Biopsychosocial Functioning Research Articles

Does Implantation of an Artificial Soft Anal Band Provide an Opportunity for Improvement of Biopsychosocial Function in Patients with Severe Fecal Incontinence?

Introduction Severe fecal incontinence describes a condition of complete loss of control over fundamental physiological functions and loss of abilities to fulfil psychosocial functions by the patients. The last-step procedure, that is, to restore hope for improvement of biopsychosocial functioning and quality of life determined by the patient's health status is implantation of an artificial anal sphincter. Objective The study was a comparative analysis of the effect of the employed surgical procedure upon the degree of defecation control and quality of life indices in its behavioral, mental, and social aspects prior to and 3, 6, and 12 months postoperatively. The analysis also included the effect of the patient's individual style of coping with stress and the functional outcome of the procedure. Material and Methods The study included a group of 12 patients: 6 females and 6 males, aged from 36 to 60 years of life. The tools consisted of scoring systems that measured symptom intensity (FISI and Jorge and Wexner scale). In assessing the psychosocial functioning, the authors employed the Fecal Incontinence Quality of Life Scale (by Rockwood). The individual mode of coping with the disease was evaluated by using the CISS scale by Endler and Parker. Conclusions The analysis of results demonstrated that the procedure of implanting an artificial anal sphincter affected the “continence” (up to 50–60% postoperatively) and led to improvement in psychosocial functioning in all its assessed aspects, i.e., lifestyle, employment of precautionary measures, depression, anxiety, and embarrassment. It was also noted that due to the specific character of the procedure (the necessity to operate an artificial implant), better mean results in assessment of the procedure functionality were achieved by patients presenting the goal-concentrated mode rather than emotions-concentrated mode of coping with the disease. Thus, it seems justified to state that assessment of biopsychological functioning may be a good criterion of the procedure effectiveness.

Should rehabilitation goals reflect all aspects of functioning in relation to a biopsychosocial ICF perspective?

Purpose To classify short-term and long-term rehabilitation goals and analyse how they capture functioning in a biopsychosocial International Classification of Functioning, Disability and Health (ICF) perspective. Materials and methods A retrospective study was conducted at two specialised outpatient multidisciplinary rehabilitation centres for polio survivors and accident victims. Rehabilitation goals extracted from patient journals were linked to the ICF according to linking rules. Results One hundred patients were included. Four hundred and eighty-seven short-term and long-term rehabilitation goals were linked to the ICF. Fifty-seven per cent were linked to Activity and Participation, 22% to Body Functions, 1% to Body Structure, 4% to Environmental Factors, 4% to Personal Factors, whereas 11% were not defined and 1% was not covered. The identified categories covered all ICF domains. The most frequent categories for short-term goals were d450 “Walking” and d570 “Looking after one’s health.” For long-term goals, d850 “Remunerative Employment” and d920 “Recreation and Leisure” were the most frequent. Conclusion The study showed challenges in capturing all aspects of biopsychosocial functioning in rehabilitation goals, particularly Contextual Factors. This study indicates that rehabilitation goals capture capacity rather than performance. Further research could highlight if functioning is captured in the rehabilitation plan, and in this way include both capacity and performance. Implications for rehabilitation Health professionals in a post-acute or long-term rehabilitation setting should pay attention to capacity and performance when rehabilitation goals are set. The rehabilitation plan should contain goals and a description of patient’s contextual factors and both should be equally valued and combined in a description of functioning. In a post-acute or long-term rehabilitation setting short-term and long-term goals are affected by the context. A longer rehabilitation intervention lead to goals linked to activity and participation.

Clinical and demographic patient characteristics, alcohol treatment goal preference and goal attainment during computer-assisted therapy with Breaking Free Online

ABSTRACTBackground: Few alcohol misuse interventions can be tailored to the individual and allow individuals to set personalized treatment goals, including reduction/moderation or abstinence. This study examined outcomes from a tailorable computer-assisted therapy program, Breaking Free Online (BFO), which prompts users to set personalized goals. Methods: Participants completed baseline and post-treatment assessments of alcohol dependence and use and biopsychosocial functioning. Whether baseline clinical and demographic participant characteristics predicted preferred treatment goal, and whether these characteristics and preferred treatment goal then predicted treatment goal attainment, were examined. Results: Participants who prioritized abstinence were more likely to be abstinent at baseline and to have received previous treatment, than participants who prioritized reduction/moderation. Participants who preferred reduction/moderation demonstrated better biopsychosocial functioning and lower alcohol dependence at baseline than those who preferred abstinence. Lower biopsychosocial impairment, lower alcohol dependence, and lower alcohol consumption were associated with a higher likelihood of achieving treatment goals, as was having abstinence as a goal. There were significant interactions between baseline alcohol consumption/severity of alcohol dependence and treatment goal preference. Conclusions: Findings may inform guidance around recommended treatment goals for individuals engaging with treatment for alcohol misuse.

Paradigm of Rehabilitation of People with Disability

Background. Disability is part of human condition. The number of people with disabilities is growing. Every epoch has faced the moral and political issue of how to include and support people with disabilities best. This issue will become more acute as the demographics of societies change and more people live to an old age. There is a global increase in chronic health conditions such as diabetes, cardiovascular diseases and mental disorders, which will influence the nature and prevalence of disability. Establishment of a complex rehabilitation system of disabled people is a great challenge. The aim of this article is to discuss issues concerning the provision of help for people with disabilities and devising effective rehabilitation system for them. Discussion. Help for people with disabilities should be understood as a versatile system of legal, medical, economical, organizational, etc., means, which help people regain their disturbed biopsychosocial functions, compensate them and adapt them to society. The article further calls to organise, strengthen, and extend comprehensive rehabilitation services and programmes for disabled people and start them as early as possible based on multidisciplinary assessment of individual needs and strengths, including the provision of assistive devices and technologies using ICF. Conclusion. Multidisciplinary teams can convey many rehabilitation benefts to patients. International cooperation can help share good and promising practices and provide technical assistance to countries that are introducing and expanding rehabilitation services.Keywords: rehabilitation, persons with disabilities, biopsychosocial function, the ICF.

Body image in perimenopausal women

IntroductionMenopause is the last natural menstruation, followed by a period of 12 months during which no bleeding occurs (WHO). This natural process results from the phasing out of the physiological activity of the ovaries and involves numerous psychological and somatic disturbances. Although perimenopausal ailments are experienced by most women, the correlation between their perception of the bodies and biopsychosocial functioning in the climacteric period is not fully understood. The aim of the study was to determine whether women’s body image varies depending on the period of their reproductive life.Material and methods113 women aged 25-60 were examined (both menopausal and postmenopausal) with the control group comprising 58 women. The following scales were used: the Appearance-Related Picture Self-Appraisal Form and the Appearance Self-Appraisal Scale.ResultsThe study demonstrated statistically significant differences between the groups on 7 scales and the overall score. It can be said that postmenopausal women, whose ovarian activity has nearly ceased, in comparison with those in the premenopausal and menopausal groups attribute lower importance to the following areas of the body: eyes, nose, mouth, stomach, buttocks, thighs, and calves. The mean values of satisfaction in the three groups under comparison were not statistically different.ConclusionsThe subjects of the postmenopausal group attribute lower importance to different body areas, deriving greater satisfaction from their own bodies.

Endure, evolve, achieve: Stakeholder perspectives on the effectiveness of the Swamp Apes program in restoring biopsychosocial functioning of American veterans

A growing body of evidence highlights the benefits of recreational outdoor therapy for veterans experiencing posttraumatic stress disorder. We employed the Hawkins Model for “Nature as Strengths-ba...

Protocol for a randomized controlled trial of the Breaking Free Online Health and Justice program for substance misuse in prison settings

BackgroundSubstance misuse, including problematic drug and alcohol use, are significant issues in society that can have multiple detrimental effects. Many people access support for their substance misuse during prison sentences, due to the associations between substance misuse and offending, and the high proportion of the prison population who have drug and alcohol issues. Breaking Free Online Health and Justice is a computer-assisted therapy program that has been developed to support substance-involved offenders to address their substance misuse and associated offending within prison settings.MethodsThis will be a parallel-group randomized controlled trial of 4-week Breaking Free Online Health and Justice program as an adjunct to standard treatment for substance misuse, in comparison to standard treatment only, in a male Category D open prison. Interventional and control groups will be compared in terms of the changes in their scores on multiple measures from baseline to post-treatment assessment at 4-weeks, and then 3- and 6-months follow-up. Participants will be adult male offenders serving sentences in prison in England who have demonstrable difficulties with drugs and/or alcohol for at least the past 12-months. The primary outcome measure will be self-reported substance misuse, with secondary outcomes being standardized psychometric assessments of substance dependence, mental health, biopsychosocial functioning, quality of life and post-release offending. Other secondary measures will include frequency of completion of specific intervention strategies in the program.DiscussionThis study will examine whether Breaking Free Online Health and Justice as an adjunct to standard substance misuse interventions in prisons, improves outcomes for substance-involved offenders receiving interventions in custodial settings. Findings from the study will be used to inform further developments of the program and potential improvements to custodial treatment.Trials registrationISRCTN09846981.

A biopsychosocial model of resilience for breast cancer: A preliminary study in mainland China.

Patients diagnosed with breast cancer exhibited critical biopsychosocial functions following surgery or adjuvant treatment; therefore, it is important that they exhibit resilience. A Resilience Model for Breast Cancer (RM-BC) was developed using Chinese breast cancer patients to increase our understanding of how resilience outcomes are positively and negatively affected by protective and risk factors, respectively. Chinese women with breast cancer completed the questionnaires within 1 week of beginning treatment. Exploratory Structural Equation Modeling was used to evaluate the RM-BC using a sample size of 342 patients. RM-BC suggested satisfactory goodness-of-fit indices and 67 percents of variance for resilience was explained. The Fit Indices for the measurement model were as follows: CFI = 0.909, GFI = 0.911, IFI = 0.897, NFI = 0.922, PNFI = 0.896, PCFI = 0.884, and RMSEA = 0.031. Three risk factors - emotional distress, physical distress, and intrusive thoughts - and four protective factors - self-efficacy, social support, courage-related strategy, and hope - were recognized. The resilience model allows for a better understanding of Chinese breast cancer patients' resilience integration while undergoing treatment and provides an effective structure for the development of resilience-focused interventions that are grounded in their experiences. A randomized trial has provided evidences of feasibility in Chinese women with breast cancer and the resilience model could be used as a useful framework for more resilience intervention in the future.

Long-term changes in biopsychosocial characteristics related to temporomandibular disorder: findings from the OPPERA study.

Painful temporomandibular disorders (TMDs) are both consequence and cause of change in multiple clinical, psychosocial, and biological factors. Although longitudinal studies have identified antecedent biopsychosocial factors that increase risk of the TMD onset and persistence, little is known about long-term change in those factors after TMD develops or remits. During a 7.6-year median follow-up period, we measured change in psychosocial characteristics, pain sensitivity, cardiovascular indicators of autonomic function, and clinical jaw function among 189 participants whose baseline chronic TMD status either persisted or remitted and 505 initially TMD-free participants, 83 of whom developed TMD. Among initially TMD-free participants who developed TMD, symptoms and pain sensitivity increased, whereas psychological function worsened. By contrast, participants with chronic TMD at baseline tended to show improved TMD symptoms, improved jaw function, reduced somatic symptoms, and increased positive affect. In general, clinical and psychosocial variables more frequently changed in parallel with TMD status compared with pain sensitivity and autonomic measures. These findings demonstrate a complex pattern of considerable changes in biopsychosocial function associated with changes in TMD status. In particular, several biopsychosocial parameters improved among participants with chronic TMD despite pain persisting for years, suggesting considerable potential for ongoing coping and adaptation in response to persistent pain.

Theoretical Concept of Impact of Tai Chi on Falls in Clients with Parkinson’s Disease

Introduction. At present, in Poland and other European countrieswe are witnessing an increase in the number of elderly people. Of particular importance is the psychophysical evaluation of the patient and defining the deficits in their everyday functioning.Aim. The aim of the study was to analyze selected demographic factors affecting biopsychosocial functioning of neurogeriatric patients.Material and Methods. The research was carried out in the Department of Geriatrics at University Hospital No. 1 in Bydgoszcz on a group of 122 patients aged from 60 to 95 years, hospitalized for diseases of the nervous system. The biopsychosocial assessment was performed with the use of the NOSGER scale (Nurses’ Observation Scale for Geriatric Patients) — the Nursing Care Scale of Geriatric Patients and the Barthel scale.Results. As a result of the analysis, it was found that the average assessment of the functioning of older people in the assessment of the NOSGER scale was 89.89 for 150 maximum points. As a result of the analysis, it was found that respondents aged up to 64 years functioned best in each aspect of the NOSGER scale, whereas respondents aged over 90 years functioned the worst, with the exception of moods and emotions subscales. In the age groups 65–74 and 75–89, functioning was similar in all subscales. The statistical analysis carried out showed that the respondents who were in the second group of fitness had significantly worse functioning in each subscale and the overall NOSGER assessment than those who were in the first fitness group (p<0.05).Conclusions. There were no statistically significant differences found between gender, age, marital status, education, and functional fitness of patients on the Barthel score. There was also no significant effect of gender, age and education on the NOSGER patients assessment. Significant influence of marital status on the assessment in the area of destructive and disruptive behaviors on the NOSGER scale was observed. (JNNN 2018;7(3):118–123)

Selected Factors Affecting Biopsychosocial Functioning of Neurogeriatric Patients

Introduction. At present, in Poland and other European countrieswe are witnessing an increase in the number of elderly people. Of particular importance is the psychophysical evaluation of the patient and defining the deficits in their everyday functioning.Aim. The aim of the study was to analyze selected demographic factors affecting biopsychosocial functioning of neurogeriatric patients.Material and Methods. The research was carried out in the Department of Geriatrics at University Hospital No. 1 in Bydgoszcz on a group of 122 patients aged from 60 to 95 years, hospitalized for diseases of the nervous system. The biopsychosocial assessment was performed with the use of the NOSGER scale (Nurses’ Observation Scale for Geriatric Patients) — the Nursing Care Scale of Geriatric Patients and the Barthel scale.Results. As a result of the analysis, it was found that the average assessment of the functioning of older people in the assessment of the NOSGER scale was 89.89 for 150 maximum points. As a result of the analysis, it was found that respondents aged up to 64 years functioned best in each aspect of the NOSGER scale, whereas respondents aged over 90 years functioned the worst, with the exception of moods and emotions subscales. In the age groups 65–74 and 75–89, functioning was similar in all subscales. The statistical analysis carried out showed that the respondents who were in the second group of fitness had significantly worse functioning in each subscale and the overall NOSGER assessment than those who were in the first fitness group (p<0.05).Conclusions. There were no statistically significant differences found between gender, age, marital status, education, and functional fitness of patients on the Barthel score. There was also no significant effect of gender, age and education on the NOSGER patients assessment. Significant influence of marital status on the assessment in the area of destructive and disruptive behaviors on the NOSGER scale was observed. (JNNN 2018;7(3):118–123)

Psychological Impact of Shift Work

Technology and globalization have been central forces driving the need for shift work. This review examines recent scientific developments that inform our understanding of how psychological process contribute to and are impacted by shift work. Nascent research is beginning to expand beyond circadian misalignment to elucidate the phenomenology of shift work and the associated psychological impairments. Psychological processes and their interaction with biology are considered in the pathophysiology of shift work sleep disorder. Additionally, a review of the adverse consequences of shift work in the cognitive, emotional, and psychosocial domains are reviewed and discussed. The phenomenology of shift work encompasses multiple domains of biopsychosocial functioning. As such, interventions to reduce the adverse impact of shift work may benefit from an integrated approach.

Effect of a mentor-based, supportive-expressive program, Be Resilient to Breast Cancer, on survival in metastatic breast cancer: a randomised, controlled intervention trial

Background:Because of medical advances, metastatic breast cancer (MBC) is now viewed as a chronic disease, rather than an imminent death sentence. Helping women live with this disease requires more than a medical approach to symptoms. Thus, a mentor-based and supportive-expressive program ‘Be Resilient to Breast Cancer’ (BRBC) was designed to help Chinese women with MBC enhance their resilience levels, biopsychosocial functions, and potentially extend their life span.Methods:A total of 226 women with MBC were randomly assigned, in a 1 : 1 ratio, to an intervention group (IG) that participated in BRBC or to a control group (CG) that received no intervention. Be Resilient to Breast Cancer was conducted for 120 min once a week. Primary outcomes were cancer-specific survival and secondary outcomes were resilience, Allostatic Load Index (ALI), anxiety, depression, and quality of life (QoL). The Cox proportional-hazards model was used for survival analysis and growth mixture models were performed for secondary outcomes.Results:Be Resilient to Breast Cancer did not significantly prolong 3- or 5-year survival (median survival, 36.7 months in IG and 31.5 months in CG). The hazard ratio for death was 0.736 (95% CI, 0.525–1.133, P=0.076; univariate Cox model) and 0.837 (95% CI, 0.578–1.211, P=0.345; multivariate Cox analysis). The IG improved in anxiety (ES=0.85, P<0.001), depression (ES=0.95, P<0.001), QoL (ES=0.55, P<0.001), resilience (ES=0.67, P<0.001), and ALI (ES=0.90, P<0.001) compared to CG.Conclusions:BRBC does not improve survival of women with MBC in this study, though longer follow up is warranted. It positively impacts resilience, QoL, ALI, and emotional distress.

Childhood bereavement: The role of the surviving parent and the continuing bond with the deceased

ABSTRACTThis study investigated the relationship between the role of the surviving parent in the child’s grieving process, the continuing bond with the deceased parent and biopsychosocial functioning and active grief in adulthood. A survey of 135 adults, parentally bereaved in childhood, indicated that the surviving parent’s role in facilitating the grieving process promoted a positive continuing bond with the deceased in childhood as well as general functioning in adulthood. The continuing bond with the deceased had a weak association with both better general functioning and relational active grief.

The Rapid Recovery Progression Measure: A Brief Assessment of Biopsychosocial Functioning During Substance Use Disorder Recovery

ABSTRACT Background: There is debate in the literature around how to measure outcomes in treatment and recovery from substance use disorder (SUD). Various constructs have been suggested as appropriate including “recovery capital” and “treatment progression.” To contribute to this debate, the construct of “recovery progression” has been suggested by the authors, and a psychometric assessment, the Recovery Progression Measure (RPM). Although published psychometrics data have demonstrated the RPM to be reliable, at 36-item long, it may be too lengthy to complete in clinic environments. Therefore, a shorter version has been developed, the Rapid RPM. Objectives: To examine reliability, validity, sensitivity and specificity of the Rapid RPM via data from 9208 service users. Methods: Data were collected from service users accessing the Breaking Free Online (BFO) treatment and recovery program, which has within its baseline assessment the six-item, 11-point Likert scale Rapid RPM. Psychometric properties were examined. Results: Internal reliability of the Rapid RPM was excellent, α =.92. The Rapid RPM also had good concurrent and predictive validity, with baseline scores, and changes in scores to follow-up, being significantly associated with scores on standardized measures of common mental health sequela, severity of substance dependence and quality of life, and changes in self-reported substance use. The Rapid RPM was also able to differentiate between participants scoring above thresholds on these measures for clinically relevant substance dependence and mental health difficulties. Conclusions: This study provides data to support reliability, validity, sensitivity and specificity of the Rapid RPM, indicating potential as a clinical tool.

Examining effectiveness of tailorable computer-assisted therapy programmes for substance misuse: Programme usage and clinical outcomes data from Breaking Free Online

RationaleWhen evaluating complex, tailorable digital behavioural interventions, additional approaches may be required alongside established methodologies such as randomised controlled trials (RCTs). Research evaluating a computer-assisted therapy (CAT) programme for substance misuse, Breaking Free Online (BFO), is informed by Medical Research Council (MRC) guidance recommending examination of ‘mechanisms of action’ of individual intervention strategies, which is relevant when evaluating digital interventions with content that may evolve over time. AimsTo report findings from examination of mechanisms of action of tailoring advice within the BFO programme and outcomes from specific intervention strategies. MethodologyAnalysis of covariance and linear regressions were used to assess intervention completion data, and psychometric and clinical outcomes, for 2311 service users accessing drug and alcohol treatment services across the UK. ResultsTailoring advice provided to users appeared to prompt them to prioritise completion of intervention strategies associated with their areas of highest biopsychosocial impairment. Completion of specific intervention strategies within BFO were associated with specific clinical outcomes, with a dose response also being found. Mechanisms of action analyses revealed the primacy of cognitions, with cognitive restructuring strategies being associated with improvements in mental health, severity of substance dependence, quality of life and global biopsychosocial functioning. ConclusionsThe MRC framework provides an evolved research paradigm within the field of digital behavioural change. By assessing baseline profiles of need, BFO can target the most appropriate clinical content for individual users. Mechanisms of action research can be used to inform modifications to BFO to continually update clinical content and the technology platform.

Recovery of Biopsychosocial Functions Following 15 Years after Spinal Cord Injury

Background: Spinal cord injury (SCI) causes the loss of biopsychosocial functions, body dysfunctions, decreased functional independence level, limitations in activities, and participation restriction. For recovery of functioning, comprehensive inpatient rehabilitation programs are necessary, which are more focused on recovery of physical status, capacity, functional independence level, maintenance of existing skills, and improvement of activities in daily life. In the long-term context, functioning improves naturally by engaging in various activities of everyday life. The aim of this study was to evaluate the changes in functioning and functional independence following 15 years after SCI. Material and Methods: A total of 109 people with SCI were enrolled in the study during 2007-2015. The study was carried out during inpatient rehabilitation in the Centre of Rehabilitation, Physical and Sports Medicine. The second assessment was performed after 1-15 years. For evaluation functional independence, the Functional Independence Measure (FIM) was used. Functional problems were assessed by the Comprehensive ICF Core Set for SCI. Results: Rehabilitation mostly increased the functional independence level and significantly decreased the severity of body dysfunctions and participation restriction in daily life. In the long-term context, the reached functional independence level of persons with SCI did not change significantly and remained stable, but dysfunctions of muscle strength, physical endurance, moving around, and participation in household and leisure activities significantly decreased. In the long-term context, the percentage of employed subjects and having higher education increased. Conclusion: Rehabilitation after SCI effectively improves patients’ severe functional problems, but in the following periods, functioning increases each year after SCI by naturally engaging in daily living activities.

Recovery of Biopsychosocial Functions Following 15 Years after Spinal Cord Injury

Background: Spinal cord injury (SCI) causes the loss of biopsychosocial functions, body dysfunctions, decreased functional independence level, limitations in activities, and participation restriction. For recovery of functioning, comprehensive inpatient rehabilitation programs are necessary, which are more focused on recovery of physical status, capacity, functional independence level, maintenance of existing skills, and improvement of activities in daily life. In the long-term context, functioning improves naturally by engaging in various activities of everyday life. The aim of this study was to evaluate the changes in functioning and functional independence following 15 years after SCI. Material and Methods: A total of 109 people with SCI were enrolled in the study during 2007-2015. The study was carried out during inpatient rehabilitation in the Centre of Rehabilitation, Physical and Sports Medicine. The second assessment was performed after 1-15 years. For evaluation functional independence, the Functional Independence Measure (FIM) was used. Functional problems were assessed by the Comprehensive ICF Core Set for SCI. Results: Rehabilitation mostly increased the functional independence level and significantly decreased the severity of body dysfunctions and participation restriction in daily life. In the long-term context, the reached functional independence level of persons with SCI did not change significantly and remained stable, but dysfunctions of muscle strength, physical endurance, moving around, and participation in household and leisure activities significantly decreased. In the long-term context, the percentage of employed subjects and having higher education increased. Conclusion: Rehabilitation after SCI effectively improves patients’ severe functional problems, but in the following periods, functioning increases each year after SCI by naturally engaging in daily living activities.

The Chronic Low Back Pain Epidemic in Older Adults in America

Chronic low back pain is a debilitating condition affecting millions of Americans annually. Older-adult populations suffer a high prevalence of this continually painful state, and further face a unique set of challenges to manage short- and long-term biopsychosocial functioning. As the population ages, and the proportion of older adults grow, it is essential to explore and develop the most effective interdisciplinary strategies to care for older adults who are chronic pain sufferers. In this Commentary, we highlight some of the special challenges that the older-adult population encounters, and their influence on pain management strategies.

Bereavement and Traumatic Bereavement: Working with the Two-Track Model of Bereavement

Bereavement following loss through death is a universal human experience, but how it is experienced and understood is mediated by many variables. In this article, we stress the importance of a bifocal approach to understanding, assessing and intervening following the loss of significant persons using the framework of the Two-Track Model of Bereavement. This model examines both biopsychosocial functioning as well as the nature of the ongoing relationship with the deceased and the death story in working with the bereaved. It is particularly suited to identify adaptive and maladaptive responses to loss and to optimally focus interventions where needed. Two case vignettes are presented to orient the discussion. Traumatic bereavements, a term indicating the interface between trauma and loss, increase the likelihood of complications following loss and these are considered. Bereavements that occur under external traumatic circumstances increase the risk for dysfunction, symptomatic difficulties and complicated grief. In addition, there are forms of traumatic bereavement that arise due to subjective elements related to aspects of the psychological relationship to the deceased and the relational bond with him or her. Clinically, there is a need to identify and understand the various aspects of the traumas of bereavement and to intervene appropriately. Interventions based on the Two-Track Model of Bereavement will be described.