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Grief and Bereavement

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Grief and Bereavement Definitions (Sabar, 2000) Bereavement: the losing of someone to whom one has been closely attached Root meaning: to be robbed Grief ... – PowerPoint PPT presentation

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Title: Grief and Bereavement


1
Grief and Bereavement
2
Definitions (Sabar, 2000)
  • Bereavement the losing of someone to whom one
    has been closely attached
  • Root meaning to be robbed
  • Grief subjective experience of loss
  • Root meaning heavy
  • Mourning a public process involving
    recognition by others support and social,
    cultural and religious customs and rituals
  • Root meaning remembering with care and sorrow

3
Epidemiology
  • At age 65, over 50 of women and 10 of men have
    been bereaved at least once
  • At age 85, 80 of women and 40 of men have been
    bereaved at least once

4
Tasks of Grieving (Worden)
  • Acceptance of reality of loss
  • Experience of pain of grief
  • Redefining relationship with deceased
  • Adjusting to the environment
  • Withdrawal of emotional energy and reinvestment
    in other relationships and activities

5
Phases of Grief
  • Consensus view
  • Initial shock, disbelief and denial
  • Period of weeks
  • Common early symptoms
  • Almost universal intrusive thoughts of
    deceased, sadness and yearning depression-style
    sleep problems
  • Farily common feelings of unreality and acting
    if person still alive hallucinations
  • More uncommon feelings of disorganization,
    guilt, anger
  • Lower functioning associated with low SES and
    unexpected bereavement

6
Phases of Grief (cont.)
  • Acceptance of reality of loss
  • Period of months
  • Acute morning sadness, anxiety, loneliness,
    anger
  • Restitution/acceptance
  • Feelings of grief subside
  • Reinvestment in new relationships and activities
  • Whole process takes a couple of years
  • Similar to Kubler-Ross denial, bargaining,
    despair, resignation, acceptance

7
Phases of Grief
  • Dual Process model (Stroebe Schut)
  • Two types of coping processes
  • Loss-oriented coping dealing with things
    related to the loss of a particular person more
    typical of early stages of grief
  • Restitution-oriented coping dealing with
    specific problems and developing new activities
    more typical of later stages of grief
  • People oscillate between these two types of
    coping

8
Primary Complications
  • If intense symptoms last longer than 6 months,
    called chronic grief, sometimes complicated
    grief
  • If depression develops (rate is 9X higher than in
    general population), also sometimes called
    complicated grief, now term is
    bereavment-related depression this less
    long-lasting than chronic grief
  • Chronic grief more predictive of overall
    functioning, depression of mental health status

9
Predictors of Affect
  • Positive and negative affect work independently
  • Positive affect mostly governed by restoration
    variables
  • Example Remarriage in men

10
Predictors of Affect (cont.)
  • Predictors of Negative Affect
  • Time since death
  • Circumstances of death
  • Better if person died at home
  • Worse if protracted illness with suffering,
    caregiving responsibilities
  • Relationships
  • Better if lots of neighbors
  • Richardson Balaswamy (2001) Men with active
    church involvement had more negative, less
    positive affect poor relationships or selection
    issue?

11
Grief and Depression
  • At two months post bereavement (Zisook et al.,
    1997)
  • 20 had major depression (some studies have found
    lower rates around 10-15) 70 of these were not
    depressed at 2 year followup
  • 31 subsyndromal depression rate remained steady
    at 2 year followup

12
Grief and Depression (cont.)
  • Risk factors
  • History of depression
  • History of neuroticism
  • Self-rated poor health or functional
    limitations/disability
  • Male gender (but women have more severe symptoms)
  • Less lifestyle regularity
  • Grief-related depression responds to standard
    therapy and psychopharmacological treatments
    SSRIs more effective than tricyclics

13
Grief and Anxiety
  • Anxiety symptoms more prominent than depression
    and can be independent or comorbid
  • Watson, Clark Carey (1988) Depression related
    to lack of positive events, anxiety to presence
    of negative events
  • When anxiety and depression are comorbid, each
    tend to be more severe

14
Traumatic Grief
  • Loss, not just under traumatic circumstances
  • Half have symptoms at 2 months, less that 10 at
    2 years
  • Separate from anxiety and depression reactions
  • Symptoms and treatment strategies similar to PTSD
  • Treatment uses reliving moment of death, in vivo
    exposure to avoided situations

15
Traumatic Grief (cont.)
  • Symptoms
  • Intrusive thoughts and emotions
  • Avoidant behavior, e.g. avoiding reminders of
    death
  • Failure to adapt
  • Comorbid with
  • Insomnia and depression
  • Suicidal ideation suicide in men
  • PTSD
  • In men, increased drinking

16
Traumatic Grief (cont.)
  • Predisposing factors
  • Traumatic nature of loss, e.g. from suicide or
    accident
  • Previous history of attachment problems
  • Female gender

17
Other Grief Complications
  • Physical health problems probably connected at
    least partly to immune system changes much more
    common in complicated grief
  • Feelings of neediness and loneliness
  • Slight increase in mortality during first 6 months

18
Assessment
  • Standard measures of depression
  • Inventory of Complicated Grief
  • Prigerson, H., Maciejewski, P., Newsom, J.
    (1995). The inventory of complicted grief a
    scale to measure maladaptive symptoms of loss.
    Psychiatry Research, 59, 65-79.

19
Treatment
  • Goal
  • Gestalt approach change occurs when one
    becomes what he is, not when he tries to become
    what he is not (Beisser, 1970).
  • Tasks (Sabar, 2000)
  • Accept reality of loss
  • Experience pain of grief
  • Adjust to environment
  • Withdraw (some) emotional energy and reinvest it
    in another relationship
  • Find a place for what we lose continuing bonds

20
Further Readings
  • Parkes, C. (1997). Bereavement and mental
    health in the elderly. Review of Clinical
    Gerontology, 7, 47-53
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