The Grief & Loss Lineage
The universal experience that every tradition must face — and none fully captures
Clinical and evidence statements in this lineage remain under review. The source checks below apply only to their stated treatment, population and outcome.
Guideline sources for approaches in this lineage
Prolonged Grief Disorder Treatment (PGDT/CGT)
Guidelines and official sources (1)
1 professional reference check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Prolonged Grief Disorder: patient and family information
Discussed in the source
The association discusses prolonged-grief therapy in patient information. This is distinct from a clinical practice guideline, and DSM recognition of the diagnosis is not treatment endorsement.
Scope: Information about prolonged grief disorder and treatment approaches.
12-Step Facilitation
Guidelines and official sources (3)
3 clinical guideline checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Clinical Practice Guideline for the Management of Substance Use Disorders
Recommendation for the stated population
VA/DoD suggests TSF for alcohol-use-disorder treatment. It also supports systematic mutual-help engagement, including TSF: strongly for alcohol recovery and weakly for drug-use-disorder recovery.
Scope: Alcohol-use-disorder treatment, and mutual-help engagement during early recovery or after relapse from alcohol or drug-use disorders.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
WHO reports uncertainty about the effects of a 12-step approach compared with no treatment or usual care. DRU3 recommends CBT and contingency management; it does not positively recommend a 12-step protocol here.
Scope: Adults with cocaine or stimulant dependence.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
12-step facilitation is discussed within the reviewed psychosocial interventions. WHO conditionally recommends structured psychosocial treatment as a group, with low-certainty evidence, while noting uncertainty about individual therapy types versus usual care.
Scope: Adults with alcohol dependence.
ACT
Guidelines and official sources (18)
16 clinical guideline checks · 2 evidence registry checks
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Acceptance and commitment therapy for depression
Discussed in the source
The archive lists Modest under 1998 criteria, with 2015 re-evaluation pending. A registry entry does not establish a depression guideline recommendation.
Scope: ACT for depression
- Acceptance and commitment therapy for chronic pain
Discussed in the source
The archive lists Strong under 1998 criteria, with 2015 re-evaluation pending.
Scope: ACT for chronic pain
- Chronic pain (primary and secondary) in over 16s (NG193)
Recommendation for the stated population
NICE says to consider ACT or CBT for pain, delivered by appropriately trained professionals.
Scope: People aged 16 and over with chronic primary pain
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against ACT for PTSD. This assessment does not determine its status for other conditions.
Scope: Individual psychotherapy for adults with PTSD.
- Clinical Practice Guideline for the Non-Surgical Management of Hip and Knee Osteoarthritis
Discussed in the source
The appendix names ACT as an optional psychosocial or behavioral intervention, guided by availability and patient preference. This is ungraded implementation guidance, not a separately graded osteoarthritis recommendation.
Scope: Conceptual approach to chronic primary (nociplastic) pain when self-management strategies are insufficient.
- Management of Major Depressive Disorder
Recommendation for the stated population
VA/DoD suggests acceptance and commitment therapy among seven unranked psychotherapy options (weak for). Treatment strategy also depends on severity, chronicity, prior response and preference.
Scope: Adults with uncomplicated MDD choosing psychotherapy.
- Management of Major Depressive Disorder
Discussed in the source
VA/DoD strongly recommends first-line evidence-based psychotherapy, referring to the list that includes acceptance and commitment therapy. This is a class-level recommendation, with no preferred individual approach.
Scope: Pregnant or breastfeeding adults with mild-to-moderate MDD.
- Management of First-Episode Psychosis and Schizophrenia
Discussed in the source
VA/DoD suggests the acceptance/mindfulness therapy category (weak for) and explicitly includes ACT in its evidence discussion. It does not assign ACT a separate recommendation grade.
Scope: Adults with schizophrenia; psychotherapy combined with medication.
- Clinical Practice Guideline for the Management of Substance Use Disorders
Insufficient evidence for or against
The guideline reviews ACT studies and finds insufficient evidence for or against the broader mindfulness-based treatment category. This is a neutral finding for this substance-use scope.
Scope: ACT within the review of mindfulness-based treatments for substance-use disorders.
- Clinical Practice Guideline for Tobacco Use Treatment
Insufficient evidence for or against
The guideline discusses ACT and finds insufficient evidence to recommend a specific behavioral counseling approach over standard CBT. Its description of ACT is not a separate positive recommendation.
Scope: ACT compared with standard CBT for adult tobacco cessation.
- Diagnosis and Treatment of Low Back Pain
Discussed in the source
The review found no eligible ACT studies and identifies comparative ACT research as a priority. The CBT recommendation should not be presented as a separate ACT endorsement.
Scope: ACT evidence considered in the chronic low back pain review.
- Management of Headache
Discussed in the source
The recommendation is neutral for the mindfulness-based therapy category; the discussion includes ACT. It does not assign ACT a separate recommendation grade.
Scope: Mindfulness-based interventions for headache treatment or prevention.
- Tinnitus
Insufficient evidence for or against
VA/DoD names ACT among the interventions for which evidence is insufficient to recommend for or against treatment. The list is explicitly unranked.
Scope: Adults with bothersome tinnitus receiving ACT from a trained provider.
- Management of Adult Overweight and Obesity
Discussed in the source
ACT studies inform the weak recommendation for the cognitive behavioral intervention category. ACT receives no separate grade here; this is not an eating-disorder treatment recommendation.
Scope: Internalized weight bias and stigma in adult overweight/obesity care.
- Primary Care Management of Chronic Kidney Disease
Discussed in the source
The appendix names ACT among behavioral pain-management options, selected by availability and preference. This is ungraded guidance; much supporting evidence comes from people without kidney disease.
Scope: Adults with chronic kidney disease and chronic pain; self-management insufficient.
- Management of Type 2 Diabetes Mellitus
Discussed in the source
The review includes ACT within mindfulness/acceptance interventions. The graded recommendation concerns a stress-reduction programme category, without a separate ACT grade or established long-term benefit.
Scope: Adults with stress related to type 2 diabetes.
- Clinical Practice Guideline for Psychological and Other Nonpharmacological Treatment of Chronic Musculoskeletal Pain in Adults
Insufficient evidence for or against
APA finds the evidence insufficient for a recommendation in these comparisons. This is not a finding of ineffectiveness.
Scope: Adults with chronic musculoskeletal pain; ACT versus active control or usual care.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
ACT is named in the reviewed third-wave therapy category. WHO recommends that category alongside other structured therapies; it does not give ACT a separate recommendation or separate certainty rating here.
Scope: Adults with moderate-to-severe depression, within the mhGAP non-specialist-care context.
CBT
Guidelines and official sources (59)
58 clinical guideline checks · 1 evidence registry check
Read the recommendation and its scope. A source may discuss an approach without recommending it.
- Depression in adults: treatment and management (NG222)
Recommendation for the stated population
CBT is a named adult depression treatment option.
Scope: Adults with depression
- Generalised anxiety disorder and panic disorder in adults (CG113)
Recommendation for the stated population
NICE recommends CBT for specified GAD and panic-disorder presentations. The relevant protocol and treatment step matter.
Scope: Adults with GAD or panic disorder
- Post-traumatic stress disorder (NG116)
Recommendation for the stated population
NICE recommends trauma-focused CBT protocols, including CPT, cognitive therapy for PTSD, NET and PE; generic CBT is too imprecise.
Scope: Adults with acute stress disorder or clinically important PTSD symptoms; time since trauma matters
- Obsessive-compulsive disorder and body dysmorphic disorder: treatment (CG31)
Recommendation for the stated population
NICE recommends CBT including ERP, with intensity matched to impairment.
Scope: Adults with OCD; intensity and combined treatment depend on impairment
- Psychosis and schizophrenia in adults: prevention and management (CG178)
Recommendation for the stated population
NICE recommends CBT delivered to the specified psychosis protocol.
Scope: Adults with psychosis or schizophrenia
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Discussed in the source
VA/DoD strongly recommends CPT, EMDR and PE by name. This does not give every form of CBT the same recommendation.
Scope: Adults with PTSD
- Cognitive therapy for depression
Discussed in the source
The archive rates this specific treatment Strong under 1998 criteria; this is not a universal CBT rating or CPG grade.
Scope: Cognitive therapy for depression
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults
Recommendation for the stated population
APA strongly recommends the trauma-focused CBT family for adult PTSD. Footnote 4 defines a broad grouping, not a specific therapy.
Scope: Adults with PTSD; trauma-focused CBT family compared with no intervention or treatment as usual
- Clinical Practice Guideline for Management of PTSD and Acute Stress Disorder
Recommendation for the stated population
VA/DoD weakly suggests trauma-focused cognitive behavioral psychotherapy for PTSD prevention in acute stress disorder. This is distinct from immediate support for everyone exposed to trauma.
Scope: Adults diagnosed with acute stress disorder; prevention of subsequent PTSD.
- Assessment and Management of Patients at Risk for Suicide
Recommendation for the stated population
VA/DoD weakly suggests suicide-focused CBT-based psychotherapy to reduce attempts in this population. Generic CBT is not interchangeable with a suicide-focused protocol.
Scope: Suicide-focused CBT-based psychotherapy for adults aged 18 and over with suicidal behavior within the past six months.
- Assessment and Management of Patients at Risk for Suicide
Recommendation for the stated population
VA/DoD weakly suggests suicide-focused CBT, including problem-solving-based psychotherapies. The ideation outcome differs from recommendation 5’s attempt outcome.
Scope: Adults aged 18 and over with a history of self-directed violence; reducing suicidal ideation.
- Clinical Practice Guideline for the Management of Pregnancy
Recommendation for the stated population
VA/DoD strongly recommends offering CBT for prevention in this at-risk population. Treatment of an existing depressive episode is addressed separately.
Scope: Pregnant patients at risk of perinatal depression; individual or group delivery.
- Clinical Practice Guideline for the Management of Pregnancy
Recommendation for the stated population
VA/DoD weakly suggests CBT for treating perinatal depression.
Scope: Depression during pregnancy or postpartum.
- Clinical Practice Guideline for the Management of Pregnancy
Recommendation for the stated population
VA/DoD weakly suggests psychotherapy, naming CBT as an example, or yoga or both for this population.
Scope: Anxiety symptoms during or after pregnancy.
- Clinical Practice Guideline for Diagnosis and Treatment of Hypertension in Primary Care
Discussed in the source
The discussion reports studies combining CBT with dietary support. Recommendation 19 strongly favors low-sodium diet plus physical activity; its strength cannot be assigned to CBT by itself.
Scope: Combined lifestyle interventions for hypertension, including low-sodium diet with CBT.
- Clinical Practice Guideline for the Non-Surgical Management of Hip and Knee Osteoarthritis
Discussed in the source
The appendix names CBT as an optional psychosocial or behavioral intervention, guided by availability and patient preference. This is ungraded implementation guidance, not a separately graded osteoarthritis recommendation.
Scope: Conceptual approach to chronic primary (nociplastic) pain when self-management strategies are insufficient.
- Management of Major Depressive Disorder
Recommendation for the stated population
VA/DoD suggests cognitive behavioral therapy among seven unranked psychotherapy options (weak for). Treatment strategy also depends on severity, chronicity, prior response and preference.
Scope: Adults with uncomplicated MDD choosing psychotherapy.
- Management of Major Depressive Disorder
Discussed in the source
VA/DoD strongly recommends first-line evidence-based psychotherapy, referring to the list that includes cognitive behavioral therapy. This is a class-level recommendation, with no preferred individual approach.
Scope: Pregnant or breastfeeding adults with mild-to-moderate MDD.
- Management of Major Depressive Disorder
Recommendation for the stated population
VA/DoD suggests CBT during continuation treatment to reduce relapse or recurrence (weak for). CBT, IPT and MBCT are not ranked against one another.
Scope: Remitted MDD with high risk of relapse or recurrence.
- Management of Major Depressive Disorder
Discussed in the source
VA/DoD suggests first-line psychotherapy, including CBT, considering preferences and medication safety (weak for). The recommendation does not establish one psychotherapy as superior.
Scope: Adults aged 65 or older with mild-to-moderate MDD.
- Management of Major Depressive Disorder
Discussed in the source
VA/DoD suggests CBT-based bibliotherapy as an adjunct, or an alternative when other treatments are declined or inaccessible (weak for). This concerns a specific delivery format.
Scope: Adults with MDD; CBT-based bibliotherapy.
- Management of Bipolar Disorder
Recommendation for the stated population
VA/DoD suggests CBT alongside pharmacotherapy (weak for). It finds insufficient evidence to prefer CBT over the other listed adjunctive psychotherapies.
Scope: Adults with bipolar I or II who are not acutely manic.
- Management of Bipolar Disorder
Recommendation for the stated population
VA/DoD suggests CBT for residual anxiety in this defined population (weak for). This does not extend to acute mania.
Scope: Adults with fully or partially remitted bipolar disorder and residual anxiety symptoms.
- Management of First-Episode Psychosis and Schizophrenia
Discussed in the source
VA/DoD suggests psychosis-focused CBT with medication (weak for). The recommendation should not be transferred to arbitrary CBT programmes.
Scope: Adults with schizophrenia or prodromal/early psychosis.
- Clinical Practice Guideline for the Management of Substance Use Disorders
Recommendation for the stated population
VA/DoD includes CBT among treatment options: weak recommendations for alcohol and cannabis use disorders, and a strong recommendation for initial cocaine-use-disorder treatment. Preference and availability guide selection.
Scope: Adults with alcohol-, cannabis-, or cocaine-use disorder.
- Clinical Practice Guideline for Tobacco Use Treatment
Insufficient evidence for or against
VA/DoD strongly supports more intensive counseling and finds insufficient evidence to prefer another counseling approach over standard CBT. That comparative uncertainty is not a recommendation against CBT.
Scope: Behavioral counseling for adult tobacco cessation.
- Clinical Practice Guideline for the Management of Chronic Multisymptom Illness
Recommendation for the stated population
VA/DoD weakly recommends CBT, drawing substantially on indirect evidence from these symptom syndromes. This is a recommendation for managing symptoms and function, not a claim that the illness is psychological or that CBT cures it.
Scope: Chronic multisymptom illness and symptoms consistent with fibromyalgia, IBS, or ME/CFS.
- Clinical Practice Guideline for the Management and Rehabilitation of Post-Acute Mild Traumatic Brain Injury
Discussed in the source
VA/DoD discusses a brief CBT trial and describes CBT as a possible fatigue-management approach. These passages are not a separate graded CBT recommendation for treating mTBI.
Scope: Behavioral symptoms or fatigue in people with symptoms attributed to post-acute mTBI.
- Diagnosis and Treatment of Low Back Pain
Recommendation for the stated population
VA/DoD suggests CBT for chronic low back pain with a weak recommendation. This is narrower than a recommendation for every pain condition or acute low back pain.
Scope: Adults with chronic low back pain.
- Management of Headache
Insufficient evidence for or against
VA/DoD finds insufficient evidence for or against CBT for headache. This neutral recommendation is not a recommendation against treatment.
Scope: CBT for headache treatment or prevention.
- Tinnitus
Recommendation for the stated population
VA/DoD weakly recommends provider-delivered CBT and sound therapy combined with CBT in a multidisciplinary team. The scope is tinnitus management, not elimination of the tinnitus sound.
Scope: Adults with bothersome tinnitus; CBT delivered by a trained provider.
- Management of Adult Overweight and Obesity
Discussed in the source
VA/DoD weakly supports cognitive behavioral interventions for internalized weight stigma. The discussion defines a broad category; this is not a recommendation for CBT to treat every weight concern or an eating disorder.
Scope: Adults experiencing internalized weight bias and stigma within overweight/obesity care.
- Use of Opioids in the Management of Chronic Pain
Discussed in the source
The algorithm lists CBT as a non-opioid psychological treatment option. This sidebar is not a separately graded CBT recommendation or an opioid-use-disorder treatment guideline.
Scope: Non-opioid options within chronic pain care.
- Primary Care Management of Chronic Kidney Disease
Discussed in the source
The appendix names CBT among behavioral pain-management options, selected by availability and preference. This is ungraded guidance; much supporting evidence comes from people without kidney disease.
Scope: Adults with chronic kidney disease and chronic pain; self-management insufficient.
- Clinical Practice Guideline for the Primary Care Management of Asthma
Recommendation for the stated population
VA/DoD weakly recommends CBT for these outcomes. This recommendation was carried forward without a new evidence review and does not replace usual asthma care.
Scope: Adults with asthma; asthma-related quality of life and self-reported control.
- Clinical Practice Guideline for Management of Stroke Rehabilitation
Recommendation for the stated population
VA/DoD weakly recommends psychotherapy and explicitly names CBT as an example. This recommendation concerns treating depression after stroke, rather than preventing stroke or restoring motor function.
Scope: Depression following stroke.
- Clinical Practice Guideline for Psychological and Other Nonpharmacological Treatment of Chronic Musculoskeletal Pain in Adults
Recommendation for the stated population
APA strongly recommends offering CBT for this comparison.
Scope: Adults with chronic musculoskeletal pain; CBT versus usual care or another active intervention.
- Clinical Practice Guideline for Psychological and Other Nonpharmacological Treatment of Chronic Musculoskeletal Pain in Adults
Discussed in the source
APA reports insufficient evidence for this comparison. The table groups these approaches without assigning separate protocol grades.
Scope: Knee osteoarthritis; the reviewed CBT/motivational-interviewing/pain-coping-skills category versus usual care.
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults
Insufficient evidence for or against
APA finds insufficient evidence to prefer trauma-focused CBT over those comparators. Its recommendation versus no treatment or usual care does not establish superiority over active therapy.
Scope: Adults with PTSD; trauma-focused CBT versus the other active psychological treatments listed in the table.
- Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder in Adults
Recommendation for the stated population
APA strongly recommends adding trauma-focused treatment in this specific combined-care comparison.
Scope: Adults with PTSD and co-occurring SUD; trauma-focused CBT plus usual SUD care versus usual SUD care alone.
- Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
Insufficient evidence for or against
APA found insufficient evidence for a CBT recommendation in this age group. Adolescents have a separate recommendation.
Scope: Children with depressive disorders; initial treatment.
- Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
Recommendation for the stated population
APA recommends CBT as one initial psychotherapy option.
Scope: Adolescents with depressive disorders; initial treatment, excluding psychotic depression.
- Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
Recommendation for the stated population
For combined treatment, APA recommends CBT plus a second-generation antidepressant. It does not identify a superior psychotherapy monotherapy.
Scope: Adult depressive disorders, excluding psychotic depression; bipolar disorder is outside scope.
- Clinical Practice Guideline for the Treatment of Depression Across Three Age Cohorts
Recommendation for the stated population
APA recommends group CBT over no treatment.
Scope: Adults aged 60 or older with MDD; group CBT, alone or added to usual care.
- mhGAP: brief structured psychological treatment for depression
Recommendation for the stated population
WHO strongly recommends structured psychological interventions including CBT for this population, based on moderate-certainty evidence.
Scope: Adults with moderate-to-severe depression, within the mhGAP non-specialist-care context.
- mhGAP: brief structured psychological interventions for anxiety
Recommendation for the stated population
WHO strongly recommends brief structured interventions based on CBT principles for GAD/panic, based on moderate-certainty evidence.
Scope: Adults with generalized anxiety disorder or panic disorder, within the mhGAP non-specialist-care context.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Recommendation for the stated population
WHO includes individual, group and digital trauma-focused CBT in a conditional recommendation. The 2023 guideline book rates certainty as low, while WHO’s web summary reports moderate quality; that discrepancy remains unresolved. Delivery requires appropriate training and supervision.
Scope: Adults with PTSD, within the mhGAP non-specialist-care context.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Recommendation for the stated population
WHO conditionally recommends considering CBT, with low-certainty evidence. The 2023 edition retains the 2015 recommendation because eligible new evidence was insufficient; suitability requires an individual assessment.
Scope: People living with dementia and mild-to-moderate depression.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Recommendation for the stated population
WHO conditionally recommends considering CBT among the listed non-pharmacological interventions, with low-certainty evidence. This does not equate CBT with cognitive stimulation or cognitive training.
Scope: People living with dementia.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
WHO strongly recommends psychosocial interventions incorporating CBT, psychoeducation and family-focused approaches, with low-certainty evidence. This is a prevention recommendation for a defined group, rather than a general child-disorder treatment recommendation.
Scope: Children whose parents have mental health conditions; prevention of depression and anxiety.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Recommendation for the stated population
WHO strongly recommends CBT, with moderate-certainty evidence. The discussion emphasizes adaptations and the ability to engage with CBT; it does not establish identical suitability across all developmental or communication needs.
Scope: Children and adolescents with autism who have anxiety.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Recommendation for the stated population
WHO includes individual and group face-to-face trauma-focused CBT in a strong recommendation based on moderate-certainty evidence. Clinicians need relevant training and demonstrated competence; lay providers require comprehensive training and close supervision.
Scope: Children and adolescents with PTSD.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Recommendation for the stated population
WHO conditionally recommends individual CBT and other listed psychological interventions as adjuncts to pharmacological treatment, with low-certainty evidence. This concerns maintenance in remission, not acute mania or a blanket depression recommendation.
Scope: Adults with bipolar disorder in remission.
- Psychosocial support for psychostimulant use disorders
Recommendation for the stated population
WHO strongly recommends CBT, with low-certainty evidence. This finding is specific to cocaine and stimulant dependence, rather than all substance use conditions.
Scope: Adults with cocaine or stimulant dependence.
- Mental Health Gap Action Programme (mhGAP) guideline for mental, neurological and substance use disorders
Discussed in the source
CBT is discussed within the reviewed psychosocial interventions. WHO conditionally recommends structured psychosocial treatment as a group, with low-certainty evidence, while noting uncertainty about individual therapy types versus usual care.
Scope: Adults with alcohol dependence.
- Self-harm: assessment, management and preventing recurrence (NG225)
Recommendation for the stated population
NICE says to offer a tailored intervention and explicitly names CBT and problem-solving therapy. This does not endorse every generic protocol or establish a reduction in suicide deaths.
Scope: Adults who have self-harmed; a structured, person-centred CBT-informed intervention tailored to their needs.
- Attention deficit hyperactivity disorder: diagnosis and management (NG87)
Recommendation for the stated population
NICE says the required ADHD-focused psychological support may include CBT components or a full course; CBT is not compulsory or universally first-line.
Scope: Adults with ADHD in the specified indications for non-drug or combined care.
- Chronic pain (primary and secondary) in over 16s (NG193)
Recommendation for the stated population
NICE says to consider pain-focused CBT; outcomes and evidence limitations are described separately from other pain diagnoses.
Scope: Chronic primary pain, age 16 and over; trained pain-focused CBT.
- Sexual and Reproductive Health: Management of Erectile Dysfunction
Recommendation for the stated population
EAU gives a strong recommendation for this indicated combined-care use; it does not cover every sexual dysfunction.
Scope: Men with erectile dysfunction; indicated CBT involving the partner and combined with medical treatment.
Grief is not a disorder. It is the human response to loss — of a person, a relationship, a future, an identity. Yet psychotherapy has always struggled with it: is grief a natural process that needs witnessing, or a clinical problem that needs intervention? Freud's "Mourning and Melancholia" (1917) made the first formal distinction between normal and pathological grief. Kübler-Ross gave us five stages — then the field spent decades arguing whether stages exist at all. Worden shifted from stages to tasks. Stroebe and Schut offered the Dual Process Model, recognizing that grieving people oscillate between confronting the loss and attending to ongoing life. Most recently, Prolonged Grief Disorder entered the DSM-5-TR (2022), formally pathologizing grief that persists beyond expected timelines — a move both praised for enabling treatment access and criticized for medicalizing a normal human experience.
Full Contents
Read all 8 entries as a single page
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Freud: Mourning and Melancholia
The founding text of grief psychology. Freud distinguished mourning (normal, time-limited grief where the bereaved gradually withdraws emotional investment from the lost object) from melancholia (pathological grief where the loss becomes internalized as self-attack).
Concepts: Grief work · Decathexis · Mourning vs. melancholia · Identification with the lost object · Internalized aggression
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John Bowlby
Applied attachment theory to grief. Four phases of mourning: numbness, yearning and searching, disorganization and despair, reorganization. Grief is the activation of the attachment system in the absence of the attachment figure.
Concepts: Attachment and loss · Four phases of mourning · Yearning and searching · Separation protest · Internal working models of the deceased
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Elisabeth Kübler-Ross
On Death and Dying (1969) — originally about dying patients, not bereaved survivors. The five stages (denial, anger, bargaining, depression, acceptance) were never meant as a linear sequence, but popular interpretation made them exactly that.
Concepts: Five stages · Denial · Anger · Bargaining · Depression · Acceptance
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J. William Worden
Replaced passive stages with active tasks: (1) accept the reality of the loss, (2) process the pain, (3) adjust to a world without the deceased, (4) find a way to maintain connection while embarking on new life.
Concepts: Four tasks of mourning · Grief as active work · Continuing bonds · Adjustment to the new world
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Stroebe & Schut: Dual Process Model
The most empirically supported grief model. Bereaved people oscillate between loss-oriented coping (confronting grief, yearning) and restoration-oriented coping (attending to life changes, new roles, taking breaks). Both are necessary; problems arise when stuck in one mode.
Concepts: Loss-oriented coping · Restoration-oriented coping · Oscillation · Dosing grief · Adaptive alternation
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Continuing Bonds
Klass, Silverman, and Nickman challenged Freud's model. Healthy grief does not require severing the bond. The bereaved maintain an ongoing inner relationship with the deceased through memory, ritual, internal conversation, and symbolic connection.
Concepts: Ongoing relationship with the deceased · Meaning reconstruction · Adaptive vs. maladaptive bonds · Internalized relationship
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Prolonged Grief Disorder
DSM-5-TR (2022) included PGD for the first time. Criteria: intense yearning, identity disruption, emotional numbness, avoidance, functional impairment persisting beyond 12 months. Treatment protocols now exist (Shear).
Concepts: Prolonged grief criteria · 12-month threshold · Identity disruption · Complicated vs. prolonged grief
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Meaning Reconstruction
Robert Neimeyer proposed that grief's central challenge is meaning reconstruction: rebuilding a world of meaning shattered by loss. Narrative approaches invite the bereaved to story and re-story their relationship with the deceased and their own changed identity.
Concepts: Meaning reconstruction · Narrative retelling · Benefit finding · Identity reconstruction · Continuing the story