The Role of the Acute Stress Response in Grief

I want you to think about the worst moment of your life.  When was it?   What was happening?  Personally, I can think of two.

  1. When I found out my mother had terminal cancer.
  2. The morning my father called me at an abnormally early hour to tell me my older brother had been in a devastating car accident.  He’s okay now, but at the time, and for days afterwards, we had absolutely no idea if he would live or die.

These “moments” were distinct and different, but in certain ways felt remarkably similar. Both of these instances seemed terrifying, threatening, and painful, and both resulted in an immediate physical response – increased heart rate, sick stomach, racing thoughts – as well as an emotional response.

HiResWhen one perceives circumstances as extremely threatening to their emotional and physical well-being, their body is hard-wired to respond. First, note my use of the word perceived” and remember that what one person considers threatening another may not. There are many differences in the way people react to crisis situations and perceived threat can account for some of that.

When the traumatic event occurs the person might think “I’m in shock,” but the technical name for this reaction is the Acute Stress Response. The response is considered “acute” because it typically comes on quickly and subsides within minutes to hours (and sometimes days) afterwards.

Most major grief theorists made provisions for an acute stress-type response in the first step/process/task of their respective grief-models.  Kubler-Ross spoke of denial; Worden discussed accepting the reality of the loss; Rando talked about acknowledging the loss; and Bowlby and Parks focused on coping with shock and numbness. Although the acute stress response varies depending on the person, situation, and level of trauma and distress associated with the death, it’s important that people generally conceptualize acute stress as either part of the grief process or, how I sometimes look at it, as a precursor to grief.  

Although understanding the acute stress response is useful for people facing the death of a loved one, it may also be helpful to those supporting people during times of trauma such as a grave diagnosis or death.  Friends, family, nurses, chaplains, social workers, doctors and even sometimes funeral home staff might come into contact with someone still reeling from a death, especially when the death was sudden and unexpected.

Understanding acute stress provides context for what people are able to hear, process and understand.  It might also prevent people from quickly labeling the situation as “grief” and responding with conventional sympathies, stories, offers of help, expressions of hope and meaning making.  These are well-intentioned gestures, but it’s often way too soon for the person experiencing the loss to find them helpful.

Okay so let me back up and explain how our bodies generally react to terrifying and traumatic events.  The first thing a person might notice is their physical reaction to the event.  This might feel like an amplified version of the sensations you feel when doing something exhilarating, thrilling, or that makes you nervous; for example last night my 5-year-old sang in front of an audience of people and afterwards she said that during the song “her body felt weird.”

When one feels scared or threatened their sympathetic nervous system kicks in and triggers the ‘fight or flight‘ response.  This is a physical response that primes a person to either stay and fight the threat or run for their life. This response is seen with animals in nature and was most useful to humans in the days when they roamed the woods with lions and tigers and bears (oh my).  For the purposes of this discussion, the response usually feels something like an increased heart rate, rapid breathing, muscle tension, feeling sick to the stomach, light headed, chest pains, headaches, and abdominal pains.

Medical Team Working On Patient In Emergency Room

Additionally, acute stress can have a profound impact on our emotional and cognitive function in the following ways…

Feeling detached or numb: Although the person is physically present, they may remove themselves from the situation mentally or emotionally.  This protects the person from having to face the reality of the situation and deal with the complex emotions.  A person who is detached may be obviously preoccupied or distracted, however, it’s possible to seem fully present intellectually and remain disconnected emotionally.

Feelings of derealization: Some may experience feelings of alienation, confusion, and unfamiliarity with their surroundings.  If you consider the fact that many people are thrust into foreign environments like hospitals, police stations, funeral homes and morgues, you can see how it would be easy for someone to feel like they are living in an alternate reality.

People may also feel emotionally disconnected from those they are normally close with, as though separated by some inability to connect or communicate.  Their surroundings might appear distorted and blurry or they may experience a heightened awareness and clarity.

Feelings of depersonalization:  A person might feel as thought they are an outside observer of their thoughts, feelings, or body.

Dissociative Amnesia –  This occurs when a person blocks out certain information associated with a stressful or traumatic event. After a traumatic event, people may say they don’t remember some or all of what happened. Their memories are thought to still exist, but they have been buried deep within the person’s mind and cannot be easily recalled.

Intrusive Thoughts:  A person may continually re-experience the event through thoughts, dreams, memories, and flashbacks.

Avoidance:  This includes avoidance of triggers and stimulus that remind the person of the traumatic event including people, conversations, or other situations; avoidance of information about the reality of the death; and avoidance of distressing memories.  For more information on avoidance, please read this post.

Increased Arousal: Sleep disturbance, hyper vigilance, anxiety, problems concentrating.

Again the response will vary from person to person, but I think even a general picture of the acute stress response is illuminating.  It is considered normal for this response to last anywhere from minutes to two days after a threatening event.  If such overall distress lasts longer than 2 days (and up to 30 days), a person may be experiencing an Acute Stress Disorder.  Of course disorders of any kind should only be diagnosed by a mental health professional using a very specific criteria.

For a more thorough discussion on supporting someone at the time of a loved one’s death, head over to this post.

Subscribe to receive posts straight to your email inbox.  Also, a great way to provide support to someone who’s experienced the death of a loved on is by providing them with information they can read when they’re ready, so check out our print grief resources.

April 12, 2017

7 responses on "The Role of the Acute Stress Response in Grief"

  1. Gretchen Greeley WatersMarch 21, 2015 at 8:19 pmReply

    Although my husband had terminal cancer, I expected him to live longer than 3 months after the diagnosis. His death was sudden and very unexpected. I initially was relieved as he was suffering so, but then the reality of it all kicked in. As I suffer from both depression and anxiety, I isolated myself from the world. Since his death I have lost 60 lbs…..I am happy at the weight I am now at and have been to see my physician for a complete physical – coming out with a clean bill of health. I see both a psychiatrist and a therapist (bi-weekly) to help me cope with my husband’s death. As with grieving, I take it one day at a time just to survive. I am slowly – slowly – making strides and am now doing volunteer work to honor my husband’s legacy.

    • Profile photo of Eleanor Haley

      Gretchen,

      I am so sorry about everything that you are your husband went through. I understand it has been a struggle for you, but I do have to say it sounds like you are being really proactive and are doing as well as possible. So congratulations on being able to get out of bed and take it one day at a time 🙂 I guess that’s the best many of us can hope for!! I’m sorry about the death of your husband, I am sure he is dearly missed.

      Eleanor

  2. When my son died suddenly three years ago, I had “Increased Arousal: Sleep disturbance, hyper vigilance, anxiety, problems concentrating” for a full two years afterward, not two to thirty days. I saw a therapist and a psychiatrist and neither one brought up the fact that this was abnormal, but I did receive some good support. I took three months of that time off, which was all I could afford. I was walking zombie the rest of the time. My boss marked me down on my evaluation and also said I missed too much time. I wanted to scream at him, “Do you even realize it’s a miracle every day for me to just show up?” I didn’t want to talk to anyone either for a while – it was too painful. I broke off some friendships because I just couldn’t maintain the contact. I gained twenty pounds. Only in the last year have I started to feel like a person again. Hugs to all of us going through horrible experiences – the world has a hard time understanding us.

  3. I was already living with Complex PTSD when my husband of 34 years died last year.

    During his 7 month illness, and because I’m also an introvert, I found it intolerable to have to manage people who wanted updates on how he was going. Ultimately I just tried to avoid stress triggers as much as I could. For my own sanity, I just ignored all but my closest friends and family.

    After his death, it all intensified, and my usual stress management of walking became really difficult as I kept meeting people who wanted to know how I was doing. After talking about with my therapist, we decided avoidance was the best option for me, and I took to getting up very early and walking then. If I did meet anyone I knew, I pretended to be talking on my mobile (cell) phone until I passed them, so I wouldn’t be expected to stop.

    8 months later and I feel much better and on a good day able to talk to people again, although I usually say after the initial “I doing ok, good days, bad days etc” that I don’t want to talk about it. I still not ready to go there and I still experience very a strong stress response talking about T’s illness and death.

    Now, it’s only very rarely that I need to pretend to be on the phone.

  4. What perfect timing!!! this was a huge help for a couple of clients of mine. Thank you so much. I always enjoy your posts.

  5. I experienced amnesia after henrys death. I still dont remember details about the funeral or wake. For 3 or 4 days after i was in shock, spoke slowly, they thought i had to go in a facility for shock( i havr a history of depression). I was ok after a while. But i do avoid certain places we used to go, just cant face going there without henry. Hopefully in time i can.

  6. Marty Tousley (@GriefHealing)March 17, 2015 at 1:13 pmReply

    This information is important, Eleanor, and I thank you for writing this. As a hospice bereavement counselor, I’d sometimes get a referral from a member of our hospice team immediately following a death, out of genuine concern for a family member who seemed to be “hysterical” or “falling apart” ~ when what was really happening was the person’s initial reaction to the loss, which can look and sound quite “crazy” to the observer. So often this is simply (as you say) an acute stress response. That is why in most instances rather than right away, we’d prefer to contact a family two or three weeks following the death, thereby giving the bereaved sufficient time for things to settle down a bit before offering grief support.

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