Self-defining memories in complicated grief

There is increasing attention to the mechanisms underpinning maladaptive responses to bereavement. This study indexed self-defining memories in bereaved individuals with and without complicated grief (CG). Participants with and without complicated grief (N = 40) were asked to describe three self-defining memories. Results showed that CG participants provided more self-defining memories involving the deceased. Both groups were equally likely to report their loved one's death as a self-defining moment, however, the no-CG group showed more evidence of benefit finding in their memory narratives and experienced less negative emotion on recall. The findings suggest that CG is associated with distinctive patterns of autobiographical memory that are linked to self-identity. The pattern is consistent with self-memory system models of autobiographical remembering, and suggests that grieving individuals who experience ongoing yearning for their loved one view their self-identity as more closely linked to the deceased are more distressed by memories involving the loss.     

Impaired autobiographical memory in complicated grief

This study investigated the relationship between autobiographical memory and goals in complicated grief (CG). Twenty-four individuals with CG and 21 bereaved individuals without CG completed an autobiographical memory task and a personal goals task. CG participants were more likely to recall memories related to their loss, particularly in response to negative cues. There was a positive relationship between the proportion of loss-related memories recalled and the proportion of grief-related goals held by individuals after controlling for symptom level. Individuals with CG also showed impaired retrieval of specific autobiographical memories in response to both positive and negative cues. These results suggest that CG is characterised by impaired and biased retrieval of specific autobiographical memories. These patterns are consistent with propositions stemming from the self-memory models of autobiographical memory.     

Interpersonal predictors of group therapy outcome for complicated grief

This study investigated three aspects of patients' interpersonal functioning as predictors of outcome for two forms of group psychotherapy for complicated grief. Patients presented with a variety of death losses and met criteria for complicated grief. The three aspects of interpersonal functioning were the patient's (1) attachment to the lost person, (2) quality of object relations (QOR), and (3) level of recent social role functioning. A more secure attachment to the lost person and better social role functioning were associated with more favorable outcome in both forms of therapy. In addition, patients with higher QOR had more favorable outcome in interpretive therapy while lower QOR patients had more favorable outcome in supportive therapy. The results suggest that each aspect of interpersonal functioning is important to consider when treating patients for complicated grief.     

Patient personality and time-limited group psychotherapy for complicated grief

We used a randomized clinical trial to investigate the interaction of two patient personality characteristics (quality of object relations [QOR] and psychological mindedness [PM]) with two forms of time-limited, short-term group therapy (interpretive and supportive) for 139 psychiatric outpatients with complicated grief. Findings differed depending on the outcome variable (e.g., grief symptoms, general symptoms) and the statistical criterion (e.g., statistical significance, clinical significance, magnitude of effect). Patients in both therapies improved. For grief symptoms, a significant interaction effect was found for QOR. High-QOR patients improved more in interpretive therapy and low-QOR patients improved more in supportive therapy. A main effect was found for PM. High-PM patients improved more in both therapies. For general symptoms, clinical significance favored interpretive therapy over supportive therapy. Clinical implications concerning patient-treatment matching are discussed.     

Cohesion and outcome in short-term psychodynamic groups for complicated grief

This study used two measures of cohesion for the process analysis of 12 short-term, time-limited groups for complicated grief. The measures had similar theoretical definitions but differed in terms of rater source (member vs. observer), measurement score (mean of items vs. global rating), and rating unit (individual vs. group). We examined the relationship between the measures, assessed the development of cohesion over the life of the group, and evaluated each measure's relationship to outcome. A principal components analysis with each measure yielded one cohesion component, which supported a unidimensional model; however, the two cohesion components were independent of each other, which supported a multidimensional model. Repeated measures analyses indicated that observer-rated cohesion developed in a quadratic manner (v pattern) across sessions, while member-rated cohesion developed in a linear manner. The object focus (the group, other members, the therapist) of the members' ratings determined whether cohesion increased or decreased across sessions. No significant relationships between cohesion and outcome were identified. Implications of the findings for the understanding of group cohesion are considered.     

Post-traumatic growth and optimism as outcomes of an internet-based intervention for complicated grief

This explorative study examines the effects of an internet-based cognitive-behavioural therapy for complicated grief on post-traumatic growth and optimism. The study is part of a larger randomized controlled trial described in Wagner, Knaevelsrud, and Maercker (2006). The patients were randomly assigned to either a treatment group (n = 26) or a waiting list control condition (n = 25). The internet-based intervention consisted of exposure to bereavement cues, cognitive reappraisal exercises, and a module on integration and restoration. A short form of the Post-traumatic Growth Inventory (PTGI), the Life Orientation Test-Revised (LOT-R), and measures of complicated grief and psychopathological outcomes were administered. Results indicate that post-traumatic growth increased in the treatment group. No treatment effect was found for optimism. These findings contribute to the growing literature on personal growth in psychotherapy.     

Unresolved grief

This paper has reviewed the literature on bereavement and, with particular emphasis on the authors' own work, describes three syndromes which seem to be related to the nonresolution of distinct phases of the grief process. The possibility of unresolved grief should receive a high index of suspicion for the patient with otherwise unexplainable depression, chronic illness behavior, or symptoms similar to those of a deceased relative or friend. When any of these syndromes are identified, it is useful to ask the patient who he has lost, how he has lost them, how he felt about the loss, whether he felt that he grieved, whether he still cries or feels the need to cry, and whether he has adjusted. The answer to these questions--both verbal and nonverbal--will help identify unresolved grief, when present, and may be a guide to specific interventions. On the other hand, our studies have suggested that unresolved grief is a somewhat overly simplistic concept. Most, if not all, people never totally resolve their grief; significant aspects of the bereavement process go on for years after the loss, even in otherwise normal patients. For some, identification syndromes continue. Others may continue to feel the presence of the deceased or have daily visions of him or her. Still others may feel pain, anger, and guilt for years after the death. It is still unclear at what point and to what degree these behaviors and symptoms become medical or psychiatric concerns and become pathological or predispose to serious medical, psychological, or social complications. Investigations into these unreported areas have been initiated and, we trust, will lead to clinically useful answers.     

Measuring grief: A short version of the perinatal grief scale

Despite a considerable number of studies, there are two major drawbacks in the literature on grief and bereavement. One is a lack of adequate and generally agreed upon measures for assessing grief. The second is a lack of ability to predict from existing measures the likelihood of what has been termed chronic or pathological grief reactions. This paper reports the results of the development of a bereavement measure for the study of perinatal loss which attempts to address these gaps. The measure is specific to a pregnancy-related loss, although it has the potential for adaptation to use for other types of loss. Analysis of responses from 138 women has resulted in the reduction of the original measure from 104 to a more manageable and almost equally comprehensive and reliable 33 items. In addition, a factor analysis has produced three factors, two of which indicate the possibility for longer-term and more severe grief reactions. Because of its sound psychometric qualities and interesting factor structure, the measure shows promise of being useful for both research and clinical purposes.This research was funded by National Institute of Child Health and Human Development Grant R01 H18431-04, with additional assistance from the Center for Social Research at Lehigh University. Dr. Potvin is supported by the Quebec Health Research Fund.     

Some stages of grief

Does grief progress through stages? Do all people go through the same experiences? What health considerations are present in each grief experience? Does religion help? Although all people do not go through the same stages nor do they progress at the same rate, many people do go through such stages as the following: shock, lamentations, withdrawal, frustration, panic, depression, detachment, adaptation, reinvestment, and growth. There is often an interaction in these stages between stress and physical symptoms, and many grievers report that religion gives a good philosophical arean in which to work through their grief.     

Impact of current grief on memory for past grief in spousal bereavement

This study examined the impact of changes in level of current grief over time on changes in memory for past grief. Following from previous work on the impact of current affective state on memory for past affectively salient events, bereaved individuals who underwent a greater reduction in grief over time were expected to show a similar pattern of changes in memory for past grief. A sample of conjugally bereaved participants completed measures of current grief and memory for past grief at the time of the loss of their spouse at each of the 2, 6, 13, and 30 month post-loss time periods. As predicted, those who reported greater reduction in grief over the course of the study were more likely to remember their past grief as progressively less severe relative to those who underwent less reduction in grief over time. A nonrecursive causal model analysis verified that changes in memory for past grief were explained by changes in current grief. These results were discussed in terms of contemporary reconstructive memory accounts of the effect of affective state on memory.     

Impact of current grief on memory for past grief in spousal bereavement

This study examined the impact of changes in level of current grief over time on changes in memory for past grief. Following from previous work on the impact of current affective state on memory for past affectively salient events, bereaved individuals who underwent a greater reduction in grief over time were expected to show a similar pattern of changes in memory for past grief. A sample of conjugally bereaved participants completed measures of current grief and memory for past grief at the time of the loss of their spouse at each of the 2, 6, 13, and 30 month post-loss time periods. As predicted, those who reported greater reduction in grief over the course of the study were more likely to remember their past grief as progressively less severe relative to those who underwent less reduction in grief over time. A nonrecursive causal model analysis verified that changes in memory for past grief were explained by changes in current grief. These results were discussed in terms of contemporary reconstructive memory accounts of the effect of affective state on memory.     

Levels of specificity of autobiographical memories and of biographical memories of the deceased in bereaved individuals with and without complicated grief

Traumatized individuals experiencing posttraumatic stress have difficulty retrieving specific autobiographical memories to cue words on the Autobiographical Memory Test (AMT; J. M. G. Williams & K. Broadbent, 1986). This may represent a generalized, functional avoidance of the personal past. However, such individuals also often report specific intrusive memories of their trauma in the day-to-day. This raises the possibility that memories tied to the source of the person's distress are immune to this putative avoidance process. This was investigated in bereaved individuals with complicated grief (CG) who reported intrusive, specific memories from the life of their deceased loved one, and matched bereaved controls without CG. Participants performed the AMT and two Biographical Memory Tests (BMTs), cueing memories from the life of the deceased (BMT-Deceased) and from a living significant other (BMT-Living). To negative word cues, the CG group showed reduced specificity for the AMT and BMT-Living, relative to controls, but this effect was reversed on the BMT-Deceased. These data support the proposal that memories tied to the source of an individual's distress are immune to the processes that underlie the standard reduced specificity effect.     

The syndrome of traumatic grief

Traumatic grief is a common and debilitating syndrome whose clinical presentation is well recognized but whose diagnostic criteria have only recently been delineated. Though it shares features with major depressive disorder, adjustment disorder, and posttraumatic stress disorder, none of these subsume the criteria set for traumatic grief, and the diagnostic overlap is limited in community samples. Furthermore, diagnosis of traumatic grief appears to have prognostic value for clinical course and treatment response among bereaved individuals. In the absence of empirically supported treatments of pathological grief, a new, manualized treatment for traumatic grief symptoms has been developed and is currently undergoing testing in a randomized controlled trial. The conceptual basis for Traumatic Grief Treatment (TGT) is presented, the structure of the treatment is outlined, and the primary clinical strategies employed are described.     

Factors affecting grief adjustment

Earlier research has suggested that therapy and time are factors of change in grief level for those who are grieving. This follow-up study of widows and widowers suggests that there are also other relevant factors such as church activities, death of other relatives, other activities, time of grief counseling group, health, age, consideration of remarriage, religion, number of months widowed, and financial situation. A regression analysis of 138 widows and widowers found each of these factors significantly related to the. 05 critical level of significance to various measures of grief level.     

Making sense of divorce grief

The various models of divorce recovery put forward by researchers have previously been divided into two general categories. The first focuses on emotional or affective stages, while the second describes the recovery in terms of behavior/event dimensions. These two approaches are now integrated by recognizing that the behavior/event stages represent specific psycho/social losses in the life of the divorcing person. Stages of grief, therefore, may arise repeatedly in response to the different losses. These emotional stages may reappear with varying intensity, depending on the varying amount of importance of each loss to the individual. The complex interaction between sequential losses and responding emotional stages is described. Erikson's thematic theory of development and the Tennessee Self Concept Scale are offered as helpful tools for clarifying the meaning of emotions and needs which appear to spiral back and forth within the individual's experience.Mr. Hagemeyer is co-author, with Sue Richards, ofMinistry to the Divorced, to be released by Zondervan in June, 1986, and is a D.Min. candidate at Western Theological Seminary, Holland, MI. He is the former Director of Good News Community, a ministry to single adults in Grand Rapids. He may be addressed at 2377 Post Drive, Belmont, MI 49306.     

Cognitive behavioral grief therapy

From a REBT perspective, loss through death is viewed as an intense negative and traumatic Activating event which effects the Belief system and related emotional and behavioral Consequences. Grief, then, is seen as a normal reaction and the process that follows is a necessary one characterized by the bereaved attempting to reorganize a shattered belief system. In the present paper a distinction between functional and dysfunctional grief is made. Based on Ellis' differentiation between iB's and RB's, typical irrational grief-related beliefs are identified (with specific focus on pain related ones). Various REBT interventions aimed at facilitating a more functional, healthier course of grief are suggested.     

The hidden grief of abortion

This article explores the possibility of dealing with grief reaction when counseling a woman who has undergone an abortion. It first defines what is meant by a grief reaction in this context, then proposes a model for understanding various degrees of grief reaction, and finally examines some of the factors which determine the severity of a grief reaction in the case of abortion.