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From Denial to Acceptance: Understanding the Five Stages of the Grief and Adjustment to Hearing Loss: Information for Audiologists

last modified on: Wed, 01/12/2022 - 20:37

See also: Articles on Music, Hearing Loss, and Hearing DevicesPages for audiologists

 

As you read this website, keep in mind the following:

  • People with hearing loss can differ in many ways.  

  • ​Some information may be more applicable.

  • Pick and choose the information most useful for you.

 

From Denial to Acceptance:

Understanding the Five Stages of the Grief and Adjustment to Hearing Loss

Five stages of grief

1, 2

Hearing loss affects people in different ways, but many adults with hearing loss may share similar types of feelings. Some mourn the loss of their hearing, including music enjoyment, in a manner similar to the five stages of grief described by Elizabeth Kübler-Ross (Kübler-Ross, & Kessler, 2005). Understanding these stages can help hearing professionals frame and identify what patients may be feeling.

People with hearing loss may experience all, some, or none of the following symptoms of grief. Not every person passes through each stage or experiences them in the same order or in the same period of time. In counseling patients, try and understand:   

1) their current feelings about hearing loss, including how it affects their enjoyment of music,

2) the various reactions that occur over time,

3) distinctions between psychological symptoms of early- and late-onset hearing loss. 

This can help the audiologist to provide more useful and accessible information or guidance that each patient understands and is ready to accept and apply.  

1. Denial stage

  • People may not realize their hearing loss until a friend or family member calls it to their attention, because it often occurs gradually over time and is invisible. 

  • People may blame others for their inability to hear clearly – 'She mumbles', 'He talks too softly', 'That pianist missed some musical notes', 'This music has poor sound quality', etc. 

  • People may avoid participating in music-related and routine activities due to difficulties with music perception and enjoyment.

  • There can be other underlying factors in the denial of hearing loss: 

    • Stigma associated with hearing loss or hearing aids, or the fear of negative social consequences – 'I did not want my friends to know that I had a hearing aid because it somehow made me feel less capable.' 

      • Denial of a hearing problem may lead to reluctance to use hearing aids.

    • Some people deny hearing loss or the need for hearing assessment and treatment, which they associate with 'getting old.' 

    • Other factors such as financial, vocational, emotional, and social effects can also affect individuals' willingness to seek hearing assessment and treatment. 

2. Anger stage

  • Anger may surface when someone eventually faces their hearing problem:

    • People with hearing loss may feel angry that they have hearing loss or feel that it is unfair – 'Why is this happening to me?', 'This isn't fair!', etc. 

    • They may direct this anger or resentment at their loved ones, audiologists, a higher power, or even themselves – 'Why can't the audiologist fix my hearing?  This hearing aid is worthless!'

  • Anger may arise during social interactions when a person with hearing loss feels left out or has difficulty responding to others. 

  • People may feel resentment that listening to music is no longer enjoyable or relaxing – 'I can hear music, but I can't enjoy it!  It's too hard to understand.  I had to give up music.'

  • People may resent that music does not sound 'normal' through a hearing device. 

3. Bargaining stage

  • People may acknowledge their hearing loss but may still feel like their hearing loss is not a permanent condition. 

  • People may try to bargain with themselves, with other people, or even with God to restore their hearing – 'If only my hearing comes back, I will not take it for granted again'. 

  • Bargaining also takes different forms:

    • Comparing – 'I can’t really hear things, but at least I still have my health'.

    • Devaluing – 'Who cares if I can't hear, I didn't like going to concerts all that much anyway.'

  • This step is often private for the individual and may not be shared with others around them. Bargaining can make the person feel guilty, stressed, anxious, and irritable. 

  • If no bargain can be reached, the individual may move to the next stage, which is depression. 

4. Depression stage

  • Not being able to hear enjoyable sounds like music can increase social isolation, and contribute to a loss of self-worth. Social isolation due to hearing loss can also worsen depression.

  • Depression can manifest itself in changes of behavior such as tearfulness, slower responses, difficulty concentrating, or even changes in weight or sleeping patterns.

  • ​Once a person suffers from depression, it can be difficult to motivate him or her to rejoin social situations. 

  • Depression can precede acceptance if/when it represents a realistic awareness of the negative aspects of one’s disability.

5. Acceptance stage

  • Acceptance can take different forms for different people. People with strong support systems are more likely to reach this stage. 

  • It usually indicates some integration of the loss into one’s life. At this point, the person can admit that they have hearing loss and that they are ready to explore their treatment options – 'My hearing is not perfect, but I can still hear music with my hearing aids.' 'Not all music sounds good, but I found some songs that still sound OK.'

  • Acceptance may mean acknowledging negative feelings about one’s hearing loss, yet not letting these feelings interfere with relationships in one's daily life. 

 

Q. What is the role of hearing healthcare professionals in supporting patients through stages of grief?  

  • Use typical counseling methods to support expressions of feelings. If a patient is particularly fond of music, ask about music as well as speech experiences in their daily life. 

  • Ask patients about how hearing loss has impacted their lives, including experiences with music. Ask what their listening goals are, including for music. Support realistic and positive hope. 

  • Provide resources that focus on music enjoyment for hearing aid (HA) users or cochlear implant (CI) recipients. Click here for more information on CI and music enjoyment. Click here for more information on HA technology and music.

  • Discuss various assistive listening devices [Click here for more information on assistive listening devices] or program settings on hearing aids or cochlear implants to assist music listening.

  • Teach new ways to interact with the world to increase involvement while in the early stage of depression. Click here for more information on self-efficacy. Click here for more information on self-advocacy.

  • Ask patients if they would like to have information about online resources or support groups.

 

References

Babeu, L. A., Kricos, P. B., & Lesner, S. A. (2004). Application of the stages-of-change model in audiology. J Acad Rehabil Audiol, 37, 41-56.

Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior (Vol. 4, pp. 71-81). New York: Academic Press.

Ekberg, K., Grenness, C., & Hickson, L. (2016). Application of the transtheoretical model of behaviour change for identifying older clients’ readiness for hearing rehabilitation during history-taking in audiology appointments. International Journal of Audiology, 55(sup3), S42-S51.

Kaland, M., & Salvatore, K. (2002). The psychology of hearing loss. The ASHA leader, 7(5), 4-15.

Kübler-Ross, E., & Kessler, D. (2005). On grief and grieving: Finding the meaning of grief through the five stages of loss. Simon and Schuster.

Laplante-Lévesque, A., Hickson, L., & Worrall, L. (2013). Stages of change in adults with acquired hearing impairment seeking help for the first time: application of the transtheoretical model in audiologic rehabilitation. Ear and Hearing, 34(4), 447-457.

Mamo, S. K., Reed, N. S., Nieman, C. L., Oh, E. S., & Lin, F. R. (2016). Personal sound amplifiers for adults with hearing loss. The American Journal of Medicine, 129(3), 245-250.

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