The relation of continuing attachment to adjustment in conjugal bereavement

Still With Me? Assessing the Persisting Relationship to a Deceased Loved-One - Validation of the "Continuing Bonds Scale" in a German Population

Continuing the bond (CB) to a deceased loved one plays a clinically significant role in grief. We validated the Continuing Bonds Scale (CBS) examining externalized CB (illusions and hallucinations) versus internalized CB (use of the deceased as a secure base) in relation to risk factors of complicated grief and bereavement-related adjustment. Data from 364 bereaved German participants on CBS, Inventory of Complicated Grief (ICG), and Posttraumatic Personal Growth Inventory (PPGI) entered an exploratory factor analysis. This yielded a two-factor-solution representing externalized and internalized CB (KMO = .89, χ2 = 2100.5, df = 120). Both factors demonstrated high internal consistency (Cronbach's α = .87). ICG and PPGI highly correlated with externalized and internalized CB. Cause of death and feelings of responsibility were associated with externalized CB. In the future, the use of the CBS could help predict problems in grief processing and consequently implement early interventions.

Exploring an Extended Conception of Grief: Sense of Presence and Grief Reactions in German Widows

This study explores sense of presence (SOP) as an important feature of continuing bonds (CB) in the context of normal grief. A community sample of widows (N = 51) filled in a multidimensional grief questionnaire and a depression scale. A moderate positive association between sensing the deceased husband´s presence and cognitive and emotional impairments emerged. A positive relationship between SOP and guilt was found only if the influence of religiosity was controlled for statistically. There were no significant associations of SOP with long-lasting positive reactions to loss, such as personal growth and increase in sensitivity for others. Widows with clinically relevant depression indicated a stronger SOP than those with lower depression scores. These differentiated findings may stimulate the elaboration of an extended conception of grief beyond the focus on clinically relevant impairments.

"Giving voice to the voiceless": An exploration of the grieving ritual for a therapy dog

The use of animal-assisted therapy with children who have experienced trauma is receiving increasing attention in the literature. However, there is a lack of attention given to the death of therapy animals. The scholarship on the death of animal companions highlights a varying depth of acknowledgment of children's grief. This article draws on the clinical experience of one therapy center's approach to the death of a therapy dog. Knowledge gained from this experience highlighted the necessity of acknowledging the death, the need for clear communication with children and young people, and the importance of involving children in a memorial ritual.

How we continue bonds with deceased persons: The proximity-seeking behavior scale

Continuing bonds is a multifaceted process, encompassing perceptions, beliefs, illusions and hallucinations, and overt behaviors. We developed the Proximity-Seeking Behavior Scale (PSBS) to assess overt behavior to continue bonds with the deceased person. We had 694 bereaved adults complete an online survey. Exploratory and confirmatory factor analyses yielded a one-factor model for PSBS items. PSBS reliability was good. PSBS scores correlated positively with rumination and yearning, feeling connected to the deceased person, and prolonged grief and depression symptoms. The PSBS appears a reliable and valid instrument to assess proximity-seeking behaviors.

"Parenting Beyond the Veil": The Continued Parenting Relationship After a Child's Death Due to Cancer

Background: Childhood cancer is the leading cause of illness-related death, leaving thousands of parents to experience bereavement. This article presents select findings about the nature of the continued parenting relationship, which is an essential theme of the parental bereavement experience. Method: Heideggerian phenomenology provided the philosophical underpinnings of this study, which aimed to describe the lived experience of bereaved parents who experienced the death of a child due to cancer. Van Manen's (1997) method guided data collection and analysis. Six parents participated in interviews to share what it has been like for them since their child's death. The researcher wrote analytic memos, documented detailed field notes, and used a member checking process to ensure trustworthiness of findings. Results: A structure of the lived experience of parental bereavement emerged, which included the essential theme of the continued parenting relationship. The parenting relationship continues throughout a parent's lifetime in spite of the child's physical absence, albeit in a different manner. This different nature of parenting is known as parenting beyond the veil. Bereaved parents continue to parent beyond the veil by engaging in meaningful activities, seeking activities that strengthen a deep connection with the child, and being open to comforting signs that enhance their continued relationship. Discussion: Parents believe sharing their experience can help nurses and other professionals understand the importance of their continued parenting relationship and their need to parent beyond the veil so that they can provide high quality care to bereaved parents in the future.

A Literature Review: Pet Bereavement and Coping Mechanisms

The loss of a companion animal results in millions of pet owners grieving annually. To date, little information has been synthesized on the grief response and coping mechanisms of bereaved pet owners. The aim of this review was to examine the relationship between pet loss and owner grief response. Major themes included: factors that influence the grief response, the disenfranchised nature surrounding pet loss, ambiguous pet loss and coping mechanisms used. Across the 48 studies included in this review, bereaved pet owners frequently reported feelings of embarrassment and loneliness following the loss of their pet. Types of coping mechanisms used by bereaved pet owners were identified and included: isolation, social support, continuing bonds, memorialization, religion, and relationships with other animals. Overall, this review was able to identify a consensus among the literature that bereaved pet owners are likely to experience disenfranchisement surrounding their loss. Based on the present findings, suggestions for future research include a focus on the effectiveness of coping mechanisms used by bereaved pet owners.

Bereavement Outcomes for Atheist Individuals: The Role of Spirituality, Discrimination, and Meaning

The present study applied several concepts typically included in thanatology research to an atheist sample. Atheists are a growing segment of the population in the United States, though little is known about this group. A sample of 355 adults who self-identify as atheist completed an online survey assessing forms of spirituality, anti-atheist discrimination, and meaning reconstruction in order to examine associations between these variables and bereavement outcomes of complicated grief and psychological distress. Results of a multiple regression analysis suggested that spirituality was not related to bereavement outcomes, anti-atheist discrimination was related to poorer bereavement outcomes, while the relationship between meaning reconstruction and bereavement outcomes was mixed. These results provide a foundation for additional exploration of bereavement processes in atheist individuals, and implications for future research and practice are discussed.

Internalized versus externalized continuing bonds: Relations to grief, trauma, attachment, openness to experience, and posttraumatic growth

This research investigated the predictors of internalized versus externalized continuing bonds to examine whether internalized bonds are more associated with adaptive adjustment to bereavement than externalized. Four studies were conducted: two of romantic partner loss (n = 268 & 218), one of dog or cat loss (n = 199), and one of prenatal loss (n = 226). Participants completed questionnaires online. As predicted, the use of internalized continuing bonds was related to indicators of positive adaptation to grief (e.g. more secure attachment to deceased) while externalized was more strongly associated with indicators of clinical distress (e.g. greater trauma symptomatology).

Transitional objects of grief

BACKGROUND

Transitional objects provide security and symbolic connection with valued others when separated from them. Bereaved parents often keep, cherish and visit saved objects of their deceased child. This research examined the hypothesis that these objects behave as transitional objects of grief in bereaved mothers during three years following their infants' deaths from Sudden Infant Death Syndrome.

METHODS

Questionnaires were administered asking about the presence of kept objects and momentos from their deceased infant, and the frequency, location and emotions experienced during visits to them. Diagnostic criteria for Prolonged Grief Disorder (PGD) were assessed using the Parental Bereavement Questionnaire.

RESULTS

98.6% of the mothers reported having transitional objects of grief, and most visited them more frequently than once per week regardless of PGD status. Mothers with PGD reported significantly more distress when visiting the objects, especially those visiting them privately. Mothers with PGD who felt comforted by the objects had lower risk for finding life meaningless or finding discussion about the infant intolerable.

CONCLUSIONS

Transitional objects of grief are common and associated with key aspects of grief. There is a need to understand the potential therapeutic uses of transitional objects in promoting bereavement adjustment.

To grieve or not to grieve (online)? Interactions with deceased Facebook friends

Besides seeking social support, connecting with bereaved others, and maintaining relationships with the deceased, bereaved Facebook users may express their grief on Facebook to reduce their death anxiety. Notably, research has not yet explored the psychological outcomes of expressing grief on Facebook. This study undertook quantitative analysis of survey data from an initial community sample of 409 bereaved Facebook users (77.8% survey completion rate, n = 312; M_age = 34.46, SD = 12.38; 90% women) to ascertain whether expressions of grief on Facebook had negative psychological outcomes, and whether terror management theory (TMT) provided an appropriate lens for understanding Facebook grief expressions (FBGE). The aims of this study were three-fold: to clarify rates at which Facebook profiles of deceased users are deactivated, memorialized, unchanged, or managed; frequency and types of FBGE; and prevalence of/visitation to commemorative groups. Results-though insufficient to support TMT as an explanatory theoretical framework for FBGE-indicated that individuals who participated in FBGE reported higher anxiety and stress compared to bereaved individuals who did not express their grief on Facebook. Results provide a useful starting point for future research regarding online grieving behaviors and psychological wellbeing.

Implications for Reward Processing in Differential Responses to Loss: Impacts on Attachment Hierarchy Reorganization

When an attachment relationship is severed, so is homeostatic maintenance, leading to dysregulation of multiple physiological systems. Expanding upon Sbarra and Hazan's original model, we suggest that the degree to which an individual's physiological systems remain dysregulated depends on the state of one's attachment hierarchy-namely, whether an individual continues to seek a lost partner for support as their primary attachment figure. To recover from the loss of a romantic partner, an individual's attachment hierarchy must be reorganized. Our model proposes that an individual will go through a series of physiological changes before their attachment hierarchy is reorganized, which can either help or hinder their recovery. We consider the role of reward processing, including endogenous opioids, in this recovery process. Along the way, we identify mechanisms for continued dysregulation of biological systems among those who take longer to recover from a loss.

Self-Compassion, Social Constraints, and Psychosocial Outcomes in a Pet Bereavement Sample

This study investigated self-compassion in the context of grief following the death of a companion animal in a recently bereaved sample (N = 431). We addressed social contexts and individual differences focusing on how psychosocial outcomes vary as a function of social constraints, as well as individual differences in self-compassion and use of continuing bonds (CB). We observed that self-compassion related to the frequency of engagement in CB. Self-compassion also moderated relationships between grief severity and depression as well as social constraints and depression. We recommend future research on self-compassion training and psychosocial outcomes, especially for those experiencing social constraints or disenfranchised grief.

Bereavement hallucinations after the loss of a spouse: Associations with psychopathological measures, personality and coping style

Bereavement hallucinations (BHs) were assessed in 175 conjugally bereaved participants 4 years post loss, to explore whether BHs were: (a) associated with psychological distress and (b) predicted by sociodemographic variables, personality and/or coping style. Participants with BHs scored significantly higher than those without BHs on prolonged grief, post-traumatic stress, depression symptoms, and emotional loneliness. Hierarchical logistic regression analysis showed avoidant coping, openness to experience, and length of marriage to significantly predict BHs, while detached coping was negatively associated with BHs. This study suggests that BHs may be an indicator of psychological distress in bereavement.

Daily life and maternal mourning: A pilot study

This study aimed to understand, through the bias of everyday life, the phenomenon of maternal mourning. It is a qualitative pilot study on three bereaved mothers. Semi-structured interviews were used for data collection and content analysis was performed using typical categories of daily life. It was possible to observe significant changes in the mothers' daily lives after their children's deaths; however, they created strategies that minimized such impacts. Losing a child leads to reconstructing one's own history and identity. It is believed that daily life is an important bias, and thus its study could help us understand this phenomenon.

Lived experience of young widowed individuals: A qualitative study

Young widowhood is a unique experience that has received little in-depth attention in research and clinical settings. The present study examined the lived experiences of young men and women who had lost a spouse. Eleven men and women between the ages of 18 and 49 were interviewed about their experiences postloss using phenomenological methods. After coding the interviews, three themes emerged: (1) relationship prior to death, (2) coping, and (3) concerns. Clinical implications included the need for more accessible resources for young widowed individuals, such as therapeutic services, finances, and childcare.

Exploratory study of metacognitive beliefs about coping processes in prolonged grief symptomatology

Despite research examining the role of metacognitive beliefs about coping processes in maintaining psychological disorders, to date, no studies have explored their role in the maintenance of prolonged grief. Twelve semistructured interviews were conducted with bereavement specialists and bereaved people with elevated grief to identify metacognitive beliefs about coping processes relevant to prolonged grief. Analysis revealed several metacognitive beliefs potentially driving maladaptive coping processes used by people with prolonged grief symptomatology. Findings may underpin the development of interventions that aim to modify unhelpful metacognitive beliefs that perpetuate maladaptive coping processes.

Predictors of Continuing Bonds Among Bereaved Adolescents

This study examined the relationship between continuing bonds (CBs) among 50 bereaved youth (ages 11–17) and their bereaved adult caregivers, and predictors of CBs among youth. Results indicated there was not a significant relationship between caregiver CB and youth CB. However, significant relationships were found between youth bereavement symptomatology, their relationship to the deceased, and youth CB. Specifically, youth with higher levels of symptomatology and those who lost an immediate family member were more likely to maintain CBs. Results suggest the need for practitioners to incorporate grief symptomatology and CBs in assessment and intervention with bereaved youth.

Posttraumatic Growth Following the Loss of a Pet

The current study examined Posttraumatic Growth (PTG) experienced by bereaved pet owners in the United States, French-Canada, Japan, and Hong Kong following the death of their pet. Using qualitative methodology, we analyzed responses of participants who answered "yes" to a question about experiencing PTG and explored to what extent the cross-cultural responses mapped onto the five factors of the Posttraumatic Growth Inventory (PTGI). For the U.S. sample, 58% of responses mapped onto the PTGI. For French-Canada, 72% of responses mapped onto the PTGI. For Japan, 50% of responses mapped onto the PTGI and for Hong Kong, 39% of responses mapped onto the PTGI. We also explored emergent categories related to PTG for individuals who have lost a pet and discerned the unique aspects for PTG across cultures.

A Model of Transcorporeal Communication: Communication Toward/With/to the Deceased

Research indicates that people maintain a connection with deceased loved ones, which can be healthy for the bereaved individuals. To maintain these bonds, people readily admit to communicating with the deceased. Although communication with the deceased shares similarities with traditional models of interpersonal communication, it is distinctly different. Interviews with 20 individuals revealed support for a model of transcorporeal communication, communication to people who do not maintain a physical presence. This communication includes the components of sender, inner representation of the deceased as receiver, message, feedback based on what the sender believes the deceased would say, and a metaphysical element. Implications of transcorporeal communication for griefwork are also discussed.

Posttraumatic Growth Following the Loss of a Pet

The current study examined posttraumatic growth (PTG) experienced by bereaved pet owners following the death of their pet. Using qualitative methodology, we analyzed responses of 308 participants who answered yes to a question about experiencing PTG. Within the five factors model of PTG, the most endorsed included the following: Relating to Others ( n = 76), Appreciation of Life ( n = 52), Personal Strength ( n = 51), Spiritual Change ( n = 32), and New Possibilities ( n = 29). Other themes not captured by the PTG included as follows: relating to animals ( n = 70), continuing bonds ( n = 53), attachment relationship ( n = 44), and unconditional love ( n = 13). Our findings support the notion that PTG occurs for people who have experienced pet loss, with new emergent themes.

Complicated Grief and the Quest for Meaning: A Constructivist Contribution

One of the more important results of the upwelling of research on bereavement in recent decades has been the development of criteria for complicated grief, a disorder whose coherence, correlates and consequences have been subjected to increasing scrutiny. In this article I argue that clinical, conceptual, and evidence-based considerations converge to support the further refinement of such criteria, with a special emphasis on their connection to the protracted and painful quest for meaning that characterizes a subset of the bereaved. As further research supports and extends these current efforts, there is reason to believe that an understanding of complicated grief can make a significant contribution to research, theory, and practice concerning adaptation in the wake of loss.

The push and pull of grief: Approach and avoidance in bereavement

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.

Attachment, continuing bonds, and complicated grief following violent loss: testing a moderated model

There is increasing consensus that mourners' general attachment security and ongoing sense of connectedness to the deceased figure prominently in adjustment to bereavement. However, the interplay between these variables has not been investigated thoroughly. We therefore studied 195 young adults who were bereaved by violent causes (homicide, suicide, and fatal accidents) in the previous 2 years, measuring their attachment-related insecurities (anxiety and avoidance), their specific ongoing attachment or "continuing bond" (CB) to the deceased, and their complicated grief (CG) symptomatology over the loss of this relationship. Analyses indicated that CBs were concurrently linked with greater CG symptomatology. However, other results also suggested that attachment could moderate the adaptiveness of maintaining a sense of connection to the deceased loved one. Specifically, CBs were less predictive of CG symptomatology for individuals with high anxiety and low avoidance, and most predictive of intense grieving for bereaved people whose attachment styles were more highly avoidant and minimally anxious. These findings suggest the relevance of evaluating the appropriateness of clinical techniques that emphasize or deemphasize the CB for mourners who differ in their styles of attachment. Such studies could potentially promote a better match of interventions to clients whose styles of coping are congruent with these procedures.

Internalized and externalized continuing bonds in bereaved parents: their relationship with grief intensity and personal growth

Continuing bonds (CBs) expression appears especially prevalent among bereaved parents. This study examined the relationship between CBs and grief outcomes for this population. A customized CB scale for use with bereaved parents was derived from the literature. Three hundred fifty-four participants (10 male) recruited from online support groups completed an internet questionnaire. A 3-factor dimensional structure of CB (internalized, externalized, and transference) was supported. Structural equation modeling showed clear links between internalized bonds and a more positive grief status; externalized bonds showing an opposite relationship. Weaker effects were found for child's age, time since death, and type of death.

Online Survey as Empathic Bridging for the Disenfranchised Grief of Pet Loss

The current cross-cultural study investigated grief reactions of bereaved individuals following the death of a pet. We used qualitative methodology to compare, analyze, and report responses of U.S. and French Canadian participants to the last open-ended question on our online pet loss survey. We explored the degree to which our data illustrated pet loss as disenfranchised grief and asked whether there are differences and commonalities in the expression of grief between the two samples. Four major themes emerged: lack of validation and support; intensity of loss; nature of the human pet relationship; and continuing bonds. Findings confirm that, for both the U.S. and French Canadian participants, pet loss is often disenfranchised grief and there are ways to facilitate expressions of grief. Many participants wrote that the survey was therapeutic. Our survey allowed participants to express their grief in an anonymous, safe way by serving as empathic bridging and a willingness to help others.

Network analysis of persistent complex bereavement disorder in conjugally bereaved adults

Persistent complex bereavement disorder (PCBD) is a bereavement-specific syndrome characterized by prolonged and impairing grief. Most research on this syndrome rests on the traditional latent variable model, whereby symptoms reflect an underlying entity. The network (or causal system) approach offers an alternative framework for understanding PCBD that does not suffer from limitations inherent in the latent entity approach. The network approach to psychopathology conceptualizes the relation between symptoms and disorder as mereological, not reflective. That is, symptoms do not reflect an inferred, unobservable category or dimension, but rather are themselves constitutive of the disorder. Accordingly, we propose that PCBD constitutes a causal system of mutually reinforcing symptoms that arise following the death of a loved one and settle into a pathological equilibrium. In this study, we used data from the Changing Lives of Older Couples database to identify symptoms central to PCBD, to distinguish the PCBD network from an overlapping but distinct network of depression symptoms, and to examine how previously identified risk factors may contribute to the maintenance or development of PCBD. Together, these findings provide an important first step toward understanding the nature and etiology of the PCBD network.

Remarriage of war and terror widows: a triadic relationship

The article focuses on the intimate relationships of remarried Israeli national widows. An analysis of interviews with 15 widows and 12 of their husbands demonstrated the widows' continuing connection to the deceased husband and thus gives further corroboration to the theory of "'continuing bonds'"; husbands also express their relationship as triadic, with the fallen husband assigned a unique position in the family constellation, albeit not threatening to the new husband. The article concludes with specific guidelines for planning therapeutic programs, e.g., recommending clients to use some symbolic objects, either abstract or concrete, to help widows rebuild their self-identity.

Let me hear of your mercy in the mourning: forgiveness, grief, and continuing bonds

Clarity about the utility of continuing bonds (CB) continues to be evasive in the research. In 2 different correlational studies, the authors explored the relationship between CB and 2 other variables: 1 representing mental health (forgiveness of the deceased) and the other representing psychological distress (prolonged grief). Although researchers have addressed the latter relationship in the literature, assessing the relationship between CB and forgiveness has not been undertaken. Results suggest that forgiveness in general, and affective aspects of forgiveness in particular, predict psychological forms of CB. Results related to grief depended on how CB was assessed. These findings provide evidence of the relative health of certain types of relationship with deceased persons and also suggest that forgiveness interventions may be a way of promoting such healthy bonds.

The role of continuing bonds in coping with grief: overview and future directions

The existing empirical literature depicts a complex picture of the role that continuing bonds play in coping with bereavement, with contradictory findings emerging across studies. This article presents an overview of continuing bonds research and highlights several areas ripe for exploration. First, definitional issues are identified. Second, three paths for clarification are presented: the bereaved's perception of the bond as positive or negative, the quality of the predeath relationship, and the bereaved's afterlife beliefs. Through refining the definition and exploring these potential avenues of research, we hope to clarify the roles that continuing bonds may play in coping with bereavement.

Type of continuing bonds expression and its comforting versus distressing nature: implications for adjustment among bereaved mothers

This study investigated type of continuing bonds (CB) expression and its comforting versus distressing nature in relation to psychosocial adjustment among bereaved mothers. Twenty-eight mothers whose child had died within the previous five years participated in a CB interview in which they rated the extent they used each of 11 different types of CB expression during the past month and the degree to which they experienced each of the CB expressions as comforting and distressing. CB expressions involving illusions and hallucinations of the deceased child were predictive of greater distress whereas those involving belief that the deceased child was aware of the mother or communicating with her through dreams were not associated with symptoms, but instead linked to greater spirituality. Furthermore, mothers who reported CB as more comforting than distressing had lower symptom ratings. The implications of the findings for the attachment theory perspective on unresolved loss are discussed.

Death-related versus fond memories of a deceased attachment figure: examining emotional arousal

Grieving is infused by memories and emotions. In this study, bereaved participants recalled either death-related or fond memories of their loved ones. Their emotional arousal was examined via physiologic and voice analytic measures. Both death-related and fond memories generated an acoustic profile indicative of sadness (reflected by voice quality related parameters). Death-related memories, moreover, lead to bodily tension reflected by increased diastolic blood pressure levels and mean fundamental frequency of the voice signal. Consistent with the continuing bond and attachment perspectives, "death," a reminder of the irrevocability of the loss, induced distress/anxiety. In contrast, fond memories lead to more moderate, melancholic sadness, presumably because of their association with the soothing qualities of the attachment figure.

A Cognitive Attachment Model of prolonged grief: integrating attachments, memory, and identity

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.

Continuing bonds, attachment style, and adjustment in the conjugal bereavement among Hong Kong Chinese

The present study examined the effects of attachment style and continuing bonds, defined as the extent to which a bereaved individual feels that the deceased remains a part of his/her life, on postbereavement adjustment among 71 conjugally bereaved individuals. It was shown that bereaved individuals with an anxious attachment style tended to show more externalized continuing bonds as well as more grief symptoms. An anxious attachment style played a direct and significant role in postbereavement adjustment over and above the contribution of externalized continuing bonds. Interventions to facilitate restoration tasks and to reduce externalized continuing bonds would be discussed.

Continuing bonds after suicide bereavement in childhood

It has been argued that the grieving process after suicide bereavement has unique properties (e.g.,J. R.Jordan, 2001). A qualitative study was conducted to explore one aspect of the grieving process--continuing bonds--after suicide bereavement in childhood. Data were collected through semi-structured interviews with 10 suicide-bereaved children and analyzed using Interpretative Phenomenological Analysis (Smith & Osborn, 2003). Three themes are discussed: thinking about the deceased, coping strategies, and ongoing connections to the deceased. The findings highlight potentially unique qualities of continuing bonds after childhood suicide bereavement and factors that might influence their adaptiveness. Theoretical and clinical implications are outlined.

Therapeutic Implications of Continuing Bonds Expressions following the Death of a Pet

Through the exploration of 12 continuing bonds expressions (CBE), this current study investigated the grief reaction and continuing impact of the death of a pet. Thirty-three individuals were interviewed to determine the degree of connection maintained with the deceased pet and how that affects their coping. Findings emphasize that the majority of respondents frequently maintain ongoing meaningful ties with their deceased pet through the use of CBE such as fond memories, rituals, dreams. The findings suggest that it is not the number of CBE but the degree of adaptability that is significant. The importance of recognizing the unique, total experience of those grieving the death of a pet is addressed. Implications for those working with and supporting those in grief are included. Future directions for research are described.

The Continued Lived Experience of the Unexpected Death of a Child

The purpose of this qualitative study was to further examine the lived experiences of families that faced the sudden loss of a child. Six mothers that had previously participated approximately 9 years ago in the study entitled “The Lived Experience of the Unexpected Death of a Child” were interviewed. All of the mothers were Caucasian and had achieved a high school or greater level of education. Taped interviews and field notes were transcribed for data display. Together, two raters completed data reduction and coding for theme identification and categorization. Six themes were revealed that described helpful coping behaviors used by the mothers: positive beliefs, faith beliefs, everlasting love, pleasant remembrances, social engagement, and staying connected. Two themes, avoidance and rumination, described the behaviors that did not help the mothers cope with their loss. Finally, answers to the questions regarding acceptance and healing time were also revealed.

Comparison of continuing bonds reported by parents and siblings after a child's death from cancer

Few studies have distinguished similarities and differences between continuing bonds as they appear in various bereaved populations, particularly parent versus sibling cohorts following a child's death. This mixed-method study compared how parents and siblings experienced continuing bonds in 40 families who lost a child to cancer. Thirty-six mothers, 24 fathers, and 39 siblings were recruited 3-12 months post-loss (M = 10.7, SD = 3.5). Nearly all participants (97%) reported engaging in purposeful bonds with deceased children, while only 14% reported nonpurposeful connections. Over half of participants (58%) experienced comforting effects from reminders of the deceased child, whereas only 10% of family members experienced discomforting effects. Mothers communicated with the deceased, thought about the deceased, and did things that the deceased child would have liked more often than siblings. Mothers also reported significantly more comforting effects than siblings. Additional research is needed to further delineate continuing bonds for different types of loss and examine associations with positive and negative outcomes for bereaved individuals.

The Relationship between Grief Adjustment and Continuing Bonds for Parents Who Have Lost a Child

This article presents findings from a study on the impact of a child's death on parents. We explored the prominence and adaptiveness of parents' continuing bonds expressions, psychological adjustment, and grief reactions. A qualitative case study methodology was used to describe six cases. Participants were classified into two groups based on scores on the Inventory of Complicated Grief. Commonalities in themes on the Continuing Bonds Interview and projective drawings were assessed. Those in the Non-Complicated Grief Group reported internalization of positive qualities and identification with the deceased child as a role model, whereas participants in the Complicated Grief Group did not report these experiences. In addition, the drawings of those in the Non-Complicated Grief Group were evaluated as more adaptive than those in the Complicated Grief Group.

Reconstructing Meaning Through Occupation After the Death of a Family Member: Accommodation, Assimilation, and Continuing Bonds

Reactions to death have been studied extensively from psychological, behavioral, and physiological perspectives. Occupational adaptation to loss has received scant attention. Qualitative research was undertaken to identify and describe occupational responses in bereavement. The constant comparative approach was used to analyze and interpret the occupational responses. Adaptive strategies of occupational accommodation and assimilation were used after the death of a family member. Desire to sustain bonds with the deceased motivated specific occupational engagements. These occupational responses served to reconstruct meaning after the death of a family member. These findings contribute to understanding adaptation after death by adding an occupational perspective to previous theories. Occupational therapists’ abilities to support clients after loss can be enhanced through appreciation of occupational accommodation and assimilation and the role of continuing occupational bonds after the death of a loved one.

Continuing bonds, risk factors for complicated grief, and adjustment to bereavement

This study examined type of continuing bonds (CB) expression in relation to risk factors for complicated grief and measures of bereavement-related adjustment. Externalized CB expressions involving illusions and hallucinations with the deceased were distinguished from internalized CB expressions involving use of the deceased as an autonomy promoting secure base. 502 bereaved participants completed over the internet a CB measure assessing externalized and internalized CB along with various known risk-factor measures that included cause of death (i.e., violent vs. non-violent death), responsibility for the death, and attachment style as well as measures of psychological adjustment that included complicated grief symptoms, perceived physical health, and personal growth. As predicted, externalized CB was positively associated with violent death and responsibility for the death, whereas internalized CB was negatively associated with these risk factors as well as uniquely positively linked to personal growth. The implications of the findings for the role of CB in adjustment are discussed.

Influences of religion and culture on continuing bonds in a sample of British Muslims of Pakistani origin

This study considered the nature of continuing bonds with deceased relatives in a sample of Pakistani Muslims living in the United Kingdom. Ten participants were interviewed following a cultural psychology approach and transcripts were analyzed using grounded theory methodology. Dreaming, talking with others about the deceased, following the deceased's example, keeping memories and mementos, and doing actions thought to help the deceased were forms of continued relationship found. These were intertwined with the process of grieving and were influenced by the family, culture, and religion. Religion was a strong influence on the prominence given by participants to finishing well and on the notion of doing actions thought to help the deceased. Cultural mores, such as the community, and collectivist ethos and the expectation that emotion would be expressed around the time of death, were found to be supportive for some but sources of tension for other participants. Expressing a continuing bond through following the deceased's example so as to make them proud or happy seemed to be reinforced by cultural roots in respect for elders. Participants gave instances of tensions in areas such as expression of emotion and communality versus individualism that arose as a result of their position between two cultural frameworks, some illustrating how assimilation into the host culture set up conflict with the expected norms of their family/ancestral culture. The study highlights how understanding different cultural and religious influences may enrich the concept of continuing bonds.

Sibling bereavement and continuing bonds

Historically, from a Freudian and medical model perspective, emotional disengagement from the deceased was seen as essential to the successful adaptation of bereavement. A major shift in the bereavement literature has occurred and it is now generally accepted that despite the permanence of physical separation, the bereaved remains involved and connected to the deceased and can be emotionally sustained through continuing bonds. The majority of literature has focused on adults and on the nature of continuing bonds following the death of a spouse. In this article, the authors demonstrate how the continuing bonds concept applies to the sibling relationship. We describe the unique continued relationship formed by bereaved children and adolescents following a sibling loss, highlight the factors that influence the siblings continuing bonds expressions, and offer clinical interventions. In our view, mental health professionals can play an important role in helping parents encourage activities that may facilitate the creation and maintenance of continuing bonds in their children.

Continuing relationships with the deceased: disentangling bonds and grief

Some studies of the relationship between continuing bonds and grief intensity have claimed that continuing bonds lead to poor adaptation to bereavement. However, operationalizations of continuing bonds and grief intensity appear to overlap conceptually. Thus, it is still unclear what character the connection between continuing bonds and grief bears and how strong the relationship is. Three studies are reported, 2 of which examine the perception of conceptual overlap between continuing bonds and grief intensity, and 1 that examines whether reducing this perceived conceptual overlap affects the association between continuing bonds and grief intensity. In the first 2 studies, extent of perception of conceptual overlap was established, and subscales for the bonds and grief measures were derived that could be considered less overlapping. In the third study, relationships between bonds, grief, and well-being were calculated for the original scales and those reduced on the basis of deleted perceived overlap. When conceptual overlap was reduced, the relationship between grief and continuing bonds was slightly lower but not significantly so, as happened to the relationship between bonds and well-being. By contrast, the link between grief intensity and well-being did not diminish after deleting the overlapping items. These patterns suggest that future research should continue to explore whether the association between continuing bonds and grief intensity is due to conceptual overlap.

Continuing bonds in adaptation to bereavement: introduction

The role of the continuing bond to the deceased in adjustment to bereavement has been given considerable attention in the bereavement literature. It is increasingly recognized that it is a normative part of adjustment to the loss of a loved one and that it can be adaptive. It may be the case however that a continuing bond to the deceased may also be maladaptive under certain conditions. In this special topic series of articles, the implications of a continuing bond for adjustment to bereavement is addressed. Conceptually and empirically focused papers as well as clinically oriented papers on the continuing bond to the deceased have been included in order to provide the reader with a broad sampling of contemporary work in this area. The aim is to inspire further thinking and research on this topic as well as to promote greater awareness among grief counselors and practitioners on the importance of the continuing bond to the deceased in working with the bereaved.