The Neurobiology of Loss

Loss is an inevitability of life. Whether from death, relocation, serious illness or the end of a romantic relationship, we all in varying times of life experience loss. Though preferably avoided, it is best to understand loss, so that we may confront it in a healthy manner. Having a deep understanding of the neurobiological changes associated with loss may provide insight into how best to treat and overcome the pain of grief.

One may commonly associate the struggles of grief as something completely mental, separate from other more physical forms of pain. However, to distinguish the mind and body into two distinct systems is to not fully comprehend the interconnectivity of our person. Across various studies that elicit grief responses through pictorial and verbal means, common brain areas that are associated with the experience of pain are activated (anterior cingulate cortex, insula, and periaqueductal gray)(O’Connor & McConnell, 2018). Meaning, the pain from loss can be physical, and not just in the mind. In one of these studies, both forms of grief evocation showed significant activation in the cerebellar vermis (Gündel et al., 2003). This is particularly interesting, because the cerebellum is classically associated with the automatic control of our balance and motor control, but has also been shown to be associated with significant activation for emotions such as sadness, anger, fear and happiness (Damasio et al., 2000). Additionally, this same study (Gündel et al., 2003) found activation in the posterior cingulate cortex (PCC) when widows were exposed to pictures that elicited grief. The PCC is involved in autobiographical emotional memories (O’Connor & McConnell, 2018). Indicating, unsurprisingly, that the recalling of memories is a common practice in the process of grief. What is important to note is the PCC is also related to the default mode network (DMN) (O’Connor & McConnell, 2018), a system described as activated during times of rest and deactivation during cognitive and attentional tasks (Fox et al., 2005). However, the understanding of this system has been further refined and as a system that activates when internal mental-state processes occur (Ekhtiari et al., 2016). This system, in depressive patients, is activated more during depressive ruminations and less during autobiographic memory recall (Hamilton et al., 2011, 2015; Spreng, 2000; Zhou et al., 2020). Meaning, those who show greater signs of depression during times of grief spend their mental effort constantly reflecting upon how sad they are and the implications of their sadness. They spend more time ruminating over their depression than they do actually thinking back upon their life with their loved one. Suggesting that thinking back on beloved memories is a healthy part of grief, whereas the constant contemplation of one’s pain is not.

A system that is seemingly impaired by grief and loss is the emotional processing system. The amygdala is highly involved in emotional processing, and hyperactivity of this brain region is indicative of depression (Lu et al., 2012; Rubinow et al., 2016). Proper prefrontal cortex activation inhibits amygdala activation, so that unhealthy emotional processing is avoided (Davidson, 2001). Therefore, poor prefrontal-amygdala connectivity is associated with poor emotional regulation and depression (Lu et al., 2012). Interestingly, those consumed with grief have been shown to have an attention bias towards deceased related words, while also showing high amygdala activity and poor PFC regulation (Freed et al., 2009). Meaning, the hyper sensitivity to words that elicit negative feelings is correlated to physical negative changes on how our brain processes emotions. The failure of these systems is also likely related to the activation of the stress response (Britton, 2006). Again, this goes to show the traumatic events of loss and the process of grief is capable of inducing poor mental habits that can develop into mental unhealth. It is very difficult to lose someone you love and so easy to succumb to the offer of prescribed antidepressants, sleeping tablets or anti-anxiety medication. But, is it wise to numb ourselves to our loss?

Grief cannot and perhaps should not be avoided in times of extreme loss. On the contrary, one should be very conscious and mindful of their thoughts and feelings in the body during times of loss, navigating the journey within allowing so that the grieving process can naturally unfold. Retraining the mind to be present and when possible, avoiding “memorising” and “projecting” can be helpful in lessening the load on the brain and body. It is very common that those who experience extreme loss may indeed experience the first Buddhist insight of the “impermanence of all things”. This can painfully catapult one on the spiritual path, often without warning, and this can be where we start to re-evaluate our lives and what we choose to live for.

How do we engage in a conscious grieving process, giving ourselves the best chance of full recovery, in brain, heart and body?

Here, information from a paper written by Dr. David Crenshaw will be discussed (Crenshaw, 2007). The following information is a model for treatment directed toward childhood traumatic grief based on a neurologic evidence. Though specific to that form of loss, the techniques are highly applicable to varying forms of grief, and are worth discussion.

The 11 tasks of a healthy grieving process are as follows:

Task 1: Create a Sense of Safety
Providing a safe environment and a feeling of secure attachment is crucial for the healing process to take place. Additionally, using techniques such as breathing and meditation, in order to calm the nervous system, is also very helpful in providing the correct physical environment for the healing process to be effective.

Task 2: Acknowledge the Reality of the Loss
Facing the reality of a situation is a very important initial process, so that the grieving may begin.

Task 3: Identify, Embrace, and Express the Emotions of Grief
It is important to be mindful and open to all of the emotions we experience during the grieving process. Allowing oneself to release and express those emotions is critical. Doing so can allow emotions to naturally diminish over time.

Task 4: Commemorating the Loss
Human beings have historically used various rituals to honor the dead. These rituals can be helpful in the mourning process, by allowing the individual to find meaningful ways to honor the life of the loved one.

Task 5: Acknowledging Ambivalence
No relationship is perfect, and there are always things about an individual or loved one, that we do not particularly enjoy. It is also important to be open and mindful about these particular feelings. The reason this is important is because it is important to process these emotions so that they do not hinder one’s ability to create healthy relationships in the future.

Task 6: Resolution of the Ambivalence
In accordance to the previous task: if the feelings of ambivalence are abundant, the conflict between positive and negative emotions may be confusing. Therefore, it is important to process these emotions and bring balance to the varying perspective. Doing so can allow the individual to grieve, rather than being focused on the confusing emotions.

Task 7: Recovering and Preserving Positive Memories
The traumatic event of the loss may be so overwhelming that it supersedes all of the positive memories one had with the loved one. Therefore, it is important to recall and remind oneself of these positive memories so that they may be what truly lasts within an individual’s mind.

Task 8: Holding on to the Timeless Attachment
Often in times of grief, the individual focuses on the loss itself. However, what is better to focus on is all of the memories, teachings, feelings and love one retains toward the lost. They may be lost forever, however, their memory forever lives on. The latter is a more positive perspective to carry.

Task 9: Finding Meaning and Creating a Coherent Narrative
Research has shown that creating a narrative and meaning behind an event is very helpful in making sense of a situation. Doing so generates a perceptive that is less likely to generate traumatic reactions.

Task 10: Letting Go
Sometimes, a loss can occur without the ability to say good-bye. This can be very difficult, and provide a strong feeling of the absence of closure that cannot be resolved. It is important to emotionally let go of this struggle, for holding onto this painful idea causes agony and pain.

Task 11: Moving On
This step involves generating hopes, dreams and plans for one’s future. Oftentimes, a loss can be difficult but these goals, in some way, revolved around the loved one. It is important to restructure these goals so that one may continue to live their life.

Loss can be incredibly difficult. As described above, those who are experiencing heavy grief can have neurologic changes within the brain that can induce poor mental health. It is important that we understand grief, so that we may allow it to work through its natural process. The avoidance of grief is very unhealthy, and can likely result in chronic, long-lasting grief and poor health and emotional control. Alternatively, one could choose to be emotionally mindful and sit truthfully with the heavier emotions, ideally in the presence of a safe other, so that the grief may run its course and the individual can return to a healthy state of being.

We encourage you to further your understanding by reading about the ache in heartache here and attending our HLL03 BioMedical Yoga Therapy for Grief, Loss, and Trauma, Registered 20 hour Higher Level Learning (HLL) Certificate