Continuing bonds in adaptation to bereavement: introduction

Grief from Afar: Parental bereavement for fallen "lone soldiers" in the Israel Defense Forces-an exploration of parents' continuing bond with their deceased offspring who is buried in a different country

Based on continuing bonds theory, this research assessed the manifestation of a continuing relationship for bereaved parents with their deceased offspring who is buried in a different country. This qualitative interpretive phenomenological study is based on interviews with seven bereaved parents whose offspring died during military service in the Israel Defense Forces (IDF) and were buried in Israel, whilst the parents live outside of Israel. Analysis revealed three themes: (a) fulfillment of their offspring's will; (b) commemoration; (c) physical and emotional proximity to their offspring. The geographical distance from the grave presented a challenge to parents' continuing bonds with their deceased offspring, manifesting as a dialectical bond of distance and closeness with their offspring. A key finding was the relational dynamic of the parent-offspring relationship through the continuing bond that emerged following the death of their offspring. Implications for parental bereavement support are considered.

Still With Me? Assessing the Persisting Relationship to a Deceased Loved-One - Validation of the "Continuing Bonds Scale" in a German Population

Continuing the bond (CB) to a deceased loved one plays a clinically significant role in grief. We validated the Continuing Bonds Scale (CBS) examining externalized CB (illusions and hallucinations) versus internalized CB (use of the deceased as a secure base) in relation to risk factors of complicated grief and bereavement-related adjustment. Data from 364 bereaved German participants on CBS, Inventory of Complicated Grief (ICG), and Posttraumatic Personal Growth Inventory (PPGI) entered an exploratory factor analysis. This yielded a two-factor-solution representing externalized and internalized CB (KMO = .89, χ2 = 2100.5, df = 120). Both factors demonstrated high internal consistency (Cronbach's α = .87). ICG and PPGI highly correlated with externalized and internalized CB. Cause of death and feelings of responsibility were associated with externalized CB. In the future, the use of the CBS could help predict problems in grief processing and consequently implement early interventions.

The Lived Experiences of Spousal Bereavement and Adjustment Among Older Chinese Immigrants in Calgary

Spousal bereavement poses considerable challenges to adults in late life. Some populations, such as older immigrants, may experience heightened negative outcomes as a consequence of spousal bereavement, due to migratory stress and social isolation. Spousal bereavement is culturally embedded as it is related to cultural beliefs and attitudes concerning death and family relationships. However, studies on spousal bereavement or widowhood among older immigrants are extremely limited. This study aims to fill the gap by exploring, via a phenomenological approach, the lived experiences of widowed older Chinese immigrants in Calgary and responding to the question: What are the lived experiences of widowed Chinese older immigrants in coping with their spousal bereavement? With the data drawn from 12 in-depth qualitative interviews, findings were categorized into individual, family, community and societal levels. Study participants experienced long-lasting grief that was private and impacted by their culture and immigration status. Although family and ethno-cultural communities provided various types of supports during participants' widowhood, they did not directly assist them in coping with spousal loss. Most participants did not access social services for bereavement support, more often relying on cultural rituals and faith practices. Findings suggest the need for culturally appropriate bereavement supports and family/community involvement for older immigrant adults who have experienced spousal loss.

Bereavement Outcomes for Atheist Individuals: The Role of Spirituality, Discrimination, and Meaning

The present study applied several concepts typically included in thanatology research to an atheist sample. Atheists are a growing segment of the population in the United States, though little is known about this group. A sample of 355 adults who self-identify as atheist completed an online survey assessing forms of spirituality, anti-atheist discrimination, and meaning reconstruction in order to examine associations between these variables and bereavement outcomes of complicated grief and psychological distress. Results of a multiple regression analysis suggested that spirituality was not related to bereavement outcomes, anti-atheist discrimination was related to poorer bereavement outcomes, while the relationship between meaning reconstruction and bereavement outcomes was mixed. These results provide a foundation for additional exploration of bereavement processes in atheist individuals, and implications for future research and practice are discussed.

"I can't explain it": An examination of social convoys and after death communication narratives

The hierarchical mapping technique is utilized to study individuals' social convoys (i.e., networks). Though convoys typically exclude deceased persons, the continuing bonds model argues that relationships between surviving and deceased persons can be sustained. After Death Communication (ADC), an experience where the deceased contacts surviving persons, facilitates continuing bonds. This study examines how ADC influences reports of convoys and continuing bonds. Using Labov's narrative framework, ADC narratives from 10 bereaved individuals were analyzed for content and structure. Most participants apologized, indicating their ADC experience was inexplicable. Consequently, reports of convoys and continuing bonds may be influenced by concerns of perception.

Lessons from filial piety: A social-life-span approach to building the connection that survives death

The purpose of this article is to unpack concepts surrounding "the connection that survives death" between living people and the deceased. The study was designed as the qualitative arm of an integrated project on filial piety in contemporary times, and data were collected from 17 interviews with Korean human service professionals from Australia, New Zealand and Korea. The findings from the study indicate that the connectedness with the dead is an important part of the participants' mental and social lives, and this postmortem relationship can be embodied through practising "memorial piety" and "memorial work".

Change in death metaphors among university students in Hong Kong from 2004 to 2016

Death metaphors are a meaningful way to understand personal perceptions of death, an important construct affecting how people live. This study collected death metaphor data among 100 university students in Hong Kong in 2016 and compared the findings with another study reported in 2004. Interpersonally oriented death metaphors were still popular among students a decade later. There was a general decrease in positive perception of death and an increase in negative perception of death from 2004 to 2016. Death metaphors are useful tools in death education programs, especially in cultures where death is a taboo topic.

Clinical work with suicide loss survivors: Implications of the U.S. postvention guidelines

The loss of a loved one to suicide can present difficult challenges for suicide loss survivors (people bereaved by suicide) as well as for clinicians who would seek to help them. Building on the recommendations in the new document Responding to Grief, Trauma, and Distress after a Suicide: U.S. National Guidelines, this article provides an overview of clinical work with suicide loss survivors. It includes discussions of the common themes of suicide bereavement, the psychological tasks for integration of a suicide loss, and the options for providing grief therapy after a suicide. The article will be of value to caregivers who work with suicide loss survivors in counseling or therapeutic context.

A New State of Being

In spite of growing bereavement literature, the meaning of the lived experience of parental bereavement is not well understood. This article presents selected findings from a Heideggerian hermeneutic phenomenological study which aimed to describe the lived experience of bereaved parents who experienced the death of a child due to cancer. Conversational interviews were conducted with six parents who experienced the death of a young child due to cancer at least one year prior to participation. The nature of parental bereavement was revealed to be a new state of being into which parents enter immediately after the death of a child and which has no end point. Findings will equip health professionals and others who work with bereaved parents with a deeper understanding of the meaning of parental bereavement.

Love and Bereavement

This research examines how do bereaved wives and partners resemble and differ from their nonbereaved counterparts. Guided by the Two-Track Model of Bereavement, we focused on biopsychosocial functioning and the nature of the ongoing relationship to their partner. The sample included 85 bereaved women who were compared with 87 nonbereaved women currently married or in a stable pair-bond relationship. As predicted, the results demonstrated the continuing impact of bereavement years after the loss, but the pattern of similarities and differences between the groups sheds additional light on the loss experience. The discussion of these findings and their implications conclude the article.

Neuropeptidergic regulation of pair-bonding and stress buffering: Lessons from voles

This article is part of a Special Issue "SBN 2014". Interpersonal attachment is a critical component of the human experience. Pair-bonding ameliorates the severity of several mental and physical diseases. Thus, a better understanding of how the central nervous system responds to and encodes social-buffering during stress is a valuable research enterprise. The prairie vole (Microtus ochrogaster), as a laboratory animal model, provides the gold standard for the investigation of the neurobiology underlying attachment. Furthermore, emerging research in voles, additional laboratory rodents, transgenic mice, primates, and humans has provided novel insight into the neurochemical mechanisms underlying the therapeutic effects of social bonds reducing anxiety, depression, and drug abuse liability. In the present review, we highlight the work from this burgeoning field and focus on the role(s) of the neuropeptides oxytocin (OT), vasopressin (AVP), and corticotrophin releasing hormone (CRH) mediating stress buffering. Together, the data suggest that OT underlies social bonding to reduce stress-induced psychological illness while AVP and CRH facilitate arousal to enhance autonomic reactivity, increasing susceptibility to adverse mental and physical health.

Parental relationships beyond the grave: Adolescents' descriptions of continued bonds

OBJECTIVE

Many people experience an ongoing relationship with a deceased loved one. This is called a "continued bond." However, little is known about the adolescent experience with continued bonds once a parent has died. This study describes three ways that adolescents continue their relationship with a parent after that parent's death.

METHOD

Individual semistructured interviews were conducted with nine adolescent children of deceased hospice patients from a large hospice in northeastern Ohio as part of a larger grounded-theory study. The interviews were audiotaped, transcribed verbatim, and analyzed using a conventional content analysis approach.

RESULTS

Adolescents continued their bonds with deceased parents in one of three ways: experiencing encounters with the deceased parent, listening to the inner guide of the parent, and keeping mementos to remind them of the parent.

SIGNIFICANCE OF RESULTS

The ways that the adolescents continued their bond with a deceased parent assisted them in creating meaning out of their loss and adjusting to life without that parent. Our results can be used by health professionals and parents to help adolescents after a parent has died.

Zum Verlauf „normalen“ Trauerns

Zusammenfassung. Gegenstand der Untersuchung ist die Frage, ob bei Erwachsenen Unterschiede in der Ausprägung verschiedener Aspekte des Trauerns in Abhängigkeit von der Dauer des Trauerprozesses bestehen. Bei einer Stichprobe von 521 trauernden Personen, die das Würzburger Trauerinventar bearbeiteten, zeigt sich innerhalb der ersten zwei Jahre nach Verlust für akute emotionale und kognitive Beeinträchtigungen (BEEIN) sowie für das Empfinden der Nähe zur verstorbenen Person (NÄHE) ein umgekehrt u-förmiger Verlauf mit nachfolgend weiterer Abnahme. Frauen weisen in beiden Skalen höhere Werte auf als Männer. Deskriptiv zeigt sich für Persönlichkeitsentwicklung/Wachstum (WACHS) sowie Empathie für andere (EMPATH) nach einem anfänglichen Absinken eine kontinuierliche Intensitätszunahme über einen Zeitraum von zwei Jahren hinaus. Die Ergebnisse werden u. a. im Kontext des Konzepts der fortdauernden Bindungen diskutiert, und es werden Schlussfolgerungen für die klinische Praxis aufgezeigt.

Internalized and externalized continuing bonds in bereaved parents: their relationship with grief intensity and personal growth

Continuing bonds (CBs) expression appears especially prevalent among bereaved parents. This study examined the relationship between CBs and grief outcomes for this population. A customized CB scale for use with bereaved parents was derived from the literature. Three hundred fifty-four participants (10 male) recruited from online support groups completed an internet questionnaire. A 3-factor dimensional structure of CB (internalized, externalized, and transference) was supported. Structural equation modeling showed clear links between internalized bonds and a more positive grief status; externalized bonds showing an opposite relationship. Weaker effects were found for child's age, time since death, and type of death.

Bereavement support used by mothers in Ireland following the death of their child from a life-limiting condition

BACKGROUND

Children's palliative care is a rapidly developing specialism internationally. Bereavement support is an integral component of children's palliative care but to date little research has investigated the bereavement support that mothers in Ireland use following the death of their child.

OBJECTIVE

The aim of this study was to explore mothers' experiences of bereavement support in Ireland following the death of their child from a life-limiting condition.

METHOD

A descriptive qualitative design was used. The study sample was ten mothers who had been bereaved in the previous 5 years. All mothers were recruited to the study by a gatekeeper from a voluntary organisation. Data were obtained through unstructured single interviews and analysed using conventional content analysis.

RESULTS

The findings indicate that the mothers relied on a combination of informal and formal bereavement support. In addition to depending on others to provide support, the mothers described their ability to self-support.

CONCLUSIONS

The findings show that mothers in Ireland use a variety of sources of support following the death of their child from a life-limiting condition. Health professionals involved in caring for families and children with a life-limiting condition should have an understanding of these sources.

Breaking bonds in male prairie vole: long-term effects on emotional and social behavior, physiology, and neurochemistry

Social relationships are essential for many fundamental aspects of life while bond disruption can be detrimental to mental and physical health. Male prairie voles form enduring social bonds with their female partners, allowing the evaluation of partner loss on behavior, physiology, and neurochemistry. Males were evaluated for partner preference formation induced by 24h of mating, and half were separated from their partner for 4 wk. In Experiment 1, partner loss significantly increased anxiety-like behaviors in the elevated plus maze and light-dark box tests and marginally increased depressive-like behaviors in the forced swim test. In addition, while intruder-directed aggression is common in pair bonded prairie voles, separated males were affiliative and lacked aggression toward an unfamiliar female and an intruding male conspecific. Partner loss increased the density of oxytocin-immunoreactivity (-ir), vasopressin-ir, and corticotrophin-releasing hormone-ir cells in the paraventricular nucleus of the hypothalamus and oxytocin-ir cells in the supraoptic nucleus. Tyrosine hydroxylase-ir was not affected. In Experiment 2, partner preference was observed after 2 wk of partner loss but eliminated after 4 wk partner loss. Body weight gain and plasma corticosterone concentrations were elevated throughout the 4 wk. No effects were observed for plasma oxytocin or vasopressin. Together, partner loss elicits anxiety-like and depression-like behaviors, disrupts bond-related behaviors, and alters neuropeptide systems that regulate such behaviors. Thus, partner loss in male prairie voles may provide a model to better understand the behavior, pathology, and neurobiology underlying partner loss and grief.

Losing a child: finding meaning in bereavement

BACKGROUND

Confronting the loss of a loved one leads us to the core questions of human existence. Bereaved parents have to deal with the rupture of a widely shared concept of what is perceived to be the natural course of life and are forced into meaning reconstruction.

OBJECTIVE

This study aims to expand upon existing work concerning specific themes of meaning reconstruction in a sample of bereaved parents. More specifically, the relationship between meaning reconstruction, complicated grief, and posttraumatic growth was analyzed, with special attention focused on traumatic and unexpected losses.

METHOD

In a mixed methods approach, themes of meaning reconstruction (sense-making and benefit-finding) were assessed in in-depth interviews with a total of 30 bereaved parents. Posttraumatic growth and complicated grief were assessed using standardized questionnaires, and qualitative and quantitative results were then merged using data transformation methods.

RESULTS

In total 42 themes of meaning reconstruction were abstracted from oral material. It was shown that sense-making themes ranged from causal explanations to complex philosophical beliefs about life and death. Benefit-finding themes contained thoughts about personal improvement as well as descriptions about social actions. Significant correlations were found between the extent of sense-making and posttraumatic growth scores (r s=0.54, r s=0.49; p<0.01), especially when the death was traumatic or unexpected (r s=0.67, r s=0.63; p<0.01). However, analysis revealed no significant correlation with complicated grief. Overall results corroborate meaning reconstruction themes and the importance of meaning reconstruction for posttraumatic growth.

Continuing bonds after suicide bereavement in childhood

It has been argued that the grieving process after suicide bereavement has unique properties (e.g.,J. R.Jordan, 2001). A qualitative study was conducted to explore one aspect of the grieving process--continuing bonds--after suicide bereavement in childhood. Data were collected through semi-structured interviews with 10 suicide-bereaved children and analyzed using Interpretative Phenomenological Analysis (Smith & Osborn, 2003). Three themes are discussed: thinking about the deceased, coping strategies, and ongoing connections to the deceased. The findings highlight potentially unique qualities of continuing bonds after childhood suicide bereavement and factors that might influence their adaptiveness. Theoretical and clinical implications are outlined.

The Continued Lived Experience of the Unexpected Death of a Child

The purpose of this qualitative study was to further examine the lived experiences of families that faced the sudden loss of a child. Six mothers that had previously participated approximately 9 years ago in the study entitled “The Lived Experience of the Unexpected Death of a Child” were interviewed. All of the mothers were Caucasian and had achieved a high school or greater level of education. Taped interviews and field notes were transcribed for data display. Together, two raters completed data reduction and coding for theme identification and categorization. Six themes were revealed that described helpful coping behaviors used by the mothers: positive beliefs, faith beliefs, everlasting love, pleasant remembrances, social engagement, and staying connected. Two themes, avoidance and rumination, described the behaviors that did not help the mothers cope with their loss. Finally, answers to the questions regarding acceptance and healing time were also revealed.

Continuing bonds in bereaved Pakistani Muslims: effects of culture and religion

This study explores the bereavement process and continuing bond in Pakistani Muslims with the focus on how culture and religion influence these processes. Ten participants were interviewed and their transcribed interviews were analyzed using a grounded theory approach. Three main domains were identified from the narratives expressed by the participants: death and the process of grieving, continuing the link with the deceased, and influencing agents. The findings indicated that Pakistani Muslims maintained their link with the deceased through cultural and religious rituals, such as performing prayers, reciting holy verses, talking and dreaming about the deceased, doing charity, visiting graves, and arranging communal gatherings. The prime purpose of many of these practices was the forgiveness of the deceased. Grief reactions seemed to be determined by the nature of death, prior relationships with the deceased, reaction of society and gender of the bereaved. Religion provided a strong basis for coping and adjustment of the bereaved, through rationalizing and accepting the death. This study has important implications for counselors and family therapists who can use religious affliations to reduce the impact of loss and complicated bereavement.

Religious beliefs affect grieving after pregnancy loss

Religious beliefs and practices may aid in coping with bereavement and grief after pregnancy loss. Data from 103 women enrolled in the original Lehigh Valley Perinatal Loss Project, and who were followed-up for at least 1 year, were evaluated for the impact of initial religious practices and beliefs on the course and severity of grief. Religious practices corresponding to standard scales of religiosity and agreement with specific beliefs were rated by the women on a Likert scale of 1-5. Neither agreement with statements corresponding to extrinsic and intrinsic religiosity or to positive religious coping, nor frequency of religious service attendance was predictive of follow-up scores on the Perinatal Grief Scale. Religious struggle, agreement with statements classified as negative religious coping, and continued attachment to the baby were all associated with more severe grief.

Young people living with parental bereavement: Insights from an ethnographic study of a UK childhood bereavement service

The purpose of this two-year ethnographic study was to explore the experiences of parentally bereaved young people who sought support from the Rocky Centre (a pseudonym), a childhood bereavement service in the United Kingdom. Data were generated from extended periods of participant observation and semi-structured interviews with both staff and service users. In this article we focus specifically on the interviews with 13 young people to elucidate the factors that helped them to live with parental bereavement. Of these participants, four had been recently bereaved and nine had experienced the death of a parent over ten years ago. Seven key themes emerged from the analysis of the interview data: expressing emotion, physical activity, positive adult relationship(s), area of competence, friendships/social support, having fun/humour and transcendence. These themes are discussed in turn, and implications for research and practice are addressed.

Bereavement interventions for adults with intellectual disabilities: what works?

Examination of the theory base for bereavement and loss is currently just beginning for adults with intellectual disabilities (ID). Yet, as life spans increase for individuals with ID, these adults experience more and more loss and bereavement events. Practitioners, especially grief counselors, are finding it increasingly critical for them to understand best practice principles for working with bereaved adults with ID in their daily work. Practitioners also are asked to guide families and care providers regarding grief and death education. This article provides counselors and other professionals with a review of existing bereavement intervention research for adults with ID. Practice recommendations are made on three levels: informal support; formal intervention; and community education.

Separation from loved ones in the fear of death

Individuals' death anxiety or fear of death has been extensively investigated, and there are numerous conceptualizations used in the literature, including a distinction between the dimensions of death and dying of self and death and dying of others. This article addresses a gap in the literature and re-examines the relationship between these two dimensions, which are assumed to be positively, linearly related. Using both quantitative and qualitative data, this study indicates that regardless of the degree to which individuals fear their own death, most individuals fear the death and dying of others. Specifically, the leaving, or loss of loved ones, was a central theme in people's fear of death, and this is discussed in relation to current trends in the literature.