheaval, which can involve feelings of anger, loneliness, disbelief, or denial. The final phase of grief is the one in which people find some way to come to terms with the loss. The ACS provided insight into the process.

Often, people's initial reaction to a loss is one of shock, disbelief, and numbness, which can last anywhere from a few hours to days or weeks. During this time, the bereaved may feel emotionally "shut off" from the world.

However, their numbness may be interrupted by waves of distress from time to time. During these periods of distress, which are often triggered by reminders of the deceased, they may feel agitated or weak, cry, engage in aimless activities, or become preoccupied with thoughts or images of the deceased.

The rituals of mourning — receiving friends, preparing for the funeral, and burial — often structure this time for people. They are seldom left alone. Sometimes the sense of numbness persists, leaving the person feeling as though they are mechanically going through the rituals.

At some point the reality of the loss becomes painfully apparent, and the numbness wears off. This phase of grief, sometimes called confrontation, is when the feelings of loss are most intense and painful. It is during this phase that one must confront the loss and cope with the changes it has brought about in their lives.

People have many different ways of confronting loss, so this time can involve many different, equally intense emotions. This time of grief, with its characteristic waves of distress and difficulty concentrating and functioning, can last for weeks to months. The length of time can vary greatly.

Characteristics seen in a person who is grieving:

• Withdraws socially
• Has difficulty concentrating
• Becomes restless and anxious at times
• Has little appetite
• Carries a sad appearance
• Has a depressed mood
• Dreams of the deceased
• Loses weight
• Has difficulty sleeping
• Experiences fatigue or weakness
• Becomes preoccupied with death or events surrounding death
• Searches for reasons for the loss (sometimes with irrational results)
• Dwells on mistakes, real or imagined, that he or she made with the deceased
• Feels somehow guilty for the loss
• Feels distant from others
• Expresses anger or envy at seeing others united with loved ones

It is often during this time that a grieving person needs the most emotional support. And unfortunately this may be the time when the initial strong support of others begin s to dissipate. Finding sources of support, whether they are family members, friends, support groups, or community organizations, can be the key to a person's eventual recovery and acceptance of the loss.

The first two phases of grief are designed to help people come to terms with the loss in some way. Usually, one comes to accept a loss gradually over the months that follow it. Like the first and second phases, acceptance does not happen overnight. It is not uncommon for it to take as long as a year or two or more for someone to resolve the emotional and life changes that result from the death of a loved one.

Although the intensity of the loss may lessen, it is common for people to continue to feel emotionally involved with the deceased for many years after their death.

With time and support, the bereaved person will acknowledge and understand the loss, experience the pain of separation, and adapt to a new life and identity.

According to grief expert Ringdal, a study she conducted with grieving adults showed that most bereaved spouses were most distressed after one month, with gradual reductions over the next four years. She reported her findings in the medical journal Palliative Medicine (Vol. 15, No. 2:91-105).

"Most of the spouses expressed no difficulty in accepting the fact of the loss and most felt that their life was full," she said. "However, despite all of these positive outcomes, the majority of the bereaved spouses did not even after four years feel that they have made what they would call an excellent adjustment.

"That so many bereaved spouses are not totally satisfied with their adjustment to bereavement attests to the fact that grief is often an ongoing, life-long process rather than a crisis that is simply mastered or resolved over a circumscribed period of time," Ringdal said.

To begin the process of grieving after loss and continue to heal, the ACS suggested the following may help:

• Give yourself permission to feel the pain and loss.
• Be patient with the process and don't pressure yourself with certain expectations.
• Accept yourself as you experience your pain, your emotions, your own way of healing, and your own timetable.
• Express your feelings. Let yourself cry. Both are necessary for healing.
• Get support. Talk about your loss, your memories, and your experience of the life and death of your loved one. Do not protect your family and friends by not expressing your sadness. Ask others for what you need. Find others to talk to who have also lost a loved one to.
• Try to maintain your basic lifestyle. Avoid making major life changes (for example, moving, changing jobs, altering important relationships) within the first year of bereavement. This will allow you to maintain roots and a sense of security.
• Take care of yourself: eat well and exercise. Physical activity is a good way to release tension. Allow yourself small physical pleasures that may help you replenish yourself like hot baths, naps, and favorite foods.
• Avoid overindulgence in alcohol. Since alcohol is a depressant, it will only make you feel worse in the long run.
• Forgive yourself for all the things you said or didn't say or do. Compassion and forgiveness for yourself and others is important in healing.
• Give yourself a break from grief. Although it is necessary to work through grief, you do not need to constantly focus on it. It is healthy to find appropriate distractions like going to a movie, dinner, or a ball game, reading a good book, listening to music, getting a massage or manicure.
• Prepare for holidays and anniversaries. Decide if you want to continue certain traditions or create new ones. Plan in advance how you want to spend your time and with whom. Do something symbolic in memory of your loved one.
• Join a bereavement support group. Others can give encouragement, information, guidance, comfort, practical suggestions, and can help you feel less isolated.