Attachment and grief in young adults after the loss of a close friend: a qualitative study

Background Although many lose a close friend each year, they are seldom the focus of grief research. However, these losses often cause severe and long-lasting reactions. Deaths among adolescents and young adults are also often caused by traumatic events, e.g. from accidents, suicides, and homicides, placing them at significant risk for complicated grief reactions. The focus of this paper is bereaved friends after the shootings at Utøya, Norway in 2011, which is among a few studies that focus on bereaved friends, exploring how attachment affects the grief process after the loss of a close friend. Methods This paper explores qualitative data from in-depth interviews with thirteen bereaved friends, conducted about 28 months after the loss. The interview sample consisted of eight females and five males, aged 18–31 years. The interviews were semi-structured, with a theme guide of 14 questions, and the method used for analyses was systematic text condensation. Results Two main themes were identified from the analyses of the interviews: Friendship and Grief, with the subordinate themes: The importance of the friendship, Longing and remembrance, How the loss has affected other relationships, How the loss has affected the friend’s daily lives, Processing of the grief and Not being family. For most of the bereaved friends the loss and the grief had a profound effect on them and their overall lives, from daily functioning in school or at work, to changes in attitudes, and the way they were met as bereaved. Conclusions The support, intimacy, and feelings of togetherness we share with our friends are of great importance and value for all people, but maybe especially for young people. When adolescents and young adults experience losses, their reactions are often intense and long-lasting, and especially complicated grief reactions can affect school performance and concentration, health, result in emotional problems; and disrupt development (e.g. identity formation and social skills). We don’t know much about the grief of bereaved friends and how their reactions can be explained. Thus, we hope that these findings could shed light on their grief reactions, and provide new knowledge on the short- and long-term psychological impact of losses of friends.

Effectiveness of a Cognitive-behavioral Group Therapy for Complicated Grief in Family Members of Patients With Cancer

Introduction: complicated grief can affect a large number of individuals who have lost a relative due to cancer. Objective: to assess the efficacy of a cognitive-behavioral group therapy (CBGT) for complicated grief in those who have lost a relative due to cancer in comparison with a psychoducational and emotional expression intervention (PSDEEI).Method: 249 relatives of deceased cancer patients with complicated grief were randomly assigned to treatment with CBGT or PSDEEI. Complicated Grief (ICG), depression (BDI-II), hopelessness (BHS), anxiety (BAI) symptoms and general health (GHQ28) were assessed at pre-treatment, post-treatment, and follow-up at 6 and 12 months. Results: the CBGT group improved significantly (p<0.001), with the scores in ICG, BDI-II, BAI, BSH, and GHQ28 (p<0.001) being higher than those for the PSDEEI group in each of the assessed moments, with high effect sizes: ICG (η2=0.16), BDI (η2=0.10), BAI (η2=0.06), BSH (η2=0.21) and GHQ28 (η2=0.21). At the 12-month follow-up, the number of cases of complicated grief decreased by 81.1% for the CBGT group vs. 31.7% in the PSDEEI group. Conclusions: The CBGT treatment is effective for complicated grief, for depression, anxiety, and hopelessness symptoms and for mental health, and is superior to PSDEEI treatment.

The Virulence of Grief in the Pandemic: Bereavement Overload During COVID

The COVID-19 pandemic brought about bereavement overload as a risk factor for complicated grief. Bereavement overload (BO) describes individuals’ reactions to losses transpiring in a quick succession, without the time and opportunity for coping [9]. It can occur during catastrophic events and impact everyone experiencing the loss. With the high death toll from COVID-19, many people have lost multiple loved ones followed by an abbreviated grieving process due to the nature of the pandemic. This can have psychosocial impact on survivors for years. One of the evolving roles of Palliative Care within and after the pandemic should be to recognize those suffering from BO. Obtaining loss histories may identify those at risk of pathologic grief to provide preventive bereavement care. We present three cases encountered in our health system during the COVID-19 pandemic amongst a family member, a patient, and a healthcare provider. In each case the Palliative Care Team worked closely with these individuals to identify COVID-associated BO and helped them reconcile their unresolved grief to be able to move forward. These cases reflect only a fraction of those who experienced loss during the pandemic, but they illustrate how grief can be complicated by the pandemic for everyone involved. Palliative Care will have a crucial role moving forward, in treating the pandemic of complicated grief within the pandemic to adapt to the needs of all survivors, as we realize the effects of COVID will last long after its virulence has waned.

Effectiveness and Feasibility of Internet-Based Interventions for Grief After Bereavement: Systematic Review and Meta-analysis

Background Although grief and its symptoms constitute a normal reaction to experiences of loss, some of those affected still report elevated levels of distress after an extended period, often termed complicated grief. Beneficial treatment effects of face-to-face therapies, for example, grief counseling or cognitive behavioral therapy against complicated grief, have been reported. Evaluations of internet- and mobile-based interventions targeting symptoms of grief in bereaved individuals with regard to objective quality criteria are currently lacking. Objective We aim to conduct a systematic review and meta-analysis on the effectiveness and feasibility of internet- and mobile-based interventions against symptoms of grief after bereavement. Methods We conducted systematic literature searches of randomized controlled trials or feasibility studies published before January 9, 2020, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, in PubMed, PsycINFO, Web of Science Core Collection, and the Cochrane Library. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations system. We further assessed aspects of feasibility and rated quality of interventions using criteria suggested by an expert panel on mental health care (German Association for Psychiatry, Psychotherapy, and Psychosomatics). A random-effects meta-analysis was conducted to assess between-group effect sizes. Results In total, 9 trials (N=1349) were included. Of these, 7 studies were analyzed meta-analytically. Significant effects were found for symptoms of grief (g=0.54, 95% CI 0.32-0.77), depression (g=0.44, 95% CI 0.20-0.68), and posttraumatic stress (g=0.82, 95% CI 0.63-1.01). Heterogeneity was moderate for grief and depression (I2=48.75% and 55.19%, respectively) and low for posttraumatic stress symptoms (I2=0%). The overall quality of evidence was graded low (grief and depression) to moderate (posttraumatic stress). User satisfaction with the interventions was high, as was the quality of the interventions assessed using objective quality criteria. Conclusions Internet- or mobile-based interventions might constitute an effective treatment approach against symptoms of grief in bereaved adults. However, the small sample sizes and limited number of studies included in the review warrant further investigation. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42012002100; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131428

Ambivalence Resolution in Meaning Reconstruction Grief Therapy: An Exploratory Study

In psychotherapy, ambivalence may be conceptualized as a conflict between two distinct motivations: one that is favorable to change (pro-change) and another that favors the maintenance of a problematic pattern (pro status quo). Previous studies identified two processes by which clients resolve this conflict: imposing the innovative part and silencing the problematic one (dominance), and establishing negotiations between the innovative and the pro status quo parts (negotiation). The present exploratory study examined ambivalence resolution in a sample of clients diagnosed with complicated grief. Results revealed that, in recovered cases, negotiation increases and dominance decreases from the beginning until the middle sessions of therapy and the opposite tendency is observed from the middle to the final sessions. Unchanged cases reveal an overall high proportion of dominance and an overall low proportion of negotiation. These results are partially divergent from those reported in previous studies with samples of clients diagnosed with major depression.

Impact of Opera on Mental Health Stigma: Pilot of Provider/Community Workshop

Background Arts can influence mental health stigma, but little is known about impact of operas. We examined effects of a two-opera workshop on complicated grief and schizophrenia. Methods Pre-post audience surveys with post-workshop discussion. The primary outcome was a 4-item measure of willingness to engage with persons with grief or schizophrenia. Secondary outcomes were perceptions of art affecting stigma and stigma mediators. Of 47 participants, 33 had pre-post surveys for both operas. Results There was a significant pre-post opera increase in audience willingness to engage with persons with grief or schizophrenia (p < .001). Perceptions of impact on mediators such as empathy, were significantly greater for the opera on schizophrenia relative to grief (p < .001).. Conclusion The pre- to post increase in audience willingness to engage with affected persons (primary) with greater impact on secondary mediators for the schizophrenia opera and post-discussion suggest that operas may be a forum for addressing mental health stigma and promoting empathy.

Psychometric properties of the Inventory of Complicated Grief in Mexican community sample during COVID-19 pandemic.

Objective: The aim of the present study was to validate the Inventory of Complicated Grief (ICG) in the adult population, since there is no valid instrument that evaluates this construct in the Mexican population.Method: This study was based on an Ex Post Facto, instrumental design with a convenience sample. The ICG was applied to 4014 participants (3540, females, 470 males and 4 individuals classified as other) who had experienced a loss of a loved one during the COVID-19 pandemic. Exploratory and confirmatory factor analyses were conducted. The internal reliability of each factor was examined by means of the Cronbach’s alpha index (α). Correlation analyses between the ICG, the Center for Epidemiologic Studies Depression Scale, the Satisfaction with life scale and the Beck's Hopelessness Scale were performed to assess convergent and divergent validity of the ICG.Results: The ICG showed a high internal reliability with a Cronbach alpha of 0.92. The confirmatory factor analysis demonstrated that a four-factor model of the ICG (normal grief symptoms, emotional-anxious detachment, intense negative emotions, loss-impairing anxiety) fits the data well. According to bivariate analyses the ICG was correlated with measures of life satisfaction (r = -.208, n = 1984, p = .001), hopelessness (r = .522, n = 1984, p = .001), and depressive symptoms (r = .641, n = 1984, p = .001).Conclusions: The ICG with a Mexican sample is valid, with good psychometric properties and an appropriate measure of complicated grief for Mexican adults.