Theories Of Grief Research Articles

Determinants of the Effect of Existential Behavioral Therapy for Bereaved Partners: A Qualitative Study

Informal caregivers of palliative patients took part in existential behavioral therapy (EBT), a group intervention comprising mindfulness exercises to reduce psychological distress and improve quality of life. This study examined what the participants perceived as helpful to cope with their loss during the first year of bereavement, particularly with regard to the EBT intervention. Sixteen problem-centered, semi-structured interviews were evaluated with content analysis. Two main categories were found: social support and self-regulation. Social support includes sense of belonging as well as emotional, cognitive, and practical help experienced from others. Mindfulness and acceptance, a clear focus on the positive, and orientation toward the future were helpful strategies of self-regulation; these were also part of the EBT intervention. Mindfulness was understood as permitting emotions and acceptance of one's inner processes, even if they were not pleasant, and was found to be helpful to stop ruminative thinking. The categories considered as being helpful parallel core elements of EBT and recent grief theories. The intervention was found to be supportive and met the needs of the participants. The interviewees appreciated the continuity of EBT support from palliative care into bereavement.

Grandparents Raising Their Grandchildren: Acknowledging the Experience of Grief

The grandparent-as-parent role is a growing social issue both within Australia and internationally. This paper explores the experience of grief as reported by grandparents who are raising their grandchildren. The data presented are part of a larger qualitative study that investigated the lived experience of 34 grandparents who have taken on the full-time care of grandchildren when their own children have been unable to parent them. In-depth interviews conducted with the grandparent participants and analysed through a three-layer narrative analysis reveal the paradoxical dimension of grandparents’ experience as they navigate the complex issues that characterise their predominantly unanticipated role. While all of the grandparents referred to the benefits, satisfaction, and joy of taking on the parenting of grandchildren, their narratives were deeply imbued with experiences of loss and grief. The discussion analyses this experience in relation to grief theory and posits that the complex and disenfranchised nature of grandparents’ grief means it often goes unacknowledged, including in the policies, programs, and services developed to support grandparents-as-parents.

Meaning Reconstruction in Bereavement: Sense and Significance

Recently there has been growing empirical and theoretical attention to the role of meaning in grief, along with increased recognition of the need for more sophisticated definitions of meaning. The present article highlights philosophical issues inherent in the study of meaning and grief, reviews the place of meaning in current theories of grief, and provides a brief overview of the ways that meaning has been operationalized by grief researchers, including sense-making, benefit finding, identity change, and purpose in life. It is argued that, in our focus on the ways mourners make sense of loss, we have neglected an important aspect of meaning: life significance. Life significance is the felt perception that some aspect of one's life experience “matters.” The construct is explored as a potentially important outcome of bereavement; mourners may lose life significance along with their lost loved one, or they may develop new avenues to life significance as they confront mortality and rebuild shattered worldviews. Related literature, such as appreciation of life as a facet of posttraumatic growth, is surveyed for clues as to the role of life significance in grief. Suggestions for future study are offered.

Experiences of memory-writing in bereaved people

Abstract Grief following the loss of a close person, and dealing with bereavement, is painful and demanding. Grief theory emphasizes the positive value of memories and of continuing bonds to the deceased. Furthermore, writing is a powerful tool for expressing and handling difficult and painful experiences. This qualitative study explores and describes the experiences of memory-writing in 13 bereaved people attending a structured grief management programme. Qualitative data from written reports following writing in groups and at home, and from an extensive individual report compiled two weeks after completion, was analysed. The findings indicate that memory-writing seems to evoke and preserve significant memories. Although distressing, this memory process has a meaning-reconstruction role for most people, and provides power to move forward on the road of life. The findings suggest that memory-writing might be a useful tool in grief processing and suitable for use in health care.

Using multidimensional grief theory to explore the effects of deployment, reintegration, and death on military youth and families.

To date, the US military has made major strides in acknowledging and therapeutically addressing trauma and post-traumatic stress disorder (PTSD) in service members and their families. However, given the nature of warfare and high rates of losses sustained by both military members (e.g., deaths of fellow unit members) and military families (e.g., loss of a young parent who served in the military), as well as the ongoing threat of loss that military families face during deployment, we propose that a similar focus on grief is also needed to properly understand and address many of the challenges encountered by bereaved service members, spouses, and children. In this article, we describe a newly developed theory of grief (multidimensional grief theory) and apply it to the task of exploring major features of military-related experiences during the phases of deployment, reintegration, and the aftermath of combat death--especially as they impact children. We also describe implications for designing preventive interventions during each phase and conclude with recommended avenues for future research. Primary aims are to illustrate: (1) the indispensable role of theory in guiding efforts to describe, explain, predict, prevent, and treat maladaptive grief in military service members, children, and families; (2) the relevance of multidimensional grief theory for addressing both losses due to physical death as well as losses brought about by extended physical separations to which military children and families are exposed during and after deployment; and (3) a focus on military-related grief as a much-needed complement to an already-established focus on military-related PTSD.

RECOVERING OUR LOST SAINTS

While faith and a spiritual perspective offer hope and reassurance in bereavement, not all Christians find that their faith gives them the framework they need in their loss and for some it may serve to slow down or disrupt the grief process. However, taking current grief theories, and applying them to a realistic theology, and in particular the concept of the communion of saints, has the potential to allow the Christian to grieve in a healthy way while continuing to hold to principles and beliefs informed by their faith.

Steps, stages, and structure: Finding compensatory order in scientific theories.

Stage theories are prominent and controversial in science. One possible reason for their appeal is that they provide order and predictability. Participants in Experiment 1 rated stage theories as more orderly and predictable (but less credible) than continuum theories. In Experiments 2-5, we showed that order threats increase the appeal of stage theories of grief (Experiment 2) and moral development (Experiments 4 and 5). Experiment 3 yielded similar results for a stage theory on Alzheimer's disease characterized by predictable decline, suggesting that preference for stage theories is independent of valence. Experiment 4 showed that the effect of threat on theory preference was mediated by the motivated perception of order, and Experiment 5 revealed that it is particularly the fixed order of stages that increases their appeal.

Understanding Factors that Influence the Grieving Process

Grief is a universal response to loss. Despite its universality, variation exists in how it is experienced and expressed. In light of evidence from bereavement research over the last two decades, previous paradigms regarding grief and loss are changing, which has important implications for professionals, including nurses, who work in end-of-life care. Much research centres on the recognition of grief as a complex, multidimensional phenomenon that is influenced by a variety of external factors. Social, cultural and religious worldviews all influence grief reactions, informing individual response to death. When caring for dying patients and their relatives/loved ones, nurses must be aware of the process of grief and the factors that influence the bereavement process following the patient’s death. Lack of openness towards death and bereavement may affect the quality and range of support and care services made available to families. This article will focus on the bereavement experienced by adults. It will provide an overview of the theories of grief. The external factors that may affect the grief process will then be considered. Conflicts of interest: none

Catching the light: Finding words for grief with Lewis, Didion and Woolf

When my dad said, ‘You’re going to get some very bad news here, so you have to prepare yourself,’ I began to understand the word grief. For most of the 20th century, grief was categorised by stage models and binaries, and described as a process that eventually ends. Philosopher Thomas Attig, however, contributesto a “new wave” of grief theory that dismisses these interpretations as reductive. He describes grief as a process of ‘relearning the world of ourexperience’. As I go about doing just that, ‘relearning the world’ without my mother in it, I rely on Joan Didion’s The Year of Magical Thinking, Virginia Woolf’s life and work, and CS Lewis’s A Grief Observed to show me the way. I find a common thread in the feeling of being pushed to the social margins when grieving. I ask, where is the space for grief, if – as Philippe Ariès has suggested–Western culture subscribes to a ‘social obligation’ to strive for happiness? With the help of these three writers from three different eras, I learn that grief does not, in fact, end; and suggest that, as grieving writers, we may have access to a culturally accepted space for grief that the general population does not.

Pastoral Theological Reflection on Grief: Contemporary Theory and the Practice of Ministry by Melissa Kelley

This article highlights four of Melissa Kelley’s contributions in her book Grief: Contemporary Theory and Practice. The author identifies these as: 1) Kelley’s capacity to distill and synthesize the most important areas of contemporary grief theory; 2) her work on attachment theory and its relationship to people’s ways of coping with grief; 3) the focus on the research of Bonanno et al. (Journal of Gerontology Series B: Psychological Sciences and Social Sciences 60:67–73, 2005) and showing us who is most vulnerable and in need of pastoral care during grief; 4) her emphasis on meaning making as the core of the grieving process. The article also lifts up questions concerning communal practices for grieving loss born of injustice and the need for prevention and fostering coping mechanisms so that the worst effects of grief might be mitigated.

Definitional Distinctions in Response to Perinatal Loss and Fertility Barriers

Women of childbearing age may face unanticipated perinatal losses and fertility barriers which challenge emotional well-being. However, the conceptual fit of perinatal and reproductive loss into contemporary grief theory is less well defined. This article utilizes secondary data from the National Survey of Fertility Barriers (NSFB) (Johnson & White, n.d.) to examine the definitional distinctions between depression, complicated grief, and personal growth. In the study ( N = 4,712), approximately one-third of participants (34%) had experienced a pregnancy loss, stillbirth, or infant/child death, while another one-third (33%) experienced some degree of fertility challenge other than miscarriage. Through descriptive multi-group comparisons and confirmatory factor analysis (CFA), we explore definitional distinctions between these groups within constructs of depression, complicated grief, and personal growth. Study findings highlight the complex interrelationships among grief, depression, and personal growth which are interwoven with experiences of perinatal and infant death as well as fertility challenges.

Effects of patient death on nursing staff: a literature review

There were 509090 deaths recorded in England and Wales for 2008 (Office for National Statistics, 2010); of these, over 56% (260000) occurred in NHS hospitals. The death of a patient is an event that most, if not all, nursing staff will encounter during their work. This experience can elicit physical, cognitive, behavioural, spiritual and emotional responses (Parkes, 1998). The aim of this literature review is to explore how the death of patients in a hospital setting impact on nursing staff. A review of the literature was undertaken using the online databases CINAHL, Medline and PsychInfo. The search was limited to articles in the English language and those from peer-reviewed journals. Themes arising from the literature review included: the theoretical context; the emotional impact; the culture of the healthcare setting; staff's previous life experiences; and support available for healthcare staff. The death of patients does have an impact on nurses. This can affect them both in their work environment and outside of work. Education around grief theory and support from others are helpful for staff in developing strategies for coping with patient deaths.

Professionals' Experiences of Grief Counseling: Implications for Bridging the Gap between Research and Practice

Despite the escalating interest in grief interventions, there is a clear misalignment between contemporary grief research and grief counseling practices, and this disparity may limit intervention effectiveness. Semi-structured interviews with 19 grief counselors revealed their current practices of grief counseling. The counselors' descriptions of grief and their grief counseling practices were diverse and many were influenced by classic grief theories and the grief work hypothesis. The grief counselors described negotiating several issues and dilemmas in their work and provided recommendations for achieving greater exchange between research and practice. The findings have the potential to inform the delivery, efficacy, and relevance of grief counseling in Western Australia.

Innovations in Bereavement Education

Advanced practice nursing students provide care for clients and families in numerous settings where they will encounter end-of-life issues. Thus, graduate nursing education should include information on current trends in thanatology, such as the debate over the proposed complicated grief criteria and the paradigmatic shift toward evidence-based grief theory. In this article, an innovative approach to teaching bereavement content to graduate nursing students during a 3-hour class is presented. The assignments were developed specifically for adult learners with clinical experience. Students' responses to the learning activities and recommendations for modifications of the teaching methods are presented.

Do Shattered Worldviews Lead to Complicated Grief? Prospective and Longitudinal Analyses

Theories of complicated grief (CG) and posttraumatic stress disorder (PTSD) posit a central etiological and maintaining role for global beliefs about the world (Janoff-Bulman, 1992). In two studies using separate bereaved samples, we examined these theoretical postulates. Study 1 included prospective data on bereaved spouses and nonbereaved controls at baseline and 6-months post-loss. High pre-loss justice beliefs and acceptance of death prospectively predicted lower depression in bereaved but not control participants, providing evidence for buffering effects. Study 2 used longitudinal data on bereaved spouses and parents (4- and 18-months post-loss), and matched nonbereaved controls. In comparisons to matched controls, bereaved persons showed more benevolent but less meaningful worldviews, and violent or sudden loss was not associated with negative worldviews. In contrast to theoretical proposals, early benevolence, and meaningfulness beliefs showed no longitudinal relation to later PTSD, grief, and depression symptoms. By contrast, early PTSD, grief, and depression predicted later levels of benevolence. Findings support that pre-loss worldviews can buffer the impact of loss, that post-loss worldviews have minimal effects on subsequent adjustment, and that grief symptoms can compromise subsequent worldviews.

The mourning before: can anticipatory grief theory inform family care in adult intensive care?

Although anticipatory grief is a much-debated and critiqued bereavement concept, it does offer a way of understanding and exploring expected loss that may be helpful in certain situations. In end-of-life care in adult intensive care units, families often act as proxy decision makers for patients in the transition from curative treatment efforts to planned treatment withdrawal. Despite there being a developed evidence base to inform care of families at this time, few of the clinical studies that provided this evidence were underpinned by bereavement theory. Focusing on end-of-life intensive care practices, this paper integrates work on anticipatory grief and family interventions to present a family-centred framework of care. Through this it is argued that the complex needs of families must be more comprehensively understood by doctors and nurses and that interventions must be more systematically planned to improve quality end-of-life care for families in this setting.

Grief as social experience: Death and bereavement in Lihir, Papua New Guinea1

This paper explores the nature of grief in Lihir, Papua New Guinea, in light of psychological theories of bereavement and grief. Anthropologists have demonstrated that culture has an impact on both the expression and experience of grief and can offer both a challenge to established theories and new perspectives on the conceptualisations and experiences of the bereaved. Until recently, ‘grief work’ was the foremost model for understanding bereavement as a psychological process and was also used by anthropologists in cross‐cultural work. However, since the 1990s, a number of alternative models of normal grief have emerged, including the dual process coping model and the model that proposes resilience as a central concept. These newer models, particularly the one which incorporates resilience, offer more for understanding grief in Lihir. The article argues that grief in Lihir has a phase of sorrow and worry that is dealt with through the sociality and activity of the mourning period, and then a longer phase of active remembering and forgetting of the deceased. The social and cultural context of bereavement is not adequately captured in current psychological conceptualisations of social support, which need to be broadened to encompass cross‐cultural material.

The Grief Support in Healthcare Scale

Social support is an important factor to consider in understanding the grief process. However, existing measures of social support fail to account adequately for the unique characteristics of grief experienced by healthcare workers in relation to the deaths of patients or nursing home residents. The purposes of this study were to develop and to test a grief support measure specific to the experiences of healthcare workers. Using a cross-sectional design, 380 nursing assistants completed self-administered surveys focusing on grief and loss in the nursing home setting. Exploratory factor analysis and regression analysis were conducted to test the psychometric properties of the Grief Support in Healthcare Scale (GSHCS) and to investigate the scale's relationships with grief outcomes. Reflective of the theory of disenfranchised grief, the 15 items of the GSHCS were loaded onto three distinct factors: recognition of the relationship, acknowledgement of the loss, and inclusion of the griever. Reliability was acceptable to high across these factors (Cronbach's α of .89, .86, and .78, respectively). Regression analysis indicated that the three subscales of the GSHCS were related significantly to both distress from grief and growth from grief, yet these relationships were unique for each factor. This research demonstrated that the GSHCS has acceptable reliability and face validity for understanding grief in healthcare workers and may aid in the development of interventions targeted at enfranchising grief in this population. Additional testing is needed to estimate the validity and the reliability of the scale with other groups of healthcare workers.

An Examination of Stage Theory of Grief among Individuals Bereaved by Natural and Violent Causes: A Meaning-Oriented Contribution

Despite its popularity, few attempts have been made to empirically test the stage theory of grief. The most prominent of these attempts was conducted by Maciejewski, Zhang, Block, and Prigerson (2007), who found that different states of grieving may peak in a sequence that is consistent with stage theory. The present study aimed to provide a conceptual replication and extension of these findings by examining the association between time since loss and five grief Indicators (focusing on disbelief, anger, yearning, depression, and acceptance), among an ethnically diverse sample of young adults who had been bereaved by natural (n=441) and violent (n=173) causes. We also examined the potential salience of meaning-making and assessed the extent to which participants had made sense of their losses. In general, limited support was found for stage theory, alongside some evidence of an "anniversary reaction" marked by heightened distress and reduced acceptance for participants approaching the second anniversary of the death. Overall, sense-making emerged as a much stronger predictor of grief Indicators than time since loss, highlighting the relevance of a meaning-oriented perspective.

Applicability of general grief theory to Swedish women's experience after early miscarriage, with factor analysis of Bonanno's taxonomy, using the Perinatal Grief Scale

Background. Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief.Material and methods. Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman's categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks.Results. Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage.Conclusion. Women's experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman's age, or her number of earlier miscarriages.