Grief Group Research Articles

Losing a Loved One in Medical School: The Need for Medical Student Grief Groups.

1Fourth-year medical student, Oregon Health & Science University, Portland, Oregon; email: [email protected]; ORCID: http://orcid.org/0000-0001-6923-0101. Funding/Support: None reported. Other disclosures: None reported. Ethical approval: Reported as not applicable. First published online.

“I’m Not Alone”: A Group Intervention for Grieving Children

Grieving children are at risk for negative outcomes (American Academy of Child and Adolescent Psychiatry, 2020). This study described a collaboration between a community agency and a large school district to create and implement groups for grieving children. A preliminary evaluation of the effectiveness of these groups was conducted. Quantitative and qualitative data from 318 students, 59 group facilitators, and 59 school counselors indicated that the grief group was a promising intervention for diverse students with regard to enhancing awareness about grief, reducing isolation, providing a place to share feelings, and learning coping strategies after the death of a significant person. This research may inform the development, implementation, and evaluation of other important interventions established through community partnerships to prevent negative outcomes associated with unattended grief in childhood.

Supporting Childhood Bereavement Through School-Based Grief Group.

With 7.3% of children under the age of 18 experiencing the death of a parent and more who experience a loss of a loved one bereavement is a common experience in the lives of children and youth. The current study sought to evaluate the effectiveness of an 8-week, school-based grief group treatment program in reducing symptoms of grief, dysregulation, and improving social support. A total of 296 children and youth (age 11-18) participated in the grief programming provided by a local hospice agency. With a retention rate of 76% the researchers identified a significant reduction in grief symptomology, frequency of emotion dysregulation, and a significant increase in perceived social support from pre- to post-8-week school-based grief programming. A reduction in intensity of dysregulation was not significant. Implications for school personnel and parental support of children and youth experiencing loss are discussed.

Grief Responses during the COVID-19 Pandemic: Differences in Attachment and Emotion Regulation

This study assessed grief reactions amongst individuals who lost a loved one to COVID-19. Differences in attachment-related anxiety, avoidance, and emotion dysregulation were compared between absence, delayed, prolonged, and resolved grief reactions. 146 participants completed self-report measures after they experienced the loss of a parent, sibling, child, or spouse. A series of one-way analyses of variance indicated that there were significant differences in emotion dysregulation and attachment-related anxiety between grief reactions. Additionally, the resolved grief group had the lowest levels of emotion dysregulation. The findings highlight the importance of examining relational and emotional factors in the context of bereavement.

Complicated grief group therapy for community-residing persons diagnosed with serious mental illness

ABSTRACT The traumatic death of a significant person is an under-appreciated adverse life event. Unresolved grief from traumatic death is associated with complicated grief (CG) in adulthood and both contribute to and sustain serious mental illness in adulthood. Persons diagnosed with serious mental illness experiencing CG represent vulnerable persons for whom traditional care is therapeutically insufficient, when the trauma of underlying grief is unaddressed. We examined the feasibility and impact of community implementation of Complicated Grief Group Therapy for persons diagnosed with serious mental illness with CG. Program completers showed statistically significant improvement in grief measures and interpersonal well-being.

We Speak a Different Language: End-of-Life and Bereavement Experiences of Older Lesbian, Gay, and Bisexual Women Who Have Lost a Spouse or Partner.

We examine the end-of-life (EOL) experiences, communications, and grief support during and after their loved one's death of older lesbian, gay, and bisexual women (LGB) ages 60 to 85 who have lost a spouse or partner. Queer gerontology was used as a theoretical framework, and descriptive qualitative analytical methods were used to discern themes. Through semi-structured interviews with a purposive sample of 16 participants, we identified two main themes: Gathering the Women and Compassionate Care. Although older LGB women may have some similar support needs as non-LGB adults, other needs are distinct but often unmet. While our participants' interactions with health care professionals were overtly positive, there was often a lack of communication about grief resources, including lesbian and women-specific grief groups. Overall researchers, policymakers, and practitioners should be mindful of the importance of fully integrating and including populations into their care practices to avoid creating systems of superficial tolerance.

Pre-loss group therapy for dementia family care partners at risk for complicated grief.

IntroductionDementia family caregiving may span more than a decade and places many family care partners (CPs) at risk for poor bereavement outcomes; estimates of complicated grief in bereaved dementia family CPs range from 10% to 20%. We adapted our efficacious complicated grief group therapy intervention for bereaved dementia caregivers for soon‐to‐be bereaved dementia CPs at risk for complicated grief to facilitate healthy death preparedness and eventual bereavement—pre‐loss group therapy (PLGT).MethodsIn this Stage IB pilot intervention study, we implemented and evaluated PLGT in three psychotherapy group cohorts with family CPs at‐risk for complicated grief whose person living with dementia (PLWD) had a life expectancy of 6 months or less and resided in a nursing home. PLGT is a 10‐session multi‐modal psychotherapy administered by social workers.ResultsParticipants in PLGT realized significant improvement in their pre‐loss grief and in reported preparedness for the death of their family member, and participants evidenced lowered pre‐loss grief severity and improvement, as measured by facilitators. Participants also realized significant improvement in meaning making, particularly as a sense of peace and a reduction of loneliness.DiscussionThe process and treatment elements of the PLGT intervention affirm the value of specialized care for those dementia family CPs at risk for complicated grief, as the PLGT groups demonstrated a steady progression toward improvement collectively and individually. PLGT participants realized statistical and clinical improvement across pre‐loss grief measures suggesting that their risk for complicated grief risk was mitigated, and they were better prepared for the death of their PLWD.

It's Like We Speak a Different Language: Support Needs and Preferences of Older LGB Women Who Have Lost a Spouse or Partner

Needs during and following end-of-life (EOL) experiences are distinctive for sexual and gender minority (SGM) people and, in particular, older lesbian, gay, and bisexual women (LGB) women; however, access to supportive services is limited. This poster presents findings from a qualitative study of older (60+) LGB women who have lost a spouse or partner. This work draws on queer gerontological theory, addressing issues of individual agency, systemic silence, and marginalization by invisibility of older SGM women in order to illuminate specific areas in which policy may be changed and improved. The study analyzed participants’ (n = 16) reflections on their experiences of losing a loved one, including how they sought out and received essential grief support and the type of support they would have preferred and from whom, particularly immediately following their spouse or partner’s death. Thematic analysis revealed three main findings: 1) having a women-identifying support presence at the time of death for both themselves and their spouse or partner; 2) needing LGB women (or women allies) during EOL for support; and 3) preferring grief groups comprised of other LGB women (or women allies) based on their feelings of difference from gay men and heterosexual/non-SGM women and men. Findings reveal the need for a better understanding among healthcare and social work support professionals regarding LGB women’s grief needs and preferences; grief options (e.g. lesbian and non-monosexual (bi+) grief groups); and how to implement policy changes reflecting these needs and preferences.

Group therapy for family caregivers of PWD at risk for complicated grief: A feasibility and efficacy analysis of pre‐loss group therapy

AbstractBackgroundOur previous evaluation of Complicated Grief Group Therapy (CGGT) in bereaved dementia family caregivers demonstrated efficacy and identified intervention elements suitable for adaption into a preventative care approach.MethodWe adapted CGGT treatment elements into a manualized 10 session pre‐loss group psychotherapy—Pre‐Loss Group Therapy (PLGT)—for dementia caregivers at risk for Complicated Grief (CG). We implemented and evaluated three PLGT cohorts in three long‐term care facilities with family caregivers at‐risk for CG whose care recipient had a life expectancy of 6 months or less and resided in a long‐term care facility (NT = 24).ResultEvaluation of participant preparedness for the death of the person with dementia (PWD), self‐care and grief outcomes showed significant improvement across domains between pre and post‐group. Notably, there was a statistically significant decrease in grief as measured by the Inventory of Complicated Grief score from baseline (M = 25.67, SE=1.80) to post‐group (M = 14.41, SE=1.65) t(21)= 6.280, p<0.001 and a statistically significant increase in meaning making as measured by the Grief and Meaning Reconstruction Inventory score from baseline (M = 111.74, SE=1.96) to post‐group (M = 116.46, SE=1.65) t(21)= ‐3.197, p<0.01. Clinician‐rated grief severity declined (N=22, β = –0.472, SE = 0.018, p < 0.001) per week and grief improvement increased (N=22, β = 0.259, SE = 0.023, p < 0.001) per week, as assessed on the Clinician Global Impressions Scale. We evaluated Early‐Stage intervention feasibility components of recruitment, retention, treatment fidelity, as well as PLGT participant acceptability, tolerability, satisfaction and treatment adherence. Of participants, 75% completed at least 80% of sessions, and 91% completed all assessments. Each feasibility target was achieved.ConclusionThis is the first known application of proven therapeutic strategies to address CG applied to high‐risk dementia caregivers prior to the death of the PWD. Caregivers at risk for CG may benefit from group therapy targeting preparedness and pre‐loss grief experience, as we provide with PLGT. PLGT holds promise for translation into comprehensive caregiver support programs and delivered to active caregivers of living PWD at risk for CG across community and in the settings of hospice and long‐term care.

When the Bond Breaks: Variables Associated with Grief Following Companion Animal Loss

ABSTRACT This research used an online quantitative survey to investigate variables related to grief following pet loss. These included type of relationship, animal species, amount of time since death, cause of death, attachment, and social support. We also examined emotions hypothesized to be associated with pet loss: grief, guilt, and loneliness. Female and male participants over the age of 18 years (n = 85) who had lost a companion animal within the previous six months completed the survey. We divided the cohort into three groups rep- resenting high, middle, and low levels of grief. Individuals in the high grief group experienced the highest level of guilt and loneliness when compared with those with low and medium levels of grief. Grief was also related to the way in which participants described their pets. Those who classified their pet as their “child” or “best friend” reported significantly higher levels of grief in comparison with those who considered their pets to be “good companions.” Furthermore, a high level of pet attachment was associated with higher grief. Other variables related to level of grief included age, which was inversely related to grief, guilt, and loneliness, and the presence of supportive others ameliorated guilt and loneliness. Species of animal was related to guilt and grief, with rabbit owners exhibiting significantly less guilt and grief than dog and cat owners. The type of death was not associated with grief, guilt, or loneliness scores. The major- ity of respondents felt supported following their loss, although some did not feel understood and expressed a lack of social recognition for their loss.

Extending our reach: telehealth delivered grief support groups for rural hospice

ABSTRACT The purpose of this pilot project was to develop, implement, and evaluate a distance-technology delivered grief support group program for grieving persons in underserved rural/frontier communities in Utah. This project was a collaboration between an established university-based grief support program, the (blinded) Telehealth Network and with one primary nonprofit hospice (blinded) and two secondary nonprofit hospice agencies (blinded) serving underserved/rural-frontier communities. We evaluated program feasibility (recruitment, retention, acceptability, tolerability, clinician trainability, and stakeholder satisfaction) and participant grief outcomes. Distance delivered grief groups compared favorably to face-to-face groups and met an unmet need for bereaved hospice families.

Grief after suicide: A study of taboo and metaphor

This article analyzes the negotiation of taboo surrounding grief after the suicide of a loved one. It draws on ethnographic fieldwork with a support group and individual interviews with its members. While the topic of taboo was prominent at group meetings, the same group members tended to claim in the interviews that they had not experienced it. To explore the issue of taboo, beyond affirmation or denial of its existence, we analyzed how the bereaved navigated the topic of suicide in language using Werner’s psychological theory of metaphor, which argues that metaphors arise to circumvent explicit reference to tabooed subjects. Members of the grief group clearly developed different strategies of metaphorical and other linguistic rephrasing to deal with the topics of death and suicide. Additionally, their language use differed depending on the person’s attitude toward the suicide, whether he or she was alone or with other group members, as well as whether the general public was being framed as an out-group.

Honoring grief, honoring ourselves: Mindfulness-based stress reduction education for grief group clinician-facilitators

ABSTRACTWe conducted a nine-session Mindfulness Based Stress Reduction (MBSR) educational program for clinician-facilitators who conduct grief support groups, and evaluated the impact of MBSR education on the self-efficacy of facilitators. Fifteen grief support group clinician-facilitators were assessed on 13 dimensions of self-efficacy. Using a mixed methods approach, we evaluated survey responses and short-answer narratives. Grief group facilitators, even those with prior mindfulness knowledge and practice, made substantial gains in self-efficacy in both professional and personal practice.

Voices that want to be heard: Using bereaved Danish students suggestions to update school bereavement response plans

ABSTRACTThis study explored how Danish students experienced returning to school following parental bereavement. Eighteen focus group interviews were conducted with 39 participants aged 9 to 17. All participants had experienced the loss of a primary caregiver. Data collection was divided into two phases. In Phase I, 22 participants from four grief groups were interviewed 4 times over the course of a year. During Phase II, confirmatory focus groups were undertaken with the 17 participants. This article explores the findings related to ideas and suggestions made by the students about how the Danish school response could be improved to better meet their needs. The presentation of data is divided into seven themes, which are: Desired school response; Desired support from teachers; Desired boundaries between students and teachers; Desired collaboration; Desired support from peers; Desired rules and structure, and; Desires related to gifts and rituals. Study findings indicate that most students want to be included and have a say when the school plans how to respond to their loss. Students further highlight a need for teacher support when having to reconnect with the class; a need for set rules in relation to leaving the class when feeling sad, and; a need for schools to see the loss as a life-changing event, and grief as something that does not simply disappear after a few months. The article concludes by discussing the ways in which the recommendations provided by the participants can be incorporated into a modern revision of Danish school bereavement response plans.

Psychology of the Facelift Patient.

This paper presents an extensive literature review of the psychology of facelift patients as it has evolved over the past 50 years. Earlier studies revealed significant levels of pre and perioperative depression. Facelift patients generally exhibit emotional and social concerns about facial appearance that are higher than the general population. Many are undergoing midlife situational stresses and may lack the positive characteristics to deal with them. The most common diagnoses seen include depression, impulsivity, unstable personality, and passive dependence, albeit not necessarily serious. Improvement in body image is the major driver for surgery. Characteristics of female patients as defined by their age are described. These include the younger emotionally dependent group, the worker group of middle age, and the older grief group. Male patients are seen to have a higher level of psychological dysfunction, but a higher improvement in postoperative quality of life. Motivations for surgery include increasing self-esteem, making new friends, improving relationships, and getting better jobs. Overall patient satisfaction is more than 95%, with improvement seen in positive changes in their life, increased self-confidence and self-esteem, decreased self-consciousness about their appearance, and overall improvement in quality of life. Postoperative psychological reactions are seen in about half the patients, these primarily being anxiety and depression of varying degrees. Predictors of patient satisfaction include the desire for self-image improvement in contradistinction to a change in life situation. Negative predictors include male sex, young age, unrealistic expectations, relationship disturbances, and preexisting psychological pathology. The importance of good patient selection in achieving a satisfied patient is outlined and emphasized.

The transformation of the meaning of death in complicated grief group therapy for survivors of suicide: A treatment process analysis using the meaning of loss codebook

ABSTRACTWe examined the therapeutic process of grief change in survivors of suicide participating in complicated grief group therapy (CGGT) using the meaning of loss codebook (MLC). Complicated grief group therapy is a multimodal group psychotherapy designed to restore normal grieving in persons with complicated grief. Using video data, we evaluated transition points in psychotherapy associated with meaning reconstruction: retelling the narrative of the death, having an imaginal conversation with the deceased, and memory integration. The MLC codes captured most of the voiced statements of participants, provided a valuable lens for articulating the therapeutic process, and affirmed that CGGT facilitated effective grief.

The Process of Change in Complicated Grief Group Therapy for Bereaved Dementia Caregivers: An Evaluation Using the Meaning of Loss Codebook

ABSTRACTCaring for a person with dementia has adverse health and mental health effects that, for 9–25% of caregivers, persist as complicated grief (CG). For bereaved dementia caregivers unable to satisfactorily grieve, specialized Complicated Grief Group Therapy (CGGT) can restore healthy grief. We investigated therapeutic change in CGGT participants, using an adapted version of the Gillies’ Meaning of Loss Codebook. Participants demonstrated positive gains in 16 thematic areas, notably in moving on with life, summoning pleasant memories, and ascribing bad memories to disease rather than decedent. Meaning transitioned from negative to positive interpretations of the death over the course of treatment.

Voices We Forget-Danish Students Experience of Returning to School Following Parental Bereavement.

This study explores how Danish students experience returning to school following parental bereavement. Eighteen focus group interviews with 39 participants aged 9 to 17 years were conducted. All participants had experienced the loss of a primary caregiver. Data collection was divided into two phases. In Phase I, 22 participants from four grief groups were interviewed 4 times over the course of a year. During Phase II, confirmatory focus groups were undertaken with the 17 participants. This article explores findings related to the four themes of initial school response, long-term support, challenges within the class, and academic challenges. The study found that (a) students struggle to reconnect with classmates following the return to school and often feel alone, (b) schools fail to have guidelines in place for what they are allowed to do if becoming sad the class, and (c) schools seem to forget their loss as time passes.

Resolution of Delusional Parasitosis within Complicated Grief Group Therapy: A Case Analysis

ABSTRACTIn this article, the authors present the case of a 71-year-old female suicide survivor in our Complicated Grief Group Therapy research study who presented with delusional parasitosis (DP) that resolved over the course of treatment. The authors describe Complicated Grief Group Therapy for survivors of suicide and the effect of therapy on her DP symptoms. The unique treatment elements of Complicated Grief Group Therapy addressed the trauma features of her grief, her relationship with her deceased son, her social isolation, health care adherence, and progression to a healthy grief process.

Videoconference Grief Group Counseling in Rural Texas: Outcomes, Challenges, and Lessons Learned

Disparities in access to mental health care, especially in rural areas, demand continued attention from practitioners, researchers, and community stakeholders. Telehealth, or the use of long distance technology to provide mental health services, is one well-recognized solution for reducing mental health disparities. At the Telehealth Counseling Clinic, advanced doctoral students provide telepsychology services to low-income and uninsured individuals living in a rural region in Texas. In response to an identified community need for grief counseling services, an 8-week grief group utilizing videoconference technology was conducted. This article discusses clinical and methodological challenges and lessons learned that are unique to delivering group counseling services over videoconference technology in a rural area, as well as preliminary data of the group’s effectiveness as measured by a satisfaction survey, the Patient Health Questionnaire–9, the CORE–B, and the Complicated Grief Assessment are presented.