Internalized versus externalized continuing bonds: Relations to grief, trauma, attachment, openness to experience, and posttraumatic growth

Perceptions of internal and external continuing bonds in bereaved individuals with and without prolonged grief disorder

This study aimed to compare individuals with and without a diagnosis of Prolonged Grief Disorder in terms of the intensity of internal and external continuing bonds, as well as the extent to which they interpret these bonds as comforting, socially acceptable, and an inseparable part of their self-identity. The sample consisted of 229 bereaved adults (PGD: N = 27; non-PGD: N = 202). Results indicated that the PGD group experienced internal and external bonds more intensely, reporting higher scores for interpreting them as an inseparable part of self-identity and lower scores for interpreting them as socially acceptable. While the PGD group found external bonds more comforting than the non-PGD group, no such difference was observed for internal bonds. These findings suggest that, when assessing whether continuing bonds are adaptive or maladaptive, it is crucial to consider not only their internal or external nature but also how they are interpreted.

How reminiscing about deceased close others together with continuing bonds relates to grief severity and personal growth: a cross-sectional study with bereaved adults

OBJECTIVES

One of the reasons why people engage in reminiscences about their past is to maintain intimacy with deceased close others. Although previous research alerts to the negative effects of reminiscence for intimacy maintenance on mental health, little is known about its relation to individuals' reactions to loss (i.e. grief severity and personal growth). In two samples, we focus on time since loss and continuing bonds, to elucidate the role of reminiscence for intimacy maintenance in grief.

METHOD

The samples comprised 111 and 198 bereaved adults. All participants rated the frequency of reminiscence for intimacy maintenance and loss-related variables, such as time since loss, continuing bonds, and grief severity. Sample 2 additionally completed measures of personal growth, loss-centrality, and their interconnectedness with the deceased.

RESULTS

Reminiscence on intimacy maintenance was positively related to grief severity. This relation was independent of time since loss and partly driven by externalized bonds. Internalized bonds mediated the relation between reminiscence for intimacy maintenance and grief severity (in sample 1) and personal growth (in sample 2).

CONCLUSION

Continuing bonds help explain why reminiscing for intimacy maintenance can be harmful in terms of grief severity but also fosters personal growth after the loss.

Facilitation or hindrance? The impact of downward social comparison on adversarial growth

Introduction

While adversity can bring great challenges to individuals' life and work, many people also find ways to make positive changes and adapt to these difficult circumstances. Individuals tend to make social comparisons more frequently and intensely when faced with adversity or high stress. The study attempts to examine the influence mechanism of downward social comparison on individual adversarial growth.

Methods

By collecting data from 353 Chinese who have experienced adversities in the past 3 years, the study validates the dual mediating model of gratitude and self-acceptance and explores the moderating effect of interpersonal sensitivity.

Results

The findings indicate that: downward social comparison can increase the occurrence of adversarial growth by enhancing individuals' self-acceptance and gratitude. Compared to individuals with low interpersonal sensitivity, individuals with high interpersonal sensitivity are more likely to facilitate the occurrence of adversarial growth through self-acceptance and gratitude due to downward social comparison.

Discussion

In the face of adversity, individuals can regain self-confidence and respond positively by comparing themselves to people in worse situations than themselves. In particular, individuals with higher interpersonal sensitivity are more likely to benefit from downward social comparisons and grow from adversity.

Continuing Bonds in grieving men: A comparative description of Costa Rica and Spain

Continuing Bonds among grieving men from Costa Rica and Spain were compared, with the primary hypothesis that there would be significant differences between the two groups. A descriptive, comparative, and cross-sectional research study was conducted. Non-probability and convenience sampling was employed, involving 227 grieving men who completed an online questionnaire comprising sociodemographic data, mediators of mourning, and the Continuing Bonds Scale. The results did not reveal significant differences in Continuing Bonds expressions. However, upon controlling for the interaction between degree of kinship with the deceased person, notable differences emerged in Continuing Bonds and internalized and externalized Continuing Bonds (p < 0.05). The influence of sociocultural factors in each country on Continuing Bonds expressions is considered. The findings could support the development of strategies centered on grieving men, Continuing Bonds, and their specific needs.

Continuing bonds in parents after a loss in pregnancy, or a death at or shortly after birth: A population-based study

In this study, we describe continuing bonds and grief reactions and assess their association in 980 parents bereaved in pregnancy, at or shortly after birth. We found that most parents experienced continuing bonds. However, they differed by type of loss. Parents losing their child due to termination of pregnancy or miscarriage experienced bonds less frequently and had the least intense grief reaction. Parents losing their child postpartum experienced bonds most frequently and had the most intense grief reaction. Continuing bonds were associated with intensified grief in parents losing their child after termination or miscarriage, while this relationship was less obvious after stillbirth or postpartum death.

Continuing bonds in men grieving a loved one

OBJECTIVE

to examine internalized and externalized continuing bonds in men grieving a loved one.

METHOD

a correlational, descriptive and cross-sectional study. Convenience sample comprised by 170 mourning men. The variables were mediators of mourning, continuing bonds and sociodemographic data. The instrument used was an online questionnaire comprised by mediators of mourning, a continuing bonds scale and sociodemographic data. Descriptive statistics, analysis of variance and Spearman's coefficient were used. The significance level adopted was p<0.05.

RESULTS

the participants' mean age was 36.61 years old (SD=13.40), and 80.00% had Higher Education. The mean values corresponding to internalized and externalized continuing bonds were 24.85 (SD=7.93) and 7.68 (SD=2.33), respectively. Significant differences were established referring to internalized and externalized continuing bonds in terms of kinship with the deceased person (p<0.001), and none with the cause of death or with the time elapsed since the event. No significant correlations were defined between internalized/externalized continuing bonds and mediators of mourning.

CONCLUSION

grieving men express internalized and externalized continuing bonds frequently and occasionally, respectively, with differences according to who the deceased person was. The Nursing discipline might devise specific strategies that strengthen coping with grief in this population group. (1) It was usual to continue the bond with the deceased loved one. (2) The expression of internalized continuing bonds was frequent after the death. (3) When facing the loss, there was occasional expression of externalized continuing bonds. (4) There were differences in internalized and externalized continuing bonds according to kinship. (5) There were no associations between continuing bonds and mediators of mourning.

Attachment styles, continuing bonds, and grief following companion animal death

The death of a companion animal can cause severe grief, yet previous research investigating factors predicting grief has been hampered by limitations. We explored how attachment styles, continuing bonds, and time since loss interacted to predict grief severity in a large sample of individuals grieving the loss of a variety of companion animals. Participants (n = 496) aged between18 and 79 years (Mage = 41.60, SD = 13.62) who had lost a companion animal in the previous three years completed a continuing bonds questionnaire, and animal-oriented assessments of grief and attachment styles online. After controlling for time since loss, higher attachment anxiety predicted more severe grief, a relationship partially moderated by continuing bonds, whereas attachment avoidance predicted less severe grief irrespective of continuing bonds. We recommend reconsideration of the non-human animal exclusion in prolonged grief disorder, and suggest that bereavement supports embrace targeted approaches that consider attachment styles.

"I Want My Loved One Back Virtually": Exploring the Desire of Bereaved People to Create and Maintain Digital Bonds With Their Deceased Loved Ones

With the rapid development of digital technology in recent years, virtual funerals and the reproduction of deceased persons in digital spaces have become possible. However, few empirical studies have been conducted on this topic. This study assessed the attitudes of bereaved people toward digital bonds with their deceased relatives, and explored related factors. A survey was administered to bereaved, middle-aged Japanese citizens who had lost a first-degree relative within the previous 10 years. The results showed that most respondents did not seek digital bonds, but nearly 20% wanted to be reunited with their deceased in a digital space. The desire to maintain digital bonds was significantly related to other variables, such as the deceased's age and years since their death. Regression analysis revealed that the desire for digital bonds predicted complicated grief 5 months later. The findings suggest that digital bonds may influence post-bereavement maladjustment.

Very Present and Very Real: A Case Study of Regularly Hearing the Voice of the Deceased Without Distress in Bereavement

Although sensory and quasi-sensory experiences of the deceased (SED) have been the subject of much debate, research on the phenomenology of auditory verbal experiences in the bereaved has been neglected. This case study describes the phenomenology of a regularly occurring voice hearing experience and its meaning for a single bereaved individual. The voice of the deceased can be heard as though in external space, and the experience can feel real, even when the death is fully acknowledged. A bereaved individual can welcome and benefit from the experience even when it is not recognized as a normal part of grieving in the individual's cultural context, when no afterlife belief is present, and when the experience remains unexplained. The case study demonstrates that hearing the voice of the deceased can be a regular occurrence without causing distress or dysfunction and lends support to the idea that SED are a common concomitant of normal bereavement.

The impact of continuing bonds following bereavement: A systematic review

Following bereavement, continuing bonds (CBs) include engaging with memories, illusions, sensory and quasi-sensory perceptions, hallucinations, communication, actions, and belief that evoke an inner relationship with the deceased. To date, the literature has been unable to confirm whether retaining, rather than relinquishing, bonds is helpful. A mixed studies systematic literature search explored how CBs affect grief. Studies on the effect or experience of CBs on adjustment following bereavement were eligible for inclusion. Six computerized databases were searched. A total of 79 of 319 screened studies were included. Three themes were derived from the thematic analysis: (1) comfort and distress, (2) ongoing bonds and relational identity, and (3) uncertainty, conceptualizing, and spirituality. Themes describe the role of CBs for the accommodation of the death story, transformation of the relationship, meaning reconstruction, identity processes, and affirmation of spiritual belief. Results shed light on the adaptive potentials for CBs.

Relationship between World Assumptions and Post-Traumatic Growth among Polish Cancer Patients: Moderating Effect of Rumination

BACKGROUND

Although post-traumatic growth is believed to be the result of complex interplays between various factors, cognitive variables appear to play a special role in these interactions. Yet, research on this topic is scant. Therefore, the first purpose of this study was to verify whether there is a direct relationship between world assumptions and post-traumatic growth among Polish cancer patients. As the effect of psychological change in post-traumatic growth may be affected by basic beliefs about the world and oneself, the second goal was to assess whether this association is moderated by rumination.

METHODS

The study included 215 Polish cancer patients. The Post-traumatic Growth and Depreciation Inventory-Expanded version-(intrusive and deliberate rumination), the World Assumption Scale, and the Event-related Rumination Inventory were applied.

RESULTS

Positive, albeit weak, correlations were found between the dimensions of world assumptions and post-traumatic growth. Post-traumatic growth correlated negatively with intrusive rumination and positively with deliberate rumination. The outcomes show that the level of post-traumatic growth resulting from world assumptions is significantly different at various levels of intrusive and deliberate rumination.

CONCLUSION

Lower/medium intrusive rumination seems to strengthen the relationship between benevolence of the world/worthiness of the self and post-traumatic growth, and higher deliberate rumination tends to reinforce the relationship between meaningfulness and post-traumatic growth.

Quality of Life of Older Adults With Complicated Grief: A Mixed Methods Exploration

The current mixed methods study investigated what changes in quality of life (QOL) mean to older adults with complicated grief treated with Accelerated Resolution Therapy (ART) post-hospice services. An informational matrix, which included select patient characteristics (e.g., number of comorbidities, single versus multiple deaths, relationship role), four identified qualitative themes, end of study QOL scores measured by the Centers for Disease Control and Prevention Health-Related QOL Healthy Days Module, and changes in scores from baseline to end of study, was created to analyze the data. Results showed that although a history of multiple deaths may contribute to greater improvements in QOL with therapy, having at least one comorbidity resulted in a richer description and endorsement of QOL in response to treatment. This is the first longitudinal, randomized controlled trial using a mixed methods approach to examine QOL of hospice family caregivers with complicated grief who are receiving ART. This study identifies potential links of QOL and caregiver characteristics, providing nurses with foundational knowledge for assessment, care, and further research on the experiences of complicated grief. [Journal of Gerontological Nursing, 48(5), 19-26.].

"Giving voice to the voiceless": An exploration of the grieving ritual for a therapy dog

The use of animal-assisted therapy with children who have experienced trauma is receiving increasing attention in the literature. However, there is a lack of attention given to the death of therapy animals. The scholarship on the death of animal companions highlights a varying depth of acknowledgment of children's grief. This article draws on the clinical experience of one therapy center's approach to the death of a therapy dog. Knowledge gained from this experience highlighted the necessity of acknowledging the death, the need for clear communication with children and young people, and the importance of involving children in a memorial ritual.

Disorganized attachment and prolonged grief

OBJECTIVE

While the relationship between attachment anxiety and avoidance and the severity of prolonged grief disorder (PGD) has been well-studied, less is known about the relationship between disorganized attachment and PGD. We test the associations between disorganized attachment and the interaction between it and attachment avoidance and anxiety on PGD.

METHOD

Participants (N = 258) who had lost a family member from 0.5 to 8.0 years before the survey completed the experiences in close relationships-revised, the adult disorganized attachment scale, and the PGD-13 scale.

RESULTS

The model explaining PGD symptoms through attachment, taking into account the level of disorganized attachment, explained variance in PGD significantly better than the model taking into account only the level of attachment anxiety and avoidance as predictors. Additionally, the relationships between attachment avoidance and PGD were positive, negative, or neither, depending on the configuration of the levels of disorganized attachment and attachment anxiety.

CONCLUSION

Future research into the relationships between attachment and PGD should take into account disorganized attachment. Attachment-informed grief therapy focused on insecure styles of attachment - including the disorganized style - to the deceased person and other loved ones may prove a promising approach for bereaved persons who experience PGD.

Conflicted or close: Which relationships to the deceased are associated with loss-related psychopathology?

OBJECTIVES

Prior studies have shown that pre-loss closeness and conflict with a deceased person are associated with the severity of symptoms of prolonged grief and/or depression. Nevertheless, mechanisms underlying these relationships are not well understood. We propose a theoretical model in which past closeness and conflict are related to prolonged grief and depression via concrete and symbolic continuing bonds (CB). The aim of our study was to test this model in a sample of bereaved family members.

METHODS

Individuals (N = 244) who had lost a family member from 0.5 to 8.0 years before the survey completed the Quality of Relationships Inventory-Bereavement Version, the Continuing Bonds Scale, the Prolonged Grief Disorder-13 scale, and the Patient Health Questionnaire-9.

RESULTS

The findings partially confirmed our model. Closeness was positively and moderately associated with symptoms of prolonged grief but not with symptoms of depression. Conflict was positively and weakly associated with symptoms of depression and prolonged grief. All of these relationships were only partially mediated by concrete/maladaptive and symbolic/adaptive CB.

CONCLUSIONS

The differences in the relationship of past closeness and conflict to prolonged grief and depression symptoms suggest that inter- and intrapersonal mechanisms of prolonged grief and depressive symptoms may be distinct. If future, especially longitudinal studies, confirm our model, CB would be a possible target for interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience loss-related psychopathology.

PRACTITIONER POINTS

Continuing bonds (CB) are a potential target of interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience symptoms of prolonged grief and/or depression. Internalization of the capacity to care for yourself and feel autonomous in a safe and stable therapeutic relationship may lead to increased self-confidence, promote working through past experiences in the relationship with the deceased, and gradual reduction of concrete forms of CB. Increasing awareness and acceptance of emotional experiences may contribute to the appreciation of past relationship with a deceased person and the growth of symbolic forms of CB. Future research should focus on verifying the effectiveness of the attachment-informed therapeutic approach to working with CB.

Associations between interpersonal dependency and severity of prolonged grief disorder symptoms in bereaved surviving family members

BACKGROUND

Several studies have shown that interpersonal dependency is a risk factor for prolonged grief disorder (PGD), a disorder that has been recently approved by the American Psychiatric Association Assembly for inclusion in the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-TR). Nevertheless, it remains unclear whether this relationship is independent of depression, which may also be related to both loss and interpersonal dependency. Furthermore, anaclitic dependency (maladaptive and immature) compared to relatedness (more adaptive and mature) dependency, and the relationships between these types of dependency and PGD, have not been examined. The aim of the present study was to determine how anaclitic and relatedness dependency are associated with PGD symptom severity, controlling for depressive symptom severity, over and above potential sociodemographic and loss-related confounder variables.

METHODS

Participants (N = 241) bereaved after the death of a family member from 0.5 to 8 years before the survey (M = 3.36, SD = 2.02) completed the Depressive Experiences Questionnaire, the Patient Health Questionnaire-9, and the Prolonged Grief Disorder-13 scale (PG-13).

RESULTS

A hierarchical regression analysis confirmed that anaclitic dependency is positively associated with PGD symptom severity, even when controlling for depression severity and other potential confounder variables. There was no significant association between relatedness dependency and PGD.

CONCLUSIONS

To assess the risk of PGD in individuals bereaved after the death of a family member, it is important to assess anaclitic dependency.