Cognitive behavioral variables mediate the associations of neuroticism and attachment insecurity with Prolonged Grief Disorder severity

Prolonged Grief Disorder (PGD) is a debilitating syndrome of grief. A recent cognitive behavioral model asserts that three processes are critical to this condition: (1) insufficient integration of the loss with autobiographical knowledge about the self and the lost person; (2) negative cognitions; and (3) anxious and depressive avoidance behaviors. These processes are assumed to contribute to PGD symptoms and to mediate the influence of personality-related vulnerabilities on the development and maintenance of these symptoms. The present study examined the mediational role of these three processes in the linkage between neuroticism, attachment anxiety, and attachment avoidance on the one hand and PGD symptom severity on the other hand. Self-reported data from 348 bereaved people were used. The results showed that the three personality variables were significantly associated with PGD symptom severity. Moreover, the results provided support for the mediating effects of indices of insufficient integration, negative cognitions, as well as avoidance behaviors - even after controlling for the shared variance between mediators. Theoretical and clinical implications are discussed.     

Psychometric Properties of the Grief Cognitions Questionnaire (GCQ)

Cognitive behavioral conceptualizations of complicated grief propose that negative cognitions play a core role in the development and persistence of emotional problems after bereavement, because they generate negative emotions and cause mourners to engage in counterproductive attempts to avoid the implications and the pain of the loss. To facilitate the assessment of potentially problematic cognitions after bereavement, the Grief Cognitions Questionnaire (GCQ) has been developed—a 38-item questionnaire representing 9 categories of cognitions. Building on a previous study that supported the reliability and validity of the GCQ, the current study further examined its psychometric properties, with data of 531 bereaved individuals who completed research questionnaires online through the Internet. Confirmatory factor analyses supported the nine-factor structure with 9 interrelated factors. The reliability and convergent and discriminative validity were found to be adequate. Altogether the GCQ seems to be a useful tool for the assessment of negative thinking after bereavement in research and clinical practice.     

延长哀伤障碍的概念、流行病学和病理机制

延长哀伤障碍是一种由亲近的人去世引发的病理性哀伤反应, 即死亡发生6个月后, 个体对死者的想念影响到了生活各方面, 且社会功能受损, 其最近20年才开始受到临床心理学研究者关注和探讨。本文首先回顾了概念提出及后续发展, 并讨论了其与持续性复杂哀伤相关障碍的区别与联系。随后, 本文综述了其独立的诊断标准、评估工具和流行病学调查、以及与正常哀伤、抑郁症和创伤后应激障碍的区别。接下来, 本文对其病理机制的理论思考和实证研究进行了讨论。最后, 本文指出未来可考察诊断标准的跨文化适用性、丰富病理机制的理论与研究。     

The associations between adult attachment,posttraumatic symptoms,and posttraumatic growth

Background and Objectives: Individual differences after trauma vary considerably and can range from posttraumatic stress disorder (PTSD) to posttraumatic growth (PTG). Current theoretical models cannot fully explain this variability. Therefore, we integrated attachment theory with Ehlers and Clark's model of PTSD to understand whether attachment style is associated with negative appraisals of a traumatic event(s), posttraumatic stress symptoms (PTS), and PTG. Our aim was to test this integrated model PTSD in an analog sample who had experienced at least one traumatic event. Design: We used structural equation modeling to test the association of adult attachment and posttraumatic cognitions (self and world/others) with PTS and PTG using a cross-sectional, correlational design. Methods: The sample comprised 393 university staff and students (Range_Age= 18–49, 85% females) who completed online measures. Results: Attachment anxiety and negative posttraumatic self-cognitions were positively associated. Negative posttraumatic self-cognitions were positively associated with PTS. Attachment anxiety had an indirect effect (via negative posttraumatic self-cognitions) on PTS, whereas attachment avoidance predicted more negative posttraumatic world cognitions and lower perceived PTG. Conclusions: The study highlights the importance of considering how attachment styles influence posttraumatic emotion regulation and cognitive processing of the trauma to determine posttraumatic mental health.     

Cross-Lagged Analyses of Prolonged Grief and Depression Symptoms With Insomnia Symptoms

Prolonged grief disorder, characterized by severe, persistent and disabling grief, has recently been added to the DSM-5-TR and ICD-11. Treatment for prolonged grief symptoms shows limited effectiveness. It has been suggested that prolonged grief symptoms exacerbate insomnia symptoms, whereas insomnia symptoms, in turn, may fuel prolonged grief symptoms. To help clarify if treating sleep disturbances may be a viable treatment option for prolonged grief disorder, we examined the proposed reciprocal relationship between symptoms of prolonged grief and insomnia. On three time points across 6-month intervals, 343 bereaved adults (88% female) completed questionnaires to assess prolonged grief, depression, and insomnia symptoms. We applied random intercept cross-lagged panel models (RICLPMs) to assess reciprocal within-person effects between prolonged grief and insomnia symptoms and, as a secondary aim, between depression and insomnia symptoms. Changes in insomnia symptoms predicted changes in prolonged grief symptoms but not vice versa. Additionally, changes in depression and insomnia symptoms showed a reciprocal relationship. Our results suggest that targeting insomnia symptoms after bereavement is a viable option for improving current treatments for prolonged grief disorder.     

The Role of Avoidance in Complicated Grief: A Detailed Examination of the Grief-Related Avoidance Questionnaire (GRAQ) in a Large Sample of Individuals with Complicated Grief

Grief-related avoidance is a significant component of complicated grief, yet has rarely been formally measured in a validated fashion. Further, more work is needed to understand the impact of grief-related avoidance on symptom severity and functional impairment among individuals with complicated grief (CG). The Grief-Related Avoidance Questionnaire (GRAQ; Shear, Monk et al. 2007) was created to assess grief-related avoidance and the present analysis aimed to further develop this measure and construct by confirming the GRAQ’s psychometric properties and examining loss-related predictors of avoidance. In a sample of 393 adults with CG, we found the GRAQ had high internal consistency, with a Cronbach’s alpha of 0.89 and good convergent validity. While the EFA results suggest that the GRAQ may be unidimensional, a 3-factor model generally corresponded with the findings by (Shear, Monk et al. 2007), which suggested the presence of 3 subscales. Loss-related variables age, relationship to the deceased, and cause of death were all significant predictors of GRAQ scores. Our findings support that among individuals with complicated grief, avoidance is common, measurable and an important contributor to impairment.     

The Underlying Structure of Grief: A Taxometric Investigation of Prolonged and Normal Reactions to Loss

Recent studies have supported the distinctiveness of complicated and prolonged forms of grief as a cluster of symptoms that is separate from other psychiatric disorders. The distinction between prolonged and normal reactions to loss remains unclear, however, with some believing that prolonged grief represents a qualitatively distinct clinical entity and others conceptualizing it as the extreme end of a continuum. Thus, in this study a taxometric methodology was used to examine the underlying structure of grief. Participants included 1,069 bereaved individuals who had lost a first-degree relative. Each participant completed the Dutch version of the Inventory of Complicated Grief–Revised, which was used to create indicators of prolonged grief. The mean above and mean below a cut (MAMBAC) and maximum eigenvalue (MAXEIG) tests supported a dimensional conceptualization, indicating that pathological reactions might be best defined by the severity of grief symptoms rather than the presence or absence of specific symptoms.

Neuroticism and attachment insecurity as predictors of bereavement outcome

Adult attachment dimensions as well as the personality trait neuroticism have been shown to be related to psychological adjustment after bereavement. No investigations so far have studied the relative contribution of these constructs to grief and depression. In our study of 219 bereaved parents, the two adult attachment dimensions, attachment anxiety and attachment avoidance, were compared to the personality trait neuroticism in predicting psychological adjustment. The attachment dimensions explained a unique part over and above neuroticism, but contrary to expectations, neuroticism explained more variance than attachment dimensions. Implications are discussed.     

The role of cognitive variables in psychological functioning after the death of a first degree relative

The present study sought to explore the relationship between negative cognitions and emotional problems after bereavement, with a group of 329 adults who had suffered the loss of a first degree relative. The following cognitions were assessed: global negative beliefs, cognitions about self-blame, negative cognitions about other people's responses after the loss, and negative cognitions about one's own grief reactions. Results showed that each of these cognitive variables was significantly related to the severity of symptoms of traumatic grief, depression and anxiety, even when background and loss-related variables that were initially found to influence symptom severity, were statistically controlled. When the shared variance between the cognitive variables was controlled, it was found that global negative beliefs about life, the world, and the future, and threatening interpretations of grief reactions each explained a unique proportion of variance in traumatic grief symptom severity. Global negative beliefs about life, the self and the future, and threatening interpretations of grief explained most variance in depression, while negative beliefs about the self and threatening interpretations of grief explained most variance in anxiety. Overall, the findings are in support of cognitive theories of grief, and suggest that effective treatment of problematic grief will need to address negative cognitions.     

Cognitive risk factors explain the relations between neuroticism and social anxiety for males and females

The hierarchical model of vulnerabilities to emotional distress contextualizes the relation between neuroticism and social anxiety as occurring indirectly through cognitive risk factors. In particular, inhibitory intolerance of uncertainty (IU; difficulty in uncertain circumstances), fear of negative evaluation (FNE; fear of being judged negatively), and anxiety sensitivity (AS) social concerns (fear of outwardly observable anxiety) are related to social anxiety. It is unclear whether these risk factors uniquely relate to social anxiety, and whether they account for the relations between neuroticism and social anxiety. The indirect relations between neuroticism and social anxiety through these and other risk factors were examined using structural equation modeling in a sample of 462 individuals (M age = 36.56, SD = 12.93; 64.3% female). Results indicated that the relations between neuroticism and social anxiety could be explained through inhibitory IU, FNE, and AS social concerns. No gender differences were found. These findings provide support for the hierarchical model of vulnerabilities to emotional distress disorders, although the cognitive risk factors accounted for variance beyond their contribution to the relation between neuroticism and social anxiety, suggesting a more complex model than that expressed in the hierarchical model of vulnerabilities.     

Fear of death mediates ostracism distress and the moderating role of attachment internal working models

Ostracism is known to cause psychological distress; however, it remains unclear why ostracism evokes this response. Two experiments tested empirically whether fear of death mediates ostracism effects and whether attachment internal working models moderate this role. A total of 288 participants played Cyberball with two other ostensible players. After the game the accessibility of their death-related thoughts was assessed by a word completion task, and the Needs Satisfaction Scale was used to measure their distress. Participants’ attachment orientation was measured using the Experiences in Close Relationship scale. Death anxiety fully mediated ostracism distress. However, this effect was stronger in low-anxiety individuals. These studies contribute to the ostracism literature by providing further empirical support that death anxiety mediates ostracism distress, and to the attachment literature by documenting the moderation effect of attachment anxiety.     

Mammograms and the management of existential discomfort: Threats associated with the physicality of the body and neuroticism

The current research employs ideas from terror management theory to investigate why mammograms may be psychologically problematic. This perspective suggests that individuals, particularly those high in neuroticism, are threatened by that which reminds them of their physical and mortal nature. In Study 1, a laboratory experiment demonstrated that when concerns about mortality were primed, reminders of one's physical nature (i.e. creatureliness) led women who were high in neuroticism to report reduced willingness to imagine undergoing a mammogram. In Study 2, a field experiment among women receiving a mammogram showed that priming creatureliness increased perceptions of discomfort with the procedure for women high in neuroticism. Theoretical and practical implications are discussed.     

The relationship between the adult attachment and the tendency to judge others as liars

The relationship between 2 dimensions (anxiety and avoidance) of adult attachment and tendency to judge others as liars was examined in this study. We measured 308 participants' adult attachment and tendency to judge others as liars in self‐, other‐, or relationship‐oriented situations. Results supported our hypotheses by showing that (a) anxiety positively predicted the tendency to judge others as liars in self‐oriented situations and (b) avoidance moderated the relationship between anxiety and the tendency to judge others as liars in other‐ and relationship‐oriented situations. Attachment anxiety could positively predict the tendency to judge others as liars only when participants' avoidance was high. Theoretical implications and suggestions for future studies were discussed.     

Understanding the impact of attachment insecurity on PTSD symptoms among male Veterans and military personnel

ABSTRACT

Attachment insecurity (i.e., attachment anxiety and attachment avoidance) has been found to contribute to PTSD symptom severity in Veterans. However, little is known of the unique contribution of attachment insecurity on individual PTSD symptom clusters. In a community sample of 106 combat-deployed Veterans, active duty service members, and reservists, this study examined: (1) the relationships between childhood family experience, combat experience, attachment insecurity, and PTSD symptom clusters, and (2) the influence of attachment insecurity on PTSD symptom clusters. Results revealed significant correlations between attachment anxiety and all PTSD symptom clusters (rs = .22 –.43) and attachment avoidance and PTSD symptom clusters, except the avoidance cluster (rs = .21 ?.36). Four multiple regression analyses were employed to address the second study aim. Childhood family experiences predicted negative alterations in cognitions and mood (β = –.30) and alterations in arousal and reactivity (β = –.20). Further, combat experience significantly predicted each symptom cluster of PTSD (βs = .03 –.44). In the second step, attachment anxiety and attachment avoidance were added to each model. Attachment anxiety and attachment avoidance predicted negative alterations in cognitions and mood (βs = .22 and .35) and alterations in arousal and reactivity (βs = .27 and .17). Inconsistent with previous research, attachment insecurity did not predict symptoms of avoidance. These results highlight the impact of attachment among a diverse sample of trauma exposed individuals and may provide insights for clinical implications and therapeutic approaches when working with Veterans and military personnel high in attachment insecurity.     

Divergent and Convergent Validation of the Complicated Grief Prototype Narrative

Although there is a prototype narrative for complicated grief (CG), there are neither divergent nor convergent validity studies of its clinical value. We evaluated the CG prototype narrative using a sociodemographic questionnaire and the Clinical Interview for Complicated Grief Diagnosis. We first conducted a convergent validation analysis followed by a divergent validation analysis. Results showed that participants with CG identified significantly more with the complicated grief prototype narrative than participants without CG.     

Prolonged grief disorder symptoms in bereaved internally displaced Tiv persons in Nigeria: associations with rumination,rebirth concerns and gender

ABSTRACT

There is burgeoning research on prolonged grief disorder (PGD) among several vulnerable populations but PGD symptoms have been scarcely examined among bereaved internally displaced persons (IDPs). This study investigated the associations of rumination, rebirth concerns and gender with symptoms of PGD following conflict-related bereavement. Participants were 379 Nigerian IDPs who were of the Tiv ethnic group. They provided demographics and completed self-report measures grief and rumination, while concern about rebirth status of the deceased was assessed using a single item which requested participants to indicate whether they had any concerns about the re-incarnation of the deceased. Results showed that gender was not associated with PGD symptoms. High intrusive rumination and high deliberate rumination were associated with increased PGD symptoms in males and females. Rebirth concern was associated with high PGD symptoms in males but not in females. Findings highlight the need for socio-culturally-informed screening/intervention in the wake of conflict-related bereavement.     

Authenticity: a mediator in the relationship between attachment style and affective functioning

Attachment has been show to exhibit a strong effect on emotional well-being throughout an individual’s lifetime. This study examined individuals’ authenticity as a potential mediating variable in the relationship between insecure attachment and affective functioning. Authenticity was examined from multiple perspectives to better define its role as a mediating variable. Results showed that avoidant attachment is a predictor of affective functioning, and that authenticity acts as a mediating variable in this relationship. Anxious attachment showed no direct relationship with affective functioning, yet evidence was found for an indirect pathway from anxious attachment through authenticity on affective functioning. The differing results by attachment style support Mikulincer, Shaver, and Pereg’s theory suggesting a two-part model of emotional response style, wherein individuals with avoidant attachment deactivate emotion and individuals with anxious attachment show hyper-activation when coping with emotion. The study examines the construct of authenticity and its importance in affective functioning. Implications for therapists working with clients are made that highlight the importance of authentic relationships in therapy and life.     

The Role of Fear-Avoidance Cognitions and Behaviors in Patients with Chronic Tinnitus

The current study investigated the role of fear-avoidance—a concept from chronic pain research—in chronic tinnitus. A self-report measure the “Tinnitus Fear-Avoidance Cognitions and Behaviors Scale (T-FAS)” was developed and validated. Furthermore, the role of fear-avoidance behavior as mediator of the relationship between anxiety sensitivity and tinnitus handicap was investigated. From a clinical setting, N = 373 patients with chronic tinnitus completed questionnaires assessing tinnitus handicap (Tinnitus Handicap Inventory), anxiety, depression (Hospital Anxiety and Depression Scale), anxiety sensitivity (Anxiety Sensitivity Index-3), personality factors (Big Five Inventory-10), and fear-avoidance. To analyze the psychometric properties, principal component analysis with parallel component extraction and correlational analyses were used. To examine a possible mediating effect, hierarchical regression analysis was applied. The principal component analysis resulted in a three-factor solution: Fear-avoidance Cognitions, Tinnitus-related Fear-Avoidance Behavior, and Ear-related Fear-Avoidance Behavior. Internal consistency was satisfactory for the total scale and all subscales. High correlations between tinnitus-related handicap scales, depressive and anxiety symptoms, and the T-FAS were found, whereas associations with personality factors were low. Moreover, results indicate a significant partial mediation of fear-avoidance behaviors in the relationship between anxiety sensitivity and the cognitive dimension of tinnitus handicap. Results show that fear-avoidance behavior plays an important role in tinnitus handicap. More attention should be paid to this concept in research and clinical practice of psychotherapy for chronic tinnitus.     

The role of objective health indicators and neuroticism in perceived health and psychological well-being among patients with chronic heart failure

A total of 119 clinically stable patients with symptomatic congestive heart failure (34 females, 85 males) were recruited from an outpatient hospital practice to explore the role of objective health indicators and neuroticism in subjective health (physical limitations) and psychological well-being. Patients were grouped according to the New York Heart Association functional class criteria (NYHA: indicator of functional status) and proatrial natriuretic factor (proANF), a cardiac hormone that maintains normal fluid balance and vascular resistance. Scores on these two objective indicators of disease severity were generally unrelated to psychological measures, whereas neuroticism scores (EPQ-N) were significantly correlated with indicators of subjective health (perceived disease-related physical limitations) and psychological well-being (depression, general life-satisfaction). Significant interactions between proANF and neuroticism appear due to low physical limitation score among subjects with elevated level of proANF and low scores on neuroticism. High physical limitation was reported by subjects with high level of proANF as well as high scores on neuroticism. Moreover, a marginal significant interaction between NYHA and EPQ-N scores in relation to severity of depression was detected by analyses from two-way ANOVA. Gender differences were due to higher proANF scores in males than females, whereas females scored higher than males on EPQ-N, perceived physical limitation and depression. Results from path analyses supported an indirect effect of neuroticism via perceived physical limitation for males. Possible mechanisms involved in these relations are discussed.