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Gouveia A. On the concept, taxonomy, and transculturality of disordered grief. Front Psychol 2024; 14:1165421. [PMID: 38374931 PMCID: PMC10875014 DOI: 10.3389/fpsyg.2023.1165421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 12/18/2023] [Indexed: 02/21/2024] Open
Abstract
The enduring question of whether grief can ever be pathological (and, if so, when) has been shrouding mental health and psychiatric care over the last few years. While this discussion extends beyond the confines of psychiatry to encompass contributions from diverse disciplines such as Anthropology, Sociology, and Philosophy, scrutiny has been mainly directed toward psychiatry for its purported inclination to pathologize grief-an unavoidable facet of the human experience. This critique has gained particular salience considering the formal inclusion of prolonged grief disorder (PGD) in the 11th edition of the International Classification of Diseases (ICD-11) and the subsequent Text Revision 5th Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This study contends that the inclusion of prolonged grief disorder as a diagnostic entity may be excessively rooted in Western cultural perspectives and empirical data, neglecting the nuanced variations in the expression and interpretation of grief across different cultural contexts. The formalization of this disorder not only raises questions about its universality and validity but also poses challenges to transcultural psychiatry, due to poor representation in empirical research and increased risk of misdiagnosis. Additionally, it exacerbates the ongoing concerns related to normativism and the lack of genuine cultural relativism within the DSM. Furthermore, the passionate discussion surrounding the existence, or not, of disordered forms of grief may actually impede effective care for individuals genuinely grappling with pathological forms of grief. In light of these considerations, this study proposes that prolonged grief disorder should be approached as a diagnostic category with potential Western cultural bias until comprehensive cross-cultural studies, conducted in diverse settings, can either substantiate or refute its broader applicability. This recalibration is imperative for advancing a more inclusive and culturally sensitive understanding of grief within the field of psychiatry.
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Affiliation(s)
- Afonso Gouveia
- Psychiatry Service, Department of Mental Health, Local Health Unit of Baixo Alentejo, Beja, Portugal
- CHRC, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
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Den Elzen K, Breen LJ, Neimeyer RA. Rewriting grief following bereavement and non-death loss: a pilot writing-for-wellbeing study. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2023. [DOI: 10.1080/03069885.2022.2160967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Katrin Den Elzen
- School of Media, Creative Arts and Social Inquiry (MCSI), Curtin University, Perth, Australia
| | - Lauren J. Breen
- Curtin School of Population Health and Curtin enAble Institute, Curtin University, Perth, Australia
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González D, Cantillo J, Pérez I, Farré M, Feilding A, Obiols JE, Bouso JC. Therapeutic potential of ayahuasca in grief: a prospective, observational study. Psychopharmacology (Berl) 2020; 237:1171-1182. [PMID: 31938878 PMCID: PMC7113212 DOI: 10.1007/s00213-019-05446-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/27/2019] [Indexed: 12/22/2022]
Abstract
RATIONALE Recent studies have assessed the therapeutic potential of ayahuasca for the treatment of depression with promising preliminary results. OBJECTIVES Here, we examine the course of grief over 1 year of follow-up in a bereaved sample that attended a center in Peru to participate in indigenous Shipibo ayahuasca ceremonies. We also explore the roles of experiential avoidance and decentering as mechanisms of change. METHODS Bereaved participants who attended the ayahuasca center responded to an online survey that included the Texas Revised Inventory of Grief, Symptom Assessment-45, WHO Quality of Life-Bref, Acceptance and Action Questionnaire, and Decentering. Baseline assessment was completed by 50 individuals (T0). Of these, 39 completed the post-assessment at 15 days (T1), 31 at 3 months (T2), 29 at 6 months (T3), and 27 at 12 months (T4) after leaving the retreat. Pearson's analysis was performed to examine the relationship between the severity of grief and mechanisms of change during the period of T0 and T1. RESULTS A significant decrease in Texas Revised Inventory was observed at all time points (T1: Cohen's d = 0.84; T2: Cohen's d = 1.38; T3: Cohen's d = 1.16; T4: Cohen's d = 1.39). We found a relationship between experiential avoidance (r = 0.55; p < .01), decentering (r = - 0.47; p < .01), and a reduction in the severity of grief. CONCLUSIONS Our results suggest that the ceremonial use of ayahuasca has therapeutic value by reducing the severity of grief. Acceptance and decentering are both psychological processes that mediate the improvement of grief symptoms.
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Affiliation(s)
- Débora González
- International Center for Ethnobotanical Education, Research and Services (ICEERS), Carrer de Sepúlveda, 65, Office 2, 08015, Barcelona, Spain.
- PHI Asociation, Passeig del Calvell 35-37, 08005, Barcelona, Spain.
| | - Jordi Cantillo
- International Center for Ethnobotanical Education, Research and Services (ICEERS), Carrer de Sepúlveda, 65, Office 2, 08015, Barcelona, Spain
- PHI Asociation, Passeig del Calvell 35-37, 08005, Barcelona, Spain
| | - Irene Pérez
- International Center for Ethnobotanical Education, Research and Services (ICEERS), Carrer de Sepúlveda, 65, Office 2, 08015, Barcelona, Spain
| | - Magí Farré
- Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol and Institut de Recerca Germans Trias i Pujol (IGTP), Ctra. de Can Ruti s/n, 08916, Badalona, Spain
- Department of Pharmacology, Therapeutics and Toxicoloy, Universitat, Autònoma de Barcelona, Avinguda de Can Doménech, 08193, Cerdanyola del Vallés, Spain
| | | | - Jordi E Obiols
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Bellaterra Campus, Building B, Office B5/016b, 08193, Cerdanyola del Vallés, Spain
| | - José Carlos Bouso
- International Center for Ethnobotanical Education, Research and Services (ICEERS), Carrer de Sepúlveda, 65, Office 2, 08015, Barcelona, Spain
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Milman E, Neimeyer RA, Fitzpatrick M, MacKinnon CJ, Muis KR, Cohen SR. Rumination moderates the role of meaning in the development of prolonged grief symptomatology. J Clin Psychol 2019; 75:1047-1065. [DOI: 10.1002/jclp.22751] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/19/2018] [Accepted: 12/27/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Evgenia Milman
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | | | - Marilyn Fitzpatrick
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | | | - Krista R. Muis
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | - S. Robin Cohen
- Departments of Oncology and MedicineMcGill UniversityMontreal Quebec
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Abstract
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.
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Affiliation(s)
- Jenine Anne Wenn
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Moira O'Connor
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Robert T Kane
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Clare Samantha Rees
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Lauren J Breen
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Castanhel FD, Liberali R. Mindfulness-Based Stress Reduction on breast cancer symptoms: systematic review and meta-analysis. EINSTEIN-SAO PAULO 2018; 16:eRW4383. [PMID: 30540032 PMCID: PMC6282865 DOI: 10.31744/einstein_journal/2018rw4383] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/27/2018] [Indexed: 12/30/2022] Open
Abstract
Mindfulness-Based Stress Reduction practices increase the capacity for concentration and attention, and these practices are particularly effective for people with breast cancer. To analyze the effects of the application of Mindfulness-Based Stress Reduction on breast cancer symptoms. Systematic review and meta-analysis were carried out. To find suitable studies, the PubMed/ MEDLINE database was searched using the keywords "breast cancer" and "Mindfulness-Based Stress Reduction". Studies included were published between 2013 and 2017, written in English and showed methodological quality through the PEDro scale (score greater than 3). They also presented empirical evidence, had an experimental study design (randomized or non-randomized), and had full text available. For the meta-analysis, we used a random-effects model, with standardized mean differences and 95% confidence intervals. Seven studies were included, one non-randomized and containing only an intervention group of Mindfulness-Based Stress Reduction, and six randomized including samples of two or three groups. The non-randomized study showed 6 points on the PEDro scale, the randomized studies of two groups 6 to 7 points and studies with three groups showed 7 points. In the meta-analysis of the two randomized studies, the results, although not significant, revealed a moderate effect for Mindfulness-Based Stress Reduction on the outcome of fatigue, with a mean difference of -0.42 (95%CI -0.92- -0.07; p=0.09). Mindfulness-Based Stress Reduction seems to be a promising alternative for treatment of this disease's symptoms.
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Affiliation(s)
| | - Rafaela Liberali
- Universidade Federal de Santa Catarina, Florianópolis, SC, Brazil
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Levi-Belz Y. Relationship with the deceased as facilitator of posttraumatic growth among suicide-loss survivors. DEATH STUDIES 2017; 41:376-384. [PMID: 28129044 DOI: 10.1080/07481187.2017.1285372] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study aimed to investigate the role of ongoing relationships with the deceased in facilitating posttraumatic growth among suicide-loss survivors. The sample comprised 58 suicide-loss survivors, 48 sudden-death, and 53 natural-death bereaved individuals, who completed questionnaires assessing the two-track model of bereavement, grief, and growth-related characteristics. Suicide-loss survivors reported lower levels of positive relationships with the deceased than did the other groups. An interaction was found between relational-active grieving and type of death in predicting posttraumatic growth. The study concluded that intense grief along with preoccupation with the deceased lessened positive personal transformation, especially among those struggling with a loved one's suicide.
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Affiliation(s)
- Yossi Levi-Belz
- a Department of Behavioral Sciences , Ruppin Academic Center , Emek Hefer , Israel
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González D, Carvalho M, Cantillo J, Aixalá M, Farré M. Potential Use of Ayahuasca in Grief Therapy. OMEGA-JOURNAL OF DEATH AND DYING 2017; 79:260-285. [DOI: 10.1177/0030222817710879] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The death of a loved one is ultimately a universal experience. However, conventional interventions employed for people suffering with uncomplicated grief have gathered little empirical support. The present study aimed to explore the potential effects of ayahuasca on grief. We compared 30 people who had taken ayahuasca with 30 people who had attended peer-support groups, measuring level of grief and experiential avoidance. We also examined themes in participant responses to an open-ended question regarding their experiences with ayahuasca. The ayahuasca group presented a lower level of grief in the Present Feelings Scale of Texas Revised Inventory of Grief, showing benefits in some psychological and interpersonal dimensions. Qualitative responses described experiences of emotional release, biographical memories, and experiences of contact with the deceased. Additionally, some benefits were identified regarding the ayahuasca experiences. These results provide preliminary data about the potential of ayahuasca as a therapeutic tool in treatments for grief.
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Affiliation(s)
- Débora González
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
| | - María Carvalho
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
- Centro de Estudos em Desenvolvimento Humano (CEDH), Faculdade de Educação e Psicologia, Universidade Católica Portuguesa, Rua Diogo Botelho, Portugal
| | - Jordi Cantillo
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
| | - Marc Aixalá
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
| | - Magí Farré
- Autonomous University of Barcelona, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol (IGTP), Badalona, Spain
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Eisma MC, Boelen PA, Schut HAW, Stroebe MS. Does worry affect adjustment to bereavement? A longitudinal investigation. ANXIETY STRESS AND COPING 2016; 30:243-252. [DOI: 10.1080/10615806.2016.1229464] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Maarten C. Eisma
- Health Psychology Group, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Paul A. Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Henk A. W. Schut
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Margaret S. Stroebe
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
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Abstract
PURPOSE OF REVIEW There is increasing recognition that a minority of bereaved persons experiences persistent and disabling grief symptoms, also termed complicated grief. We review currently proposed criteria for complicated grief in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) and the International Statistical Classification of Diseases and Related Health Problems (ICD-11), highlight controversies with regard to establishing complicated grief as a psychiatric disorder, summarize recent complicated grief treatment research within a cognitive behavioral treatment framework, and establish a novel and systematic research agenda for complicated grief treatment. RECENT FINDINGS Clinicians should be wary of overdiagnosis and misdiagnosis of complicated grief. Recent changes to definitions of complicated grief may threaten generalizability and clinical application of research findings. Universal treatment, treatment for at-risk groups and preventive complicated grief treatment appear ineffective. Although medication is often prescribed to bereaved persons, evidence for its effectiveness is equivocal. Face-to-face and internet-based cognitive behavioral therapy techniques appear most effective in targeting complicated grief. However, little is known about what, how, and for whom treatment works best. SUMMARY In light of these findings, we recommend systematic investigation of: what works best in complicated grief treatment, by conducting well designed, stepped effectiveness trials and treatment component dismantling studies; how it works, by conducting investigations on therapeutic theories and examining mediators of therapeutic change; and for whom it works, by examining potential moderators of treatment effects.
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