2.1 Outline key points of theories about the emotional and psychological processes that individuals and key people may experience with the approach of death

This guide will help you answer 2.1 Outline key points of theories about the emotional and psychological processes that individuals and key people may experience with the approach of death.

Facing death affects people in many ways. Their emotions and psychological state can shift at different times. This can apply to the person who is dying, but also to those close to them. Understanding some key theories can help workers offer more effective support.

The Five Stages of Grief — Elisabeth Kübler-Ross

Elisabeth Kübler-Ross wrote about the emotional responses people may experience when they are dying or grieving the loss of someone. The model is often called the “Five Stages of Grief” or “Kübler-Ross Model”.

The five stages are:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

Denial

At first, people may struggle to believe the seriousness of a terminal diagnosis. They may refuse to accept that death is approaching. This stage acts as a defence mechanism. It offers emotional protection against the shock.

Example: Someone recently told they only have months to live might continue to make long-term plans. They may avoid discussing their health or refuse to listen to doctors.

Anger

When reality sets in, feelings can change to anger. This can be directed at those close by, professionals, themselves, or even towards a higher power. The anger is usually not personal. It is an emotional response to the feelings of loss and a lack of control.

Example: A dying person might get upset with family for minor issues or question, “Why me?”

Bargaining

As the person processes what is happening, they may start bargaining. This often involves making deals or promises. Some may try to “negotiate” with doctors or a higher power for more time.

Example: “If I can just live to see my child graduate, I’ll do anything.”

Depression

When the reality becomes clear, deep sadness often follows. People might feel hopeless, lose interest in things they once enjoyed, or withdraw from others.

Example: The person might ask to be left alone more often or cry more frequently.

Acceptance

At this stage, the person has come to terms with their situation. Acceptance does not mean happiness. Rather, it is a sense of peace or readiness. People may want to put their affairs in order or say goodbye to loved ones.

Example: Someone may calmly discuss their wishes for their funeral or write letters to family.

Applying the Kübler-Ross Model

It is important to remember:

• People do not always move through these stages in order.
• Moving back and forth between stages is common.
• Not everyone experiences all five stages.

The model can apply to relatives and close friends as well. Their emotional responses may mirror these five stages as they anticipate losing someone or after bereavement.

Tasks of Mourning — William Worden

William Worden studied the specific “tasks” people need to work through as they grieve:

1. Accept the reality of the loss
2. Experience the pain of grief
3. Adjust to an environment without the deceased
4. Find a way to remain connected while moving forward with life

Accepting Reality

Some deny the loss by acting as if nothing has changed. This can cause problems later. Accepting the truth is a key first step.

Experiencing Pain

People must let themselves feel sadness, anger, fear, or any other emotion. Avoiding pain can delay grieving and healing.

Adjusting to Life

Losing someone may mean new roles and routines. People have to develop new skills and adapt to changed circumstances.

Remaining Connected

Finding a healthy bond with the deceased is important. This could be through memories, rituals, or talking to the person in private moments, while carrying on with living.

Worden’s Approach in Practice

Everyone moves through Worden’s tasks at their own pace. Pressure or expectations can make it harder. Support from carers, friends, or professionals makes a difference.

Attachment Theory — John Bowlby

Attachment theory, created by John Bowlby, looks at how people form bonds with others. These bonds shape emotional reactions when death is likely.

Key Points of Attachment Theory

• Strong attachments are natural.
• When a bond is threatened or broken (as with the approach of death), emotional pain is a normal response.
• People may try to restore lost attachments or protest the loss, showing intense emotions.

For those close to the dying person, attachment loss can lead to different reactions such as anxiety, anger, sadness, or seeking comfort from others.

Phases of Grief According to Bowlby

Bowlby listed several phases following a loss:

• Numbness (shock and disbelief)
• Yearning and searching (wanting the person back)
• Disorganisation and despair (life feels empty)
• Reorganisation (gradual adjustment to the loss)

Implications in Care

Knowing a person’s history of attachments helps staff provide sensitive support. Disrupted attachments can bring strong emotional reactions. Recognition and comfort are beneficial.

Dual Process Model of Grief — Stroebe and Schut

Margaret Stroebe and Henk Schut developed the Dual Process Model. It shows how people often move between two types of responses:

• Loss-oriented responses: focusing on the loss (crying, thinking about the person who is dying, talking about memories).
• Restoration-oriented responses: focusing on changes and new roles (handling practical matters, adapting routines).

People often shift between these modes. This “oscillation” is seen as healthy. It helps them cope with both the pain and the practical side of things.

Examples in Daily Life

• A partner may sort clothes one day (restoration) and cry over a cherished photo the next (loss).
• A dying person might spend the morning talking about funeral plans (restoration), then share childhood stories in the afternoon (loss).

Continuing Bonds Theory

Earlier theories stressed letting go. More recent thinking shows that maintaining “continuing bonds” with the deceased can be healthy.

People may keep a personal relationship with someone who has died or is dying by:

• Looking at photos
• Remembering shared stories
• Celebrating birthdays or anniversaries

These bonds do not mean people are “stuck” in their grief. They provide comfort, connection, and sometimes a sense of guidance.

Theories on Family Systems and Collective Grief

When someone nears death, the entire family or group of close friends often feels the impact. Family systems theory explores how individuals’ emotions affect everyone in the group.

Key Points

• Each family member may react differently.
• Communication styles, past conflicts, and cultural beliefs shape how people approach death.
• Tensions can rise, roles can shift, and old issues can return.

Understanding group dynamics helps workers spot those who need extra support.

Children’s Understanding of Death

Children see death differently, depending on age and development. Theories such as Jean Piaget’s stages of cognitive development are useful.

Young Children (Up to Age 5)

• Often believe death is reversible.
• May not fully understand the process.

School-Aged Children

• Begin to grasp that death is final and universal.
• May worry about who will look after them.

Adolescents

• Understand death is permanent, but may feel invincible.
• Can experience mood swings, anger, or deep sadness.

Support should be honest and at the child’s level of understanding.

Cultural and Spiritual Theories

Beliefs and traditions shape emotional and psychological reactions towards death.

• Rituals provide comfort and structure.
• Spiritual beliefs may offer hope or peace.
• Some faiths have particular practices around dying, which help people prepare emotionally.

Supporting people to express their spiritual or cultural needs can make the process less isolating.

Psychological Defence Mechanisms

Defence mechanisms are ways people protect themselves from painful emotions. Examples include:

• Denial: Refusing to believe bad news.
• Displacement: Focusing anger or sadness on a less threatening person or object.
• Rationalisation: Making excuses to avoid difficult feelings.

Recognising these behaviours helps workers respond with empathy, not frustration.

Applying Theories to Key People

The approach of death triggers reactions not only in the dying person but in friends, relatives, and carers.

Key people may:

• Cycle through denial, anger, bargaining, depression, and acceptance.
• Experience guilt or regret.
• Worry about coping alone.
• Focus on practical arrangements as a distraction from their pain.

Support for key people might involve:

• Listening without judging
• Providing space to talk or grieve in private
• Information and reassurance
• Practical assistance, such as help with paperwork or household tasks

Emotional Challenges: Anticipatory Grief

Anticipatory grief happens before the actual death. Both dying individuals and those close to them can start grieving as soon as they know death is likely.

Features of anticipatory grief include:

• Sadness about what lies ahead
• Anxiety about the dying process
• Worry for loved ones

Support at this stage can improve emotional wellbeing and prepare people for the time after death.

The Importance of Support from Workers

Having support makes a difference for both dying individuals and those who are close to them. Workers in health and social care settings should take account of each person’s emotional and psychological needs.

Best practice includes:

• Listening (even when silence is the main form of communication)
• Responding to cues for help or conversation
• Respecting varied grief responses
• Encouraging memories, conversations, or rituals that are meaningful

Final Thoughts

Helping someone through the approach of death, whether it is the dying person or those close to them, involves much more than looking after physical needs. Every emotional and psychological response is shaped by experiences, beliefs, personality, and relationships.

The theories provided here offer a structure for understanding what people might feel or think. Knowing these points helps support workers respond to each person’s unique situation. They are not fixed rules but helpful guides. It remains important to treat each person as an individual and allow them to process things at their own pace.

Everyone deserves care and respect during this time. By recognising common reactions and the reasons behind them, you can improve the comfort and dignity of those you care for. This knowledge enables you to make a positive difference at one of the most important moments of life.