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Smith KV, Wild J, Ehlers A. From loss to disorder: The influence of maladaptive coping on prolonged grief. Psychiatry Res 2024; 339:116060. [PMID: 39068899 DOI: 10.1016/j.psychres.2024.116060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 06/21/2024] [Accepted: 06/22/2024] [Indexed: 07/30/2024]
Abstract
Research indicates that post-bereavement coping strategies can be adaptive or maladaptive. Understanding which strategies lead to poorer outcomes is an important clinical and theoretical question with the potential to guide intervention. The Oxford Grief - Coping Strategies scale was developed from interviews with bereaved people with and without prolonged grief disorder (PGD) to assess the frequency of maladaptive cognitive and behavioural strategies after bereavement. Factorial and psychometric validity were assessed using exploratory and confirmatory factor analysis (N = 676). A three-wave cross-lagged panel model (N = 275) was used to assess the predictive validity of the tool in explaining symptoms of PGD. Results supported a four-factor solution (Avoidance, Proximity Seeking, Loss Rumination, Injustice Rumination) with good psychometric properties. The OG-CS predicted prospective symptoms of PGD in the short-term (6-12 months) and long term (12-18 months), controlling for baseline symptoms and autocorrelations. Subscale analyses demonstrated that the use of coping strategies predicted ICD-11 PGD in both the short-term and the long-term. However, avoidance was not predictive of outcomes early in the grieving process. At 6-12 months, avoidance predicted PGD at 12-18 months.
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Affiliation(s)
- Kirsten V Smith
- Department of Experimental Psychology, University of Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; The Loss Foundation, [Registered Charity 1147362], London, UK.
| | - Jennifer Wild
- Department of Experimental Psychology, University of Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK; Phoenix Australia Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Johannsen M, Schlander C, Farver-Vestergaard I, Lundorff M, Wellnitz KB, Komischke-Konnerup KB, O'Connor M. Group-based compassion-focused therapy for prolonged grief symptoms in adults - Results from a randomized controlled trial. Psychiatry Res 2022; 314:114683. [PMID: 35717855 DOI: 10.1016/j.psychres.2022.114683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 06/07/2022] [Accepted: 06/13/2022] [Indexed: 11/18/2022]
Abstract
Prolonged grief disorder is a debilitating condition, which affects approximately one out of ten who lose a loved one. While existing meta-analyses have synthesized evidence regarding the overall effect of psychological interventions for pathological grief across different types of psychotherapy, it remains clinically relevant to explore whether specific types of psychological interventions are efficacious in the treatment of grief. The present study investigated the efficacy of group-based Compassion-Focused Therapy (CFT) for adults who had lost a spouse or a parent, and who reported clinically relevant levels of prolonged grief symptoms (PGS) at 11 months post-loss. A total of 82 participants were randomized to the CFT group (n = 42) or the waitlist control (n = 40). Time × group interactions showed no statistically significant effects of the intervention on the primary outcome PGS at post-intervention or 6-month follow-up. Likewise, no statistically significant effects were found for any of the secondary outcomes or process variables, with the exception of posttraumatic stress symptoms and self-reassurance. Taken together, in the present study group-based CFT did not emerge as an efficacious treatment for PGS. Possible explanations include that CFT may not target core maintaining processes in PGS and that the group-based, 8-week operationalization of CFT may be less than optimal.
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Affiliation(s)
- Maja Johannsen
- Unit for Bereavement Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Alle 11, Aarhus C DK-8000, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Alle 11, Bartholins Allé 9, Bld. 1350, Aarhus C DK-8000, Denmark
| | - Christina Schlander
- Centre for Compassion-Focused Therapy, Møllestien 52, Aarhus C DK-8000, Denmark
| | | | - Marie Lundorff
- Department of Communication, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N DK-8200, Denmark
| | - Kaare Bro Wellnitz
- Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Alle 11, Bartholins Allé 9, Bld. 1350, Aarhus C DK-8000, Denmark; Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 21-23, Aarhus C DK-8000, Denmark
| | - Katrine B Komischke-Konnerup
- Unit for Bereavement Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Alle 11, Aarhus C DK-8000, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Alle 11, Bartholins Allé 9, Bld. 1350, Aarhus C DK-8000, Denmark
| | - Maja O'Connor
- Unit for Bereavement Research, Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Alle 11, Aarhus C DK-8000, Denmark; Department of Psychology and Behavioural Sciences, Aarhus University, Bartholins Alle 11, Bartholins Allé 9, Bld. 1350, Aarhus C DK-8000, Denmark.
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Negative Cognitions and Emotional Distress Following Job Loss: Development and Validation of the Beliefs About Loss of Work (BLOW) Scale. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00126-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Negative cognitions following job loss can contribute to emotional distress by motivating individuals to adopt coping styles that reduce stress in the short run while obstructing adjustment in the long run. It is unclear which specific cognitions are related to symptoms of complicated grief, depression, and anxiety following job loss. To fill this gap, this study introduces the Beliefs about Loss of Work (BLOW) scale and examines its psychometric properties. We recruited 222 Dutch workers who had lost their job, including 70 men and 152 women, with an average age of 52.5 years. Confirmatory factor analyses revealed that a second-order eight-factor model had the best fit to the data. The BLOW scale is a reliable instrument with a good convergent and divergent validity. This instrument may stimulate research on mechanisms involved in job loss-related distress and could inform the development of interventions to reduce this distress.
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Wagner B, Hofmann L, Grafiadeli R. The relationship between guilt, depression, prolonged grief, and posttraumatic stress symptoms after suicide bereavement. J Clin Psychol 2021; 77:2545-2558. [PMID: 34081784 DOI: 10.1002/jclp.23192] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/30/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE A profound feeling of guilt and its role in complicating psychological reactions are accepted as central issues in suicide bereavement. However, research examining the relationship of guilt with mental disorders commonly following suicide bereavement is still lacking. This study aimed to examine the association between guilt and symptoms of depression, prolonged grief disorder, and posttraumatic stress disorder (PTSD) after suicide bereavement, as well as its moderating role in the association between the time which elapsed since bereavement and psychopathological symptoms. METHODS 154 self-selected adult German participants bereaved by suicide completed online questionnaires assessing sociodemographics, characteristics related to the loss, guilt, depression, prolonged grief, and PTSD. RESULTS Significant positive correlations were found between guilt and all assessed psychopathological symptoms. Further, guilt was a significant correlate with symptoms of depression, prolonged grief, PTSD over and above sociodemographic factors, and time that elapsed since the loss. Guilt furthermore moderated the link between the time which elapsed since bereavement and depressive symptoms, while this effect was not observed for prolonged grief and posttraumatic stress symptoms. CONCLUSION Our findings replicate theoretical frameworks linking feelings of guilt with mental disorders after suicide bereavement. Accordingly, they highlight the necessity to adapt psychotherapeutic interventions according to the specific needs of this population to maximize treatment effectiveness.
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Affiliation(s)
- Birgit Wagner
- Department of Clinical Psychology, Medical School Berlin, Berlin, Germany
| | - Laura Hofmann
- Department of Clinical Psychology, Medical School Berlin, Berlin, Germany
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5
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Smith KV, Ehlers A. Prolonged grief and posttraumatic stress disorder following the loss of a significant other: An investigation of cognitive and behavioural differences. PLoS One 2021; 16:e0248852. [PMID: 33793567 PMCID: PMC8016232 DOI: 10.1371/journal.pone.0248852] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 03/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cognitive behavioural correlates to bereavement-related mental health problems such a Prolonged Grief Disorder (PGD) and Posttraumatic Stress Disorder (PTSD) are of theoretical and clinical importance. METHODS Individuals bereaved at least six months (N = 647) completed measures of loss-related cognitions and behaviours (i.e., loss-related memory characteristics, negative appraisals, coping strategies, grief resilience, and perceived social disconnection) and measures of PGD and PTSD symptoms. Individuals were assigned to one of four groups depending on probable clinical diagnoses (No-PGD/PTSD, PTSD, PGD, PGD+PTSD). RESULTS Results indicated that higher loss-related memory characteristics and lower grief resilience increased the likelihood of a clinical problem. The PGD and PGD+PTSD groups reported significantly higher loss-related memory characteristics and appraisals compared to the PTSD group. Social disconnection increased the likelihood of comorbid PGD+PTSD in comparison to any other group. CONCLUSIONS Results indicate cognitive differences between loss-related cognitions, memory characteristics and coping strategies between PGD and PTSD, and points to distinct cognitive correlates to psychopathology following loss.
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Affiliation(s)
- Kirsten V. Smith
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- The Loss Foundation, London, United Kingdom
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
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Kaya E, Aydemir Ö. Correlation of Alexithymia with Grief and Depression Symptom Severity in Persistent Complex Bereavement Disorder. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2021. [DOI: 10.1007/s10942-021-00388-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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7
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Doering BK, Boelen PA, Eisma MC, Barke A. Validation of a German Version of the Grief Cognitions Questionnaire and Establishment of a Short Form. Front Psychol 2021; 11:620987. [PMID: 33536985 PMCID: PMC7848142 DOI: 10.3389/fpsyg.2020.620987] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 12/28/2020] [Indexed: 01/02/2023] Open
Abstract
Background Whereas the majority of bereaved persons recover from their grief without professional assistance, a minority develops pathological grief reactions. Etiological models postulate that dysfunctional cognitions may perpetuate such reactions. The Grief Cognitions Questionnaire (GCQ) assesses thoughts after bereavement in nine interrelated domains. A short form (GCQ-SF) with four domains is often used. However, an evaluation of the psychometric properties of the GCQ-SF and its utility compared to the GCQ is lacking and these instruments have not been validated in German. Method German bereaved persons (time since loss 35.3 ± 34.6 months) responded to an online survey containing the GCQ, measures of grief severity, grief rumination, symptoms of depression and anxiety, and optimism and pessimism. 585 participants (18–78 years, 88% women) were included. Item analyses and confirmatory factor analyses were conducted. Correlations between the GCQ and GCQ-SF and grief rumination, optimism and pessimism assessed construct validity. Criterion-related validity was assessed by comparing whether the correlation of the GCQ (and the GCQ-SF) with grief severity was higher than with anxious and depressive symptoms. Logistic regression and receiver-operator characteristics (ROC) compared the questionnaires on their ability to predict probable prolonged grief ‘caseness’ (ICG ≥ 25, time since loss ≥6 months). Results Internal consistencies for both questionnaires were identical and excellent (α = 0.96). Confirmatory factor analyses obtained a satisfactory fit for models with nine and four correlated subscales and respective higher-order factor models. The GCQ and the GCQ-SF correlated higher with grief severity than with other measures of psychopathology. The logistic regression showed a significant association between the GCQ-SF and prolonged grief ‘caseness’. Of the remaining subscales of the GCQ, only one subscale (‘Others’) contributed to the prediction. The ROC analyses showed nearly identical areas under the curve. Conclusion The translated GCQ and GCQ-SF demonstrated very good psychometric properties. The correlations with grief severity highlight the questionnaires’ clinical relevance. The questionnaires possessed identical diagnostic specificity and sensitivity. Whenever a timesaving assessment of the most typical grief-specific cognitions is important, the GCQ-SF represents an alternative to the GCQ. The original GCQ may still be superior when a more detailed description of a bereaved person’s cognitions is desirable.
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Affiliation(s)
- Bettina K Doering
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Paul A Boelen
- Clinical Psychology, Utrecht University, Utrecht, Netherlands.,ARQ National Psychotrauma Centre, Diemen, Netherlands
| | - Maarten C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, Netherlands
| | - Antonia Barke
- Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany
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8
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Cesur G, Durak-Batıgün A. A Turkish adaptation of the grief cognitions questionnaire: Factor analysis, reliability and validity. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-018-9983-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Cesur-Soysal G, Durak-Batıgün A. Prolonged grief, emotion regulation and loss-related factors: An investigation based on cognitive and behavioral conceptualization. DEATH STUDIES 2020; 46:1316-1328. [PMID: 33180665 DOI: 10.1080/07481187.2020.1846639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The study aimed to examine the variables that play a role in the process of prolonged grief within the framework of the cognitive-behavioral model. Participants (N = 475) from Turkey took part in a cross-sectional questionnaire survey. The study used structural equation modeling to test a hypothesized model via AMOS v23. After testing two options, the final model was found to be good fit for the data. Results suggested the importance of adopting a comprehensive approach to prolonged grief interventions which includes the loss- and relationship-related factors as well as emotion regulation difficulties, autobiographic memory characteristics, and the grief cognitions.
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Affiliation(s)
- Gizem Cesur-Soysal
- Department of Psychology, Istanbul Medipol Universitesi, Istanbul, Turkey
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10
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Williams JL, Hardt MM, Milman E, Rheingold AA, Rynearson EK. Development and psychometric validation of the Dying Imagery Scale-Revised. DEATH STUDIES 2020; 46:1243-1252. [PMID: 32866083 DOI: 10.1080/07481187.2020.1812135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Survivors of sudden death losses frequently experience vivid imagery associated with the events surrounding their loved one's death. This paper describes the development and psychometric validation of the Dying Imagery Scale-Revised (DIS-R), a 15-item measure assessing three forms of death imagery, including Reenactment, Remorse, and Revenge imagery. The first study details the development of the DIS-R in a sample of suddenly bereaved college students. The second study examines the validity and reliability of the DIS-R among suddenly bereaved adults. Results suggest that the measure is psychometrically sound and may provide clinically useful information for bereavement counselors.
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Affiliation(s)
- Joah L Williams
- Department of Psychology, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Madeleine M Hardt
- Department of Psychology, University of Missouri - Kansas City, Kansas City, Missouri, USA
| | - Evgenia Milman
- School of Human Development and Education, St. Edward's University, Austin, Texas, USA
| | - Alyssa A Rheingold
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Edward K Rynearson
- Separation and Loss Services, Virginia Mason Medical Center, Seattle, Washington, USA
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11
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Lacour O, Morina N, Spaaij J, Nickerson A, Schnyder U, von Känel R, Bryant RA, Schick M. Prolonged Grief Disorder Among Refugees in Psychological Treatment-Association With Self-Efficacy and Emotion Regulation. Front Psychiatry 2020; 11:526. [PMID: 32581893 PMCID: PMC7291948 DOI: 10.3389/fpsyt.2020.00526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 05/22/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND While Prolonged Grief Disorder (PGD) among refugees has recently started to attract scientific attention, knowledge regarding associated psychological factors remains limited. Given the multifactorial context of persecution, trauma, displacement, and exile-related difficulties, obtaining a better understanding of PGD in refugees is crucial because PGD may affect psychological well-being, level of functioning, and social integration. METHODS In a sample of refugees receiving psychological treatment in Switzerland (N = 88), we examined the relationship between severity of PGD and potentially associated factors such as emotion regulation, perceived self-efficacy, as well as potentially traumatic events and post-migration living difficulties. RESULTS In a regression analysis, difficulties in emotion regulation and lower perceived self-efficacy were associated with greater severity of PGD, while post-migration living difficulties and potentially traumatic events did not emerge as significant factors. CONCLUSION These findings suggest that emotion regulation and perceived self-efficacy are associated with PGD in refugees in psychological treatment and are thus potential targets for treatment interventions.
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Affiliation(s)
- Oriane Lacour
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Naser Morina
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Julia Spaaij
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Angela Nickerson
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Ulrich Schnyder
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
| | - Richard A. Bryant
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| | - Matthis Schick
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital, Zurich, University of Zurich, Zurich, Switzerland
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Buqo T, Ward-Ciesielski EF, Krychiw JK. Do Coping Strategies Differentially Mediate the Relationship Between Emotional Closeness and Complicated Grief and Depression? OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:985-997. [DOI: 10.1177/0030222820923454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although complicated grief (CG) following the death of a loved one has traditionally been viewed as avoidance-driven, recent research implicates approach behavior. Researchers have investigated how coping styles predict CG; however, emotional closeness remains unexamined. This study investigated the differential relationship of approach- and avoidance-focused coping on CG and depressive symptoms. Bereaved adults ( n = 340) completed questionnaires about their loss, coping styles, CG, and depression. Results suggest that approach-, but not avoidance-, focused coping mediates the relationship of emotional closeness on CG, while emotional closeness of the relationship had no direct impact on depressive symptoms. This suggests closeness of the relationship plays a unique role in CG.
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Affiliation(s)
- Tom Buqo
- Department of Psychology, Hofstra University, Hempstead, New York, United States
| | - Erin F. Ward-Ciesielski
- Department of Psychology, Hofstra University, Hempstead, New York, United States
- Department of Psychological and Brain Sciences, Boston University, MA, United States
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13
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Stammel N, Heinzl L, Heeke C, Böttche M, Knaevelsrud C. Association Between Prolonged Grief and Attitudes Toward Reconciliation in Bereaved Survivors of the Khmer Rouge Regime in Cambodia. Front Psychiatry 2020; 11:644. [PMID: 32754059 PMCID: PMC7366248 DOI: 10.3389/fpsyt.2020.00644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND During the Khmer Rouge regime in Cambodia, about a quarter of the population died, resulting in many individuals losing close relatives. Still today, many individuals are suffering from the psychological consequences of these losses, which might also affect the process of reconciliation within the Cambodian society. The aim of this paper is therefore to investigate the association between symptoms of prolonged grief and attitudes toward reconciliation. METHODS A sample of 775 survivors of the Khmer Rouge regime who lost relatives during the conflict were interviewed about their losses and traumatic events, prolonged grief (PG; Complicated Grief Assessment Self-Report, CGA-SR), posttraumatic stress disorder (PTSD Checklist - Civilian Version) and attitudes toward reconciliation (Readiness to Reconcile Inventory, RRI). RESULTS A higher symptom severity of PG was significantly associated with readiness to reconcile even when controlling for other relevant variables (β = -0.22; p <.001). Persons who met caseness criteria for PG were significantly less ready to reconcile, t(773) = 5.47, p <.001, than persons who did not meet caseness for PG. CONCLUSION PG seems to be a relevant mental health correlate of attitudes toward reconciliation. The results of the current study underline the importance of also considering PG with regard to the reconciliation process in Cambodia and possibly also in other post-conflict regions.
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Affiliation(s)
- Nadine Stammel
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.,Research Department, CENTER ÜEBERLEBEN, Berlin, Germany
| | - Louisa Heinzl
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Carina Heeke
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
| | - Maria Böttche
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany.,Research Department, CENTER ÜEBERLEBEN, Berlin, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychological Intervention, Freie Universität Berlin, Berlin, Germany
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14
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Vara H, Thimm JC. Associations between self-compassion and complicated grief symptoms in bereaved individuals: An exploratory study. NORDIC PSYCHOLOGY 2019. [DOI: 10.1080/19012276.2019.1684347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Helga Vara
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jens C. Thimm
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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15
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Smith KV, Ehlers A. Cognitive predictors of grief trajectories in the first months of loss: A latent growth mixture model. J Consult Clin Psychol 2019; 88:93-105. [PMID: 31556649 PMCID: PMC6939605 DOI: 10.1037/ccp0000438] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: The identification of modifiable cognitive antecedents of trajectories of grief is of clinical and theoretical interest. Method: The study gathered 3-wave data on 275 bereaved adults in the first 12–18 months postloss (T1 = 0–6 months, T2 = 6–12 months, T3 = 12–18 months). Participants completed measures of grief severity, cognitive factors (loss-related memory characteristics, negative appraisals, unhelpful coping strategies, and grief resilience), as well as measures of interpersonal individual differences (attachment and dependency). Latent growth mixture modeling was used to identify classes of grief trajectories. Predictors of class membership were identified using multinomial logistic regression and multigroup structural equation modeling. Results: Four latent classes were identified: 3 high grief classes (Stable, Low Adaptation, and High Adaptation) and a low grief class (Low Grief). When considered separately, variance in all four cognitive factors predicted membership of the high grief classes. When considered together, membership of the high grief classes was predicted by higher mean scores on memory characteristics. More negative appraisals predicted low or no adaptation from high grief severity. Losing a child also predicted membership to the stable class. Fast adaptation of high grief was predicted by a pattern of high memory characteristics but low engagement with unhelpful coping strategies. Conclusions: The findings have implications for clinical practice and point to early cognitive predictors of adaptation patterns in grief. Findings are consistent with cognitive models highlighting the importance of characteristics of memory, negative appraisals, and unhelpful coping strategies in the adaptation to highly negative life events. The study identifies a number of modifiable cognitive predictors that are linked to grief severity and maintenance in the first months of loss. Targeting these cognitive predictors in the first 6 months of loss may prove helpful in facilitating grief adaptation.
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Shi G, Wen J, Xu X, Zhou N, Wang J, Shi Y, Liu H, Wang J, Stelzer EM. Culture-related grief beliefs of Chinese Shidu parents: Development and psychometric properties of a new scale. Eur J Psychotraumatol 2019; 10:1626075. [PMID: 31303970 PMCID: PMC6609346 DOI: 10.1080/20008198.2019.1626075] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/24/2019] [Accepted: 05/15/2019] [Indexed: 12/19/2022] Open
Abstract
Background: In China, parents whose only-child dies and who have no living or adopted child are called Shidu parents. Negative thinking is assumed to contribute to the development of emotional problems in bereavement. Because grief cognitions are likely influenced by the concepts of Chinese traditional culture (e.g., family continuation), Shidu parents may hold specific culture-related grief beliefs about themselves or the world, which, in turn, could impede their recovery. Objective: This study developed a questionnaire assessing the culture-related grief beliefs of Shidu parents and examined its psychometric properties. Methods: This newly developed questionnaire was administered to the combined sample of 313 Shidu parents. Exploratory (n = 164) and confirmatory factor analysis (n = 149) were conducted. Psychometric properties of the questionnaire were evaluated. Results: Exploratory factor analysis revealed three distinct factors (filial piety belief, destiny belief and perceived stigma), generating a nine-item culture-related grief beliefs of Shidu parents questionnaire (CBSQ). Confirmatory factor analysis verified the three-factor structure (χ2(24) = 39.103, p = 0.027, χ2/df = 1.630, CFI = .980, TLI = .970, RMSEA = .065, SRMR = .052). Internal consistency and temporal stability were adequate. Convergent, discriminant and concurrent validity were supported. Conclusions: This study highlights the importance of extending the concept of grief cognitions to include culture-specific beliefs, and provides a first measurement tool to assess culture-related grief beliefs after only-child loss, which can be used in future research with Shidu parents.
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Affiliation(s)
- Guangyuan Shi
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Jun Wen
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Xin Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Ningning Zhou
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Jiani Wang
- Department of Psychology, Queen’s University, Kingston, Canada
| | - Yuqing Shi
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
| | - Han Liu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
- Students Affairs Division, Shanxi University, Shanxi, P. R. China
| | - Jianping Wang
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (Beijing Normal University), Faculty of Psychology, Beijing Normal University, Beijing, P. R. China
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17
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Camacho D, Pérez-Nieto MÁ, Gordillo F. The role of rumination in the guilt associated with bereavement according to cause of death. Psychiatry Res 2018; 270:1053-1058. [PMID: 30196977 DOI: 10.1016/j.psychres.2018.04.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 02/05/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022]
Abstract
The purpose of this study was to analyse the role rumination plays in the relationship between cause of death and the guilt present during bereavement. The sample consisted of 90 people that had suffered a loss due to an expected or unexpected natural death, suicide or accident. The results suggest that rumination increases the levels of guilt felt by people that had suffered a loss due to suicide compared to those whose loss was due to an expected natural death. These findings contribute to a better understanding of the mechanisms with an influence on bereavement.
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Affiliation(s)
- Dulce Camacho
- Alaia Association. C/ Fernández de los Ríos, 87. 28015 Madrid, Spain.
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18
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Kokou-Kpolou K, Megalakaki O, Nieuviarts N. Persistent depressive and grief symptoms for up to 10 years following perinatal loss: Involvement of negative cognitions. J Affect Disord 2018; 241:360-366. [PMID: 30144719 DOI: 10.1016/j.jad.2018.08.063] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/08/2018] [Accepted: 08/12/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Perinatal loss is known to be associated with a heightened risk of mental health complications. However, the psychological mechanisms underlying the perinatal grief process are less well documented. We hypothesized that negative cognitions are associated with post-perinatal loss symptomatology, and vary according to whether the death occurs before or after birth. METHODS We adopted a cross-sectional design to assess demographics, variables related to the death, five types of negative cognitions (about the self, world, life, future, and self-blame), prolonged grief, and depressive symptoms. The sample included 98 perinatally bereaved mothers with a mean age of 33.9 years. RESULTS When we controlled for demographics and variables related to the death, hierarchical linear regression showed that maladaptive cognitions about life, the future and the world were associated with prolonged grief symptoms, whereas only maladaptive cognitions about the world were associated with depressive symptoms. Significant interaction effects confirmed that cognitions about the world were associated with increased depressive symptoms when the death occurred after the birth, and cognitions about life when it occurred before the birth. LIMITATIONS The cross-sectional design precluded causal conclusions. However, the sample size was relatively representative and limited to perinatally bereaved mothers. CONCLUSIONS Different negative cognitions are involved in persistent depressive versus grief symptoms following perinatal loss, and vary depending on the type of loss. These results will serve to enhance perinatal grief interventions.
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Affiliation(s)
| | - Olga Megalakaki
- Department of Psychology, Picardy Jules Verne University, Amiens, France
| | - Nicolas Nieuviarts
- Department of Psychology, Picardy Jules Verne University, Amiens, France
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Narrative Identity and Grief Reactions: A Prospective Study of Bereaved Partners. JOURNAL OF APPLIED RESEARCH IN MEMORY AND COGNITION 2018. [DOI: 10.1016/j.jarmac.2018.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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20
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Ionio C, Camisasca E, Milani L, Miragoli S, Di Blasio P. Facing Death in Adolescence: What Leads to Internalization and Externalization Problems? JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:367-373. [PMID: 32318162 PMCID: PMC7163872 DOI: 10.1007/s40653-017-0166-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this study was to test a model to better explain which factors are linked to the development of internalized and externalized problems in adolescents experiencing death through structural equation model. Internalizing problems were predicted by low self-esteem, high PTSD symptomatology and by being a female, whereas externalizing problems were predicted by low self-esteem, by the experience of the loss as central in their own life and by being a male. Our results pointed out the potential importance of controlling this factors in order to provide focused interventions for adolescents after the death of a significant one.
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Affiliation(s)
- Chiara Ionio
- CRIdee, Department of Psychology, Università Cattolica, Largo Gemelli, 1, 20123 Milano, Italy
| | | | - Luca Milani
- CRIdee, Department of Psychology, Università Cattolica, Largo Gemelli, 1, 20123 Milano, Italy
| | - Sarah Miragoli
- CRIdee, Department of Psychology, Università Cattolica, Largo Gemelli, 1, 20123 Milano, Italy
| | - Paola Di Blasio
- CRIdee, Department of Psychology, Università Cattolica, Largo Gemelli, 1, 20123 Milano, Italy
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21
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Trevino KM, Litz B, Papa A, Maciejewski PK, Lichtenthal W, Healy C, Prigerson HG. Bereavement Challenges and Their Relationship to Physical and Psychological Adjustment to Loss. J Palliat Med 2017; 21:479-488. [PMID: 29182478 DOI: 10.1089/jpm.2017.0386] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The psychosocial challenges confronted by bereaved survivors may contribute to poor bereavement adjustment. Measures of the challenges of bereavement are limited. This study is a preliminary examination of the factor structure of a new measure of bereavement challenges and their relationships to quality of life and mental illness in bereaved cancer caregivers. This measure was designed to identify intervention targets to reduce the likelihood of prolonged grief. METHODS Caregivers of advanced cancer patients were administered measures of bereavement challenges (Bereavement Challenges Scale, BCS), quality of life (Medical Outcomes Study Short Form-36), prolonged grief (PG-13), and mental disorders (Structured Clinical Interview for the DSM-IV). Principal component factor analyses identified the underlying factor structure of the BCS. We examined associations between the factors and caregiver quality of life, prolonged grief, and rates of mental disorders. RESULTS A factor analysis identified five factors: "Challenges with Connecting with Others," "Challenges with Change," "Challenges Imagining a Hopeful Future," "Challenges with Accepting the Loss," and "Challenges with Guilt." Greater endorsement of bereavement challenges was associated with worse quality of life, more severe symptoms of prolonged grief, and greater likelihood of meeting criteria for a mental disorder. CONCLUSIONS Assessing the challenges associated with bereavement is important to understanding barriers to bereaved individuals' adjustment. The five factors of the BCS point to potential targets for clinical intervention. Additional research on the BCS is needed, including validation in larger more diverse samples, and confirmation that reduction of these challenges is associated with less psychiatric morbidity and, specifically, symptoms of prolonged grief.
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Affiliation(s)
- Kelly M Trevino
- 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York
| | - Brett Litz
- 3 VA Boston Healthcare System , Jamaica Plain, Massachusetts.,4 Department of Psychiatry, Boston University Medical Center , Bosten, Massachusetts
| | - Anthony Papa
- 5 Department of Psychology, University of Nevada , Reno, Reno, Nevada
| | - Paul K Maciejewski
- 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,6 Department of Radiology, Weill Cornell Medicine , New York, New York
| | - Wendy Lichtenthal
- 7 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Charlotte Healy
- 8 Department of Professional Studies, Columbia University , New York, New York
| | - Holly G Prigerson
- 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York
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22
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A pilot study of virtual support for grief: Feasibility, acceptability, and preliminary outcomes. COMPUTERS IN HUMAN BEHAVIOR 2017. [DOI: 10.1016/j.chb.2017.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Skritskaya NA, Mauro C, Olonoff M, Qiu X, Duncan S, Wang Y, Duan N, Lebowitz B, Reynolds CF, Simon NM, Zisook S, Shear MK. Measuring Maladaptive Cognitions in Complicated Grief: Introducing the Typical Beliefs Questionnaire. Am J Geriatr Psychiatry 2017; 25:541-550. [PMID: 27793576 PMCID: PMC5357591 DOI: 10.1016/j.jagp.2016.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/09/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Maladaptive cognitions related to loss are thought to contribute to development of complicated grief and are crucial to address in treatment, but tools available to assess them are limited. This paper introduces the Typical Beliefs Questionnaire (TBQ), a 25-item self-report instrument to assess cognitions that interfere with adaptation to loss. DESIGN Study participants completed an assessment battery during their initial evaluation and again after completing treatment at 20 weeks. Test-retest reliability was assessed on a subsample of the participants who did not show change in complicated grief severity after the first 4 weeks of treatment. To examine latent structure of the TBQ, an exploratory factor analysis (EFA) was performed. SETTING Academic medical centers in Boston, New York, Pittsburgh, and San Diego from 2010-2014. PARTICIPANTS 394 bereaved adults who met criteria for complicated grief. MEASUREMENTS The TBQ along with assessments of complicated grief symptoms and related avoidance, depression symptoms, functional impairment, and perceived social support. RESULTS The TBQ exhibited good internal consistency (α = 0.82) and test-retest reliability (N = 105; intraclass correlation coefficient = 0.74). EFA indicated a five-factor structure: "Protesting the Death," "Negative Thoughts About the World," "Needing the Person," "Less Grief is Wrong" and "Grieving Too Much." The total score and all factors showed sensitivity to change with treatment. CONCLUSIONS This new tool allows a clinician to quickly and reliably ascertain presence of specific maladaptive cognitions related to complicated grief, and subsequently, to use the information to aid a diagnostic assessment, to structure the treatment, and to measure treatment outcomes.
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Affiliation(s)
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Xin Qiu
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Sarah Duncan
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Naihua Duan
- Division of Biostatistics, Department of Psychiatry, Columbia University, New York, NY
| | - Barry Lebowitz
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh School of Medicine and Department of Community and Behavioral Health Science, University of Pittsburgh Graduate School of Public Health, Western Psychiatry Institute and Clinic, Pittsburgh, PA
| | - Naomi M Simon
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Sidney Zisook
- Department of Psychiatry, University of California, San Diego, La Jolla, CA
| | - M Katherine Shear
- Columbia University School of Social Work, Columbia University, New York, NY; Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY
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24
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Camacho D, Pérez Nieto M, Gordillo F. Guilt and Bereavement: Effect of the Cause of Death, and Measuring Instruments. ACTA ACUST UNITED AC 2017. [DOI: 10.1177/1054137316686688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guilt is a common reaction in bereavement. Our aim is to explore the guilt in bereavement depending on the cause of death. The sample involved 73 participants who had lost a family member to a terminal illness, suicide, sudden illness, accident, or perinatal death. Guilt was measured using the items of self-blame and regret in the Tübingen Bereavement Symptoms Questionnaire, the SC-35, and the Bereavement Guilt Scale (BGS). The results reveal significant differences in suicide bereavement on the self-blame subscale compared with unexpected natural death. Further there are significant differences in suicide bereavement in the regret subscale compared with unexpected natural death, and in the BGS as regards both an expected and an unexpected natural death. There are no significant differences in guilt when it is measured through the SC-35. These data suggest that the measurement of guilt in bereavement calls for the use of specific scales for this context.
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Affiliation(s)
| | - M.A. Pérez Nieto
- Department of Psychology. Camilo José Cela University, Madrid, Spain
| | - Fernando Gordillo
- Department of Psychology. Camilo José Cela University, Madrid, Spain
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25
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Bryant RA, Kenny L, Joscelyne A, Rawson N, Maccallum F, Cahill C, Hopwood S. Predictors of treatment response for cognitive behaviour therapy for prolonged grief disorder. Eur J Psychotraumatol 2017; 8:1556551. [PMID: 30815235 PMCID: PMC6383610 DOI: 10.1080/20008198.2018.1556551] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 11/19/2018] [Accepted: 11/23/2018] [Indexed: 10/31/2022] Open
Abstract
Background: Prolonged grief disorder (PGD) causes significant impairment in approximately 7% of bereaved people. Although cognitive behaviour therapy (CBT) has been shown to effectively treat PGD, there is a need to identify predictors of treatment non-response. Methods: PGD patients (N = 80) were randomly allocated to receive 10 weekly two-hour group CBT sessions and (a) four individual sessions of exposure therapy or (b) CBT without exposure. PGD was assessed by self-report measures at baseline, post-treatment (N = 61), and six-months (N = 56) after treatment. Results: Post-treatment assessments indicated that greater reduction in grief severity relative to pretreatment levels was associated with being in the CBT/Exposure condition, and lower baseline levels of self-blame and avoidance. At follow-up, greater grief symptom reduction was associated with being in the CBT/Exposure condition and lower levels of avoidance. Conclusions: These patterns suggest that strategies that target excessive self-blame and avoidance during treatment may enhance response to grief-focused cognitive behaviour therapy.
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Affiliation(s)
- Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Lucy Kenny
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Amy Joscelyne
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Natasha Rawson
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Fiona Maccallum
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Catherine Cahill
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Sally Hopwood
- School of Psychology, University of New South Wales, Sydney, Australia
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Clark K, Willis A, Byfieldt N. An Observational Study to Explore the Feasibility of Assessing Bereaved Relatives' Experiences Before and After a Quality Improvement Project to Improve Care of Dying Medical Inpatients. Am J Hosp Palliat Care 2016; 34:263-268. [PMID: 26746878 DOI: 10.1177/1049909115625280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although hospitals are the most likely place of death, the quality of care received by dying inpatients remains variable. This is concerning for both the dying person and their relatives, with poorer bereavement outcomes likely for those who perceived their family member suffered unduly. There is a real need to consider how this situation can be improved. This work was conducted with the aim of exploring the feasibility of including bereaved relatives' experiences as part of a larger project exploring the use of a care bundle to improve care of the dying inpatients. Fifty relatives of inpatients who had died previously in hospital were contacted by letter with a request for interview before the implementation of a care bundle for the dying, with a care bundle being a collection of care processes that are implemented together. After this project had been in place for 6 months, a further 50 families were contacted who had died on the bundle. Ten families responded initially to the first request and 10 the second, with the interviews based on the Quality of Dying and Death (QODD) tool and a final open-ended question. Although all families who agree to be interviewed completed the session, with regard to the QODD, some families indicated that they would rather talk than provide numeric scores. No major differences in the prescores and postscores were noted. When invited to share their experiences, without prompting, families spoke of consistent concerns that included communication, place of death, and symptom control. This work confirms that it is highly feasible to incorporate assessments of bereaved family members' opinions as part of the wider assessment of research into end-of-life care.
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Affiliation(s)
- Katherine Clark
- 1 Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,2 The University of Newcastle, Newcastle, New South Wales, Australia
| | - Abby Willis
- 1 Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Naomi Byfieldt
- 1 Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
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Spuij M, Prinzie P, Boelen PA. Psychometric Properties of the Grief Cognitions Questionnaire for Children (GCQ-C). JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2016; 35:60-77. [PMID: 28286374 PMCID: PMC5323485 DOI: 10.1007/s10942-016-0236-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Negative thinking is seen as an important mediating factor in the development of prolonged grief disorder (PGD), a syndrome encompassing debilitating symptoms of grief. No measure of specific grief related cognitions is available yet. Based on an adult measure of negative thinking in adults we developed a questionnaire for children, the Grief Cognitions Questionnaire for Children (GCQ-C). This study investigated several psychometric properties of the GCQ-C. Both reliability and validity were investigated in this study, in which hundred fifty-one children and adolescents (aged 8-18 years) participated. Findings showed that items of the GCQ-C represented one underlying dimension. Furthermore, the internal consistency and temporal stability were found to be adequate. Third, the findings supported the concurrent validity (e.g., significant positive correlations with self-report indices of PGD, depression and posttraumatic stress disorder), convergent and divergent validity of the GCQ-C. This study provides further evidence for the importance of negative thinking in PGD in children and adolescents.
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Affiliation(s)
- Mariken Spuij
- Department of Child and Adolescent Studies, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands
| | - Peter Prinzie
- Department of Pedagogical Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul A. Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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Li J, Stroebe M, Chan CLW, Chow AYM. The Bereavement Guilt Scale. OMEGA-JOURNAL OF DEATH AND DYING 2015; 75:166-183. [DOI: 10.1177/0030222815612309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The rationale, development, and validation of the Bereavement Guilt Scale (BGS) are described in this article. The BGS was based on a theoretically developed, multidimensional conceptualization of guilt. Part 1 describes the generation of the item pool, derived from in-depth interviews, and review of the scientific literature. Part 2 details statistical analyses for further item selection (Sample 1, N = 273). Part 3 covers the psychometric properties of the emergent-BGS (Sample 2, N = 600, and Sample 3, N = 479). Confirmatory factor analysis indicated that a five-factor model fit the data best. Correlations of BGS scores with depression, anxiety, self-esteem, self-forgiveness, and mode of death were consistent with theoretical predictions, supporting the construct validity of the measure. The internal consistency and test–retest reliability were also supported. Thus, initial testing or examination suggests that the BGS is a valid tool to assess multiple components of bereavement guilt. Further psychometric testing across cultures is recommended.
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Affiliation(s)
- Jie Li
- Department of Psychology, Renmin University of China, China
| | - Magaret Stroebe
- Department of Clinical & Health Psychology, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Cecilia L. W. Chan
- Centre on Behavioral Health and Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong (SAR), China
| | - Amy Y. M. Chow
- Centre on Behavioral Health and Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong (SAR), China
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Kho Y, Kane RT, Priddis L, Hudson J. The Nature of Attachment Relationships and Grief Responses in Older Adults: An Attachment Path Model of Grief. PLoS One 2015; 10:e0133703. [PMID: 26462062 PMCID: PMC4603668 DOI: 10.1371/journal.pone.0133703] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 06/30/2015] [Indexed: 11/23/2022] Open
Abstract
Background Various researchers have theorized that bereaved adults who report non-secure attachment are at higher risk of pathological grief. Yet past findings on avoidant attachment representations and grief have yielded limited and contradictory outcomes. Little research has been conducted with older adults to identify the psychological processes that mediate between self-reported attachment representations and the patterns of grief. Objective To examine the impacts of avoidant attachment and anxious attachment dimensions on emotion and non-acceptance, in response to the loss of a conjugal partner, and the mediating effect of yearning thoughts. Design Men (N = 21) and women (N = 68) aged 60 years and above who had lost a partner within the last 12 to 72 months were invited to participate. Participants rated their levels of yearning thoughts about the deceased, emotions and non-acceptance on the Texas Revised Inventory of Grief (TRIG-Present), and their type and level of general romantic attachment on the Experiences In Close Relationship questionnaire (ECR). Results Structural equation modelling (SEM) indicated that individuals who reported higher levels of avoidant attachment reported less emotional responses and less non-acceptance. SEM also showed that individuals who reported higher levels of anxious attachment reported greater emotional responses and greater non-acceptance. SEM further indicated that these relationships were mediated by yearning thoughts. Conclusion People adopt different grief coping patterns according to their self-reported attachment representations, with the nature of their yearning thoughts influencing the process. Grief therapy may be organized according to individual differences in attachment representations.
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Affiliation(s)
- Yan Kho
- School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
| | - Robert T. Kane
- School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
- * E-mail:
| | - Lynn Priddis
- School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
| | - Josephine Hudson
- School of Psychology and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
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Maccallum F, Sawday S, Rinck M, Bryant RA. The push and pull of grief: Approach and avoidance in bereavement. J Behav Ther Exp Psychiatry 2015; 48:105-9. [PMID: 25797028 DOI: 10.1016/j.jbtep.2015.02.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 12/17/2014] [Accepted: 02/11/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Prolonged Grief (PG) is recognized as a post-bereavement syndrome that is associated with significant impairment. Although approach and avoidance tendencies have both been hypothesized to play key roles in maintaining PG symptoms, understanding of these relationships has been limited by a reliance on self-report methodology. This study applies an experimental paradigm to simultaneously investigate the relationship between PG severity and approach-avoidance behavioral tendencies. METHODS Fifty-five bereaved individuals with and without PG completed a behavioral measure of approach and avoidance responding in which they pulled or pushed a joystick in response to grief-related, positive, negative and neutral images that appeared on a computer screen. Concurrent visual feedback created the illusion that the images were either approaching or receding from the participant. Half of the participants also received a prime designed to activate their grief prior to the task. RESULTS Irrespective of prime condition, PG participants pulled grief-related images more quickly than they pushed them. This difference was not observed in response to non-grief related images. Non PG participants showed no difference in their reaction times to grief-stimuli. LIMITATIONS This study was undertaken in a nonclinical setting and the majority of participants had lost a loved one due to chronic illness. Future research with treatment-seeking populations and sudden loss will be needed to explore the generalizability of the findings. CONCLUSIONS The findings from this study provide preliminary evidence supporting models of PG that integrate approach and avoidance tendencies.
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Affiliation(s)
- Fiona Maccallum
- School of Psychology, University of New South Wales, Australia.
| | - Simon Sawday
- School of Psychology, University of New South Wales, Australia
| | - Mike Rinck
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
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Siddaway AP, Wood AM, Schulz J, Trickey D. Evaluation of the CHUMS Child Bereavement Group: A Pilot Study Examining Statistical and Clinical Change. DEATH STUDIES 2015; 39:99-110. [PMID: 25153045 DOI: 10.1080/07481187.2014.913085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This article describes the largest evaluation of a UK child bereavement service to date. Change was assessed using conventional statistical tests as well as clinical significance methodology. Consistent with the fact that the intervention was offered on a universal, preventative basis, bereaved young people experienced a statistically significant, small to medium-sized decrease in symptoms over time. This change was equivalent across child age and gender. Type of bereavement had a slight impact on change when rated by parents. Potential clinical implications are highlighted, and various limitations are discussed that we hope to address using an experimental design in future research.
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Affiliation(s)
- Andy P Siddaway
- a Behavioural Science Centre, Stirling Management School, University of Stirling , Stirling , Scotland
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Stroebe M, Stroebe W, van de Schoot R, Schut H, Abakoumkin G, Li J. Guilt in bereavement: the role of self-blame and regret in coping with loss. PLoS One 2014; 9:e96606. [PMID: 24819238 PMCID: PMC4018291 DOI: 10.1371/journal.pone.0096606] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/09/2014] [Indexed: 11/19/2022] Open
Abstract
Despite the apparent centrality of guilt in complicating reactions following bereavement, scientific investigation has been limited. Establishing the impact of specific components associated with guilt could enhance understanding. The aim of this study was to examine the relationships between two guilt-related manifestations, namely self-blame and regret, with grief and depression. A longitudinal investigation was conducted 4–7 months, 14 months and 2 years post-loss. Participants were bereaved spouses (30 widows; 30 widowers); their mean age was 53.05 years. Results showed that self-blame was associated with grief at the initial time-point and with its decline over time. Such associations were not found for depression. Initial levels of regret were neither associated with initial levels of grief and depression, nor were they related to the decline over time in either outcome variable. These results demonstrate the importance of examining guilt-related manifestations independently, over time, and with respect to both generic and grief-specific outcome variables. A main conclusion is that self-blame (but not regret) is a powerful determinant of grief-specific difficulties following the loss of a loved one. Implications for intervention are considered.
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Affiliation(s)
- Margaret Stroebe
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
- Department of Psychology, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Wolfgang Stroebe
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
- Department of Psychology, University of Groningen, Groningen, The Netherlands
| | - Rens van de Schoot
- Department of Methods and Statistics, Utrecht University, Utrecht, The Netherlands
- Optentia Research Program, Faculty of Humanities, North-West University, Mahikeng, South Africa
| | - Henk Schut
- Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Georgios Abakoumkin
- Department of Early Childhood Education, University of Thessaly, Volos, Greece
| | - Jie Li
- Department of Psychology, Renmin University of China, Beijing, China
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Wittouck C, Van Autreve S, Portzky G, van Heeringen K. A CBT-Based Psychoeducational Intervention for Suicide Survivors. CRISIS 2014; 35:193-201. [DOI: 10.1027/0227-5910/a000252] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Bereavement following suicide is associated with an increased vulnerability for depression, complicated grief, suicidal ideation, and suicide. There is, however, a paucity of studies of the effects of interventions in suicide survivors. Aims: This study therefore examined the effects of a cognitive behavioral therapy (CBT)-based psychoeducational intervention on depression, complicated grief, and suicide risk factors in suicide survivors. Method: In total, 83 suicide survivors were randomized to the intervention or the control condition in a cluster randomized controlled trial. Primary outcome measures included maladaptive grief reactions, depression, suicidal ideation, and hopelessness. Secondary outcome measures included grief-related cognitions and coping styles. Results: There was no significant effect of the intervention on the outcome measures. However, the intensity of symptoms of grief, depressive symptoms, and passive coping styles decreased significantly in the intervention group but not in the control group. Conclusion: The CBT-based psychoeducational intervention has no significant effect on the development of complicated grief reactions, depression, and suicide risk factors among suicide survivors. The intervention may, however, serve as supportive counseling for suicide survivors.
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Affiliation(s)
- Ciska Wittouck
- Institute for International Research on Criminal Policy, Department of Penal Law and Criminology, Ghent University, Belgium
| | - Sara Van Autreve
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University, Belgium
| | - Gwendolyn Portzky
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University, Belgium
| | - Kees van Heeringen
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University, Belgium
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The Relationship between Irrational Cognitions, Autobiographical Memory, Coping Strategies and Complicated Grief. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.sbspro.2014.03.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Li J, Stroebe M, Chan CLW, Chow AYM. Guilt in bereavement: a review and conceptual framework. DEATH STUDIES 2014; 38:165-71. [PMID: 24524544 DOI: 10.1080/07481187.2012.738770] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Thirty-four quantitative and 9 qualitative studies are reviewed to indicate current understanding of the nature and impact of guilt in bereavement. This overview suggests that guilt is especially prevalent among some vulnerable subgroups, and it is associated with maladaptive health outcomes. Being male, longer bereavement time, and good end-of life experience seem to be associated with less guilt feelings. However, definition ambiguity, measurement difficulties, and cultural insensitivity are evident in studies. Therefore, a multidimensional conceptualization of guilt and a structural model to guide future investigation of this phenomenon in the bereavement context is proposed.
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Affiliation(s)
- Jie Li
- a Department of Social Work and Social Administration , The University of Hong Kong , Hong Kong
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Maccallum F, Bryant RA. A Cognitive Attachment Model of prolonged grief: integrating attachments, memory, and identity. Clin Psychol Rev 2013; 33:713-27. [PMID: 23792468 DOI: 10.1016/j.cpr.2013.05.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 05/03/2013] [Accepted: 05/05/2013] [Indexed: 10/26/2022]
Abstract
Prolonged grief (PG), otherwise known as complicated grief, has attracted much attention in recent years as a potentially debilitating condition that affects approximately 10% of bereaved people. We propose a model of PG that integrates processes of attachment, self-identity, and autobiographical memory. The paper commences with a discussion of the PG construct and reviews current evidence regarding the distinctiveness of PG from other bereavement related-outcomes. We then review the evidence regarding the dysfunctional attachments, appraisals, and coping styles that people with PG display. Recent evidence pertaining to the patterns of autobiographical memory in PG is described in the context of the self-memory system. This system provides a unifying framework to understand the roles of personal memories, identity, attachments, and coping responses in PG. The proposed model places emphasis on how one's sense of identity influences yearning, memories of the deceased, appraisals, and coping strategies, to maintain a focus on the loss. The model is discussed in relation to existing models of PG. The potential for shaping treatment strategies to shift perceptions of the self is then outlined. Finally, we outline future directions to test propositions stemming from the model and enhance our understanding of the mechanisms underlying PG.
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Affiliation(s)
- Fiona Maccallum
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
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Abstract
PURPOSE OF REVIEW DSM-5 and ICD-11 have proposed new psychiatric diagnoses to describe persistent and severe grief reactions. These initiatives have sparked much controversy because of concerns that diagnosing grief responses may overpathologize normative distress following bereavement. This review outlines the evidence for diagnosing grief. RECENT FINDINGS Multiple studies indicate that, more than 6 months after bereavement, 10-15% of bereaved people experience marked impairment secondary to severe grief responses. This response is characterized by intense yearning for the deceased together with related symptoms, is noted across cultures and age groups, is distinct from depression and anxiety, and contributes to psychiatric morbidity, poor health behaviors, physical illnesses, and occupational and social dysfunction. Psychotherapeutic interventions targeted at the core symptoms of prolonged grief show promising results, in contrast to poor response to psychotherapy and pharmacological interventions targeted at depression. SUMMARY There is convergent evidence that introducing psychiatric diagnoses to identify bereaved people suffering prolonged severe grief responses addresses a major public health issue, is supported by convergent evidence, and has the potential to minimize inappropriate treatment as a result of misdiagnosis.
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Mancini AD, Prati G, Bonanno GA. Do Shattered Worldviews Lead to Complicated Grief? Prospective and Longitudinal Analyses. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2011. [DOI: 10.1521/jscp.2011.30.2.184] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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: 532] [Impact Index Per Article: 40.9] [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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Maccallum F, Bryant RA. Attentional bias in complicated grief. J Affect Disord 2010; 125:316-22. [PMID: 20483163 DOI: 10.1016/j.jad.2010.01.070] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2009] [Revised: 01/25/2010] [Accepted: 01/25/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND Complicated Grief (CG) is a debilitating potential consequence of bereavement. Despite the significant health costs associated with CG, relatively little is known about the cognitive processes associated with the condition. This study investigated information processing in CG. METHOD Twenty four individuals with CG and 25 bereaved individuals without CG completed a modified emotional Stroop task in which they were presented with death-related and neutral cue words. Half of the participants were also given instructions to suppress thoughts of their loved one's death while completing the task. RESULTS CG participants were slower to color name death-related words than No-CG participants, and were slower to color name death-related words than neutral words. This pattern of findings suggests an attentional bias towards loss-related events. CONCLUSIONS This study represents the first demonstration of an information bias within CG. Consistent with cognitive models of CG, it is possible that dysphoric mood and preoccupation with the loss are maintained by selectively attending to reminders of the loss.
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Lobb EA, Kristjanson LJ, Aoun SM, Monterosso L, Halkett GKB, Davies A. Predictors of complicated grief: a systematic review of empirical studies. DEATH STUDIES 2010; 34:673-698. [PMID: 24482845 DOI: 10.1080/07481187.2010.496686] [Citation(s) in RCA: 343] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
A systematic review of the literature on predictors of complicated grief (CG) was undertaken with the aim of clarifying the current knowledge and to inform future planning and work in CG following bereavement. Predictors of CG prior to the death include previous loss, exposure to trauma, a previous psychiatric history, attachment style, and the relationship to the deceased. Factors associated with the death include violent death, the quality of the caregiving or dying experience, close kinship relationship to the deceased, marital closeness and dependency, and lack of preparation for the death. Perceived social support played a key role after death, along with cognitive appraisals and high distress at the time of the death. Inconsistent definitions of CG and measurement tools were noted in the earlier studies reviewed. Limitations identified in the studies included use of cross-sectional designs, heterogeneous samples, high attrition, demographic differences between cases and controls, differences in length of time since death, and differences in types of death experienced. Notwithstanding these limitations, some consistent findings have emerged. Further research into conceptualizations of CG in terms of attachment theory and constructivist and cognitive-behavioral concepts of finding purpose and meaning after bereavement is warranted.
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Affiliation(s)
- Elizabeth A Lobb
- Cunningham Centre for Palliative Care, Calvary Health Care Sydney, Korgarah, New South Wales, Australia.
| | - Linda J Kristjanson
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Western Australia, Australia
| | - Samar M Aoun
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Western Australia, Australia
| | - Leanne Monterosso
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University of Technology, Western Australia, Australia
| | - Georgia K B Halkett
- WA Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, Western Australia, Australia
| | - Anna Davies
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Boelen PA, de Keijser J, van den Hout MA, van den Bout J. Factors associated with outcome of cognitive-behavioural therapy for complicated grief: A preliminary study. Clin Psychol Psychother 2010; 18:284-91. [DOI: 10.1002/cpp.720] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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van der Houwen K, Stroebe M, Stroebe W, Schut H, van den Bout J, Wijngaards-de Meij L. Risk factors for bereavement outcome: a multivariate approach. DEATH STUDIES 2010; 34:195-220. [PMID: 24479181 DOI: 10.1080/07481180903559196] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Bereavement increases the risk of ill health, but only a minority of bereaved suffers lasting health impairment. Because only this group is likely to profit from bereavement intervention, early identification is important. Previous research is limited, because of cross sectional designs, small numbers of risk factors, and use of a single measure of bereavement outcome. Our longitudinal study avoids these pitfalls by examining the impact of a large set of potential risk factors on grief depressive symptoms, emotional loneliness, and positive mood following recent bereavement (3 years maximum). Participants provided information 3 times over 6 months. A multivariate approach was chosen to avoid reporting spurious results due to confounding. As expected, risk factors were differentially related to different outcome measures. For example, being high in anxious attachment and having lost a partner were related to more intense feelings of emotional loneliness, whereas these variables did not predict any of the other outcome variables. By contrast, social support did not influence emotional loneliness but did predict grief depressive symptoms and positive mood. Implications of these findings are discussed.
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Affiliation(s)
- Karolijne van der Houwen
- Department of Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Margaret Stroebe
- Department of Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Wolfgang Stroebe
- Department of Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Henk Schut
- Department of Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Jan van den Bout
- Department of Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
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Boelen PA. A Sense of ‘unrealness’ about the death of a loved-one: An exploratory study of its role in emotional complications among bereaved individuals. APPLIED COGNITIVE PSYCHOLOGY 2010. [DOI: 10.1002/acp.1557] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Boelen PA. The centrality of a loss and its role in emotional problems among bereaved people. Behav Res Ther 2009; 47:616-22. [PMID: 19394589 DOI: 10.1016/j.brat.2009.03.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2008] [Revised: 02/23/2009] [Accepted: 03/18/2009] [Indexed: 10/21/2022]
Abstract
In literature on posttraumatic stress-disorder (PTSD) there is growing interest in the concept "centrality of event", referring to the degree to which the memory of a traumatic event is central to one's everyday inferences, life-story, and identity. Using self-reported data from 254 bereaved individuals, this study examined the centrality of the loss-event in emotional problems following loss. Findings showed that this centrality (a) varied as a function of kinship to the deceased but not other loss-related variables, (b) was correlated with complicated grief (CG), depression, PTSD, and with neuroticism and several cognitive-behavioural variables, and (c) remained correlated with CG but not depression and PTSD when controlling for the shared variance between these symptoms, neuroticism, and these cognitive-behavioural variables.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical and Health Psychology, Utrecht University, 3508 TC Utrecht, The Netherlands.
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Smith L, Kalus C, Russell P, Skinner TC. Exploring current service provision for Prolonged Grief Disorder and suggestions for future advances. ACTA ACUST UNITED AC 2009. [DOI: 10.1080/13576270802591251] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Boelen PA, Spuij M. Negative Cognitions in Loss-Related Emotional Distress in Adolescent Girls: A Preliminary Study. JOURNAL OF LOSS & TRAUMA 2008. [DOI: 10.1080/15325020802171292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Paul A. Boelen
- a Department of Clinical and Health Psychology , Utrecht University , Utrecht , the Netherlands
| | - Mariken Spuij
- b Department of Psychosocial Development in Context , Utrecht University , Utrecht , the Netherlands
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Minton ME, Barron CR. Spousal Bereavement Assessment: A Review of Bereavement-Specific Measures. J Gerontol Nurs 2008; 34:34-48. [DOI: 10.3928/00989134-20080801-08] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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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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