The presence of your absence: A conditioning theory of grief

Humor: A Grief Trigger and Also a Way to Manage or Live With Your Grief

In 2020-2021, a qualitative study was undertaken using an interpretive description methodology to identify what triggers grief in the first 2 years following the death of a beloved family member, and to gain other helpful insights about grief triggers from bereaved Canadian adult volunteers. In that study, a purposive sampling method was used to select 10 bereaved Canadian adult volunteers for in-depth, semi-structured interviews. This paper reports on the humor findings, as revealed to be a particularly complex grief trigger for many participants, as well as a periodic way for most to manage or live with their grief. Participant quotes and an extended discussion are included to illustrate the importance of these humor findings in relation to grief, and to inform bereaved people, bereavement service providers, and the general public about both helpful aspects and some cautionary considerations about humor.

Let's play pretend: Towards effective modelling in experimental psycho(patho)logy

BACKGROUND AND OBJECTIVES

Models are omnipresent in science. We introduce a novel framework to achieve more effective modelling practices in general psychology and experimental psychopathology.

METHOD

We analyze three types of models that are common in psychology: laboratory models, computational models, and cognitive models. We then evaluate two common ways to assess the translational value of models (phenomenological similarity and deep similarity) as well as an arguably underappreciated way (functional similarity). Functional similarity is based on an assessment of whether variables (e.g., the administration of a pharmacological substance) have a similar effect (a) in the model (e.g., in a fear conditioning procedure) and (b) on the real-life target phenomenon (e.g., on real-life anxiety complaints).

CONCLUSIONS

We argue that the assessment of functional similarity is a powerful tool to assess the translational value of models in the field of experimental psychopathology and beyond.

A pull to be close: The differentiating effects of oxytocin and grief stimulus type on approach behavior in complicated grief

Theoretical models of complicated grief (CG) suggest that maladaptive motivational tendencies (e.g., perseverative proximity-seeking of the deceased; excessive avoidance of reminders) interfere with a person's ability to recover from their loved one's death. Due in part to conflicting evidence, little mechanistic understanding of how these behaviors develop in grief exists. We sought to (1) identify behavioral differences between CG and non-CG groups based on approach/avoidance bias for grief-, deceased-, and social-related stimuli, and (2) test the role of the neuropeptide oxytocin in shaping approach/avoidance bias. Widowed older adults with (n = 17) and without (n = 22) CG completed an approach/avoidance task measuring implicit bias for both personalized and non-specific grief-related stimuli (among other stimuli). In a double-blinded, randomized, counterbalanced design, each participant attended both an intranasal oxytocin session and a placebo session. Aims were to (1) identify differential effects of CG and stimulus type on implicit approach/avoidance bias [placebo session], and (2) investigate interactive effects of CG, stimulus type, and oxytocin vs. placebo on approach/avoidance bias [both sessions]. In the placebo session, participants in the non-CG group demonstrated an approach bias across all stimuli. Intranasal oxytocin had an overall slowing effect on the CG group's response times. Further, oxytocin decreased avoidance bias in response to photos of the deceased spouse in the CG group only. Findings support the hypothesis that oxytocin has a differential effect on motivational tendency in CG compared to non-CG, strengthening evidence for its role in CG. Findings also emphasize the need to consider differences in personalized vs. generic stimuli when designing grief-relevant tasks.

Competitive Neurocognitive Processes Following Bereavement

Bereavement is a common human experience that often involves significant impacts on psychological, emotional and even cognitive functioning. Though various psychological theories have been proposed to conceptualize the grief process, our current understanding of the underlying neurocognitive mechanisms of grief is limited. The present paper proposes a neurocognitive model to understand phenomena in typical grief, which links loss-related reactions to underlying learning and executive processes. We posit that the competitive relationship between the basal ganglia (BG) and circuitry involving the medial temporal lobe (MTL) underlies common cognitive experiences in grief such as a sense of "brain fog." Due to the intense stressor of bereavement, we suggest that these two systems' usually flexible interactive relationship become imbalanced. The resulting temporary dominance of either the BG or the MTL system is then manifested in perceived cognitive changes. Understanding the underlying neurocognitive mechanism in grief could inform ways to best support bereaved individuals.

Concept of Affective Dependence and Validation of an Affective Dependence Scale

Background

There is a degree of affective interdependence that is considered normal and only becomes pathological if it causes excessive suffering, both for the subject and for those close to them. Our objective was to introduce and psychometrically validate a short and effective affective dependency scale, the Affective Dependence Scale (ADS-9).

Methods

We used a sample of 762 participants (clinical: emotional dependent subjects n = 212, comparison: non-emotionally-dependent addicted subjects n = 272, and general population n = 278) to assess the factor structure, the psychological construct validity and the measurement invariance for the ADS-9 by means of independent exploratory factor analyses for each sample group and subsequent multigroup confirmatory factor analyses.

Results

Our results confirm that ADS-9 is a psychometrically consistent instrument, with construct and clinical validity, as well as configural, metric and scalar invariance across different sample groups (clinical, comparison and general population). A hypothesized two-dimensional structure was confirmed by means of factor analyses. Both sub-scales of this abbreviated form, Submission and Craving, showed a good agreement with the previously validated Relationships and Sentimental Dependencies Inventory (IRIDS-100).

Conclusion

The ADS-9 is a brief instrument that appears to reliably detect the dependent and pathological components of affective dependence. It consists of two sub-scales, describing Submission (adaptation, accommodation, and subjugation) and Craving (imperative need for the other with the presence of disturbing states). We suggest that it is a versatile scale that may be useful for clinicians and researchers.

Desired attachment and breakup distress relate to automatic approach of the ex-partner

BACKGROUND AND OBJECTIVES

Romantic relationship breakups can lead to severe emotional disturbances including major depression. Anxious attachment and desired attachment with the ex-partner are hypothesized to elicit repetitive thought about the breakup and the former partner and attempts to reunite with (i.e. approach) the ex-partner, which fuel breakup distress. Since prior research on this topic has mostly used survey methodology, the study aim was to examine the relations between above-mentioned variables employing a behavioral measure of approach of the ex-partner.

METHODS

Automatic approach-avoidance tendencies toward the former partner were assessed with an Approach Avoidance Task (AAT). Sixty-two students (76% female) moved a manikin towards or away from stimuli pictures (ex-partner, matched stranger, landscape) as fast as possible based on the stimulus frame color (blue, yellow). Participants also completed questionnaires assessing anxious attachment, desired attachment, repetitive thought about the breakup (rumination) and the ex-partner (yearning), and breakup distress (prolonged grief symptoms).

RESULTS

Anxious attachment related positively to rumination and breakup distress. Desired attachment related positively to yearning, automatic approach bias toward the ex-partner, and breakup distress. Both anxious and desired attachment, rumination, yearning, and approach bias related positively to breakup distress.

LIMITATIONS

The use of a student sample may limit generalizability. A correlational design precludes causal conclusions.

CONCLUSIONS

Together with prior work, results suggests anxious attachment hampers psychological adaptation to a breakup by increasing the use of ruminative coping. Desire to retain an attachment bond with the ex-partner, expressed in yearning and approach of the ex-partner, may also worsen breakup distress.

Emerging experience with selected new categories in the ICD-11: complex PTSD, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder

Among the important changes in the ICD-11 is the addition of 21 new mental disorders. New categories are typically proposed to: a) improve the usefulness of morbidity statistics; b) facilitate recognition of a clinically important but poorly classified mental disorder in order to provide appropriate management; and c) stimulate research into more effective treatments. Given the major implications for the field and for World Health Organization (WHO) member states, it is important to examine the impact of these new categories during the early phase of the ICD-11 implementation. This paper focuses on four disorders: complex post-traumatic stress disorder, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder. These categories were selected because they have been the focus of considerable activity and/or controversy and because their inclusion in the ICD-11 represents a different decision than was made for the DSM-5. The lead authors invited experts on each of these disorders to provide insight into why it was considered important to add it to the ICD-11, implications for care of not having that diagnostic category, important controversies about adding the disorder, and a review of the evidence generated and other developments related to the category since the WHO signaled its intention to include it in the ICD-11. Each of the four diagnostic categories appears to describe a population with clinically important and distinctive features that had previously gone unrecognized as well as specific treatment needs that would otherwise likely go unmet. The introduction of these categories in the ICD-11 has been followed by a substantial expansion of research in each area, which has generally supported their validity and utility, and by a significant increase in the availability of appropriate services.

Grieving as a form of learning: Insights from neuroscience applied to grief and loss

Recent grief research suggests that the influential cognitive stress theory should be updated with evidence from cognitive neuroscience. Combining human and animal neuroscience with attachment theory, we propose that semantic knowledge of the everlasting nature of the attachment figure and episodic, autobiographical memories of the death are in conflict, perhaps explaining the duration of grieving and generating predictions about complications in prolonged grief disorder (PGD). Our gone-but-also-everlasting model emphasizes that grieving may be a form of learning, requiring time and experiential feedback. Difficulties before loss, such as spousal dependency or pre-existing hippocampal volume, can prolong learning and predict PGD. Complications such as avoidance, rumination, and stress-induced hippocampal atrophy may also develop after loss and create functional or structural mechanisms predicting PGD.

Preoccupation as psychopathological process and symptom in adjustment disorder: A scoping review

In the ICD‐11 diagnostic guidelines, preoccupation has been introduced as the new core symptom of adjustment disorder. Despite this essential innovation, preoccupation has so far largely been defined as rumination and worry and does not feature a distinct character as an independent symptom. In order to investigate the nature of preoccupation, various cognitive approaches are evaluated and linked to preoccupation. Furthermore, the aim of this review is to define preoccupation more precisely and to distinguish it from other symptoms in psychopathology. The evaluation of key features of cognitive dissonance theory, attention bias theory, memory theories, and other cognitive paradigms indicates that preoccupation is constituted by a complex interaction of cognitive–emotional mechanisms. In addition, this review implies that preoccupation in AjD can be defined as stressor‐related factual thinking, which is time‐consuming and often associated with negative emotions. It is assumed that rumination and dysfunctional worry serve as reactive processes to cope with preoccupation. For further distinction, this review presents similarities and differences of preoccupation and other symptoms, including negative automatic thoughts, flashbacks, and yearning. Finally, implications and suggestions for future research on preoccupation are offered. Overall, it is plausible that preoccupation is not only associated with adjustment disorder but also possesses a transdiagnostic character.

A scoping research literature review to map the evidence on grief triggers

Grief is understandably severe in the first days, if not weeks or months, following the death of a beloved person. Unless the mourner develops complicated grief, which is prolonged severe and impactful grief, the initial acute grief lessens in severity over time, although waves of significant grief will still occur with grief triggers. A scoping research literature review was undertaken in early 2021 to determine how often grief triggers occur, what the most common grief triggers are, the impact of triggered grief, and what can be done (by those not diagnosed with complicated grief) to manage grief triggers and mitigate the effect of them. Nine academic library databases were searched for English-language research reports using the keywords "grief trigger(s)" and "research": CINAHL, Directory of Open Access (online) Journals, Humanities Index, JSTOR, Medline (Ovid), Periodicals Index Online, PsychArticles, Scopus, and Web of Science. Six research papers relevant for review were published in the last two decades, with some evidence gained on how often grief triggers occur, what constitutes a grief trigger, and the impact of grief triggers. Major gaps in evidence were revealed, despite grief triggers being identified as a major consideration for grief in general and for grief recovery specifically.

The goal-directed model as an alternative to reductionist and network approaches of psychopathology

As an alternative to biological reductionist and network approaches to psychopathology, we propose a nonreductionist mental-mechanistic approach. To illustrate this approach, we work out the implications of the goal-directed framework of Moors et al., which has the potential to explain the heterogeneous manifestations of psychopathology with a restricted set of broad theoretical principles.

Cross-cultural generalizability of the ICD-11 PGD symptom network: Identification of central symptoms and culturally specific items across German-speaking and Chinese bereaved

BACKGROUND

Prolonged grief disorder (PGD) is a newcomer to psychopathology and the new ICD-11 diagnostic criteria are conceptualized with an eye towards global applicability. Yet, previous network studies have not used official ICD-11 criteria nor tested whether network structures generalize across cultural groups even though much current research relies on ICD-11 PGD criteria.

METHODS

To overcome these limitations, the present study used data from 539 German-speaking (n = 214) and Chinese (n = 325) bereaved individuals to investigate similarities and differences in network structures of ICD-11 PGD criteria. In addition, network structures were investigated for an expanded supplementary questionnaire of culturally-bound grief symptoms hypothesized to be of relevance in each cultural context.

RESULTS

Results suggested both similarities and differences in network structures between the two samples. Across cultural groups, intense feelings of sorrow and inability to experience joy or satisfaction since the death emerged as most central symptoms. Compared to the standard PGD network, the expanded network showed a better average predictability for Chinese participants, but no improvement for the German-speaking context. Unhealthy behavior change was the most central symptom for Chinese bereaved when additional grief symptoms were included.

CONCLUSIONS

Results of the present study suggest there are culturally-bound symptoms of grief which are not included in the current ICD-11 PGD criteria. These findings provide areas of special clinical attention concerning screening and treatment and present a first step towards a more cultural-sensitive understanding of grief.

CLINICAL TRIALS

NCT03568955.

Wish you were here: The Dutch, German, and English Yearning in Situations of Loss Short Form

Objective(s)

Yearning, a hallmark of grief disorders, relates to rumination and potentially to cognitive avoidance. We developed an 8‐item short form of the only existing validated yearning measure, the Yearning in Situations of Loss Scale (YSL), to improve its validity and administration ease.

Method

Cross‐sectional surveys were conducted among bereaved Dutch (N = 313) and German (N = 235) community samples and an American treatment‐seeking sample (N = 95). All samples completed the YSL, and community samples additionally measures of rumination, loss‐related avoidance, complicated grief (CG), and depression.

Results

A one‐factor model provided a good fit to the YSL Short Form (YSL‐SF) in the community samples. A two‐factor structure (cognitive and emotional yearning)best fitted the YSL‐SF in the treatment‐seeking sample. YSL‐SF scores correlated positively with rumination, loss‐related avoidance, and with CG symptoms whilst controlling for rumination and loss‐related avoidance.

Conclusion

The YSL‐SF appears an easy‐to‐administer and valid measure of yearning after bereavement.

Posttraumatic Stress Disorder and Childhood Traumatic Loss: A Secondary Analysis of Symptom Severity and Treatment Outcome

Loss is a commonly experienced traumatic event among children. Although the experience of loss can potentially lead to posttraumatic stress symptoms (PTSS), little is known about PTSS levels after traumatic loss versus other traumatic events. We investigated data from a randomized controlled trial (RCT) on trauma-focused cognitive behavioral therapy (TF-CBT) versus a waitlist condition for children with PTSS. In a secondary analysis, we compared participants who reported traumatic loss as their index event (n = 23) to those who reported the two most frequently reported index events in the RCT: sexual abuse (SA; n = 59) and physical violence (PV; n = 55). The index event was rated according to the participants' most distressing traumatic event reported on the Clinician-Administered PTSD Scale for Children and Adolescents. Participants who experienced traumatic loss reported fewer PTSS and better general functioning than those who reported SA. A subgroup RCT (n = 19) revealed TF-CBT to be highly effective in reducing PTSS in cases of traumatic loss, d = 1.69. The effect sizes for PTSS indicated that all three trauma groups benefited from TF-CBT. In the waitlist group, PTSS symptoms improved for SA and PV, ds = 0.76 and 0.98, respectively, but not for traumatic loss, d = 0.23. These findings suggest that TF-CBT is a feasible and promising treatment for children who experience PTSS after traumatic loss. The results are limited by the post hoc quality of the analyses and lack of a measure of grief in the RCT.

An investigation of approach behaviour in Prolonged Grief

Prolonged Grief (PG) is recognized as a potentially debilitating post-bereavement syndrome. Theoretical models of PG highlight the importance of both approach and avoidance behaviours in maintaining the syndrome. Research to date has focussed primarily on investigating avoidance in response to loss reminders. Comparatively few studies have indexed approach behaviours in PG. We use a quasi-experimental paradigm to simultaneously examine approach and avoidance behaviours to reminders of the deceased. Fifty-five bereaved individuals with and without PG responded to stimuli showing the deceased's name, an attachment figure's name, a neutral name, or a letter string, by pulling or pushing a joystick according to a whether the stimuli was a word or not. Concurrent visual feedback created the illusion that the images were either approaching or receding from the participant. Participants with PG were quicker to pull than push the three name stimuli, with quicker pulling of the deceased and attachment name than the neutral name. Non-PG participants responded more quickly to the attachment name but evidenced no relative approach or avoidance of any stimuli. Findings provide behavioural evidence about approach behaviour in PG, and are discussed with references to models that recognise the role of yearning for the deceased in PG.