Sorg nye perspektiver p - PowerPoint PPT Presentation

Loading...

PPT – Sorg nye perspektiver p PowerPoint presentation | free to view - id: 55d94a-ZjU2O



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Sorg nye perspektiver p

Description:

Title: Sharing Grief Do Scientific Studies Support Popular Beliefs on the Efficacy of Disclosure? Author: Stroebe Last modified by: test Created Date – PowerPoint PPT presentation

Number of Views:51
Avg rating:3.0/5.0
Slides: 55
Provided by: Stro92
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Sorg nye perspektiver p


1
Sorgnye perspektiver på livet med dødenThe
Dual Process Model Margaret Stroebe Henk
SchutDepartment of Clinical Health
PsychologyUtrecht UniversityThe
NetherlandsInvited Address to the Danish
Association of Palliative CareJune 1st, 2007
2
Scope
  • Differences in ways of coping adaptation
  • Models of coping

3
Differences in ways of coping adaptation
4
Coping with GriefAssumption (Western Societies)
(cf. Wortman Silver, 1987 1989)
  • Necessary to confront
  • Grief Work

5
Grief Work(M. Stroebe, Omega, 1992)
  • Process of
  • emotionally confronting the reality
  • going over events
  • focusing on memories
  • working toward detachment
  • Grief work hypothesis

6
Coping with GriefAssumption (Western Societies)
(cf. Wortman Silver, 1987 1989)
  • Necessary to confront
  • Grief Work
  • In C20th grief theories therapies

7
Doubts about Grief Work
  • Alternative ways of effective coping
  • Cultural patterning

8
Coping with Bereavement in Non-Western
CulturesEgypt
  • In Egypt the bereaved are encouraged to dwell
    profusely on their subjective pain in an
    atmosphere where others also immerse themselves
    in tragic tales and expressed sorrow.
  • (Wikan, 1988, p. 455)

9
Coping with Bereavement in Non-Western
CulturesBali
  • In Bali laughter and cheerfulness fill the air
    while the bereaved are enjoined to contain their
    sorrow and may be made to feel they commit an
    injustice to others should they fail to abide by
    this demand.
  • (Wikan, 1988, p. 455)

10
Doubts about Grief Work
  • Alternative ways of effective coping
    (non-confrontive)
  • Neglect of effortful struggle

11
Doubts about Grief Work
  • Alternative ways of effective coping
    (non-confrontive)
  • Neglect of effortful struggle
  • Need for dosage of grief

12
Doubts about Grief Work
  • Alternative ways of effective coping
    (non-confrontive)
  • Neglect of effortful struggle
  • Need for dosage of grief
  • Benefits of denial

13
Doubts about Grief Work
  • Alternative ways of effective coping
    (non-confrontive)
  • Neglect of effortful struggle
  • Need for dosage of grief
  • Benefits of denial
  • Other sources of stress

14
Doubts about Grief Work
  • Alternative ways of effective coping
    (non-confrontive)
  • Neglect of effortful struggle
  • Need for dosage of grief
  • Benefits of denial
  • Other sources of stress
  • Lack of empirical evidence

15
1. Expression of Emotions Well-being among
Bereaved Persons(Schut, 1992, Stroebe, Schut
Stroebe, 2005)
  • Longitudinal study, 128 recently-bereaved
  • 4 assessments, 2 years
  • Emotional disclosure adjustment

16
Path model of expression of emotions and
distress (Schut, 1992, Stroebe, Schut Stroebe,
2005)
Expression of emotions T1
Expression of emotions T2
Expression of emotions T3
Expression of emotions T4
Distress T2
Distress T3
Distress T4
Distress T1
17
Structural path-analysis of expression of
emotions and distress (Schut, 1992, Stroebe,
Schut Stroebe, 2005)
.45
Expression of emotions T1
Expression of emotions T2
.61
Expression of emotions T3
Expression of emotions T4
.42
.63
Distress T2
Distress T3
Distress T4
Distress T1
.64
.63
.41
.31
.17
Note plt.05, plt.01, plt.001
18
2. Grief Work Through Diary Writing The
Pennebaker Paradigme.g. Pennebaker Keough,
1999 Pennebaker et al., 2001)
19
Pennebakers writing paradigm Effects
  • Reduces physician consultations
  • Improves some immune functions
  • Increases grades among students
  • Improves mood
  • Effective among unemployed, prisoners,
    chronically-ill patients, etc.
  • Bereaved persons???

20
The Utrecht Diary Study (cf. Stroebe, Stroebe,
Schut, Zech, van den Bout, JCCP, 2002)
  • 157 recently bereaved men women
  • Writing non-writing conditions
  • Assessed mental physical health (inc. visits to
    doctor)

21
  • Results
  • Symptoms decrease over time, but
  • No effect of writing on
  • Emotional intensity
  • Health (subjective or objective)

22
Conclusions so far
  • The grief work model needs revision to
  • define when and for whom - and what type of
    working through / disclosure is efficacious

23
  • Models of coping

24
Grief Work Models
  • Phase Model
  • (Bowlby, 1980)
  • Shock
  • Yearning/protest
  • Despair
  • Restitution
  • Task Model
  • (Worden, 1991)
  • Accept reality of loss
  • Experience pain of grief
  • Adjust to life without deceased
  • Relocate deceased emotionally move on

25
Dual Process Model of Coping with Bereavement
(Stroebe Schut, Death Studies, 1999)
  • A taxonomy to describe ways people come to terms
    with the loss of a close person
  • Two categories of stressors
  • Analysis of coping strategies appraisal
  • Dynamic process of oscillation

26
The Dual Process Model of Coping with
Bereavement Stroebe Schut (Death Studies, 1999)
Everyday life experience
Loss- oriented
Restoration- oriented
Attending to life changes Doing new
things Distraction from grief Denial/avoidance
of grief New roles/ identities/
relationships
Grief work Intrusion of grief letting
go-continuing-relocating bonds /
ties Denial/avoidance of restoration changes
oscillation
27
Caregiving Bereavement AdaptationSchulz,
Boerner, Herbert (in Stroebe et al., Handbook
of Bereavement Research 21st Century
Perspectives, in press)
  • Caregivers at high risk
  • Most adapt well to bereavement
  • But a few have adverse bereavement outcomes

28
Comparison of Models
  • Task Model
  • (Worden, 1991)
  • Accept reality of loss
  • Experience pain of grief
  • Adjust to life without deceased
  • Relocate deceased emotionally move on

DPM (Stroebe Schut, 1999) Accept reality of
loss and accept reality of changed
world. Experience pain of grief and take time
off from pain of grief. Adjust to life without
deceased and master the changed (subjective)
environment. Relocate deceased emotionally
move on and develop new roles, identities,
relationships.
  • Phase Model
  • (Bowlby, 1980)
  • Shock
  • Yearning/protest
  • Despair
  • Restitution

29
Complicated Grief
  • Deviation in time course and/or intensity from
    the (cultural) norm, poor functioning
  • Chronic absent, delayed, inhibited
  • Prevalence rates
  • Related to other mental health difficulties
  • DSM??? (see Special Issue Omega, 2005, ed. Parkes)

30
DPM Complicated Grief
Everyday life experience
Loss- oriented
Restoration- oriented
Attending to life changes Doing new
things Distraction from grief Denial/avoidance
of grief New roles/ identities/
relationships
Grief work Intrusion of grief breaking-continuing-
relocating bonds / ties Denial/avoidance of
restoration changes
Disturbed oscillation Traumatic grief
Absent or inhibited grief
Chronic grief
31
DPM Gender Differences
32
Gender Differences in the DPM
Everyday life experience
Women
Men
Loss- oriented
Restoration- oriented
Attending to life changes Doing new
things Distraction from grief Denial/avoidance
of grief New roles/ identities/
relationships
Grief work Intrusion of grief Breaking bonds/
ties/relocation Denial/avoidance of
restoration changes
33
DPM Time
34
DPM Time
Everyday life experience
Restoration- orientation
Loss- orientation
oscillation
35
DPM Time
Everyday life experience
Restoration- orientation
Loss- orientation
oscillation
36
DPM Time
Everyday life experience
Restoration- orientation
Loss- orientation
oscillation
37
DPM Time
Everyday life experience
Have I forgot, my Only Love, to love
thee, Severed at last by Times all-wearing
wave? Emily Brönte
Loss- orientation
Restoration- orientation
38
DPM Family Grief
39
DPM Family Dynamics
?
Restoraiton- orientation
Loss- orientation
Loss- orientation
Restoration- orientation
Restoration- orientation
Loss- orientation
Restoration- orientation
Loss- orientation
?
40
DPM Family Dynamics
Restoraiton- orientation
Loss- orientation
Restoration- orientation
Loss- orientation
Restoration- orientation
Loss- orientation
?
41
DPM Family Dynamics
Restoration- orientation
Loss- orientation
Brother
Children
Wife
Restoration- orientation
Loss- orientation
Restoration- orientation
Loss- orientation
Grandchildren
42
DPM Evidence
  1. Gender differences in loss / restoration in
    bereaved couples
  2. Gender differences in intervention efficacy
  3. Intervention efficacy DPM vs. Traditional

43
DPM Evidence
  1. Gender differences in loss / restoration in
    bereaved couples
  2. Gender differences in intervention efficacy
  3. Intervention efficacy DPM vs. Traditional

44
Parental Loss of a Child Study(Wijngaards,
Stroebe, Stroebe, Schut, van den Bout, van der
Heijden, Dijkstra (British Journal of Clinical
Psychology, in press)
  • Participants Design
  • 219 parental couples
  • 6, 13, 20 months post-loss
  • Interviews / questionnaires
  • Own and partners coping (DPM) adjustment

45
Parental Loss of a Child Study(Wijngaards,
Stroebe, Stroebe, Schut, van den Bout, van der
Heijden, Dijkstra (British Journal of Clinical
Psychology, in press)
  • Results
  • Hi LO -gt poor adjustment
  • Hi RO -gt better
  • Hi RO buffered against impact of hi LO
  • For men, having hi RO partner helped adjustment

46
DPM Evidence
  1. Gender differences in loss / restoration in
    bereaved couples
  2. Gender differences in intervention efficacy
  3. Intervention efficacy DPM vs. Traditional

47
Evaluation Of Grief Counseling Utrecht Study
(Schut, Stroebe, de Keijser van den Bout, 1997)
  • Participants
  • Widows widowers
  • Medium / high distress
  • Non-intervention controls
  • Counseling
  • Client centered vs. behavior therapy
  • 7 sessions, 14-17 months post-loss
  • Measure
  • General Health Questionnaire (GHQ)

48
Behav. Treatment
Client centered
Schut, Stroebe, avan den Bout de Keijser (1997)
British Journal of Clinical Psychology
49
Levels of Distress by Therapy Type Males(Schut,
Stroebe, de Keijser, van den Bout, BJCP, 1997)
50
Levels of Distress by Therapy Type
Females(Schut, Stroebe, de Keijser, van den
Bout, BJCP, 1997)
51
DPM Evidence
  1. Gender differences in loss / restoration in
    bereaved couples
  2. Gender differences in intervention efficacy
  3. Intervention efficacy DPM vs. Traditional

52
DPM Treatment of Complicated Grief(Shear,
Frank, Houck, Reynolds, JAMA, 2005)
  • Participants
  • Bereaved men women meeting CG criteria
  • Interventions
  • Interpersonal psychotherapy (IPT)
  • Complicated grief treatment (CGT, based on DPM)

53
Treatment of Complicated Grief Study(Shear,
Frank, Houck, Reynolds, JAMA, 2005)
54
Small Group Discussion Themes
  • To what extent have you used the Phase, Task or
    DPM Models in your work? What is your experience
    with these Models?
  • More fundamentally Can one translate the DPM
    for use in palliative health care settings?
  • What are the limitations of the DPM?
  • Suggestions for adapting or extending the DPM?
About PowerShow.com