Anxious and depressive avoidance behavior in post-loss psychopathology: a longitudinal study

Background: Avoidance behavior is a central component of cognitive behavioral theories of bereavement-related psychopathology. Yet, its role is still not well understood. This study examined associations of anxious and depressive avoidance behaviors with concurrently and prospectively assessed symptom-levels of prolonged grief disorder (PGD), depression, and posttraumatic stress disorder (PTSD). Design and Methods: Two hundred and ninety-one individuals, confronted with loss maximally three years earlier, completed self-report measures of anxious and depressive avoidance and emotional distress and again completed distress measures one year later. Results: Anxious and depressive avoidance were concurrently associated with symptom-levels of PGD, depression, and PTSD, even when controlling for the shared variance between both forms of avoidance and relevant socio-demographic and loss-related variables. Prospective analyses showed that baseline anxious avoidance predicted increased symptom-levels of PGD, depression, and PTSD one year later, among participants who were in their first year of bereavement but not among those who were beyond this first year. Baseline depressive avoidance was significantly associated with elevated PTSD one year later, irrespective of time since loss. Conclusions: Both anxious and depressive avoidance are associated with different indices of poor long-term adjustment following loss. However, anxious avoidance seems primarily detrimental in the first year of bereavement.     

Intolerance of uncertainty and emotional distress following the death of a loved one

Abstract

Research has shown that intolerance of uncertainty (IU) – the tendency to react negatively to situations that are uncertain – is involved in worry and generalized anxiety disorder, as well as in other anxiety symptoms and disorders. To our knowledge, no studies have yet examined the association between IU and emotional distress connected with the death of a loved one. Yet, it seems plausible that those who have more difficulties to tolerate the uncertainties that oftentimes occur following such a loss experience more intense distress. The current study examined this assumption, using self-reported data from 134 bereaved individuals. Findings showed that IU was positively and significantly correlated with symptom levels of complicated grief and posttraumatic stress disorder (PTSD), even when controlling for time since loss (the single demographic/loss-related variable associated with symptom levels), and for neuroticism and worry, which are both correlates of IU. Furthermore, IU was specifically related with worry and symptom levels of PTSD, but not complicated grief, when controlling the shared variance between worry, complicated grief severity, and PTSD-severity. The present findings complement prior research that has shown that IU is a cognitive vulnerability factor for worry, and indicate that it may also be involved in emotional distress following loss.     

Failing to come to terms with things: a multi‐storied conversation about poststructuralist ideas and narrative practices in response to some of life's failures

This paper is designed to demonstrate some of the multi‐storied representational possibilities available to us as writers and practitioner‐researchers. It highlights some of the opportunities that are available to therapists and the people who consult them when they describe their conversational space as a site for co‐research. It illustrates the reciprocity present in conversations, including therapeutic conversations, by juxtaposing three stories that are interrelated retellings from different writing genres. In positioning poetic, storied and more academic/interpretative texts alongside each other, we hope to trouble the edges between academic and creative writing and also between practice and research. In placing these stories next to each other we seek to disrupt carefully contained ‘client’ and ‘therapist’ positions. We intend to question some current bereavement orthodoxies by demonstrating some less taken‐for‐granted ways in which people, living and dead, can and do continue to sustain each other's lives. We also hope to invite the readers and future writers of this journal to play alongside us in this conversation.     

Mental health and mediumship: an interpretative phenomenological analysis

There is a lack of research examining the mental health of practicing mediums, yet the nature of mediumship work inherently presents a number of challenges to the mental health of practitioners. In this study, we aimed to gain an understanding of how mediums experience their mental health in relation to their mediumistic practice and how they recognise and respond to psychological difficulties experienced by their clients. Fourteen mediums from the North West of England took part in one-to-one interviews, which were transcribed and subject to interpretative phenomenological analysis. Four themes were identified: from past traumas to mediumistic identity; spirit makes sense, mental illness is chaos; being resilient but vulnerable; and ethical mediumistic practice. The research highlights the value of not dismissing or attempting to change appraisals of valued aspects of mediums’ anomalous experiences. However, the findings do indicate that support for exposure to clients’ difficulties might be helpful.     

Bittersweet: a qualitative exploration of mothers’ experiences of raising a single surviving twin

Loss of a child from a multiple birth pregnancy is not uncommon yet the idiographic experience of parents who have lost a single twin from a multiple birth pregnancy is underexplored. This novel study sought to explore the experiences of mothers bereaved after loss of a twin from a multiple birth pregnancy, focusing on the dual challenges of parenting and grieving. Eighteen mothers at least 12 months post loss were recruited from a private UK based Facebook page dedicated to supporting parents after loss from a multiple birth. Eligible mothers completed an independent qualitative open-ended survey to explore maternal experiences of loss. Data were analysed using Thematic Analysis. Findings represented a sense of duality for participants, with mothers experiencing conflict between roles and identities as well as the nature of their loss. Key themes identified include ‘Narrating a story of family and loss’, ‘Finding a place for the twins within the family’ and ‘A changing sense of self’. Findings fit with theoretical conceptualisations of bereavement that acknowledge retaining relationships with the deceased. Practically, suggestions for supporting mothers to identify stock answers to often asked questions about family make up were suggested.     

Identity continuity and loss after death,divorce, and job loss

This paper examined the relationship of constructs identified by identity continuity and attachment theories of grief to adjustment to loss from the framework of identity theory. Connections between loss salience, identity construal, and balance of identity construal on grief intensity via their association with post-loss identity disruption were examined across three types of self-relevant losses; death of a family member, job loss, or divorce. We hypothesized that lower salience, higher endorsement of identity attributes represented by relational and individualistic self-construals, and an overall balance across identity attributes would be related to decreased grief severity across all types of loss. Results supported hypotheses with the exception that the hypothesized ameliorative effect of increases in relational self-construal was only seen in the bereaved group.     

The Efficacy of Adult Christian Support Groups in Coping with the Death of a Significant Loved One

Psychologists sometimes minimize important resources such as religion and spiritual beliefs for coping with bereavement. Alienation of therapeutic psychology from religious values contrasts to professional and public interest in religious experience and commitment. A supportive viewpoint has come about partially as a result of recognizing important values which clinicians have found absent in many of their clients. Until spiritual belief systems become integrated into the work of clinicians, clients may not be fully integrative in coping with loss. The key finding of this study was that individuals who participated in Christian and secular support groups showed no statistically significant difference in their mean endorsement of negative criteria on the BHS, and no statistically significant difference for their mean score endorsement of positive criteria on the RCOPE. However, a Christian-oriented approach was no less effective than a psychological-oriented one. In both groups, a spiritual connection to a specific or generalized higher power was frequently identified which clients ascribed to facilitating the management of their coping.     

Making use of the vignette technique to examine methods of bereavement counselling: An exploratory study

Aim: The principal objective of this small‐scale study was to examine methods of bereavement counselling because of their lack of clarity. Method: The study made use of the vignette technique along with six semi‐structured interviews analysed by means of thematic analysis. Findings: Results showed that bereavement counsellors are using a multitude of different and diverse methods of counselling, characteristic of postmodernism. Advantages of these postmodern methods are that bereavement counselling methods are rich, creative, supportive, pluralistic and attentive to otherness. However, disadvantages of these postmodern methods have led to a lack of consensus amongst experts, unclear methods and an anti‐methodological way of working by counsellors. Implications for practice: Postmodernism is inherent in bereavement counselling. As a result no two counsellors work in exactly the same way because of the difference in their background and experience similarly it can be said that no one counselling method has exclusivity due to the diverse nature of postmodernism.     

Bereavement Groups and Their Benefits

Abstract

This article provides a brief discussion of the various types of grief and posits that the many types, particularly disenfranchised, lend themselves to recovery through reconnection. Bereavement groups offer a particularly useful means of connection with a larger grieving community and allow validation from others along with personalization of loss. Additionally, the use of creativity creates deeper and more meaningful connections with self and others. Finally, the article ends with counseling considerations and two case examples.     

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) Wagner, B., Knaevelsrud, C. and Maercker, A. 2006. Internet‐based cognitive‐behavioral therapy for complicated grief: a randomized controlled trial.. Death Studies, 30: 429–453. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]. 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.