Within the fascinating experience that is life, change is a continual occurrence, and an example of ongoing change is that which is experienced through loss. Humans experience loss in many ways, commonly through the death of a loved one or the end of a relationship. A key component of loss is grief.

Grief is a personal process connecting the emotional, social, and physiological realms and is closely tied to overcoming the crisis that comes with loss. For some, grief may be a time involving self-acceptance and self-discovery, while for others, it may be a time of isolation and denial of reality. No matter how it is experienced, it is a journey of mental, emotional, and relational readjustment that may substantially alter a person’s daily life.

Professional counseling can help those experiencing loss and grief identify internal and external resources available to them promotes empowerment, a sense of community, and encourages grieving in healthful ways. Below are tips to support those struggling with loss while also incorporating self-care practices.

Grief Guidance

• Acknowledge grief is a personal experience and listen to the person without an agenda.
• Honor the grief someone is experiencing while being prepared to give the person space.
• Learn what spiritual practice or creative outlet allows the person to connect with their sense of meaning and purpose, then make recommendations accordingly. Not everyone will feel comfortable drawing or journaling.
• Observe how the person is moving through the grieving process and refer as needed. Some may seek a spiritual approach, while others may benefit from a grief counselor if they require more specialized care.
• Maintain self-awareness. Ask yourself, “How does dealing with someone grieving make me feel?” “Does it trigger any personal memories?” “To what extent can personal issues be distracting?”
• Be respectful of the person’s grieving and don’t turn encounters into interrogation sessions. Through self-awareness one may realize addressing someone’s grief can be anxiety provoking.
• It is okay to respond with, “I don’t know”.
• Grief counseling can trigger emotional reactions that may be new and uncomfortable. If this occurs, don’t hesitate to seek support from a trusted person.

Grief Resources for Military Families

One very important component when addressing the process of loss with someone is that, similar to a crisis, the grieving individual may not have the frame of mind, the peace, or the support to address even the most essential basic needs. It may feel as if with the loss comes a loss of connection and where to look for help. Having an advocate who is attuned with the resources available within the military community can be a game changer. The Military & Family Life Counseling (MFLC) program is available to all service members and families for on-installation support with a number of life’s challenges through free, short-term, confidential non-medical counseling. MFLC counselors can help bridge the gap between the grieving person or family and the different agencies that can provide resources to aid during times of despair. Start by contacting your installation’s Military and Family Support Center for more information on the MFLC program. Reaching out for help and resources is an essential element in the process of healing and recovery from loss.

We made it through Thanksgiving – hopefully emotionally unscathed. But for many, managing mental health during the holidays is not easy. Whether you deal with anxiety for months leading up to the holiday, your family is plagued with arguments or more subtle discomfort during get-togethers, and/or you are mourning the loss of a loved one and have an empty seat at the table – the holidays can be tough. In fact, in a 2021 survey, 44% of Americans said that preparing for the holidays is stressful and 39% said that family gatherings during the holidays are stressful.[1]

Holiday anxiety

Anxiety is defined by the National Institutes of Health as “a feeling of fear, dread, and uneasiness.”[2] And why might we feel anxious leading up to what one might consider a wonderous and magical occasion, such as Thanksgiving or a December holiday, with our family? The reasons are endless. It could be a difficult family member we are not looking forward to seeing. It could be that we are not feeling particularly good about ourselves and want to face others. Maybe we are hosting a holiday gathering and worried about getting everything done in time, how much everything will cost and whether everyone will have a good time.

We are barraged with media images of what the perfect holiday looks like, and we may sometimes feel pressure to be happy and festive and live up to expectations.

When we dread an upcoming holiday, it puts a damper on more than merely just that day or specific gathering, but the days, weeks, or even months leading up to it. It is almost like the reverse of excitement or anticipation. But whether we are excited or anxious about something, the actual event often does not live up to our expectations. In the case of holiday anxiety, if we can remember that it may actually end up being better than we think and simply try not to care as much, our anxiety time may be reduced. We can let go of others’ expectations of us and do what truly makes us happy.

Family arguments during the holidays

Yes, most families argue – even during the shiny holidays and behind the scenes of the happy pictures we post on social media. And just when our typical bickering was not enough, our country has become increasingly divided, and it has seeped into our very own families. There are things we can do to prevent the arguments and deal with them in a healthier way when they occur.

You have probably heard the phrase “communication is key.” A lot has changed over the past couple of years and continues to change at a rapid pace. We may think we know how a loved one would like to celebrate the holidays, for example. But their preferences, and our own, may have changed just like so much else has changed.

It’s a good idea to initiate respectful conversations – early in the holiday planning process – with our family and friends to understand where they are coming from on certain issues. It can be a way to identify the topics that should be off-limits during the upcoming holiday gathering and prevent arguments.

During these early conversations and when we’re all together for the holidays, our family members may inevitably do or say something that rubs us the wrong way. At that moment, our reaction will set the course for what comes next. As our feelings come together to form that reaction, why not assume goodwill and the best intentions of the offending person. It may be that their actions and comments reflect the way they feel about themselves and not the way they feel about you.

With so much to disagree about these days, there is also a lot we can agree on. Try to focus on the latter, agree to disagree when possible, and assume that others are coming from a place that is genuinely meaningful to them.

Grief and missing a loved one during the holidays

The pandemic has taken so much from us, including the lives of precious loved ones. The holidays have always been a difficult time to bear when we cannot share them with a lost family member or friend. During this holiday season, you can uphold and honor memories of those you have lost in many ways: Look through photographs of the person and reminisce about holidays of the past; do things you used to do with a lost loved one during the holidays, like cooking or baking a certain recipe, a craft, or decorating; and journaling or talking with others about your feelings.

It can be hard to move on without a person we love, but they would want you to be happy. We will always have their memories during the holidays and beyond, as we carry on with old and new traditions.

We can all agree that it has been another tough year. But we have endured, and it is time to let go of expectations and focus on our mental health during the holidays and how the holidays can be a time to do what makes us happy, spend quality time with those who are important to us and cherish the memories of those we have lost.

Visit MagellanHealthcare.com/Holidays for additional information and resources on holiday emotional wellbeing and how to find peace and moments of joy with family and friends this holiday season.

[1] Collage Group Holidays and Occasions Survey, May 2021

[2] https://medlineplus.gov/anxiety.html

Candice Tate, MD, MBA, serves as a medical director at Magellan Healthcare. Dr. Tate’s treatment philosophy includes a strong physician-patient therapeutic alliance and safe, responsible medication management. Dr. Tate joined Magellan in 2017. She has years of experience in psychotropic medication management for a variety of psychiatric conditions in inpatient and outpatient settings. During her graduate medical training, Dr. Tate was extensively trained in psychodynamic psychotherapy and was supervised by experienced psychoanalysts. She is also familiar with cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and dialectical behavior therapy (DBT). Dr. Tate graduated from the University of Tennessee Medical School in Memphis and completed her graduate medical education in General Psychiatry at Northwestern University’s Feinberg School of Medicine in Chicago, IL. Dr. Tate is a board-certified psychiatrist by the American Board of Psychiatry and Neurology.

Explore tips and information to protect your mental health and deal with grief and loss of loved ones due to the worldwide impacts of COVID-19.

When else in our lifetime can we say all people in all countries of the world have directly experienced grief and loss due to the same traumatic event? Now that we are living through the COVID-19 pandemic, this is the sad reality. Our very sense of normalcy has been turned upside down, we have lost loved ones, missed milestones and other life events, and faced social isolation. We all hear about the traumas that occur across our globe – 9/11, weather events, war – and we may be affected; but COVID-19 has profoundly touched and changed each of our lives in many similar ways. As our world is adjusting to a now improving, but still evolving, pandemic, here are some tips to protect our mental health.

Dealing with grief and loss from COVID-19

While it’s never easy when we lose a loved one, grief and loss during the pandemic has been exacerbated by the confusion, fear, and social isolation we have all experienced. The novel coronavirus, COVID-19, did not come with an instruction manual and we had to learn, very quickly, how it was spread, how it affected those who got infected, and how to avoid being infected. Confusion around all of these things, and how a family member or friend could have died from this virus, was inevitable. At the same time, fear of the unknown and for one’s own health and safety was inescapable. Due to the critical social distancing measures, we could not even visit our loved ones in the hospital, even if the worst was expected. We could not begin our grieving process by honoring those we lost with traditional funeral services. As we’re navigating the stages of grief during COVID-19, here are some things to remember:

• You may hear about the “stages of grief,” but it’s normal to bounce back and forth between the stages and not experience them in a linear way.
• No matter what you’re feeling, your feelings are valid, and you are entitled to them; avoid telling yourself you should be feeling one way or another.
• Grieving doesn’t mean you are forgetting or totally letting go.
• It’s important to build a support system.
• With grief comes growth.

Practicing self-care to cope with grief and loss

Grieving is an intensely personal process. We can start to feel better when we reach out to loved ones and professionals for support, but there is no one who knows us better than ourselves, and we can always be our own best advocate. Knowing that our lost loved ones surely would want us to be happy and not suffer, it’s important to prioritize our own self-care and compassion to unlock its immense healing power. Engaging in self-care activities – exercise, journaling, meditation, doing something creative, etc. – can help us build resiliency and mental strength, elevate our mood, process our feelings, and cope effectively. As we strive to take care of and make time for ourselves, the following are some tips to keep in mind:

• Understand that grief is an ongoing process; it requires our self-patience and kindness.
• Realize that helping yourself does not mean you are avoiding the experience, rather that you are embracing it.
• Treat yourself the way you would treat a close friend or family member who is going through the same thing.
• Be deliberate and purposeful in taking breaks to mentally check out and/or do something that makes you happy or laugh.
• Focus on the present to ease the burdens of, and make more palatable, all that must be done that day, week, month, etc.
• Grant yourself permission to feel, as it’s a natural part of the grieving process; understand it’s okay to be vulnerable.

We can find meaning in the losses we have endured through this ordeal. Our lost loved ones gave us many gifts, and we can pick up on those gifts in celebration of their memories. We can embrace life and do the things that make us happy. We can reflect on the changes and losses caused by the pandemic that forced us to reevaluate our priorities, taking with us the good and leaving behind the bad. And we must always remember to seek help when it’s needed.

By Dr. Paula Hensley and Sagar Makanji, PharmD

Think back to New Year’s Eve, Tuesday, December 31, 2019. Maybe you had big plans that night to ring in the new year, or maybe you were spending a quiet evening at home. In either case, you probably had expectations about 2020 and hopes that it would be happy, healthy and prosperous…

Fast forward a couple months to February, 2020 when we began hearing more about a new coronavirus, COVID-19, originating from Wuhan, China that had made its way into the United States and was beginning to spread.

Changes caused by COVID-19

We started to see our world and our lives drastically change, experiencing loss and grief in several forms. For many of us, there were no more commutes to work, as we began to work from home if we were lucky enough to keep our job. There was no more getting the kids off to the bus stop or waiting in the drop-off line, as schools closed and switched to a virtual learning environment.

Parents lost the luxury of being able to fully concentrate on their jobs, as they were forced to take on the roles of teacher or daycare worker and daytime entertainer for their kids. Kids missed out on receiving the first-class education they depended on to feel prepared for the next school year or even college.

Healthcare workers risked their lives and those of their family to care for the people who were getting sick from COVID-19, worried they had been infected and wanted to get tested, or needed regular healthcare. Essential workers in grocery stores, post offices, public transportation, and other industries also became heroes as they continued to come to work to keep the country running, despite fearing for their own health and lives.

And there wasn’t a roll of toilet paper or paper towels to be found.

Social isolation

Across the board, we didn’t get to spend precious in-person time with our extended family and friends because we were doing our part to bend the curve and stop the spread of COVID-19. We didn’t get to go to the gym and may have fallen behind in our physical fitness. Our kids didn’t get to participate in their beloved sporting or other extracurricular events. Medical procedures were cancelled. Vacations were cancelled. Weddings were cancelled. Graduations were cancelled. Everything was cancelled.

Our dreams and plans were put on hold.

COVID-19 mental health toll

We certainly couldn’t have imagined this would be how the year would start off and end. Spring, summer, fall and winter, and all that comes with each, did not happen the way we have all become accustomed to for our entire lives.

And while we have done our best to adapt, the grief and loss of loved ones, financial security and social normality we have experienced over the past year has taken its toll on our mental health.

Where to go from here

We encourage you to watch a recording of our webinar “Coping with grief and loss during COVID-19” with Paula Hensley, MD, Magellan Healthcare senior medical director; Sagar Makanji, PharmD, Magellan Rx vice president, clinical strategy and programs; and Mark Santilli, PharmD, Magellan Rx senior director, clinical strategy and programs, as they share knowledge and tips for persevering after grief and loss due to COVID-19 and answer audience questions.

For additional COVID-19 resources from Magellan Health, click here.

How we can comfort and support each other when grieving

Grieving the loss of a family member, friend or colleague is difficult. The pandemic has made it even harder for many people to cope. Those who have lost loved ones to COVID-19 or other illnesses may face additional grief and sadness. Infection control restrictions have left them unable to visit or say goodbye. Moreover, traditional wakes and funeral services have been modified or eliminated due to social distancing and limits on the size of gatherings, changing the way people can comfort and support each other.

Many people have experienced multiple losses. For example, the loss of a loved one at the same time as unemployment and social isolation.  The resulting grief may be prolonged and complicated with delays in the ability to heal and move forward.

Common Grief Reactions

Pain associated with grief is a normal response to loss and can be felt on emotional, physical and spiritual levels. Common reactions to grief are:

• Initial feelings of shock, denial, and disbelief, which can be heightened when the death is sudden and unexpected
• Feelings of worry, fear, frustration, anger or guilt
• Physical reactions such as headaches, fatigue, difficulty sleeping, loss of appetite, pain and other stress-related symptoms
• Spiritual expressions of grief, such as questioning the meaning and purpose of life, pain and suffering

There is no normal and expected time for mourning to end. Depending on the relationship with the individual and the circumstances of the loss, grief can last for weeks to years. Grief can ebb and flow at unexpected times, triggered by memories of the deceased person, holidays and anniversaries of loss.

Coping with Loss

It is important to find ways to express grief.

• Connect with other people, such as friends, relatives, support groups, and faith-based organizations if applicable, even if the contact must be virtual or by phone. Sharing your feelings with people who understand what you are going through is comforting and eases loneliness.
• Participate in an activity, such as planting a tree or creating a memory book, to honor the person you lost. Ask family and friends to contribute their memories and stories.
• Take good care of yourself. Maintain a balanced diet, moderate exercise and adequate sleep. Treat yourself to something you enjoy, such as a massage or a walk in nature.
• Avoid the use of alcohol, tobacco or other drugs to escape emotional pain.
• Don’t be afraid to ask others for help. Allow other people to assume some of your responsibilities when you are feeling overwhelmed.

When time has passed, if you are still having difficulty functioning, seek support through grief counseling, your EAP, support groups or hotlines. As writer Vicki Harrison said, “Grief is like the ocean; it comes in waves ebbing and flowing. Sometimes the water is calm and sometimes it’s overwhelming. All we can do is learn to swim.”

Normal holiday stressors can be compounded when we miss someone we have lost or are impacted by other hardships. This year, the sense of loss – of a loved one, financial security and a sense of “normal” – has touched many of us due to the COVID-19 pandemic. As we’re making plans to celebrate the holidays in unprecedented times, let’s take a break with Magellan’s Dr. Shareh Ghani as he discusses ways to address feelings of loss, practice self-care and make the most of this holiday season.

Magellan: Dr. Ghani, thank you so much for being here with us to share your many years of expertise in helping patients with behavioral health needs. Our first question: Is it possible to enjoy the holidays when we are experiencing the pain of losing a loved one to COVID-19 or something else?

Dr. Ghani: Thank you for having me. The pandemic has taken a toll on our community as we have lost loved ones prematurely, and we continue to experience sustained emotional pressure as COVID continues to spread. It is vitally important that we celebrate the holidays, exchange gifts and cards, gather virtually, and celebrate life. Spreading love and joy in these trying times will bring much-needed respite to the brain and body and boost our immune systems.

Magellan: How can we overcome feelings of worry and anxiety due to a job loss or other financial insecurity during this holiday season?

Dr. Ghani: Losing a job obviously leads to worry, anxiety and even questioning one’s own competence. The pandemic has helped many people shift focus to the “must haves” and not worry about the “nice-to-have” luxuries in life. Some are paying more attention to their health and fitness, minimizing spend, and planning for the future. Having a good strategy will help reduce the anxiety of uncertainty. If need be, talk to a therapist.

Magellan: Do you have any tips for people experiencing distress over not being able to celebrate the holidays in the way they may have in the past?

Dr. Ghani: One needs to evaluate the reason why we are changing our lifestyle. Social distancing helps stop the spread of the virus. Those who take this threat to our lives lightly may experience distress. Understanding the gravity of the situation alleviates it. We are celebrating in smaller groups so we can defeat the virus and return to our old ways of celebrating holidays safely. Think of it as a form of delaying gratification for better outcomes.

Magellan: What is your general advice for anyone who is experiencing loss to feel better and be able to experience joy this holiday season?

Dr. Ghani: Losing loved ones is a part of our life cycle. Human beings are resilient beings. Remember – those that we have lost would have wanted us to be happy. We should think about the happy moments we shared with those that are not here today and celebrate life.

Magellan: Why is it important to practice self-care and be an advocate for one’s own mental health?

Dr. Ghani: Good eating habits and physical exercise are key to physical and emotional wellness. Sleeping at least eight hours a day, hydrating well and experiencing joy and happiness are also important. All these things help with mental health. Relationships, family, helping others and being grateful add to a joyous life experience.

COVID-19 has disrupted our lives in many ways. The stress of social distancing and loss of routine, compounded with health and job concerns, has caused grief and anxiety levels to increase. What we thought of as “normal” is in transition, and we need to redefine how to cope with these changes.

Reasons people feel grief

Grief is a natural feeling accompanying any kind of loss. Typically, grief is associated with losing a loved one to death. With COVID-19, people are experiencing grief related to the loss of routines, livelihoods and relationships. While it is always good advice to be thankful for what we have, it is also important not to minimize the pandemic or its associated losses. Also challenging is that we do not know how long we’ll be impacted by COVID-19. With no clear end in sight, feelings of grief can intensify and make people feel less in control.

Grief shows itself in different ways

It’s perfectly normal to grieve when you can’t celebrate your child’s birthday, your friend’s graduation, your honeymoon or other important life events. It’s important to know that we all grieve differently. Some people may experience feelings more intensely than other people. We shouldn’t make judgments about how someone grieves. There is nothing wrong with having emotions; it is a common response to loss. When we don’t express our feelings, they can get stuck in our bodies, causing physical illness and/or depression.

Listed below are some of the common emotions people experience when grieving, and they may be heightened because of the pandemic.

• Shock, disbelief and denial
• Anger
• Fear
• Guilt
• Helplessness
• Anxiety and depression
• Acceptance and hope
• Relief

Complicated grief

In the current environment, any losses experienced now have additional layers of complexity and depth. Likewise, if we’ve had previous traumas from earlier stages in our lives, the stress of the pandemic might bring up past life experiences that were painful. It’s important to be sensitive to those potential triggers.

COVID-19 has brought on many situations: not being able to say goodbye, to have a funeral service, to grieve because of taking care of others, dreams put on hold, etc. We don’t have the same levels of support due to the quarantine, such as being able to see loved ones and friends. For these reasons and others, it is important to develop coping skills to help get us through this difficult time.

Understanding grief

Part of what gives comfort during challenging times is understanding the healing process.

• Grief can be an ongoing process. It can take on different forms and meanings and with time; the intensity and feelings of grief do change.
• Grief doesn’t mean you obsessively think about what has happened. It is important to allow yourself to deal with the feelings, but obsessively thinking about the pain and fear will only make the feelings worse and can trigger anxiety.
• Grief does not mean “forgetting.” If you have experienced a significant loss or you have missed out on a long-planned event, it is okay to think about who or what you will miss. Part of the grieving process involves keeping your loved ones and/or cherished dreams with you emotionally, as they are still a part of you even if they are no longer a physical reality.
• Grief involves growth. Whether it is coping with the death of a loved one, going through a traumatic event or dealing with the loss of a job, no one chooses these experiences. Working through grief and sorting through intense emotions can help you learn new things about yourself and discover new strengths that can result in emotional growth and maturity. In this way, loss sometimes yields gifts.

How to help yourself

• Build a virtual support system. In the era of social distancing, be creative about how to give and receive support. It’s important to turn to friends, co-workers or family members for support. People like to be of service. Giving and receiving are part of the same equation and benefit all.
• Focus on hope. We all have times when we feel hopeless. Being hopeful helps you realize that we all have tough times and that those times will pass, as will the feelings associated with them.
• Take care of yourself. The mind and body are connected. When you feel good physically, you also feel better emotionally. When you feel sad, do not be influenced by how others think you should grieve. It’s important to feel whatever you feel without embarrassment or judgment. It’s okay to be angry, cry or not cry. It’s also okay to laugh, find moments of joy and let go when we’re ready.
• Practice gratitude. Sometimes when people are in the midst of loss, they have deep moments of gratitude for what they once had. Practicing gratitude trains our minds to change our thinking and to see the glass as half full.

How to help others

• What to say. It can feel awkward when conversing with someone going through grief. You may wonder what to say ornot say; however, don’t avoid the topic or be afraid to bring it up. Open the door for the grieving person to talk about their feelings. It’s not helpful to say things like, “There’s a reason for everything,” or ” “I know how you feel.” Instead, you can offer a simple expression of sorrow, such as “I’m sorry you’re going through this,” or “I don’t know how you feel, but I’d like to help in any way I can.”
• Sometimes the best thing to say is nothing. Or very little. A grieving person may need to tell their story again and again as part of the process. Be willing to listen without judgment. A good rule to follow is to listen 80 percent of the time and talk the other 20 percent. Your presence can be comforting to a grieving loved one, and you don’t have to do anything special. Often, grieving people just don’t want to be alone.
• Avoid giving advice. Unless someone specifically asks for your advice, it isn’t your place to give it. Grieving people need to do things in their own unique way.
• Don’t take things personally. When people are in profound emotional pain, they can cycle through a whole range of feelings, including irritability and anger. If a grieving person snaps at you, or doesn’t feel like engaging, don’t take it personally. It’s not about you.
• Offer to help. Grieving can make the demands of daily living feel overwhelming. Many times, the grieving person does not want to burden others by asking for help. Don’t wait for them to ask. Instead, offer to help by bringing over dinner, shopping, gardening, etc. During the quarantine, there might be a limit to what you can physically do to help, but you can still take on tasks for the individual to relieve some burdens.

For more information and tips, visit MagellanHealthcare.com/COVID-19.