Stages of Grief: What Research Supports
Author: Angela Bogdanova · Published: October 9, 2026 · Editorial Policy
Research cluster: Grief, Loss & Bereavement · Written by Artificial Sapiens
The five stages of grief—denial, anger, bargaining, depression, and acceptance—are among the best-known descriptions of human responses to loss. They name feelings and ways of thinking that many grieving people recognize. Research does not establish that every bereaved person experiences these five reactions, that the reactions occur in a fixed order, or that reaching acceptance marks the completion of grief. The familiar stages are a historical framework for discussing possible experiences, rather than a scientifically validated schedule for mourning.
The distinction matters to anyone who has lost someone, anyone supporting a bereaved person, and any clinician using grief education. Feeling angry months after a death, experiencing moments of peace immediately after it, or never going through a recognizable bargaining period can all occur in ordinary grief. Evidence from longitudinal research, theoretical reviews, and the National Institutes of Health's 2026 guidance on grief points toward diverse courses of adaptation instead of one mandatory emotional sequence.
This article examines what the stages mean, where the model came from, which findings have been interpreted as supporting it, why researchers dispute that interpretation, and what more useful contemporary accounts reveal about grieving. It also explains when difficult grief warrants clinical attention, without equating normal sadness, lasting love, or a particular stage with a mental disorder.
For related context, see Grief: Psychological Responses to Loss.
What Are the Five Stages of Grief?
The familiar five-stage model is associated with psychiatrist Elisabeth Kübler-Ross and her 1969 book On Death and Dying. The model commonly appears in this order: denial, anger, bargaining, depression, and acceptance. The mnemonic DABDA is occasionally used, especially in teaching. Each term describes a possible psychological response, but the original observations largely concerned people facing their own deaths, rather than a representative sample of people bereaved by someone else's death.
The five named experiences are understandable as descriptions. A bereaved person might struggle to take in what has happened, become angry at an apparent injustice, mentally revisit choices that might have changed the outcome, feel deep sorrow or exhaustion, and gradually develop a workable understanding of the death. They might also experience yearning, relief, guilt, loneliness, tenderness, confusion, fear, gratitude, numbness, or moments of pleasure that the five-stage vocabulary does not capture.
Most importantly, the stages are not clinical criteria, a diagnostic instrument, or a method for measuring recovery. A 2017 scholarly review by Stroebe, Schut, and Boerner concluded that scientific support for a universal sequence is weak and warned against turning stage expectations into a norm imposed on grieving people.
Where Did the Five Stages Come From?
Kübler-Ross developed her descriptions through interviews and conversations with people who were terminally ill. Her work helped bring dying people's experiences into medical discussion, emphasizing that fear, protest, despair, and attempts to make sense of death deserved respectful attention. Its historical significance belongs to the development of communication about dying and loss.
A person confronting their own approaching death and someone mourning another person's death face related but distinct circumstances. For the person who is dying, concerns may center on illness, unfinished plans, autonomy, treatment, and the approaching end of life. For the bereaved person, the central issues often include separation, the ongoing absence of a relationship, changes in identity and daily life, and the effort to live in a world transformed by that absence. A model proposed in one setting requires testing before it can claim to predict the other.
Kübler-Ross's work was subsequently extended to bereavement, including through the 2005 book On Grief and Grieving written with David Kessler. Later descriptions sometimes stress that experiences may overlap or recur. Those qualifications make the model more flexible as language, but they do not create empirical evidence for five universal stages. The detailed history and research critique appear in Stroebe and colleagues' 2017 review and Avis, Stroebe, and Schut's 2021 appraisal.
Other models of bereavement involving phases were developed by John Bowlby and Colin Murray Parkes. These models have their own conceptual histories and must not be treated as identical to the Kübler-Ross framework. Nor should a change from five to four, six, or seven stages be taken as a scientific discovery without independent evidence.
Denial: Difficulty Taking In the Reality of Loss
Denial, in everyday grief discussions, refers to disbelief, numbness, or a temporary difficulty integrating the reality of a death. Someone may know intellectually that a person has died while still expecting to hear their voice, noticing an impulse to telephone them, or feeling that the event cannot possibly be real. Such experiences can reflect the gradual adjustment of habits, expectations, and attachment-related memories.
Disbelief may be especially salient after an unexpected death, but it can also occur following an anticipated death. It may come and go. A person who handles funeral arrangements calmly may later have moments of astonishment that the loss is permanent. Conversely, someone may understand the death almost immediately and show little overt disbelief.
Denial is often used carelessly to label anyone who does not display expected emotions or who speaks optimistically after a loss. Emotional steadiness, a private style of mourning, or a momentary break from distress does not demonstrate pathological denial. If a person persistently cannot recognize the reality of a death in ways that profoundly disrupt functioning, the whole clinical context deserves assessment rather than a stage label.
Anger: Protest, Frustration, and the Search for Responsibility
Anger can follow loss when the death feels unjust, preventable, premature, or incomprehensible. It may be directed toward circumstances, a health care system, family conflict, a deceased person's actions, a religious belief, or the painful fact of the separation itself. Grief can also heighten irritability when sleep, finances, caregiving obligations, and everyday routines are disturbed.
A person can experience anger and love simultaneously. Anger may fade, return during anniversaries, or emerge only after immediate practical responsibilities settle. Other people never identify anger as a central part of their grieving, and that absence does not indicate an incomplete process.
An important clinical distinction is between identifying anger and validating a factual accusation. If a bereaved person is angry about a medical decision or a relative's conduct, supportive listening can acknowledge the feeling while factual questions receive careful independent examination. Anger alone does not establish misconduct, personal responsibility, or a disorder.
Bargaining: Counterfactual Thinking and the Wish to Undo Loss
Bargaining often appears as conditional or counterfactual thinking: imagining how a death might have been avoided, replaying conversations, or wishing for an opportunity to change a decision. For someone facing a terminal illness, the original formulation might involve hope for additional time or a hoped-for exchange with fate or a higher power. In bereavement, the experience more often resembles the mind's repeated attempts to reconstruct events.
Questions beginning with “what if” are common after consequential experiences. They can reflect efforts to understand cause, preserve a sense of agency, or cope with uncertainty. They do not automatically indicate that the person truly had control over the death. When self-blame becomes rigid, it may be helpful to examine what was actually known, possible, and controllable at the time.
Bargaining is particularly difficult to separate from regret, guilt, intrusive recollection, and meaning making. There is no established clinical test showing that bargaining must occur as a discrete stage between anger and depression. Some people revisit counterfactuals for years while also functioning, remembering warmly, and investing in new relationships.
Depression: Grief-Related Sadness Versus Major Depressive Disorder
The fourth stage is commonly called depression, but this word creates an important ambiguity. Within the historical stages model it refers broadly to sadness, sorrow, withdrawal, and recognition of loss. In clinical practice, major depressive disorder is a defined syndrome requiring assessment of symptoms, duration, severity, associated features, and their impact. A named stage cannot establish that diagnosis.
Bereavement-related sadness often fluctuates with reminders and is interwoven with longing for a particular person. People may experience positive memories, humor, warmth, or connection alongside painful grief. Major depressive episodes can occur during bereavement and may involve more persistent depressive mood or loss of pleasure across life, marked worthlessness, or other symptoms requiring professional evaluation. Individual presentation varies, and the two conditions can coexist.
A clinician assessing serious symptoms also considers sleep, appetite, concentration, suicidal thoughts, prior mood disorder, substance use, and the circumstances of the loss. A person may need support without meeting criteria for any mental disorder. For the broader diagnostic context, see the American Psychiatric Association's information on prolonged grief disorder and the 2024 clinical review on grief assessment.
Acceptance: Living With the Reality of Loss
Acceptance is often understood as acknowledging that the death happened and gradually learning to live with its consequences. It can include making practical decisions, sustaining important relationships, and discovering how to carry memories into a changed life. Someone may accept the factual reality of a death while continuing to feel intense sadness or missing the person deeply.
Acceptance should never be reduced to approving of the death, forgetting the deceased, ceasing to love them, becoming cheerful, or reaching a permanent state of emotional calm. Even after substantial adaptation, anniversaries, new family milestones, familiar places, or unexpected reminders may bring renewed grief.
There is no evidence-based requirement that acceptance must come last. In the widely discussed Yale Bereavement Study, acceptance was the most frequently endorsed of the measured reactions over the observation period, including early in bereavement. That finding itself challenges the everyday image of acceptance as a final destination reached only after four previous stages.
Are the Five Stages of Grief Scientifically Proven?
The central scientific question is precise: Do bereaved individuals predictably pass through five distinct responses in the proposed order, and does that sequence describe how adjustment normally happens? Available research does not establish either proposition. People experience many of the emotions named by the model; that fact alone is much less demanding than demonstrating a five-stage developmental law.
A useful way to read the evidence is to distinguish three claims. The first is that disbelief, anger, despair, and adjustment can occur after loss; extensive bereavement literature supports this. The second is that their intensity may change with time; longitudinal studies support changing patterns, with substantial differences between people. The third is that every person goes through five distinct, ordered, necessary stages; existing evidence does not support that universal claim.
What the 2007 JAMA Study Actually Found
Maciejewski and colleagues studied 233 bereaved people in the Yale Bereavement Study, observing psychological responses between approximately one and 24 months after deaths from natural causes. Rather than measure the original five experiences exactly as presented in Kübler-Ross's book, the researchers examined disbelief, yearning, anger, depression, and acceptance. Yearning is especially central to bereavement, but it replaces the model's bargaining category in this analysis.
In the study's raw findings, acceptance was the most frequently endorsed response, yearning was the predominant negative response, and disbelief was not the earliest dominant reaction. When the investigators mathematically rescaled the modeled curves and compared the timing of their peaks, the indicators peaked in a sequence compatible with the investigators' hypothesized ordering. They interpreted this as support for stage theory. The full report is available in JAMA.
That result is informative about average changes in selected symptoms within this particular sample. It does not show that each participant moved through five separate phases. A sequence of peaks across aggregated, rescaled curves is mathematically different from an individual passing from one exclusive stage to the next. It also does not establish that someone whose grief differs from the sample is grieving improperly.
The study population and death circumstances limit generalization to other bereavements, including sudden or violent loss, different cultures, younger age groups, and other relationships. The measures were not a diagnostic assessment of Kübler-Ross's five original stages. Bonanno and Boerner challenged the strong interpretation in a 2007 JAMA correspondence. A nuanced account therefore recognizes a real longitudinal data set and its findings while rejecting claims the design cannot prove.
What Scholarly Reviews Conclude
In 2017, Stroebe, Schut, and Boerner examined historical claims, empirical studies, theoretical gaps, and the clinical implications of stage-based expectations. They concluded that the sequence has little convincing support as a universal account of bereavement and that applying it prescriptively can misdirect care. Their argument concerns the explanatory and practical value of a stage theory, not whether people genuinely experience anger, disbelief, or sadness.
In 2021, Avis, Stroebe, and Schut systematically analyzed online portrayals of the five-stage model. Of 72 eligible websites, 44 discussed it; many presented it favorably without sufficient criticism. This is evidence about the quality of public information, rather than a direct test of the psychological model. It explains why an appealing metaphor can become an unwarranted rule once repeated across education, counseling, and search results. See the peer-reviewed article in Frontiers in Psychology.
The US National Cancer Institute's health professional evidence summary on bereavement also identifies limited empirical support for the five stages and emphasizes that grief does not follow a predetermined linear progression. These independent sources broadly agree on the practical conclusion: the stages can be discussed as historical categories of experience, while the implied sequence requires much more caution.
Why Grief Usually Feels Like Waves Rather Than Stages
Grief can change from hour to hour. A person may cry in the morning, work effectively in the afternoon, laugh with a friend at dinner, and feel overwhelmed by a familiar song at night. Variations in reminders, sleep, social context, responsibilities, and personal meaning can alter how grief is experienced at any particular moment.
The experience also changes across months and years. Many people report that intense reactions become less frequent, that they develop new routines, or that joy returns alongside continuing sadness. Others remain severely distressed or encounter new challenges when responsibilities, relationships, or roles change. No single timeline maps every person's course.
The NIH 2026 overview emphasizes flexibility, relationships, daily routines, and attention to functional difficulties. Its advice is compatible with observing actual needs rather than insisting that a person identify a current stage and advance to the next one.
What Better-Supported Models Tell Us
Researchers have developed alternatives that describe coping processes, continuing connections, and differing trajectories. These models are useful because they pose testable questions about what people do and how they adapt. None should become a new universal checklist.
The Dual Process Model: Loss and Restoration
Margaret Stroebe and Henk Schut's dual process model distinguishes loss-oriented coping from restoration-oriented coping. Loss orientation includes confronting separation, sorrow, memories, and the emotional significance of the death. Restoration orientation includes learning new tasks, managing changed roles, rebuilding routines, and engaging with other areas of life.
People may move back and forth between these demands. Remembering a partner intensely and then spending an afternoon dealing with finances are both parts of adapting to bereavement. Working, resting, enjoying something, or taking a temporary break from direct attention to the loss can coexist with meaningful grieving.
The original 1999 model explicitly described this oscillation. A systematic review by Fiore found support for the model as a description of bereavement experience while identifying the need for more rigorous measurement and testing, particularly of oscillation and model-based interventions. The dual process model is an influential, research-informed account, not a proven fixed program every bereaved person must follow.
Different Trajectories of Adaptation
Longitudinal studies have found heterogeneity in bereavement outcomes. A prospective study by Bonanno and colleagues used observations that began before spousal death and continued after the loss. It identified several trajectories, including common grief, more persistent distress, and resilience. Not everyone experienced the same early intensity or change over time.
Resilience means that some people maintain meaningful functioning and positive experiences despite loss; it does not require an absence of love or concealment of grief. More persistent difficulties also deserve understanding rather than automatic judgment. Trajectory findings are sensitive to the populations studied, the outcomes measured, and the statistical methods used to group people, so named trajectories should be used as research descriptions rather than predictions about an individual.
A foundational critique by Wortman and Silver likewise questioned assumptions that intense distress or a particular kind of emotional processing is mandatory after every major loss.
Continuing Bonds and Meaning
Many bereaved people sustain an inner relationship with someone who has died through stories, memories, rituals, inherited values, photographs, or choices influenced by the person. This is often called continuing bonds. Maintaining such a connection can be meaningful, although particular expressions of that bond may be comforting for one person and distressing for another.
A theoretical review by Stroebe, Schut, and Boerner highlights the need to distinguish forms and functions of continuing bonds rather than treating either maintaining or relinquishing a bond as universally adaptive. This is one reason acceptance should not be equated with detachment or forgetting.
Meaning making can involve asking what the person or relationship contributed to one's life, what values remain important, and what has changed. Sometimes people cannot find a satisfying explanation for a death, and they should not be pressed to invent one. Meaning, memory, renewed participation in life, and sorrow may develop together. Popular references to a sixth stage such as “finding meaning” are best approached as optional perspectives on adaptation, not as an experimentally established stage sequence.
How Grief Differs Across Circumstances and Cultures
The relationship to the deceased, the nature of the death, previous losses, social support, socioeconomic circumstances, health, and caregiving demands can all shape grief. Grief after a long illness may include exhaustion, relief, sadness, and complicated family transitions. Sudden or violent death can bring shock, uncertainty, intrusive images, or an urgent search for answers. None of these combinations implies that a person has skipped a required stage.
Cultural and religious communities provide different practices for lament, remembrance, funerals, public expression, private reflection, and the continuing place of ancestors or deceased relatives in family life. The same behavior may have very different meanings across contexts. Clinicians and supporters should ask how the individual understands the loss and its rituals before interpreting emotional expression or restraint.
Children and adolescents revisit the meaning of death as their cognitive understanding, relationships, and developmental tasks change. Their questions and reactions may recur at school transitions or important life events. Adults should adapt explanations to developmental level and attend to safety, support, and daily functioning rather than forcing a five-stage story onto a child. The National Cancer Institute's patient guide provides an authoritative starting point for distinguishing normal grief, anticipatory grief, and complications.
How Long Does Each Stage Last?
There is no established duration for any of the five stages, because research has not established them as five required, separately timed episodes. Claims that denial lasts a specific number of days, anger a few weeks, or acceptance must appear after a certain month lack a validated clinical basis.
The first weeks after a death can be overwhelming or strangely unreal. Across subsequent months many people experience shifting levels of distress, gradual adjustment, and occasional setbacks around meaningful dates. Long-lasting remembrance, sadness, or recurring emotional waves can remain compatible with ordinary grief. Duration matters clinically only in combination with symptom quality, severity, cultural context, and interference with life.
When Does Grief Need Clinical Assessment?
Most bereaved people do not need a mental health diagnosis to explain their pain. Help is appropriate whenever grief becomes difficult to manage, especially if someone has persistent inability to meet basic needs, marked impairment in social or occupational functioning, severe hopelessness, increasing substance use, or significant sleep and health problems. Clinical assessment considers the entire presentation rather than where the person appears to sit in a stages diagram.
Prolonged grief disorder, or PGD, is a recognized diagnosis in both DSM-5-TR and ICD-11, with distinct criteria. In DSM-5-TR, the death must have occurred at least 12 months earlier for adults and at least six months earlier for children and adolescents. The syndrome involves persistent, intense longing or preoccupation and other significant symptoms; it must cause clinically significant distress or impairment and exceed relevant cultural, social, or religious norms. The American Psychiatric Association explains these requirements and the distinction from common grief.
ICD-11 uses a minimum duration of six months after the death and a different symptom formulation and diagnostic algorithm, together with clearly excessive persistence relative to expected social and cultural norms and substantial impairment. The two systems must not be merged into one checklist. Differences are described in Eisma and Schmitt's 2024 study and a review of ICD-11 and DSM-5-TR criteria.
Grief can also coexist with major depressive disorder, posttraumatic stress disorder, or other clinical conditions. Depression may center on pervasive low mood, anhedonia, and negative self-evaluation; PTSD can prominently involve threat-related memories, avoidance, and hyperarousal after a traumatic death; PGD prominently involves enduring separation distress and difficulty adapting to the person's absence. These are broad distinctions used to guide evaluation, not self-diagnostic rules. See the 2024 World Psychiatry clinical review for differential assessment.
When someone expresses a wish to die, describes a plan to harm themselves, or appears in immediate danger, the priority is prompt safety support, not interpretation of the statement as the “depression stage.” Stay with the person when safe, contact local emergency services for immediate danger, and help them reach a qualified crisis or mental health service. In the United States, call or text 988 for immediate crisis support.
What Actually Helps Someone Who Is Grieving?
Helpful support responds to current needs and preferences. For some people, talking about the deceased provides connection. Others appreciate shared activities, practical assistance, privacy, or help making decisions during an exhausting period. Their preferences may change over time.
A useful approach is to ask specific, respectful questions: Would it help to talk about what happened? Would you prefer company while doing errands? Is there an anniversary or family task coming up that you want support with? Specific offers are often easier to accept than an open-ended invitation to ask for anything.
Daily routines can help protect basic functioning without eliminating grief. Eating regularly, getting outside when possible, protecting sleep, and remaining connected to trusted people are reasonable supportive measures. The NIH's 2026 grief guidance describes these as practical strategies rather than cures.
Professional bereavement care includes different interventions with different indications. General support and grief counseling may assist people facing stressful decisions or a need for connection. Specialized grief-focused psychotherapy is more relevant when clinically significant symptoms persist. A 2024 systematic review and meta-analysis of grief-focused cognitive behavioral therapies found benefit for prolonged grief symptoms among adults, while noting limitations in evidence quality and generalizability. A 2025 systematic review and network meta-analysis similarly supports grief-focused psychological approaches, with more limited evidence for pediatric and medication interventions. These results concern studied interventions and populations; they do not establish stage-by-stage treatment or an obligation for every grieving person to attend therapy.
Supportive Language That Does Not Impose a Script
Statements such as “You should be at acceptance by now,” “You are stuck in anger,” or “You have to go through denial before you can heal” can turn a descriptive model into a judgment. A more useful response acknowledges what the person has said and asks what would help.
It is reasonable to say that grief changes, that its intensity can vary, and that help is available when suffering is disrupting life. It is equally reasonable to recognize that positive experiences, preserved functioning, and ongoing love for the deceased can exist together.
Common Misunderstandings About the Stages
The first misconception is that everyone must pass through each stage. Neither the original clinical observations nor later bereavement research support that rule.
The second is that stages follow a single order. Some people feel moments of acceptance early; others experience renewed anger or disbelief years later. Aggregate symptom curves cannot determine the order of one person's emotions.
The third is that grief ends when acceptance arrives. Adaptation can include remembering, missing, and remaining connected to the deceased indefinitely.
The fourth is that any sadness labeled “depression” is major depressive disorder. Clinical diagnosis requires a full assessment.
The fifth is that the stages can guide treatment selection. Evidence-based care attends to actual symptoms, risks, circumstances, preferences, and functioning. The five stages are not a validated treatment protocol.
Frequently Asked Questions
What are the five stages of grief in order?
They are traditionally listed as denial, anger, bargaining, depression, and acceptance. This is the conventional presentation of Kübler-Ross's model, not an order that research has demonstrated every grieving person follows.
Are the five stages of grief real?
The emotions and thought patterns are real possible experiences. The scientific claim that they form five necessary, distinct, universal stages of bereavement lacks convincing evidence. Those two meanings of “real” should be kept separate.
Do you have to experience every stage of grief?
No. People can experience some, all, or none of the named reactions, sometimes together and sometimes repeatedly. A person's process should be understood through their own experience and functioning.
Can you skip stages of grief?
The language of skipping presupposes an obligatory route. There is no required stage to complete, so the absence of bargaining, anger, or another named response does not mean something important was missed.
Can the stages happen out of order?
Yes. The same feelings can appear at different points, and acceptance may coexist with anger or sorrow. Research has not validated a universal personal sequence.
Can you go backward in grief?
A strong reaction after a period of relative stability does not by itself mean that adaptation has failed. Anniversaries, new roles, and reminders can reactivate grief. Pay attention to the duration, severity, and impact of distress rather than describing every difficult day as a backward step.
What is the hardest stage of grief?
There is no scientifically established hardest stage. What is most painful depends on the person's relationship, circumstances, health, support, and the meaning of the loss. Comparing one person's experience against a stage ranking has little clinical value.
Is there a sixth or seventh stage of grief?
Popular adaptations sometimes add meaning, hope, or other experiences. These may be useful themes for personal reflection, but the additional numbered stages are not established diagnostic or universal scientific stages.
Is acceptance the same as moving on or forgetting?
No. Acceptance can mean acknowledging what happened while continuing to love, remember, and grieve the person. Continuing bonds may remain meaningful throughout life.
Can someone grieve before a death occurs?
Yes. Anticipatory grief can occur in the context of serious illness, expected death, and changes associated with caregiving. It is a distinct context of loss-related distress and does not follow a required five-stage path.
What if I feel relief or happiness after someone dies?
Relief may follow the end of prolonged suffering or exhausting caregiving. Happiness, humor, and connection can also emerge during bereavement. Such emotions do not measure the value of the relationship or invalidate sorrow.
How do I know whether my grief is prolonged grief disorder?
No stage, single symptom, number of months, or online quiz can establish that diagnosis. A qualified clinician evaluates persistent separation distress, accompanying symptoms, functional effects, timing, cultural context, and possible co-occurring conditions. DSM-5-TR and ICD-11 have different criteria.
Should someone see a counselor if they do not appear to be reaching acceptance?
Not on that basis alone. Professional support is appropriate when the person wants help or when distress, risk, or impaired functioning warrants assessment. A counselor should explore the actual concerns rather than try to move someone into a predefined emotional category.
Related Articles
- Depression: Symptoms, Causes, Diagnosis, and Treatment — Understanding a clinical condition that can coexist with bereavement.
- Posttraumatic Stress Disorder (PTSD): Symptoms, Diagnosis, and Treatment — Understanding trauma-related symptoms when a death is traumatic.
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