Understanding The Seven Stages of Grief and Chronic Disease

Adapted from: Pratt, Amanda. “7 Stages of Grief for Chronic Pain and Chronic Illness: St. Petersburg Therapist.” Chronic Illness Therapy, 3 Aug. 2018, imaginelifetherapy.com/7-stages-of-grief-for-chronic-pain-and-illness/.

Understanding The Seven Stages of Grief and Chronic Disease

Article by: Robyn Kade, B.A., MBMS

It is essential to understand the Seven Stages of Grief and chronic disease if you plan to work with clients living with a chronic disease. Many individuals have heard of the five stages of grief created by Elizabeth Kubler – Ross in 1969. This model is used to explain the stages of grief over the loss of a loved one. There has been an updated model called the Seven Stages of Grief for Chronic Pain and Chronic Illness by Dr. Jennifer Martin, PsyD of imaginelifetherapy.com.

According to imaginelifetherapy.com, there are seven stages of grief for chronic disease: denial, pleading, bargaining and desperation, anger, anxiety and depression, loss of self and confusion, and acceptance. Clients can go from one stage to another until finally reaching acceptance. An individual, for example, can go from denial to anger and back to denial. Everyone will go through the stages on their own timing. There is no set time for anyone to reach acceptance of their situation. If your client can see positive changes after working with you, their outlook will be more positive. As they become stronger and learn more skills, clients will become more ambulatory and be able to move more over time.

Many times, clients will be experiencing their symptoms (chronic disease symptom cycle) and the stages of grief simultaneously. We usually think of grief with respect to the loss of a loved one. With chronic disease, your client may be grieving the life they used to live. Knowing that their lives may change because of an illness is very stressful. In addition, the individual may be thinking about the future and how their health will be ten years from now. As a Health – Fitness Professional, you need to help your client to be present and in the moment. The work that your client does today will influence how mobile they are ten years from now. If they are discouraged by the big picture, it will be harder for them to stay focused.

Each stage of grief has its own parameters and can give you insight as to which stage the client is currently in. Empathy and support are a critical part of helping a client to get through the stages of grief. Tailor exercise programming to what your client can handle each time they train. If Someone is having a rough day, you can offer the client a guided meditation session or aromatherapy with relaxing stretches instead of a training session. This trade-off will allow the client to participate even if they are not mentally ready for a regular training session, bringing benefits for the client, such as lowering stress, and saving a missed session for you!

To know which stage of grief a client may be in, you must have a firm understanding of what each stage is. Denial is the first stage in which the individual was just diagnosed and is in shock. They cannot believe that they are diagnosed with a chronic disease. They start to wonder how they will make changes and live a good life. Shock can help the person to decide to move on to the next stage and start working through the stages. It may also backfire if the individual who has the condition thinks that it will eventually go away or be okay.

The next stage is pleading, bargaining, and desperation, where the client tries really hard to bargain or plead to not have a chronic illness. The individual also wishes really hard that they could go back to the life that they had. They may feel guilty and blame themselves for becoming sick and wondering if they could have done more to prevent their illness. Guilt usually comes with bargaining as the person blames themselves for their situation.

Anger is a crucial stage for individuals to begin the healing process. There is no specific timeline for the client to get through the anger stage. Please note that a client may come in angry some days when training, but they are not angry with you. Try to remain empathetic and patient as the individual goes through this stage. Keep in mind that everyone on the healthcare team often sees anger from the newly diagnosed individual who has a chronic illness. It is normal for the client to be angry at their doctor, caregiver, family, friends, and even you, their trainer. However, they will most likely apologize after showing you that they are visibly angry. This stage comes later in the process when the disease progresses, and the individual realizes that life will change.

Anxiety and depression will set in next as life changes are solidified. The feelings of depression can be substantial and seem to the client like they will never go away. If a client starts to withdraw, offer meditation instead of a training session to keep the client on track. Try to also be understanding about their condition and how they are feeling. If they must cancel with you, ask that they do so within a certain amount of time as your time is valuable as well. There may be anxiety about the future and the unknown as the person wonders what will happen to them.

The loss of self and confusion is very real for individuals with a chronic illness. In this stage, life has changed so much for this individual that they do not recognize themselves. As a result, they cannot do what they used to and have to redefine themselves and decide how to do that. This stage may happen at the same time as anxiety and depression or separately.

In the stage of re-evaluation of Life, Roles, and Goals, the client will be thinking about how they can move forward as a wife, mother, husband, father, sibling, and friend. They are forced to re-evaluate how they fit into the picture and what that means in daily life, figuring out how to go about daily activities and what work will look like for them.

The final stage is acceptance, in which the client accepts his or her new reality. The client is not usually happy with it, but they learn how to deal with their new norm. They strive to learn new skills to make life better and discover new things that bring joy into their lives. In this stage, the client will be most accepting of trying new exercises and stress relief modalities in their training sessions.


Adapted from: Pratt, Amanda. “7 Stages of Grief for Chronic Pain and Chronic Illness: St. Petersburg Therapist.” Chronic Illness Therapy, 3 Aug. 2018, imaginelifetherapy.com/7-stages-of-grief-for-chronic-pain-and-illness/.

Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 20 years of experience in medical-based fitness. For more information on the our mind/body programs and supporting clients through stress management click HERE

Other Blog posts by Robyn:

Osteoporosis and STRESS – MedeXN

Choosing Appropriate Music for Mind/Body Classes – MedeXN

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