Model Of Grief Research Articles

Experiences of Norwegian Mothers Attending an Online Course of Therapeutic Writing Following the Unexpected Death of a Child.

The unexpected death of a child is one of the most challenging losses as it fractures survivors’ sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n = 13), qualitative data from the application and assessment surveys (n = 35; n = 21), excerpts from the journals of some participants (n = 3), and email correspondence with some participants (n = 5). We categorized the results in three meaning units: (1) where does my story begin? The “both and” of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: “careful optimism” and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self.

Self-identity processing and grief: The role of avoidance and flexibility

There is increasing evidence that self-identity processes play a key role in adaption to bereavement. Whereas much of the research to date has focussed on the content of one's self identity, the current study draws self-identity processing style theory to investigate how the socio-cognitive processes employed to negotiate identity conflicts are associated with bereavement outcomes. Participants were 194 bereaved adults from the United Kingdom and Australia (60.5% female, mean age = 40. 23, SD = 13.46, range = 18–70) drawn from a larger convenience sample, who were participating in a longitudinal online study. Participants completed self-report measures of identity processing style, prolonged grief symptoms, major depression and generalized anxiety. Linear regression and path analysis indicated that a diffuse-avoidant processing style was associated with more severe grief, depression and anxiety. A normative processing style was associated with more severe grief symptoms only. Age and gender were also related to symptom outcomes. Results are consistent with theoretical models of grief and highlight potentially modifiable mechanisms in adaption. Findings are discussed with reference to the role of individual differences in explaining grief severity and heterogeneity in bereavement outcomes. Limitations and future recommendations are discussed.

Co-Occurring Substance Use Disorders and Grief during Recovery

Background Individuals with substance use disorders (SUDs) often experience loss and grief when recovering from addiction. With fatal overdoses and suicide rates increasing for individuals with SUDs and other mental health concerns, individuals in recovery are often faced with mourning the loss of a loved one while navigating their life in recovery. The loss of a loved one can be compounded by the effect of losing their relationship with their drug of choice. These co-occurring losses may prove overwhelming during recovery and precipitate a relapse. Objectives We wish to propose the use of two bereavement models to address the grief present for individuals with SUDs experiencing loss so that providers are better able meet the complex needs of this population. Methods This article presents two separate bereavement models that may be used to shape treatment for individuals in recovery from addiction with co-occurring grief from the loss of a loved one: the dual-process model of coping with bereavement (DPM) and the two-track model of bereavement. Results We propose the application of these two grief models in treatment for individuals with SUDs who are experiencing co-occurring grief issues. We discuss therapeutic interventions that may be utilized to support clients with co-occurring losses. Conclusion/Importance: If an individual experiences the loss of a loved one while navigating their life in recovery from a SUD, they can experience complicated grief due to co-occurring losses. These models provide an opportunity for mental health providers to help those with SUDs work through this complex grief.

Stages of Grief Portrayed on the Internet: A Systematic Analysis and Critical Appraisal.

Kübler-Ross’s stage model of grief, while still extremely popular and frequently accepted, has also elicited significant criticisms against its adoption as a guideline for grieving. Inaccurate portrayal of the model may lead to bereaved individuals feeling that they are grieving incorrectly. This may also result in ineffectual support from loved ones and healthcare professionals. These harmful consequences make the presentation of the five stages model an important area of concern. The Internet provides ample resources for accessing information about grief, raising questions about portrayal of the stages model on digital resources. We therefore conducted a systematic narrative review using Google to examine how Kübler-Ross’s five stages model is presented on the internet. We specifically examined the prominence of the model, whether warnings, limitations and criticisms are provided, and how positively the model is endorsed. A total of 72 websites were eligible for inclusion in the sample. Our analyses showed that 44 of these (61.1%) addressed the model, indicating its continued popularity. Evaluation scores were calculated to provide quantitative assessments of the extent to which the websites criticized and/or endorsed the model. Results indicated low criticalness of the model, with sites often neglecting evaluative commentary and including definitive statements of endorsement. We conclude that such presentation is misleading; a definitive and uncritical portrayal of the model may give the impression that experiencing the stages is the only way to grieve. This may have harmful consequences for bereaved persons. It may alienate those who do not relate to the model. Presentation of the model should be limited to acknowledging its historical significance, should include critical appraisal, and present contemporary alternative models which better-represent processes of grief and grieving.

Small business in a time of crisis: A five stage model of business grief

In this paper we examine the implications that a crisis such as that created by COVID-19 has for the psychological well-being of small business owners. We use the psychological literature on grief, specifically, the Kübler-Ross (1969) Five Stage Model of Grief to examine the impacts. Our review of the literature indicates that although there are critics of a stage based approach there are also advocates for the use of stages to help us frame and understand the manifestations of grief. Data was collected from forty small business owners based in Ireland. Data was collected five times over a period of six months (March–September 2020). The outcome is a five-stage model of business grief. The findings provide insights into the emotional relationship between an owner and their small business. We propose that a business closure can cause small business owners to grieve in a manner that aligns with a series of stages and that these stages can be modelled and illustrated.

Lives turned upside down in COVID-19 times: exploring disabled people's experiences in 5 low-and-middle income countries using narrative interviews

This article explores COVID-19 related experiences of disabled people in Bangladesh, Kenya, Nigeria, Nepal and Uganda. Narrative interviews generated storied responses, focussing on respondents' priorities, which enabled us to hear what was most significant for them and their families. 143 interviews were conducted online or by phone by 7 local researchers (3 disabled), with appropriate inclusive support. Nearly everyone was interviewed twice to capture the progression of impacts over time. The data was analysed thematically through a virtual participatory approach.An overarching 'subjective' theme of feelings experienced by the participants was labelled 'destabilisation, disorientation and uncertainty'. We also identified 'concrete' or material impacts. People experienced various dilemmas such as choosing between securing food and keeping safe, and tensions between receiving support and feeling increased vulnerability or dependence, with interplay between the emotions of fear, loss and hope. We found both the concept of liminality and grief models productive in understanding the progression of participants' experiences. Disabled people reported the same feelings, difficulties and impacts as others, reported in other literature, but often their pre-existing disadvantages have been exacerbated by the pandemic, including poverty, gender and impairment related stresses and discrimination, inaccessible services or relief, and exclusion from government initiatives.

The role of experiential avoidance in the relationship between traumatic distress and yearning in sudden and unexpected bereavement.

Distressing preoccupation with the circumstances of the death, experiential avoidance, and yearning often manifest in pathological forms of grief following the sudden or unexpected death of a loved one. Traumatic distress-the emotional distress linked to circumstances or reminders of a death-often leads to avoidance behaviors, whereas yearning has been conceptualized as an emotional state which leads to proximity-seeking behaviors following bereavement. A gap exists in the literature explaining how these variables may interact and perpetuate one another. The present study aims to examine the role of experiential avoidance in the relationship between traumatic distress and yearning in a sample of suddenly and unexpectedly bereaved young adults. Results suggest that the association between traumatic distress and yearning may be partially mediated by experiential avoidance. Implications of these findings for theoretical models of grief and yearning are discussed. Data include a sample of 606 bereaved young adults (Mage = 21.25; 77.4% female) who participated in a larger, online survey study conducted at two universities in the United States exploring the prevalence of trauma exposure in college students. Mediation analysis demonstrated experiential avoidance as partially mediating the relationship between traumatic distress and yearning (ab = .21, SE = .10, 95% CI [.02, .40]) when controlling for presence at the scene of death or injury. This indirect effect accounted for 11.67% of the total effect. An additional moderated mediation analysis indicated this indirect effect was present across all levels of prolonged grief disorder (PGD) symptom severity. Results indicate that the association between traumatic distress and yearning may be partially mediated by experiential avoidance across all levels of PGD symptom severity. Findings suggest that bereaved individuals experiencing recurrent, death-related intrusive thoughts, imagery, and/or other memories related to the circumstances of the death may be more likely to experience intense yearning for the deceased in part due to attempts to avoid painful internal experiences associated with such cues.

Using the Kübler-Ross Model of Grief with Post-Traumatic Stress Disorder (PTSD): An Analysis of Manchester by the Sea

<p class="AbstractText">People may encounter different stages of grief during the course of bereavement, and not everyone can achieve a positive state of mind. This study intended to analyze how the characters in <em>Manchester by the Sea</em>, mainly Lee Chandler, Patrick Chandler, and Randi, manage their emotional responses when they are facing the loss of a loved one. The study used Elisabeth Kübler-Ross’s five-stage model of grief and post-traumatic stress disorder (PTSD) to analyze how these characters transition through their grief and whether they are likely to suffer from mental illness. Some people, like Randi and Patrick in the film, may recover from bereavement; however, some people, like Lee, may not, eventually becoming afflicted with mental illness or PTSD.</p>

Leading through COVID-19: understanding and supporting grief and loss

The COVID-19 pandemic has created an environment in which grief and loss are being experienced collectively. This grief can lead to increased burnout, decreased productivity, and increased likelihood of job turnover. With health care workers already facing increased risks because of their frontline pandemic responsibilities, it is important to provide leaders with knowledge and tools to support their grieving team members. Understanding the Kübler-Ross grief model, as well as grief-related concepts such as anticipatory grief, disenfranchised grief, moral injury, and complicated grief, will help leaders provide normalizing support. This approach may include building and fostering trusting relationships, engaging in self-reflection, participating in supportive conversations, and, when appropriate, sharing information around grief-support resources. There is no universal timeline for the resolution of grief; mental health impacts can last for many months and can continue to resurface for years. During the COVID-19 pandemic, we educated health care workers around the issues of grief and loss by focusing on the relationship side of the Wheel of Change, interviewing people with expertise in the area, holding town hall meetings, and hosting online “coffee and chat” sessions for physicians. We recommend relying less on policy development and, instead, focus on strengthening workplace relationships and creating opportunities for connection and discussions.

Spousal Dementia Grief: A Research Report from the Two-Track Model of Dementia Grief Project

Caregiving for a loved one suffering from cognitive decline involves coping with many challenges and losses. This experience increases the risk of worsening the physical and mental health of the caregiver and has been the subject of a substantial number of studies focusing on the stress and burden of the primary caretaker. Theory and research on the grief reactions experienced by the family members, however, continues to lag in terms of the attention given to the behavioral and psychological burden of caregivers. This study aimed for a deeper understanding of the emotional processes in an individual involved in caring and caregiving for a spouse suffering from cognitive decline, through the prism of the Two-Track Model of Dementia Grief (TTM-DG). The TTM-DG emphasizes the continuous emotional attachment to the loved one suffering from cognitive decline (Track II), along with a medico-psychiatric perspective associated with stress, trauma, and changes in life (Track I). In this research project, we examined the degree to which spouses of cognitively impaired, deceased, and healthy partners showed differences and perceptible patterns considering the elements associated with the model and their interrelationship. These elements include behavioral characteristics of the clinical patients suffering from cognitive decline, objective circumstances of the caregiving situation, personality measures of attachment of the caring spouse, and a range of measures assessing psychological well-being and spousal relationship. The current study is a part of a larger ongoing project in Israel to address loss and grief among caregiving family members whose loved ones suffer from cognitive decline. The findings reported in the current paper are based on data derived from self-report questionnaires (i.e., socio-demographic variables, problematic behaviors in patients, objective burden, social support, physical health status, attachment patterns, depression, dementia grief, and relationship satisfaction). Participants in the sample size of 49 came from three groups: (a) spouses of patients suffering from cognitive decline, (b) widowers of deceased dementia sufferers, (c) and a control group of similarly aged participants whose spouses have no cognitive or functional impairment. Examination of the research hypotheses was done by running correlations and one/two-way analyses of variance (ANOVA). Behavioral disorders in the affected spouse correlated positively with the objective burden of the caring/caregiving spouse and with outcome variables. That is, biopsychosocial functioning (Track I) and the ongoing attachment bond with the ill spouse (Track II); objective burden correlated positively with depression and dementia grief, but not with relationship satisfaction; poor caregiver’s physical health was associated positively with depression and dementia grief, but not with relationship satisfaction; social support correlated positively with low levels of depression and dementia grief, as well as to the higher degree of relationship satisfaction; insecure attachment was found to correlate positively with depression and dementia grief, but not with relationship satisfaction. Spouses of cognitively impaired patients reported more difficulties in outcome variables compared to the control group; widowers of deceased dementia sufferers reported higher levels of dementia grief and depression than the control group. In terms of outcome measures, there was no difference between widowers and spouses of cognitively impaired patients. Among the control group participants, there was no difference between secure and insecure attachment on outcome variables. A significant difference between secure and insecure attachment on outcome variables was observed among spouses of cognitively impaired patients and widowers so that insecure participants reported higher levels of distress. The findings of the present study constitute the initial empirical evidence for the utility of the TTM-DG and support the transition of the field of loss and bereavement, which emphasizes the importance of the emotional attachment with the loved one as one of the primary foci of the process of coping with the loss. Furthermore, the findings highlight factors that contribute to the health and emotional resilience (secure attachment style, perceived social support, etc.) and provide a framework that can assist in the process of clinical assessment and intervention to improve the quality of life of caregivers whose loved one suffers from cognitive decline.

Predicting models of depression or complicated grief among bereaved family members of patients with cancer.

To derive and validate a risk scoring system for predicting major depressive disorder (MDD) and complicated grief (CG) among bereaved family members of patients with cancer that is feasible for clinical use. We conducted a secondary analysis of two cross-sectional nationwide bereavement surveys in Japan. From a total of 17,312 bereaved family members of patients with cancer, 8618 and 8619 were randomly assigned to a derivation and a validation group. The Patient Health Questionnaire 9 (PHQ-9) and the Brief Grief Questionnaire (BGQ) were used to assess MDD (PHQ-9 score≥10) and CG (BGQ score≥8), respectively. We compared five models with potential predictive variables that could be easily obtained in daily practice and were included in the bereavement survey (i.e., sociodemographic data). The model which included variables such as the families' physical/mental health status and preparedness toward bereavement, in addition to their sociodemographic data, was considered modest for predicting the risk of both MDD and CG. The areas around the curve for MDD and CG were 0.74 (95% CI: 0.73-0.76) and 0.74 (95% CI: 0.72-0.75) and 0.78 (95% CI: 0.76-0.79) and 0.77 (95% CI: 0.76-0.79) in the derivation and validation groups, respectively. We developed a clinical risk score for predicting MDD and CG among bereaved family members of patients with cancer. However, further research is needed for external validation and assessment regarding its implementation in actual practice.

Narratives of Loss: Exploring Grief through Photography


 
 
 Grief is not an exclusively private and intrapsychic phenomenon but a dynamic process whereby the bereaved negotiates the meaning of the loss in a way that may challenge his/her personal self-narrative. Drawing on a social constructionist model of grief, this paper features a case study where we analyse narratives of mourning elicited through a personal photographic project. The visual-based narrative methodology used in our study (photo-production) not only allows for multi-modal forms of expression and communication in the study of grief, but it also serves as an aid for individuals to scaffold further meaning-making processes which cannot be conveyed through narrative alone. The paper concludes with an invitation to reflect on the use of photography as both a possible methodological tool to explore narratives of grief and a therapeutic tool for the construction of meanings and continuing bonds with the deceased.
 
 

Prolonged grief disorder in refugees from Syria: qualitative analysis of culturally relevant symptoms and implications for ICD-11

ABSTRACT Prolonged Grief Disorder (PGD) is a new mental disorder recognised by the ICD-11. However, the cultural norms for grief in refugees or humanitarian migrants from Syria have not yet been established. Here we conduct an exploratory qualitative study of 10 key informant interviews with refugees from Syria with two main aims: (1) to identify common symptoms of normal or abnormal grief in refugees from Syria (2) to identify barriers to the acceptability of the new prolonged grief disorder. Three levels of qualitative analysis informed a new model of grief in Syrian refugees. Important culturally relevant symptoms such as “emotional outburst” and “weariness” emerged. The theme of “refugee experience” including sub-themes such as loss of homeland, lack of social network and ambiguous loss, emerged as potential predictors of grief severity. Finally, the level of culture and society revealed key barriers to the acceptability of the PGD diagnosis including stigma.

When the labs closed: graduate students’ and postdoctoral fellows’ experiences of disrupted research during the COVID-19 pandemic

Government imposed lockdown measures in response to the COVID-19 pandemic resulted in widespread laboratory closures. This study aimed to examine the impact of this disruption on graduate students and postdoctoral fellows completing laboratory-based research in Canada. We used an anonymous online survey and semi-structured interviews to document the experiences of graduate students and postdoctoral fellows during laboratory closures and following the transition to working from home. We employed a mixed-method approach using survey and interview data to identify shared experiences, concerns, and supports. The emotions reported by respondents at different points during laboratory closures align with the Kübler-Ross model of grief following change. Respondents describe closure processes as chaotic and confusing, primarily resulting from inconsistent communication. Respondents reported increased indications of distress while working from home. Concerns about how COVID-19 might impact trainees were identified, including decreasing competitiveness of applicants while limiting future employment opportunities. Finally, we outline five types of supports that can be implemented by supervisors and administrators to support graduate students and postdoctoral fellows to return to the laboratory. Overall, we document shared experiences of respondents during the COVID-19 laboratory shutdown and identify areas of improvement in the event widespread laboratory closures occur in the future.

When Money Can’t Be Avoided: Helping Money Avoidant Widows Using the Changes and Grief Model (FTA Best Paper Award)

Widows represent one of the fastest-growing demographics due to the global COVID-19 pandemic. Many widows also lost their family’s financial manager because more men hold the role of household financial manager. When their spouse dies, the widow can experience unhealthy attitudes towards finances and financial anxiety. The Changes and Grief Model for Financial Guidance pairs financial therapy techniques and inquiry methods, such as The Work of Byron Katie®, with the grief process and the change cycle. Using this model enables financial practitioners, mental health practitioners, and financial therapists to recognize the stage of grief the widow is experiencing and use the proper financial therapy modalities to support the money-avoidant widow. The model presented will provide the process to deepen client relationships through meaningful communication while compassionately supporting money-avoidant widows through financial decisions during the difficult initial stages of grief.

The Dynamics of Hope in Unkrich and Molina’s Coco

This study analyzes how the characters in Lee Unkrich and Adrian Molina’s animated film Coco, mainly Mamá Imelda, Héctor, and Miguel, manage their emotional responses when they are facing loss, bereavement, or other significant changes in their lives. The study uses Elisabeth Kübler-Ross’s five-stage model of grief to analyze how these characters go through the grieving process. Moreover, in order to suggest how those who are grieving can enter into positive states of mind, the study expands on Kübler-Ross’s original model by incorporating a positive mindset of hope. In dialogue with Unkrich and Molina’s film, the study uses Kübler-Ross’s ideas to explore coping mechanisms that can help manage difficult times in life, while also suggesting the benefits of maintaining a positive mindset through hope.

Psychometric Evaluation of the Swedish Version of the Prolonged Grief Disorder-13 (PG-13) in a Bereaved Mixed Trauma Sample.

Background: This study aimed to examine the psychometric properties of the Swedish PG-13 in a bereaved trauma exposed sample. A second aim was to examine the latent structure of prolonged grief using the PG-13.Methods: The participants were adults (n = 123) taking part in an ongoing longitudinal study regarding the effects of potentially traumatic events. Participants had experienced a potentially traumatic event in the past 5 years and had reported a death of a significant other either as their primary traumatic event or in addition to another traumatic event. Assessment included self-report of prolonged grief, posttraumatic stress, and general psychological distress. Clinical interviews were used to assess depression, posttraumatic stress disorder, and disability level. The psychometric properties of the Swedish PG-13 were examined through reliability tests and assessment of associations with symptoms of posttraumatic stress, depression, general psychological distress, and disability level. Principal component analysis (PCA) and confirmatory factor analyses (CFA) were used to assess the latent structure.Results: The internal consistency (Cronbach's α = 0.86) and test-retest (r = 0.86) reliability were good. PCA suggested a three-factor model as descriptive of the latent structure of the instrument. Therefore, the CFA used this model, as well as two models suggested in the literature. The three-factor model had the best fit to data. Support of concurrent validity of PG-13 was shown by moderate positive associations with measures of posttraumatic stress, depression, and general psychological distress.Conclusions: The Swedish PG-13 demonstrated good psychometric properties, and its use in research and practice to assess prolonged grief was supported. The factor analyses provided stronger support for models with two or three factors, as compared with a unidimensional model of prolonged grief, with the three-factor model having the best fit.

When Ambiguous Loss Becomes Ambiguous Grief: Clinical Work with Bereaved Dementia Caregivers.

The experience of caring for someone with dementia can be heartbreaking. The losses inherent to caregiving itself can be difficult to reconcile after the death of a person with dementia, causing challenges in the bereavement stage. Although there is often significant social support to help people process the death of someone close to them, clinicians can struggle to help bereaved dementia caregivers integrate their ambiguous losses from caregiving, such as loss of roles, functions, and relationships, into a postdeath bereavement process. Many socioeconomic, personality, and family functioning factors impact an individual caregiver's experience, and there are more global influences from the nature of dementia caregiving itself that must be understood to best support a caregiver. Using the lens of the dementia grief model and examples from a case study, this article seeks to illustrate the dynamics inherent in integrating ambiguous losses following the death of a person from dementia, and it proposes clinical goals for working effectively with this population.

Operationalizing intersectionality as a framework in qualitative grief research

The field of thanatology emphasizes understanding grief as situated within social contexts. Yet, existing research largely examines individual experiences, neglecting to critically examine the role that sociocultural systems and forms of oppression play in how people grieve. In this manuscript, we use the social constructionist model of grief as an epistemological stepping stone to operationalize intersectionality as a framework to engage in this critical qualitative research. We provide an overview of the research process implementing an intersectional framework, including examples of research questions and procedures throughout, and discuss implications for helping praxis and education and future scholarship.

Recovering the body in grief: Physical absence and embodied presence.

This paper addresses the complex issue of the embodiment of grief. It explores how a theoretical shift to the body has influenced scholarly literature about grief and bereavement. Despite this shift, we argue that bodily interpretations and experiences are undertheorised in western psychological literature on bereavement. Specifically, we argue that linear stage models of grief have encouraged the view that grief needs ‘working through’ in the mind, and not necessarily the body. We draw on empirical data from interviews with bereaved people undertaken in England to illustrate aspects of the embodied experience of grief that differ from how psychological grief theories conceive of the bereaved person’s body. Findings highlight the role of the bereaved person’s body in managing grief and how the absence and continuing presence of the deceased person is managed through embodied practices. We conclude that understanding grief as an embodied experience can enable the development of grief theories that better capture the complex negotiation between the psychological processes of grief and the materiality of bodies.