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

Bereavement during the COVID-19 Pandemic: Impact on Coping Strategies and Mental Health

The COVID-19 coronavirus has caused 5.4 million deaths worldwide, including over 800,000 deaths in the United States (as of December 2021). In addition to these staggering statistics, an even greater number of individuals have died from other causes during the COVID-19 pandemic. As a result, a large portion of the global population has faced bereavement during the COVID-19 pandemic and resulting quarantine. The often rapid and unexpected nature of COVID-19 deaths and the presence of pandemic-related stressors and living restrictions make it more difficult for individuals bereaved during the pandemic to implement effective strategies for coping with the loss compared to non-pandemic periods. Quarantine-related constraints (e.g., social distancing, availability of and access to resources) impede coping strategies that have been found to be adaptive after a loss, such as supportive (e.g., seeking emotional and instrumental support) and active (e.g., problem-focused and cognitive reframing) coping, and they augment avoidant strategies (e.g., substance use, denial, and isolation) that have been found to be maladaptive. Poorer mental health outcomes (including prolonged grief disorder; PGD) have been associated with less healthy coping. This article reviews research findings regarding bereavement during the COVID-19 pandemic, discusses the effects of pandemic-related stressors on bereavement coping strategies, and proposes how different types of coping during the pandemic may account for the poorer mental health outcomes described in recent reports. Interventions for promoting adaptive coping strategies and minimizing maladaptive coping strategies are also outlined.

Concurrent Treatment for PTSD and Prolonged Grief Disorder: Review of Outcomes for Exposure- and Nonexposure-Based Treatments

This review gives an overview of treatments used to concurrently reduce symptoms of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD). For purposes of this review, emphasis is placed on locating and comparing literature on exposure- and nonexposure-based treatments. Across 14 studies, the overall findings suggest that treatments are generally effective in treating PTSD and PGD concurrently and that treatments incorporating exposure-based components performed similarly to those without exposure-based components. However, methodological limitations preclude the ability to draw firm conclusions about the added impact of exposure-based components in traumatic grief treatment. Future directions for research on concurrent treatments for PTSD and PGD are discussed.

"It is not simply the loss of a child": The challenges facing parents who have lost their only child in post-reproductive age in China

The death of one's only child in post-reproductive age (in Chinese, shidu) is a traumatic event that has specific cultural implications in China. This study investigates the experience of a changed life and emerging challenges amongst Chinese shidu parents. Thematic analysis of 36 interviews revealed four main life consequences following shidu: impairment of psychological and physical health, weakening of social networks and interactions, loss of meaning in life, and lack of care and security. We suggest that health monitoring and mental health intervention, adequate social and community support, and improved social security are the critical needs in this vulnerable group.

Stressors experienced by the family members of brain-dead people during the process of organ donation: A qualitative study

More is known about organ donor recipients than donor families. We explored the stressors experienced by family members of brain-dead people during the process of organ donation. Seventeen family members and five organ procurers were interviewed and the data analyzed through conventional qualitative content analysis. Stressors experienced by family members fell into six themes-perceived threat of loss, decision making under conflict, painful corrosive farewell, feeling of insecurity, complexity of grief, and seeking relief. Findings highlight the necessity of developing and using standard protocols for supporting brain-dead people's family members throughout the process of organ donation and following bereavement.

A pilot randomised controlled trial of metacognitive therapy for prolonged grief

OBJECTIVES

Prolonged grief disorder is associated with significant distress and impairment and thus efforts to improve treatments are essential. The present pilot study tested the efficacy and feasibility of group Metacognitive Grief Therapy (MCGT) designed specifically for prolonged grief symptomatology to reduce the psychological distress and impaired function resulting from bereavement.

DESIGN/PARTICIPANTS

Twenty-two bereaved adult participants with prolonged grief symptomatology were randomised to a wait-list control (n=10) or an intervention condition (n=12) with a 3-month and 6-month follow-up. The wait-list control group was offered treatment after the post-test assessment.

INTERVENTION

Participants attended six group MCGT sessions that ran for 2 hours per week.

OUTCOME MEASURES

A primary outcome measure of prolonged grief symptomatology and secondary outcome measures of depression, anxiety, rumination, metacognitive beliefs and quality of life were taken pretreatment and post-treatment for both groups and at the 3-month and 6-month follow-up for the intervention group. A Generalised Linear Mixed Model was used to assess treatment efficacy.

RESULTS

Post-treatment intent-to-treat analyses showed MCGT reduced prolonged grief symptomatology (Cohen's d=1.7), depression (d=1.3), anxiety (d=0.8), stress (d=1.0), rumination (d=0.9) and increased quality of life (d=0.6), and these effects were maintained at the 3-month and 6-month follow-ups. No prepost between-group differences were found in metacognitive beliefs. However, a large significant effect was identified at the 3-month and 6-month follow-ups (d=1.0).

CONCLUSION

The results show promise for the utility of group MCGT for reducing psychological distress and promoting quality of life. Additionally, the results underscore the need for a full randomised controlled trial of group MCGT, which may be an important addition to the treatment armamentarium available to support people with prolonged grief.

TRIAL REGISTRATION NUMBER

ACTRN12613001270707; Results. ORIGINAL PROTOCOL: BMJ Open 2015;5:e007221. doi:10.1136/bmjopen-2014-007221.