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Larsen LH, Hybholt L, O'Connor M. Lived experience and the dual process model of coping with bereavement: A participatory research study. DEATH STUDIES 2024:1-12. [PMID: 38822451 DOI: 10.1080/07481187.2024.2355244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
The Dual Process Model of Coping with Bereavement (DPM) proposes that there is an adaptive oscillation between loss-oriented (LO) and restorative-oriented (RO) coping processes. Empirical data supports these processes, but the oscillation process is not well-understood. This study explored the correspondence between the DPM and lived experience of bereaved people, with an additional investigation of perceived changes in grief over time. Using a cooperative inquiry inspired participatory research design, nine bereaved adults and three researchers met nine times to discuss experiences of grief. Knowledge production took place through ongoing sharing, exploration, and reflection upon personal experiences and grief theory. Support was found for the LO and RO processes, but they were perceived to overlap. Support was also found for the oscillation process, which was found to hold learning properties. Time off from grief was not supported. Perspectives on how and why grief experiences change over time emerged, emphasizing the importance of acceptance, learning, time, and contextual factors.
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Affiliation(s)
- Lene Holm Larsen
- Unit for Bereavement Research, Department of Psychology and Behavioral Science, Aarhus University, Aarhus, Denmark
- The Danish National Centre for Grief, Copenhagen, Denmark
| | - Lisbeth Hybholt
- Research Unit, Mental Health Services East, Psychiatry Region Zealand, Roskilde, Denmark
- Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Maja O'Connor
- Unit for Bereavement Research, Department of Psychology and Behavioral Science, Aarhus University, Aarhus, Denmark
- The Danish National Centre for Grief, Copenhagen, Denmark
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Bethune Scroggs L, Goodwin LR, McDougal JJW. Co-Occurring Substance Use Disorders and Grief during Recovery. Subst Use Misuse 2022; 57:418-424. [PMID: 34965842 DOI: 10.1080/10826084.2021.2019771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Individuals with substance use disorders (SUDs) often experience loss and grief when recovering from addiction. With fatal overdoses and suicide rates increasing for individuals with SUDs and other mental health concerns, individuals in recovery are often faced with mourning the loss of a loved one while navigating their life in recovery. The loss of a loved one can be compounded by the effect of losing their relationship with their drug of choice. These co-occurring losses may prove overwhelming during recovery and precipitate a relapse. OBJECTIVES We wish to propose the use of two bereavement models to address the grief present for individuals with SUDs experiencing loss so that providers are better able meet the complex needs of this population. METHODS This article presents two separate bereavement models that may be used to shape treatment for individuals in recovery from addiction with co-occurring grief from the loss of a loved one: the dual-process model of coping with bereavement (DPM) and the two-track model of bereavement. RESULTS We propose the application of these two grief models in treatment for individuals with SUDs who are experiencing co-occurring grief issues. We discuss therapeutic interventions that may be utilized to support clients with co-occurring losses.Conclusion/Importance: If an individual experiences the loss of a loved one while navigating their life in recovery from a SUD, they can experience complicated grief due to co-occurring losses. These models provide an opportunity for mental health providers to help those with SUDs work through this complex grief.
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Affiliation(s)
- Lauren Bethune Scroggs
- Department of Addictions and Rehabilitation Studies, East Carolina University, Greenville, North Carolina, USA.,Department of Psychiatry and Behavioral Sciences, Center for Addiction Science and Technology, Duke University, Durham, North Carolina, USA
| | - Lloyd R Goodwin
- Department of Addictions and Rehabilitation Studies, East Carolina University, Greenville, North Carolina, USA
| | - Jennifer J Wright McDougal
- Department of Addictions and Rehabilitation Studies, East Carolina University, Greenville, North Carolina, USA
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Caparrós B, Masferrer L. Coping Strategies and Complicated Grief in a Substance Use Disorder Sample. Front Psychol 2021; 11:624065. [PMID: 33536987 PMCID: PMC7848780 DOI: 10.3389/fpsyg.2020.624065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background: Previous research has identified a link between the loss of a significant person, grief complications, and substance abuse. People with substance use disorder (SUD) are more vulnerable to complicated grieving symptoms following loss. From sociocognitive theories, the model of coping with stress assumes that substance use is one of the responses used to cope with traumatic life events. The main objective of this study is to identify the coping strategies of people with SUD and to analyze their relationship to complicated grief (CG). Methods: A sample of 196 bereaved drug-dependent patients was assessed, after providing written consent, in sociodemographic variables, drug and bereavement related characteristics, CG symptomatology (Inventory of Complicated Grief) and coping strategies (Coping Strategies Inventory). Results: There are differences in relation to the coping strategies used among patients with CG, using more those focused on emotional expression, social withdrawal, wishful thinking, and self-criticism. Conclusion: We can conclude that, in general, CG in patients with SUD is more associated with the use of less adaptive coping strategies. This data can contribute to a better understanding of the different variables involved in the grieving process among people with SUD. It is important to point out the clinical implications of addressing what the coping strategies associated with improved grief outcomes among people with addiction problems are.
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Affiliation(s)
- Beatriz Caparrós
- Department of Psychology, University of Girona (UdG), Girona, Spain
| | - Laura Masferrer
- Department of Psychology, University of Girona (UdG), Girona, Spain.,CAS Girona, Mental Health and Addiction Research Group, Institut d'Assistència Sanitària (IAS), Institut d'Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
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Masferrer L, Mancini AD, Caparrós B. Understanding the Relationship Between Complicated Grief Symptoms and Patterns of Personality Disorders in a Substance Users' Sample: A Network Analysis Approach. Front Psychol 2020; 11:566785. [PMID: 33250810 PMCID: PMC7673378 DOI: 10.3389/fpsyg.2020.566785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The presence of personality disorders is greatly prevalent among substance users. Personality disorders could increase vulnerability to complicated grief symptoms. Bereavement is commonly overlooked among substance users. We used network analysis to estimate the structure of relations between patterns of personality disorders and complicated grief symptoms among a bereaved substance-using population. METHODS Complicated grief and personality disorders were assessed in a sample of 196 bereaved substance users. We use the graphical least absolute shrinkage selection operator (LASSO) to compute a regularized partial correlation network revealing associations among different patterns of personality disorders and complicated grief symptoms. RESULTS In a network involving nodes for personality disorders and symptomatology of complicated grief, patterns of depressive and paranoid personality disorder showed small relationships to complicated grief symptoms. All other personality disorders showed negligible to no relationship to complicated grief symptoms. Further, in the overall network, complicated grief showed the lowest level of centrality, suggesting that it is independent of personality disorders, whereas depressive and paranoid personality disorder symptoms showed the highest centrality. CONCLUSION Network analysis can be used to understand the relationships among higher-level constructs such as disorders. We found that complicated grief is largely independent of patterns of personality disorders with the exception of depressive and paranoid. Findings have implications for assessment and appropriate treatment of complicated grief symptoms and substance use disorder.
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Affiliation(s)
- Laura Masferrer
- CAS Girona, Mental Health and Addiction Research Group, Institutd’Assistència Sanitària (IAS), Institut d’Investigació Biomèdica de Girona (IDIBGI), Girona, Spain
- Department of Psychology, University of Girona, Girona, Spain
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Gallop A, Chen B, Gulati V, Barnes A. Cultural Appropriation and Substance Use Disorder: A Case Report. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2020. [DOI: 10.1080/1067828x.2020.1805838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Amy Gallop
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Bill Chen
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Vivek Gulati
- Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Alicia Barnes
- Saint Louis University School of Medicine, Saint Louis, MO, USA
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Women, addiction, and grief: A quality improvement initiative. Arch Psychiatr Nurs 2020; 34:224-229. [PMID: 32828353 DOI: 10.1016/j.apnu.2020.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/09/2020] [Indexed: 11/21/2022]
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Yang Y, Perkins DR, Stearns AE. “I Started to Feel Better now”: Qualitative Findings from Client Narratives on Early Recovery in Inpatient Substance Use Treatment. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-019-00107-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Two Cases of Persistent Complex Bereavement Disorder Diagnosed in the Acute Inpatient Unit. Case Rep Psychiatry 2020; 2020:3632060. [PMID: 32309001 PMCID: PMC7154980 DOI: 10.1155/2020/3632060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 03/23/2020] [Indexed: 11/17/2022] Open
Abstract
Pathological grief has been noted to have considerable adverse effects on affected individuals. In the DSM-5, the diagnosis of complicated grief is included under conditions for further study as Persistent Complex Bereavement Disorder (PCBD). PCBD can be easily missed because it is a relatively new and developing diagnosis. It can also be overlooked when it is comorbid with more common psychiatric disorders. We present 2 patients with PCBD diagnosed in the inpatient unit, while the patients were admitted for comorbid disorders. PCBD contributed immensely to both patients' suffering and decline in functioning. This report highlights the presentation, diagnoses, and management of these patients. We theorize that paying attention to separation distress, reactive distress to loss, and identity disruption in individuals who have been bereaved for over 12 months will enhance treatment specificity and lead to better patient outcomes.
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Fiore J. A Systematic Review of the Dual Process Model of Coping With Bereavement (1999-2016). OMEGA-JOURNAL OF DEATH AND DYING 2019; 84:414-458. [PMID: 31829782 DOI: 10.1177/0030222819893139] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This systematic review addressed the question whether the Dual Process Model of Coping with Bereavement (DPM) accurately represents the bereavement experience, and whether DPM-based interventions are more effective than traditional grief therapy. Twenty databases were searched to identify publications related to the DPM between 1999 and June 30, 2016. Coded material included source, title, research design, research question(s), data source, measures, method, and outcomes. Of the 474 articles initially identified, 86 underwent full-text review, with 22 quantitative or mixed-methods studies included. The DPM accurately represents the bereavement experience and can be used to understand how bereaved individuals cope. Interventions based upon the DPM may be more effective than traditional grief therapy. Further research is needed to test both the model and intervention design, especially in regard to oscillation, with use of consistent measures between studies.
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The relationship between substance misuse and complicated grief: A systematic review. J Subst Abuse Treat 2019; 103:43-57. [PMID: 31229191 DOI: 10.1016/j.jsat.2019.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/07/2019] [Accepted: 05/20/2019] [Indexed: 01/06/2023]
Abstract
Complicated grief is a prolonged, bereavement-specific disorder with significant psychological and physical consequences. Although complicated grief represents a risk to individuals with substance misuse, this relationship is poorly understood. Consequently, this systematic literature review examined empirical findings regarding the relationship between substance misuse and complicated grief. We searched 11 databases to identify pertinent quantitative studies published in English. Our search yielded 12 peer-reviewed journal articles (N = 1749) published between 1997 and 2017. Included studies evaluated the prevalence, assessment, etiology, correlates, risk factors, and treatment of complicated grief and substance misuse among individuals with one or both conditions. Our review found evidence of a positive relationship between complicated grief and substance misuse. Individuals with substance misuse were at increased risk for subsequent development of complicated grief, particularly when increases in substance consumption preceded bereavement. Conversely, complicated grief predicted increases in smoking and alcohol dependence. Multiple risk factors for individuals with complicated grief and substance misuse were identified and discussed. An existing complicated grief assessment performed well among individuals with substance misuse, and grief interventions were effective in reducing symptoms of complicated grief and substance misuse simultaneously. Given the severity of consequences associated with both conditions, more research is needed to understand this relationship, identify effective assessment tools, and evaluate intervention strategies to improve outcomes.
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Scott LF, Shieh C, Umoren RA, Conard T. Care Experiences of Women Who Used Opioids and Experienced Fetal or Infant Loss. J Obstet Gynecol Neonatal Nurs 2017; 46:846-856. [PMID: 28950109 DOI: 10.1016/j.jogn.2017.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To explore care experiences of women who used prescription or illicit opioids and experienced fetal or infant loss. DESIGN A qualitative, descriptive design with secondary data analysis. SETTING The Fetal and Infant Mortality Review program in an urban Midwestern county in the United States. PARTICIPANTS Eleven women with histories of prescription or illicit opioid use who experienced fetal or infant loss participated in the semistructured telephone or in-person interview portion of the mortality case review. METHODS We used thematic analysis to analyze interview data. RESULTS Five themes were identified related to the care experiences of participants throughout pregnancy and fetal/infant loss: Frustration and anger related to not being heard, feeling minimalized; Being overwhelmed with attempts to process and understand medical complications and outcomes; Profound sense of grief and coping with loss; Need to understand why and make difficult decisions; and Placing blame and guilt over death. CONCLUSION Our findings suggest that women who use opioids and experience fetal or infant loss have complex care, educational, and emotional needs. In the development of interventions for these women, it is important to address their unique and complex circumstances.
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Saavedra Pérez HC, Ikram MA, Direk N, Prigerson HG, Freak-Poli R, Verhaaren BFJ, Hofman A, Vernooij M, Tiemeier H. Cognition, structural brain changes and complicated grief. A population-based study. Psychol Med 2015; 45:1389-1399. [PMID: 25363662 DOI: 10.1017/s0033291714002499] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Several psychosocial risk factors for complicated grief have been described. However, the association of complicated grief with cognitive and biological risk factors is unclear. The present study examined whether complicated grief and normal grief are related to cognitive performance or structural brain volumes in a large population-based study. METHOD The present research comprised cross-sectional analyses embedded in the Rotterdam Study. The study included 5501 non-demented persons. Participants were classified as experiencing no grief (n = 4731), normal grief (n = 615) or complicated grief (n = 155) as assessed with the Inventory of Complicated Grief. All persons underwent cognitive testing (Mini-Mental State Examination, Letter-Digit Substitution Test, Stroop Test, Word Fluency Task, word learning test - immediate and delayed recall), and magnetic resonance imaging to measure general brain parameters (white matter, gray matter), and white matter lesions. Total brain volume was defined as the sum of gray matter plus normal white matter and white matter lesion volume. Persons with depressive disorders were excluded and analyses were adjusted for depressive symptoms. RESULTS Compared with no-grief participants, participants with complicated grief had lower scores for the Letter-Digit Substitution Test [Z-score -0.16 v. 0.04, 95% confidence interval (CI) -0.36 to -0.04, p = 0.01] and Word Fluency Task (Z-score -0.15 v. 0.03, 95% CI -0.35 to -0.02, p = 0.02) and smaller total volumes of brain matter (933.53 ml v. 952.42 ml, 95% CI -37.6 to -0.10, p = 0.04). CONCLUSIONS Participants with complicated grief performed poorly in cognitive tests and had a smaller total brain volume. Although the effect sizes were small, these findings suggest that there may be a neurological correlate of complicated grief, but not of normal grief, in the general population.
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Affiliation(s)
- H C Saavedra Pérez
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - M A Ikram
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - N Direk
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - H G Prigerson
- Department of Psychiatry,Brigham and Women's Hospital,Boston,MA,USA
| | - R Freak-Poli
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - B F J Verhaaren
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - A Hofman
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - M Vernooij
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
| | - H Tiemeier
- Department of Epidemiology,Erasmus Medical Center,Rotterdam,The Netherlands
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Furr SR, Johnson WD, Goodall CS. Grief and Recovery: The Prevalence of Grief and Loss in Substance Abuse Treatment. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2015. [DOI: 10.1002/j.2161-1874.2015.00034.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susan R. Furr
- Department of Counseling; University of North Carolina at Charlotte
| | - W. Derrick Johnson
- Department of Counseling; University of North Carolina at Charlotte
- Now in private practice in Charlotte; North Carolina
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Zisook S, Iglewicz A, Avanzino J, Maglione J, Glorioso D, Zetumer S, Seay K, Vahia I, Young I, Lebowitz B, Pies R, Reynolds C, Simon N, Shear MK. Bereavement: course, consequences, and care. Curr Psychiatry Rep 2014; 16:482. [PMID: 25135781 DOI: 10.1007/s11920-014-0482-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This paper discusses each of several potential consequences of bereavement. First, we describe ordinary grief, followed by a discussion of grief gone awry, or complicated grief (CG). Then, we cover other potential adverse outcomes of bereavement, each of which may contribute to, but are not identical with, CG: general medical comorbidity, mood disorders, post-traumatic stress disorder, anxiety, and substance use.
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Affiliation(s)
- Sidney Zisook
- Department of Psychiatry, University of California, 3350 La Jolla Village Dr, San Diego, CA, 92161-116A, USA,
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Barbosa V, Sá M, Carlos Rocha J. Randomised controlled trial of a cognitive narrative intervention for complicated grief in widowhood. Aging Ment Health 2014; 18:354-62. [PMID: 24073815 DOI: 10.1080/13607863.2013.833164] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The implementation of bereavement interventions is frequently requested, and its effectiveness has been controversial. The aim of this study is to evaluate the effectiveness of a cognitive narrative intervention for complicated grief (CG) for controlling post-traumatic and depressive issues. METHOD The study is a randomised controlled trial and uses the Socio Demographic Questionnaire (SDQ), the Inventory of Complicated Grief (ICG), the Beck Depression Inventory (BDI) and the Impact of Events Scale-Revised (IES-R). There were three phases in the study: (1) The SDQ and CG evaluations were applied to bereaved elders (n = 82). The bereaved elders with the 40 highest ICG values (≥25) were randomly allocated into two groups: the intervention group (n = 20) and control group (n = 20); (2) participants were evaluated using the BDI and IES-R and the IG gave informed consent to participate in an intervention with four weekly 60-min sessions addressing recall, emotional and cognitive subjectivation, metaphorisation and projecting. (3) Two months later, the ICG, BDI and IES-R assessments were repeated. RESULTS Outcome measures showed a statistically significant reduction of CG, depressive and traumatic symptoms compared to the controls. Very high effect sizes for the ICG, BDI and IES-R reflect the effectiveness of the intervention along the longitudinal profile. CONCLUSIONS These results reinforce the importance of brief interventions that combine a reduced number of sessions with lower costs, which is reflected in an increased adherence to the programme along with high effectiveness.
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Abstract
Complicated grief therapy (CGT) is a relatively new psychotherapy model designed to address symptoms of complicated grief. Drawn from attachment theory and with roots in both interpersonal therapy (IPT) and cognitive-behavioral therapy, CGT includes techniques similar to prolonged exposure (repeatedly telling the story of the death and in vivo exposure activities). The treatment also involves focusing on personal goals and relationships. CGT has been demonstrated to be effective in a trial in which participants with complicated grief were randomly assigned to CGT or IPT; individuals receiving CGT responded more quickly and were more likely to respond overall (51% vs 28%). This article briefly summarizes the conceptual underpinnings of CGT, discusses the empirical evidence for its efficacy, describes its techniques, and presents a case example of a client treated in a 16-session manualized CGT protocol. The article concludes with a description of future research directions for CGT.
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Abstract
AbstractObjective:Bereaved mothers have expressed the need to maintain a bond with their children who have died, to retain control over the funeral rituals, and to express their loss to others who are empathetic. This study describes grief over the loss of a child in women who have been or are currently incarcerated, and the influence of the women's family members.Method:This descriptive qualitative study consisted of open-ended interview questions to encourage the women to describe their experience in their own words. A purposive sample (N = 10) was recruited from a prison re-entry program and a county jail.Results:All of the participants described maladaptive responses such as the use of alcohol and drugs, restricted family support, and dysfunctional coping. None of the participants had received focused bereavement services.Significance of Results:The descriptive perspective from the participants can inform clinicians who work with women who have a history of involvement with the criminal justice system, and recommends that they should inquire about the women's children and experiences with loss. Community re-entry and jail/prison counselors should provide access to confidential and group-based therapeutic support, including Compassionate Friends.
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Sung SC, Dryman MT, Marks E, Shear MK, Ghesquiere A, Fava M, Simon NM. Complicated grief among individuals with major depression: prevalence, comorbidity, and associated features. J Affect Disord 2011; 134:453-8. [PMID: 21621849 PMCID: PMC3170428 DOI: 10.1016/j.jad.2011.05.017] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 04/18/2011] [Accepted: 05/09/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Growing data suggest that complicated grief (CG) may be common in clinical care settings, but there are few prior reports about CG in outpatients presenting with primary mood disorders. METHODS The present study examined rates of bereavement and threshold CG symptoms (defined as a score ≥ 25 on the Inventory of Complicated Grief scale) in 111 outpatients with major depressive disorder (MDD) and 142 healthy controls participating in a study of stress and depression. Clinical and demographic characteristics were also compared for bereaved individuals with CG (MDD+CG) to those without (MDD-CG). Participants completed structured diagnostic interviews as well as measures of CG, depression, anxiety, exposure to traumatic events, and perceived social support. RESULTS Lifetime history of a significant loss did not differ for the MDD and control groups (79.3% vs. 76.1%), but bereaved participants with MDD had higher rates of threshold CG (25.0% vs. 2.8%). Among those with MDD, CG was associated with a higher prevalence of lifetime alcohol dependence, greater exposure to traumatic events, and lower perceived social support. Depressed women, but not men, with CG also had higher rates of panic disorder, social anxiety disorder, and posttraumatic stress disorder. LIMITATIONS Our findings are limited by the lack of a clinician confirmatory assessment of CG diagnosis, absence of complete information about the nature and timing of the loss, and relatively narrow generalizability. CONCLUSIONS We found high rates of CG in a group of psychiatric outpatients with chronic MDD, suggesting that patients with depression should be routinely screened for CG.
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Affiliation(s)
- Sharon C. Sung
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - M. Taylor Dryman
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Elizabeth Marks
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - M. Katherine Shear
- Columbia University School of Social Work, New York, NY,Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, NY
| | | | - Maurizio Fava
- Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Naomi M. Simon
- Center for Anxiety and Traumatic Stress Disorders, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
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Shear MK, Simon N, Wall M, Zisook S, Neimeyer R, Duan N, Reynolds C, Lebowitz B, Sung S, Ghesquiere A, Gorscak B, Clayton P, Ito M, Nakajima S, Konishi T, Melhem N, Meert K, Schiff M, O'Connor MF, First M, Sareen J, Bolton J, Skritskaya N, Mancini AD, Keshaviah A. Complicated grief and related bereavement issues for DSM-5. Depress Anxiety 2011; 28:103-17. [PMID: 21284063 PMCID: PMC3075805 DOI: 10.1002/da.20780] [Citation(s) in RCA: 519] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally, grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence, some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This article focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders.
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Leach RM, Burgess T, Holmwood C. Could recidivism in prisoners be linked to traumatic grief? A review of the evidence. Int J Prison Health 2008; 4:104-19. [DOI: 10.1080/17449200802038249] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Shear K, Monk T, Houck P, Melhem N, Frank E, Reynolds C, Sillowash R. An attachment-based model of complicated grief including the role of avoidance. Eur Arch Psychiatry Clin Neurosci 2007; 257:453-61. [PMID: 17629727 PMCID: PMC2806638 DOI: 10.1007/s00406-007-0745-z] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Complicated grief is a prolonged grief disorder with elements of a stress response syndrome. We have previously proposed a biobehavioral model showing the pathway to complicated grief. Avoidance is a component that can be difficult to assess and pivotal to treatment. Therefore we developed an avoidance questionnaire to characterize avoidance among patients with CG. METHODS We further explain our complicated grief model and provide results of a study of 128 participants in a treatment study of CG who completed a 15-item Grief-related Avoidance Questionnaire (GRAQ). RESULTS OF AVOIDANCE ASSESSMENT: Mean (SD) GRAQ score was 25. 0 +/- 12.5 with a range of 0-60. Cronbach's alpha was 0.87 and test re-test correlation was 0.88. Correlation analyses showed good convergent and discriminant validity. Avoidance of reminders of the loss contributed to functional impairment after controlling for other symptoms of complicated grief. DISCUSSION In this paper we extend our previously described attachment-based biobehavioral model of CG. We envision CG as a stress response syndrome that results from failure to integrate information about death of an attachment figure into an effectively functioning secure base schema and/or to effectively re-engage the exploratory system in a world without the deceased. Avoidance is a key element of the model.
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Affiliation(s)
- Katherine Shear
- Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, USA.
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