Treatment Of Grief Research Articles

Treating Complicated Grief among Orphaned Children in Kenya: Effectiveness of Complicated Grief Therapy

Complicated Grief (CG) also referred to as complicated bereavement is a clinically significant condition even though there is limited evidence on its prevalence and treatment in Kenya and Africa in general. The main aim of this 2019 study was to test the efficacy of a modified Complicated Grief Therapy (CGT) in treating complicated grief (CG) among orphaned children. A total of 426 orphaned children aged 10 - 15 years were screened using the Brief Grief Questionnaire to sample those with elevated grief scores. Of the 263 who met the criteria, only 241 participants fully participated in the six months study with 123 and 118 participants in the treatment and the control groups respectively. The treatment group was subjected to a shortened version of the CGT (12 weeks) while no treatment was offered to the control group. The prevalence of grief among orphaned children was 66% and using the Inventory for Complicated Grief, to determine the clinical levels, a mean grief score of 31.6 (SD = 9.52) was recorded. The reduced version of CGT was effective in the reduction of complicated grief symptoms t(122) = -15.79, p at a weekly reduction of 1.29 points. In the case of the control group, the paired sample test showed a statistically insignificant reduction of CG score, t(117) = -0.712, p = 0.478. Conclusions: Reducing CGT sessions 12 sessions to make it shorter and less stringent and using it as group therapy in a school setup did not interfere with its effect on the treatment of complicated grief among orphaned children.

The three dimensions of caregiver grief in dementia caregiving: Validity and utility of the subscales of the Marwit-Meuser Caregiver Grief Inventory.

BackgroundThe experience of grief in family caregivers as they provide care for persons with dementia is often overlooked. The Marwit‐Meuser Caregiver Grief Inventory (MM‐CGI) is one among the few scales that capture such experiences. In a recent study, MM‐CGI was found to contain three subscales identifying dimensions of loss in caregivers—Personal‐Sacrifice Burden (PSB), Heartfelt Sadness, Longing, and Worry (HSLW), and Felt Isolation (FI). We aimed to evaluate the validity and utility of these dimensions in a multiethnic Asian population.MethodsFamily caregivers (n = 394) completed MM‐CGI and scales assessing caregiver burden, depression, and gains. Internal consistency reliability was examined using Cronbach α; test‐retest reliability using intraclass correlation coefficient; and construct validity using Pearson correlation coefficient. The utility of the MM‐CGI dimensions was evaluated by comparing caregivers with high subscale scores across dementia stages and caregiving relationship.ResultsThe three dimensions of MM‐CGI exhibited adequate internal consistency, test‐retest reliability, construct validity, and known‐group validity. PSB correlated most strongly with caregiver burden (r = 0.78); HSLW with caregiver depression (r = 0.75); and FI with caregiver burden and caregiver depression (r = 0.60, respectively). Caregivers with high total grief scores tended to experience most difficulty with HSLW (90.8%), followed by PSB (75.4%) and FI (46.2%). The three dimensions also increased across the dementia stages, with FI higher in mild dementia, PSB higher in moderate dementia, and HSLW higher in severe dementia. Spousal caregivers experienced most difficulty in HSLW, whereas children caregivers experienced similar levels of difficulty across the dimensions.ConclusionsThe three dimensions of MM‐CGI captured distinct aspects of caregiver grief in a multiethnic Asian population and would enable more individualized assessments and interventions for caregiver grief.

Changes in typical beliefs in response to complicated grief treatment.

Prolonged grief disorder (PGD) is a new diagnosis in the 11th edition of the International Classification of Diseases, estimated to affect 1 in 10 bereaved people and causing significant distress and impairment. Maladaptive thoughts play an important role in PGD. We have previously validated the typical beliefs questionnaire (TBQ), which contains five kinds of thinking commonly seen in PGD: protesting the death, negative thoughts about the world, needing the person, less grief is wrong, and grieving too much. The current paper examines the role of maladaptive cognition as measured by the TBQ in PGD and its change with treatment. Among participants in a multisite clinical trial including 394 adults, we examined (a) the relationship between maladaptive thoughts at baseline and treatment outcomes, (b) the relationship between maladaptive thoughts and suicidality at baseline and posttreatment, and (c) the effect of treatment with and without complicated grief therapy (CGT) on maladaptive thinking. TBQ scores were associated with treatment outcomes and were strongly related to suicidal thinking before and after treatment. TBQ scores showed significantly greater reduction in participants who received CGT with citalopram versus citalopram alone (adjusted mean standard error [SE] difference, -2.45 [0.85]; p = .004) and those who received CGT with placebo versus placebo alone (adjusted mean [SE] difference, -3.44 [0.90]; p < .001). Maladaptive thoughts, as measured by the TBQ, have clinical and research significance for PGD and its treatment.

A Systematic Review of Treatment Options for Grieving Older Adults.

a)The purpose of this systematic review was to characterize the studies published on grief interventions for bereaved older adults in the last 5 years. Grief intervention studies were included that exclusively focused on older adults as well as those that included older adults in their samples, in order to summarize the most up-to-date treatment options available for bereaved older adults. b)Twenty-four articles that investigated grief interventions in older adults were identified. Generally, findings suggest viable treatment approaches for bereaved older adults are those incorporating behavioral activation and guidance on restoration-oriented coping. However, similar to studies of broader adult populations, grief interventions had small effects on grief-related symptoms in older adults. Few studies examined age as a moderator of treatment effects. Studies varied greatly by study design, sample size, and outcomes measured, which all likely impacted the efficacy of results. c)This review suggests that, while there has been a growing focus on older adults, who have unique vulnerabilities in bereavement, the evidence-base of efficacious interventions for this population is limited. Given the need for specialized bereavement support for older adults will increase in the coming years, future research should prioritize rigorous investigations of grief treatment options leveraging technology to increase access and incorporate techniques that enhance engagement in life and connectedness for this vulnerable population.

Patterns, Predictors, and Prognostic Validity of Persistent Complex Bereavement Disorder Symptoms in Recently Bereaved Adults: A Latent Class Analysis.

Persistent complex bereavement (PCBD) was entered to DSM-5. No studies have yet examined the nature, prevalence, prognostic validity, and underlying mechanisms of PCBD symptom patterns in recently bereaved people. Knowledge on these issues could improve the early identification and treatment of disturbed grief. Latent class analysis was used to identify subgroups characterized by different PCBD symptom patterns among recently (≤6 months) bereaved adults (n = 476). In a subgroup (n = 251), we assessed associations of class membership with PCBD severity and functional impairment assessed 3 years later. Associations between class membership and sociodemographic and cognitive-behavioral variables were also examined. We identified a resilient (50.0%), separation distress (36.1%), and high PCBD symptoms (13.9%) class. Class membership had prognostic value as evidenced by associations with PCBD severity and functional impairment assessed 3 years later. Deaths of partners/children, unexpectedness of the loss, and maladaptive cognitions and avoidance behaviors were also associated with membership of the pervasive symptom classes.

Concurrent Treatment for PTSD and Prolonged Grief Disorder: Review of Outcomes for Exposure- and Nonexposure-Based Treatments.

This review gives an overview of treatments used to concurrently reduce symptoms of posttraumatic stress disorder (PTSD) and prolonged grief disorder (PGD). For purposes of this review, emphasis is placed on locating and comparing literature on exposure- and nonexposure-based treatments. Across 14 studies, the overall findings suggest that treatments are generally effective in treating PTSD and PGD concurrently and that treatments incorporating exposure-based components performed similarly to those without exposure-based components. However, methodological limitations preclude the ability to draw firm conclusions about the added impact of exposure-based components in traumatic grief treatment. Future directions for research on concurrent treatments for PTSD and PGD are discussed.

The relationship between substance misuse and complicated grief: A systematic review

Complicated grief is a prolonged, bereavement-specific disorder with significant psychological and physical consequences. Although complicated grief represents a risk to individuals with substance misuse, this relationship is poorly understood. Consequently, this systematic literature review examined empirical findings regarding the relationship between substance misuse and complicated grief. We searched 11 databases to identify pertinent quantitative studies published in English. Our search yielded 12 peer-reviewed journal articles (N = 1749) published between 1997 and 2017. Included studies evaluated the prevalence, assessment, etiology, correlates, risk factors, and treatment of complicated grief and substance misuse among individuals with one or both conditions. Our review found evidence of a positive relationship between complicated grief and substance misuse. Individuals with substance misuse were at increased risk for subsequent development of complicated grief, particularly when increases in substance consumption preceded bereavement. Conversely, complicated grief predicted increases in smoking and alcohol dependence. Multiple risk factors for individuals with complicated grief and substance misuse were identified and discussed. An existing complicated grief assessment performed well among individuals with substance misuse, and grief interventions were effective in reducing symptoms of complicated grief and substance misuse simultaneously. Given the severity of consequences associated with both conditions, more research is needed to understand this relationship, identify effective assessment tools, and evaluate intervention strategies to improve outcomes.

Trauma-Focused Cognitive Behavioral Therapy for Childhood Traumatic Separation.

In light of the current U.S. family separation crisis, there is growing attention to Childhood Traumatic Separation, defined here as a significant traumatic stress reaction to a familial separation that the child experiences as traumatic. When living in a family setting, Childhood Traumatic Separation may interfere with the child's relationships with the current caregiver(s). Effective treatments for Childhood Traumatic Grief can be modified to address Childhood Traumatic Separation. This article describes current applications of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for Childhood Traumatic Separation. Using two composite clinical cases, TF-CBT applications for Childhood Traumatic Separation are described. These include: (1) implementing the safety component first; (2) tailoring coping skills to address the uncertainty of Childhood Traumatic Separation; (3) integrating past traumas into trauma narration and processing of the traumatic familial separation; (4) providing Childhood Traumatic Separation-focused components to address challenges of committing to new relationships while retaining connections to the separated parent; and (5) addressing role changes. These modifications have been implemented for many youth with Childhood Traumatic Separation and have anecdotally resulted in positive outcomes. Research is needed to document their effectiveness. The above practical strategies can be incorporated into TF-CBT to effectively treat children with Traumatic Separation. Practical strategies include starting with safety strategies; tailoring skills components to address the ongoing uncertainty of traumatic separation; integrating past traumas into trauma narration and processing of traumatic separation; providing traumatic separation-focused components to balance the challenges of committing to new relationships with retaining connections to the separation parent; and addressing role changes. Through these strategies therapists can successfully apply TF-CBT for Childhood Traumatic Separation.

Evaluation of a guided internet-based self-help intervention for older adults after spousal bereavement or separation/divorce: A randomised controlled trial

BackgroundWhile several internet interventions target severe prolonged grief symptoms after bereavement, no randomised controlled trial investigated interventions for prolonged grief after separation/divorce. MethodsThis randomised controlled trial aimed to evaluate the efficacy of a guided internet-based self-help intervention for prolonged grief symptoms after spousal bereavement or separation/divorce compared to a wait-list control group. Furthermore, we analysed whether the intervention was also efficacious for participants with milder grief symptoms. ResultsA total of 110 participants were mainly recruited by newspaper articles. Average age was 51 years, 77% were separated/divorced, 79% were female. Dropout rate was 11%. Compared to the control group, the intervention resulted in significant reductions in grief (d = 0.81), depression (d = 0.59), psychopathological distress (d = 0.39) (primary outcomes), embitterment (d = 0.37), loneliness (d = 0.37) and an increase in life satisfaction (d = −0.41) (secondary outcomes). These gains were maintained over three months. Improvements were similar among widowed and separated/divorced participants as well as among participants with low, medium or high levels of grief at baseline. LimitationsLimitations include the self-selective sample and a rather small number of widowed participants. ConclusionsFindings indicate that an internet intervention based on models for coping with grief after bereavement was not only beneficial for widowed but also separated or divorced participants. Furthermore, also participants with lower levels of grief at baseline benefitted from the intervention. This corroborates that indicated prevention efforts for grief are efficacious.

Effectiveness of interventions for people bereaved through suicide: a systematic review of controlled studies of grief, psychosocial and suicide-related outcomes

BackgroundSuicide bereavement is a risk factor for adverse outcomes related to grief, social functioning, mental health and suicidal behaviour. Consequently, suicide bereavement support (i.e., postvention) has been identified as an important suicide prevention strategy. However, little is known about its effectiveness. To redress this gap, this review aimed to assess the evidence of effectiveness of interventions for people bereaved by suicide, and appraise the quality of the research in this field.MethodsWe conducted a systematic review according to PRISMA guidelines. Searches of peer-reviewed literature in Medline, PsycINFO, Embase and EBM Reviews identified 12 papers reporting on 11 relevant studies conducted between 1984 and 2018.ResultsAcross studies, there was a wide variety of intervention modalities, study populations, control groups, and grief, psychosocial and suicide-related outcome measures. Overall, the quality of studies was weak. While there was some evidence of the effectiveness of interventions for uncomplicated grief, evidence of the effectiveness of complicated grief interventions was lacking. Based on this scant evidence, interventions which seem to show promise include supportive, therapeutic and educational approaches, involve the social environment of the bereaved, and comprise a series of sessions led by trained facilitators.ConclusionsThere is a clear need for additional methodologically sound studies in this area. Specifically, selection procedures, sample sizes, randomization, and the use of appropriate measures are crucial. As people bereaved by suicide are at-risk of adverse grief, mental ill-health and suicidal behaviour, further research across the life-span is essential to prevent grief and mental health ramifications.

Development and piloting of a novel, peer-led bereavement intervention for young people living with HIV in Zimbabwe

Background: Research emphasizes lasting psychological implications when young people are not adequately supported following close family deaths. In sub-Saharan Africa, adolescents living with HIV (ALHIV) experience multiple personal deaths along with other serious losses. ALHIV highlight that not processing their grief negatively impacts their daily lives including their ART adherence. This article describes the development and piloting of a bereavement intervention for ALHIV in Zimbabwe.Methods: Formative research with 10 ALHIV peer counsellors (18–21 years) supported intervention development. After training, these peer counsellors facilitated a six-session bereavement intervention in 10 existing community-based ALHIV support groups. Qualitative data was collected from facilitators, ALHIV intervention participants, and their caregivers.Results: Key themes: i) limited experience recognizing their losses; ii) lacking control over poorly understood feelings; iii) recurrent feelings of isolation, hopelessness, depression, fear, and guilt; iv) reticence to share, believing their feelings were unusual; v) shame surrounding connections felt towards their deceased. Following intervention implementation, members reported relief in learning of shared experiences, the ability to link their feelings with specific experiences and employ constructive coping strategies to address them, leading to greater emotional control.Conclusion: Implementing high-quality grief interventions is critical when responding to the complex realities of ALHIV in sub-Saharan Africa.

Individual goal achievement in group psychotherapy: The roles of psychological mindedness and group process in interpretive and supportive therapy for complicated grief.

The ability to infer psychological meaning in behaviour-referred to as psychological mindedness-has been posited as a patient characteristic that contributes to the therapy process and consequently to therapeutic success. The present study was developed to examine the relationship between patients' psychological mindedness and improvement in patients' personal treatment goals in interpretive and supportive group therapies for complicated grief, along with patients' importance to group process. The study was conducted with a clinical sample of 109 patients (79% female; average 45years old) receiving treatment for complicated grief. Patients provided severity of distress ratings for individual target objectives at pretreatment and posttreatment. Psychological mindedness was assessed prior to treatment using the video-based, interviewer-rated Psychological Mindedness Assessment Procedure. Patients' importance to the therapy process was rated by therapists and other patients in interpretive and supportive group therapy for complicated grief. Conditional process modelling tested whether psychological mindedness would contribute to patients' goal achievement through patients' importance to group process, moderated by type of therapy. A significant, conditional indirect effect was observed for psychological mindedness as a predictor of improvement in individual target objectives, through patients' importance to group process as rated by therapists, specifically in interpretive therapy. The findings indicate that patients' psychological mindedness significantly contributes to their achievement of individual goals through their contributions to group process in interpretive group therapy. Further research is needed to understand the facilitation of individual goal achievement in supportive therapy.

An adaptive virtual reality system for the treatment of adjustment disorder and complicated grief: 1-year follow-up efficacy data.

Adjustment disorder (AD) and complicated grief (CG) are serious mental conditions that have a high prevalence and are associated with significant impairments in social and work functioning. Recently, these categories have been better specified in the new ICD-11 proposal. Empirical research on the efficacy of treatments for these problems is scarce. This study aims to offer long-term efficacy data from a between-groups controlled study that compares two treatment conditions (AD-protocol applied in a traditional way: N=18 and the same protocol supported by virtual reality (VR); VR-protocol applied in a traditional way: N=18) and a waiting list (WL) control group (N=18). Both treatment conditions resulted in statistically significant improvements on both primary and secondary outcome measures, with large effect sizes, and this improvement did not occur in the WL. These changes were maintained in both treatment conditions in the medium (6-month) and long-term (12-month follow-up). Larger effect sizes were achieved in the VR condition in the long term. Furthermore, clinically significant change estimations on the primary outcome measures showed an advantage for the VR condition This is the first controlled study to compare a traditional face-to-face protocol for the treatment of stress-related disorders with the same protocol supported by VR and a WL control group.

Persistent depressive and grief symptoms for up to 10 years following perinatal loss: Involvement of negative cognitions

BackgroundPerinatal loss is known to be associated with a heightened risk of mental health complications. However, the psychological mechanisms underlying the perinatal grief process are less well documented. We hypothesized that negative cognitions are associated with post-perinatal loss symptomatology, and vary according to whether the death occurs before or after birth. MethodsWe adopted a cross-sectional design to assess demographics, variables related to the death, five types of negative cognitions (about the self, world, life, future, and self-blame), prolonged grief, and depressive symptoms. The sample included 98 perinatally bereaved mothers with a mean age of 33.9 years. ResultsWhen we controlled for demographics and variables related to the death, hierarchical linear regression showed that maladaptive cognitions about life, the future and the world were associated with prolonged grief symptoms, whereas only maladaptive cognitions about the world were associated with depressive symptoms. Significant interaction effects confirmed that cognitions about the world were associated with increased depressive symptoms when the death occurred after the birth, and cognitions about life when it occurred before the birth. LimitationsThe cross-sectional design precluded causal conclusions. However, the sample size was relatively representative and limited to perinatally bereaved mothers. ConclusionsDifferent negative cognitions are involved in persistent depressive versus grief symptoms following perinatal loss, and vary depending on the type of loss. These results will serve to enhance perinatal grief interventions.

Therapeutic Alliance and Outcome in Complicated Grief Treatment

In this study, we examined the role of the therapeutic alliance in complicated grief treatment (CGT), an efficacious psychotherapy for complicated grief. Using data from a previously reported randomized controlled trial, we explored whether the alliance–outcome relationship differs by treatment group among treatment completers assigned to either CGT (n = 35) or interpersonal psychotherapy (IPT) (n = 34). Early alliance (at week 4) was associated with a reduction in grief symptoms in CGT but not IPT. The difference in the alliance–outcome relationship was accounted for by goal/task items on the Working Alliance Inventory. The contribution of a positive alliance, particularly the agreement on goals and tasks, may be more significant in CGT, a highly structured treatment, than IPT in reducing symptoms of complicated grief.

Treatment of Complicated Grief in Survivors of Suicide Loss: A HEAL Report.

Suffering associated with complicated grief (CG) is profound. Because suicide loss survivors are susceptible to developing CG, identifying effective treatments for suicide loss survivors with CG is a high priority. This report provides data on the acceptability and effectiveness of antidepressant medication and complicated grief therapy (CGT), a CG-targeted psychotherapy, for suicide loss survivors with CG identified by an Inventory of Complicated Grief score ≥ 30. This is a secondary analysis of data collected from March 2010 to September 2014 for a 4-site, double-blind, placebo-controlled randomized trial comparing the effectiveness of antidepressant medication alone or in combination with CGT for participants with CG (score ≥ 30 on the Inventory of Complicated Grief) who were bereaved by suicide (SB; n = 58), accident/homicide (A/H; n = 74), or natural causes (NC; n = 263). Using mode of death as a grouping factor, we evaluated acceptability of treatments by comparing 12-week medication and 16-session CGT completion; we evaluated effectiveness by comparing response at week 20, defined by a score of 1 or 2 on the Complicated Grief Clinical Global Impressions-Improvement scale (CG-CGI-I), and additional secondary response measures. Among participants receiving medication alone, SB medication completion rates (36%) were lower than rates for A/H (54%) and NC (68%; χ² = 11.76, P < .01). SB medication completion rates were much higher for SB individuals receiving CGT (82%; χ² = 12.45, P < .001) than for SB individuals receiving medication alone. CGT completion rates were similar in the 3 groups (SB = 74%, A/H = 64%, NC = 77%; χ² = 2.48, P = .29). For SB participants receiving CGT, CG-CGI-I response rates were substantial (64%), but lower compared to the other groups (A/H = 93%, NC = 84%; χ² = 8.00, P < .05). However, on all other outcomes, changes from baseline for SB participants were comparable to those for A/H and NC participants, including number and severity of grief symptoms, suicidal ideation, and grief-related impairment, avoidance, and maladaptive beliefs. These results raise concern about the acceptability of medication alone as a treatment for complicated grief in treatment-seeking suicide-bereaved adults. In contrast, CGT is an acceptable and promising treatment for suicide-bereaved individuals with complicated grief. ClinicalTrials.gov identifier: NCT01179568.

Treatment expectancy and working alliance in pharmacotherapy as predictors of outcomes in complicated grief.

Nonspecific factors, such as treatment outcome expectancy and working alliance, can influence treatment outcome. No studies to date have examined the role of expectancy and alliance on pharmacotherapy outcomes in individuals with complicated grief (CG). This secondary analysis of a larger randomized, control trial (RCT) examined the relationship between pharmacotherapy expectancy and alliance on treatment outcome in adults with CG who were participating in a multisite, double-blind, RCT examining the efficacy of citalopram and complicated grief treatment (CGT). Participants (n = 202) were randomized to one of four treatment conditions: citalopram (CIT), placebo (PBO), CGT + citalopram (CGT + CIT), or CGT + placebo (CGT + PBO). Pharmacotherapy outcome expectancy and working alliance were higher among individuals randomized to CGT + CIT and CGT + PBO compared with CIT or PBO without CGT. Pharmacotherapy outcome expectancy was higher at Week 2 among individuals who ultimately responded to treatment compared with those who did not and among those who remained in treatment compared with those who dropped out. In contrast, working alliance did not correlate with dropout or treatment outcomes in pharmacotherapy. Expectancy for medication was higher among individuals randomized to receive CGT. Clinicians should assess symptoms and expectancies in the first weeks of treatment because these could be early markers of drop out and treatment response. (PsycINFO Database Record

Bereavement care interventions and outcome criteria planned by community nurses in the Canary Islands

Nursing care in bereavement is complex. Primary health care is the ideal setting to support the bereaved, but we do not know much about the care plans designed by primary health care nurses in the treatment of grief. ObjectiveTo identify the outcomes criteria and interventions planned by nurses for mourners with and without complications in the Canary Islands. MethodRetrospective longitudinal study, using the electronic health records of the Canary Islands health service of people with a diagnosis of grieving, risk of complicated grieving and complicated grieving, in the period 2009–2014. ResultsNOC outcomes criteria were recorded in 67% of the mourners, and up to 24 different outcomes were identified. The main outcomes measures were Grief resolution; Psychosocial adjustment, Life change; Coping; Family coping; Family social climate and Caregiver emotional health. The remaining outcomes were present in less than 1% of the mourners. Although the outcomes criteria proposed by nurses in the mourners with and without complications were quite homogeneous, differences in interventions were found. In 67% of the cases, NIC interventions were reported. Ninety-nine different interventions were identified in the mourners; the most frequent were Emotional support; Grief work facilitation; Active listening; Coping enhancement and counselling. The remaining identified interventions were present in less than 5% of patients. The main interventions in the mourners with complications were Grief work facilitation; Coping enhancement; Active listening; Counselling and Family integrity promotion. ConclusionNurses state that there are more interventions and outcomes in mourners with complications. Given the few methodologically reliable studies that prove their effectiveness, continued research in this area is recommended.

Introduction to the special section: Integrative approaches for treating violent loss survivors

ABSTRACTSurvivors of sudden, traumatic death are at risk for a variety of bereavement-related mental health problems, including posttraumatic stress disorder, depression, and prolonged grief disorder. Because these conditions often cooccur, traumatic grief interventions are generally designed to be transdiagnostic, integrative treatments that combine techniques designed to treat a wide range of mood and anxiety symptoms. In this special section, expert clinicians and researchers present a series of papers describing new, integrative treatment models for violently bereaved children and adults and also describe ways that integrative treatments can be enhanced using peer support.

Attachment styles, grief responses, and the moderating role of coping strategies in parents bereaved by the Sewol ferry accident

ABSTRACTBackground: Previous studies on the influence of different types of attachment on grief responses have yielded contradictory outcomes. Little research has been conducted to identify the psychological processes that moderate the relationship between attachment representations and patterns of grief in disaster-related grief.Objective: The present study examines the effects of different attachment types on the grief responses of parents bereaved by loss of a child in a ferry accident, along with the moderating role of coping strategies.Methods: Bereaved parents (n = 81) completed self-report questionnaires evaluating attachment, coping strategies, complicated grief, and shame/guilt. We performed correlational analyses to examine the associations among variables. We also conducted hierarchical regression analyses and simple slope analyses to examine the moderation effects of coping strategies.Results: Anxious attachment was associated with severe shame/guilt, and avoidant attachment correlated with complicated grief. Anxious attachment was positively associated with all types of coping strategies, and avoidant attachment was negatively related to problem- and emotion-focused coping. The use of problem-focused coping strategies was a significant moderator of the relationship between the avoidant attachment dimension and shame/guilt. Avoidant attachment had a significant effect on shame/guilt in groups with a high level of problem-focused coping. In contrast, none of the coping strategies significantly moderated the relationship between anxious attachment and grief response.Conclusions: The results suggest that people with highly avoidant attachment might be overwhelmed by shame and guilt when they try to use problem-focused coping strategies. This finding suggests that grief interventions should be organized with consideration of individual differences in attachment representations.