Recent advances in grief research

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Normal and abnormal grief reaction

Transcript of Recent advances in grief research

  • 1.Recent Advances in Grief Research Presented by :Dr. Ramkumar G.S Chairperson : Dr. Geetha Desai

2. Overview

  • Terminology and theories
  • Phenomenology and outcome
  • Classification and proposals for DSM V
  • Grief , Depression, PTSD
  • Research on abnormal grief and interventions
  • Conclusion

3. Terminology

    • With loss anddeathcome bereavement, grief, and mourning.
    • Bereavemen t- the process of adjusting to the death of a loved one.
    • Grief- the complex emotional responses that one has during the bereavement process, such as experiencing sorrow, hurt, anger, guilt, confusion, and so onHooyman & Kiyak, 2002; Santrock, 2006
    • Mourning - the culturally structured patterns and expectations of how individuals express their griefHooyman & Kiyak, 2002 .
    • Grieving is anatural process which can be very important toward coping constructively with loss and deathAttig, 1996

4. Why do we grieve?

    • To spare oneself from grief at all cost can be achieved only at the price of total detachment, which excludes the ability to experience happiness-Erich Fromm
    • Grief is the cost of commitmentColin Murray Parkes
    • Neverthelessthe situation of loss of a loved one is of vast adaptive significance, a special state shaped to copewith that situationby signalling others, by changing goals, by preventing further losses, by reassessing priorities and plans and other relationships.

5. Grief Theories, Models...

    • Sigmund Freud (1917)- the painfull relinquishing of ties to the deceased the work of grief.
    • Lindemann(1944) normal, abnormal reactions to loss.
    • Bowlby(1969)- Attachment Theory emphasize that thework of grief involves a series of attachment behavioursrather than simply separation.
    • He preferred the term reorganization rather than detachment while referring to adult bereavement.

6. Grief theories...

  • Parkes(1972)- Grief as a series of shifting pictures
  • Worden(1983)- 4 tasks of mourning
  • Two studies in 1990
  • 1.Hogan and Desantis, 1992
  • 2.Silvermann colleagues, 1992
  • Continuing grief: a new understanding of grief(1996)

7. Grief theories...

  • Dual process model -1999Stroebe and Schut
  • Loss orientation
  • Restoration orientation
  • Grief to personal growth theory -2002Hogan

8. Six components of acute grief Lindemann-1946

    • Intense somatic distress
    • Thoughts of the deceased preoccupy the survivor
    • Quilt feeling, survivors accuse themselves
    • Irritation and anger are directed at themselves, thedeceasedand others
    • Restlessness, agitation, aimlessness, amotivation
    • Identification phenomena

9. Phenomenology of Grief

    • Proposed grieving process models-includes at least three partially overlapping phases or states
    • 1) Initial shock, disbelief and denial
    • 2) Intermediate period of acute discomfort, socialwithdrawal
    • 3) A culminating period of restitution andreorganization

10. Elisabeth Kbler-Ross stages 11. Evidence for stage theory

  • An Empirical Examinationof the Stage Theory of Grief
  • Yale Bereavement study(YBS) Paul K. Maciejewski et al2007
  • Counter to stage theory, disbelief was not the initial, dominant grief indicator. Acceptance was the most frequently endorsed item and yearning was the dominant negative grief indicator from 1 to 24 months postloss.
  • Disbelief decreased from an initial high at 1 month post loss. Yearning peaked at 4 months post loss.
  • Anger peaked at 5 months post loss, and depression peaked at 6 months post loss.
  • Acceptance increased throughout the study observation period.

12. Emperical evidence for grief stage

  • The 5 grief indicators achieved their respective maximum values in the sequence (disbelief, yearning, anger, depression, and acceptance) predicted by the stage theory of grief.
  • Identification of the normal stages of grief following a death from natural causes enhances understanding of how the average person cognitively and emotionally processes the loss of a family member.
  • Given that the negative grief indicators all peak within approximately 6 months postloss, those who score high on these indicators beyond 6 months postloss might benefit from further evaluation

13. Stage theory refuted The Myth of the Stages of Dying, Death and Grief Russell Friedman and John W James 2008 Refutes the stage theory and challenges the YBS. Kubler RossinGrief and Grieving - the stage theory has much evolved and much misunderstood over the past three decades. They were never ment to tuck messy emotions into neat packages. Our grief is as individual as our lives. Not every one goes through all of them or goes in a prescribed order. 14. Reorganisation, Bowlby1969

    • Reorganization- the optimal psychological resolution ofthe grief process involving two major tasks
    • Accepting the death of the attachment figure, returning to daily activities, and forming new bonds
    • Maintaining a symbolic attachment to the deceasedintegrating the lost relationship within a new reality.

15. Reorganisation, Bowlby1969

    • separation vs attachment dilemma.
    • editing of the hierarchy of attachment figures , resembles the replacement of parents by peers as primary attachment figures during adolescence.
    • Bereaved adults can transform the functions of the deceased as a symbolic rather than a physically present source of security ( attachment figures in reserve (Weiss, 1981)) .

16. 4 tasks of mourning-Worden 1983 accept the reality of the loss 2. working through the pain of grief 3. adjusting to the environment in which the deceased is missing emotionally relocate the deceased and move on with life 17. Grief outcome

    • Existing evidence suggests that most of the bereaved are resilient, ultimately coping well with major lossBonanno, 2004
    • However, between 10 and 20% of survivorsexperience unremitting and intense grieving that substantially impairs the quality of their lives(Bonanno, Wortman, & Nesse, 2004)
    • Predicts long-term risks to physical and mental health
    • (Ott, 2003; Parkes, 1996; Prigerson & Jacobs, 2001)

18. ICD 10

  • Normal bereavement reactions
  • Chapter XXI Z63.4-Disappearance, death of family member
  • Z73.3- stress not elsewhere classified
  • Abnormal grief reactions
  • F43.22- mixed anxiety& depressive reaction
  • F43.23- with predominant dis. of other emotion
  • F43.24- with pred. Dis. Of conduct
  • F43.25- mixed dis. Of emotions &conduct
  • F43.21-Prolonged depressive reaction

19. DSM IV

  • V 62.82 Bereavement
  • Depressive symptoms that occur within first 2months after death of loved one.
  • Lists 6 symptoms to distinguish from MDD
  • MDD diagnosed only if marked functional impairment, morbid preoccupation with quilt, suicidal ideation, or P M retardation are present
  • The rationale for exclusion , the depressive state is a culturally sanctioned response to death of loved one

20. Proposals for DSM V

  • Kendler et al. (2008) report that the similarities between bereavement-related and other life stressor-related depression far outweigh their differences, arguing against the continued use of the bereavement exclusion criterion in DSM-V.
  • Wakefield et al. (2007), on the basis of similar findings, proposed to exclude both typesof sadness from the DSM-V diagnosis of major depression (i.e., to introduce a contextual criterion excluding intense sadness that appears proportionate to a loss)

21. Proposals for DSM V

  • Whether an adverse life event has been really decisive in triggering a depressive state may be difficult to establish in several cases.
  • Aubrey Lewis(1967), testing a set of criteria aimed to distinguish between contextual and endogenous depression, concluded that most depressive cases were examples of the interaction of organism and environment, so that it was impossible to say which of the factors was decidedly preponderant

22. Proposals for DSM V

  • Current official psychiatric nomenclature does not
  • recognise chronic grief reactions as an independent entity
  • Earliest de