Grief and Loss in Young People: A Neuroscience Perspective

Read this article as part of a course!

[wlm_private “1 Year Subscription|3 Year Subscription|NPT Standard|Staff|NPT Premium|NPT Standard Monthly|2 Year Subscription”]Members Click Here to get your reading course for free.[/wlm_private]

DEVELOPMENT BACKGROUND

Benson the Boxer was developed as a psychoeducational tool to assist children and young people deal with situations of loss and to facilitate pathways towards healing.

Too often life throws curve balls, and unfortunate, often traumatic, situations occur. Sadly, children are never immune, and they will inevitably experience situations where their world is completely turned upside down. Statistics reveal that by the age of sixteen, 68% of children will experience at least one extraordinary event that is frightening and possibly life-threatening (Everstine & Everstine, 2013).

The clinical research shows that children exposed to loss, grief, and trauma experience neurobiological changes in emotions, thinking patterns, and behaviour (Howard, 2013; Rossouw, 2014). Many instances of loss have lasting consequences, particularly if a child physically witnesses or has direct exposure to the traumatic event. If the trauma involves the death of a family member or loved one, particularly when the child had a close relationship to the person, the trauma on the brain is even more intense (Joshi, Lewin, & O’Donnell, 2005). Further, that trauma is even more severe, with greater negative reactions, if the loss occurs in a place a child once considered safe (Joshi et al., 2005). Other contributing concers include situations where children have experienced previous or repeated situations of loss, those who live in dysfunctional family environments where nurture and support is minimal, and children without other significant caring people in their lives.

We like to think that children are resilient and “get over” a loss quickly. And many do. However, a Swedish study by Josefin Sveen and colleagues at Uppsala University found that more than half of the children surveyed (n = 174) had not worked through their grief 2–9 years after the death of a sibling (Sveen, Eilegård, Steineck, & Kreicbergs, 2014). And if children experience the death of a parent before the age of 19, there is a significant increase in anxiety and depression in adulthood (Luecken, 2008).

Experiencing loss is inevitable: loved ones die; divorce and separation occur all too frequently; most people move house, change schools, and suffer illness and accidents sometime in their lives; and many experience natural disasters, war, and political unrest resulting in displacement and the loss of childhood innocence and joy. All these situations can create intense emotional pain for a child and trigger activation of implicit memory systems that dominate other brain activities, ensuring that the distressing, fear-filled memories are deeply encoded in the brain in an effort to protect the individual (Noel, Chambers, McGrath, Klein, & Stewart, 2012).

The brain processes incoming sensory signals from the moment we are born and throughout our life continues to form intrinsic memories that are pivotal to the development of behaviour and the way we adapt to our environment (Perry & Szalavitz, 2006). Emotions are powerful in memory formation. Family environments of nurture, enjoyment and safety all form positive memories in a child. Experiences that are painful and frightening are especially memorable because the brain has an instinctive reaction to protect and feel safe. When negative experiences occur (i.e., things that are painful, sad, or frightening), we adopt certain behaviours to avoid the distress. Distress avoidance is a fundamental psychological need (Grawe, 2007), and in order to fulfil it our behaviours shift to maximise pleasurable experiences and feel safe (Grawe, 2007)

The release of the neurochemical dopamine is closely linked to our need for pleasure and motivates us to turn to behaviours that bring some relief from the anxiety or sadness we may be experiencing (Grawe, 2007). However, dopamine is released both for behaviours that are beneficial, such as play, exercise, connecting with others, and behaviours that can have long-term detrimental effects on our well-being, such as taking stimulants or pain suppressants, withdrawing, or hiding away (Grawe, 2007; Rossouw, 2014).

It is important, therefore, to help a child address and deal with painful memories,  or subsequent reminders of the loss and traumatic event are likely to bring about the same physiological and psychological fear reactions as occurred when the event first happened (Cohen, Mannarino, & Deblinger, 2017; Linden & Rutkowski, 2013; Medina, 2014). When loss is not addressed, the anxiety and fear a child experiences can become generalised and indiscriminate, resulting in the same level of fear taking over even when there is an inherently innocuous reminder of the traumatic incident (Cohen et al., 2006). New fears that have no apparent relationship to the original trauma commonly intrude (Cohen et al., 2017; Linden & Rutkowski, 2013). Hypervigilance and a foreboding sense of impending doom begin to impinge on a child’s ability to engage in normal developmental activities. This can lead to anxiety-driven protection behaviours, so that the child is unable to manage even low-intensity stress in future situations (Cohen et al., 2017, Howard, 2013). In order to escape the pain of negative experiences, it is common for a child to either disassociate and withdraw, or they may display hyperaroused, demanding, and disinhibited behaviours (Howard, 2013).  Both reactions can have very negative psychosocial repercussions, but if the behaviours are repeated frequently then behavioural schemas are forged and embedded in the brain, setting patterns for how stressful situations are managed in the future.

The Benefits of Using Benson the Boxer as a Psychoeducational Tool

When a child presents in therapy after experiencing a significant loss, a cognitive psychopathology approach is commonly taken to treat the child’s fear-based thoughts and responses. This top-down approach assumes the child has effective cognitive ability to address unhelpful thoughts and behaviours. However, children suffering loss and trauma are generally anxious, fearful, and a little confused (Linden, & Rutkowski, 2013). And therapy itself can be fearful! A child being told they are going to “see someone” for treatment after a loss (be that a loss due to a death, parental divorce, or any change that has resulted in anxiety) can believe there something wrong with them. Most children are uncertain what “treatment” or “therapy” is about. The environment of the therapy room is unfamiliar and the therapist unknown, all adding to the fear and anxiety the child is presently experiencing.

Before any therapy begins, the child’s limbic system must be calmed by ensuring the child feels relaxed, comfortable, valued, and safe. A positive therapeutic alliance begins with a smile, displaying warmth and showing genuine care that are all part of building a positive rapport with a child. But what next?

Many therapists feel totally out of their depth when counselling children. A child’s attention span is short, they can be fidgety and restless, or they may not “gel” with the therapist: many adults are keenly aware that children are not shy when it comes to expressing their dislike for a particular place or person. Fear may result in the child clamming up, or not being able to provide any more than an occasional yes or no, a nod or a grunt.

Storytelling and reading to a child are good ways for the therapist to engage with the child, right brain to right brain, and hold their interest (Rossouw, 2012). Children enjoy the stories and they can help create a positive therapeutic alliance as a framework of trust is generated (Geldard, Geldard, & Foo, 2013). Engaging in storytelling together inadvertently fulfils some vital psychological needs, in particular, the need to feel connection with the therapist, so that a child feels safe in sharing their vulnerabilities, and provides opportunities to build strong attachments (Allison & Rossouw 2013).

An equally important psychological need is providing the child with a sense of control. This can be achieved during the story when the therapist (the reader) invites the child to turn the pages, hold the book, point to various features in the pictures, choose to hold a soft toy while listening, or simply to choose the part they would like to read. The story of Benson provides orientation and can help give some insight into the way a child is feeling about their own personal situation of loss. Experiential evidence has shown that reading Benson the Boxer to a child has been the catalyst for a cathartic experience due to the normalizing of emotions the individual may be feeling. Interestingly, this has also been helpful for adults.

The Benson the Boxer story can help calm distress and anxiety surrounding situations of childhood loss. The artwork immediately captures a child’s attention, and as the story progresses there is a sense of understanding of what grief and emotional pain look like, normalizing the child’s behavioural reactions. It acknowledges and names the emotions associated with grief and sadness and outlines the neuroscience behind the protection behaviours a child may have adopted.

The story of Benson’s loss and grief provides children with opportunities to share their own personal journey of loss as they identify with Benson’s pain. Engaging a child in a story uses a bottom-up approach, down-regulating the stress response, activating predominantly the right frontal cortex, the primary area affected by the emotional or social pain commonly associated with loss (Dahlitz, 2017). The stories are accompanied by bright, colourful, and engaging illustrations that enhance the activation of positive memories by facilitating new memory networks. Benson the Boxer: A Story of Loss and Life identifies with the loss a child is experiencing, allowing their own personal grief to unfold.[wlm_private “1 Year Subscription|2 Year Subscription|3 Year Subscription|Staff|NPT Standard|NPT Premium|NPT Standard Monthly”]

The Storybook

Benson the Boxer: A Story of Loss and Life is a beautifully illustrated picture book that tells the story of Benson, a boxer dog, and the loss of his best friend, Lucy Labrador. As a psychoeducational tool, the book is suitable for helping a child or young person through many situations of loss, be that the death of a pet or loved one, an accident that results in a disability, an illness, or maybe a divorce or separation. Within the framework of the story, the author has addressed how the brain reacts to situations of loss and grief and woven in strategies for moving forward. Therapists, teachers, and parents will similarly find within the story framework appropriate questions to ask and how to talk to an individual who is grieving the loss of a loved one. Every page in the Benson the Boxer storybook provides opportunities for those working with children to ask questions, explore understandings, identify meanings, and observe a child’s reactions. The therapist can unobtrusively explore the child’s feelings surrounding their personal loss, help to name emotions, and then assist the child in identifying how that feels inside their body. Older children begin to relate, not just to death, but to other areas of loss that have affected them and those close to them.

Program Manual and Worksheets

The manual Benson the Boxer Program for Loss and Grief complements the storybook and is designed to provide guidance for clinicians, educators, parents and other caregivers, and to provide insight into the neuroscience surrounding situations of loss, grief and trauma. It is filled with tips and best-practice ideas for any adult who works with children and young people. The attractive and colourful activities are designed not to be difficult or challenging but to be discussion starters that can be developed. They provide unobtrusive and non-threatening ways of talking through emotions surrounding loss, building right-brain to right-brain connections and opening neural pathways. There is a deliberate attempt to focus firstly on Benson’s emotions and behavioural responses, then to transfer the focus to the child. This approach is an attempt to normalize what a child is feeling as they sense a partnership with Benson in their shared experience of grief. Identifying with Benson’s loss and his accompanying emotional and physical pain helps a child verbally express his or her own personal feelings. This is particularly relevant and useful for a child who may find the words difficult to express, perhaps young children, or children with a disability, or children who just can’t find the words to express their grief (Cohen, Mannarino, & Deblinger, 2006; Linden & Rutkowski, 2013).

The activities are varied. They are not set to benchmark standards as would be found in a classroom setting. This is purposeful! It is imperative to ensure children don’t feel they are in a classroom with just another worksheet to complete. Creative therapists, educators, and parents can expand on the activities if they wish, or use them as a starting point for further discussion. The worksheets encourage the child to identify, acknowledge, address, and name their feelings of loss. There are ideas for moving forward from that feeling of being stuck or trapped that is a common experience after a loss. The program guide is not a lengthy manual filled with psychological jargon; rather, it is designed for time-poor practitioners, educators, and parents and offers concise explanations on how to get the most from this resource.

Summary and Overview

Benson the Boxer: A Story of Loss and Life, is about Benson the boxer dog and his best friend Lucy Labrador. Life is fun and exciting for this mischievous, inseparable pair, until one day the unimaginable happens, Lucy is killed in a road accident. The tragedy leaves Benson feeling alone and miserable. Anxiety, fear, guilt and sadness fill his days and stop him doing things he used to enjoy. Benson hides away and becomes trapped in his memories of fear and sadness.

In Brief: The Benefits of Benson the Boxer as a Psychoeducational Tool

The aim of Benson the Boxer storybook and manual is to make a way for children to cope with situations of loss. The resource recognises that those who have lost someone or something precious will never forget, but it also provides opportunities, through psychoeducation, for a child’s loss to be acknowledged, identified, named, and addressed Benson the Boxer encourages children to sit with the loss and grieve, and then to move beyond protection behaviours that have the potential for long-term negative consequences. It provides practical ideas and strategies for moving forward so that there can be wellness and thriving, even after tragedy and loss.[/wlm_private]

This has been an excerpt from The Neuropsychotherapist Volume 7 Issue 3 – for the complete article and more interesting content, please subscribe to our website.

Read the full article as part of a trauma article download bundle here: [wlm_private “NPT Basic|3 Year Subscription|Standard Membership|Staff|NPT Premium|Standard Monthly”] Members use this link to get the download for free. [/wlm_private]