Kübler-Ross originally developed stages to describe the process patients with terminal illness go through as they come to terms with their own deaths; it was later applied to grieving friends and family as well, who seemed to undergo a similar process.[10] The stages, popularly known by the acronym DABDA, include:[11]

1. Denial – The first reaction is denial. In this stage, individuals believe the diagnosis is somehow mistaken, and cling to a false, preferable reality. Some may also isolate themselves, avoiding others who may have accepted what is happening.[4] This stage is usually a temporary defense, so long as the person has adequate time to move amongst the stages as they contemplate death.[4] In her book, Kübler-Ross states that technological advancements have caused people to become fearful of violent, painful deaths; therefore, in order to protect the psychological mind, they deny the reality of their own inevitable death. [4]
2. Anger – When the individual recognizes that denial cannot continue, they become frustrated, especially at proximate individuals. Certain psychological responses of a person undergoing this phase would be: “Why me? It’s not fair!”; “How can this happen to me?”; “Who is to blame?”; “Why would this happen?”. Some may lash out at loved ones, medical staff, and other family.[4] In Kübler-Ross’s other book, Questions and Answers on Death and Dying, she emphasizes the need for people to do their best to let those who are in this stage feel their feelings and try not to take the anger personally. [12]
3. Bargaining – The third stage involves the hope that the individual can avoid a cause of grief. Usually, the negotiation for an extended life is made in exchange for a reformed lifestyle. People facing less serious trauma can bargain or seek compromise. Examples include the terminally ill person who “negotiates with God” to attend a daughter’s wedding, an attempt to bargain for more time to live in exchange for a reformed lifestyle or a phrase such as “If I could trade their life for mine”.
4. Depression – “I’m so sad, why bother with anything?”; “I’m going to die soon, so what’s the point?”; “I miss my loved one; why go on?”
   During the fourth stage, the individual despairs at the recognition of their mortality. In this state, the individual may become silent, refuse visitors and spend much of the time mournful and sullen.
   Acceptance – “It’s going to be okay.”; “I can’t fight it; I may as well prepare for it.”
5. In this last stage, individuals embrace mortality or inevitable future, or that of a loved one, or other tragic event. People dying may precede the survivors in this state, which typically comes with a calm, retrospective view for the individual, and a stable condition of emotions.

In a book co-authored with David Kessler and published posthumously, Kübler-Ross expanded her model to include any form of personal loss, such as the death of a loved one, the loss of a job or income, major rejection, the end of a relationship or divorce, drug addiction, incarceration, the onset of a disease or an infertility diagnosis, and even minor losses, such as a loss of insurance coverage.[8] Kessler has also proposed “Meaning” as a sixth stage of grief.[13]

Criticism

Criticisms of this five-stage model of grief center mainly on a lack of empirical research and empirical evidence supporting the stages as described by Kübler-Ross and, to the contrary, empirical support for other modes of the expression of grief. Moreover, Kübler-Ross’ model is the product of a particular culture at a particular time and might not be applicable to people of other cultures. These points have been made by many experts,[3] including Robert J. Kastenbaum (1932–2013) who was a recognized expert in gerontology, aging, and death. In his writings, Kastenbaum raised the following points:[15][16]

• The existence of these stages as such has not been demonstrated.
• No evidence has been presented that people actually do move from Stage 1 through Stage 5.
• The limitations of the method have not been acknowledged.
• The line is blurred between description and prescription.
• The resources, pressures, and characteristics of the immediate environment, which can make a tremendous difference, are not taken into account.