Adaptation of the Spanish Grief and Meaning Reconstruction Inventory: An Initial Validation and Network Analysis

The current study was conducted to adapt the Grief and Meaning Reconstruction Inventory (GMRI) into Spanish and to establish its psychometric properties in a group of 202 mourners seeking treatment in Spain. A confirmatory factor analysis established that the Spanish GMRI yielded eight factors, displaying strong reliability and convergent validity, through the scale's inverse correlation with the Inventory of Complicated Grief and various measures of psychological distress, explaining a 48% of the variance of the former measure. A network analysis suggested that sense-making could play a central role in meaning-making during bereavement.

Caregiver Speaks Study Protocol: A Technologically-Mediated Storytelling Intervention for Hospice Family Caregivers of Persons Living With Dementia

OBJECTIVE

We present the protocol of a study aiming to examine the efficacy of a technologically-mediated storytelling intervention called Caregiver Speaks in reducing distress and grief intensity experienced by active and bereaved hospice family caregivers of persons living with dementia (PLWD).

DESIGN

The study is a mixed-method, 2-group, randomized controlled trial.

SETTING

This study takes place in 5 hospice agencies in the Midwest and Northeastern United States.

PARTICIPANTS

Participants include hospice family caregivers of PLWD.

INTERVENTION

Participants are randomized to usual hospice care or the intervention group. In the Caregiver Speaks intervention, caregivers engage in photo-elicitation storytelling (sharing photos that capture their thoughts, feelings, and reactions to caregiving and bereavement) via a privately facilitated Facebook group. This intervention will longitudinally follow caregivers from active caregiving into bereavement. The usual care group continues to receive hospice care but does not participate in the online group.

OUTCOMES MEASURED

We anticipate enrolling 468 participants. Our primary outcomes of interest are participant depression and anxiety, which are measured by the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder screening (GAD-7). Our secondary outcomes of interest are participants' perceived social support, measured by the Perceived Social Support for Caregiving (PSSC) scale, and grief intensity, which is measured by the Texas Revised Inventory of Grief Present Subscale (TRIG-Present).

Preliminary Results of Caregiver Speaks: A Storytelling Intervention for Bereaved Family Caregivers

When bereaved cancer caregivers have the opportunity to tell stories about their caregiving and bereavement journey, they are better able to make meaning of these experiences. Creating a space where they can share stories with other bereaved caregivers increases social validation, facilitates the meaning-making process, and reduces distress and risk for complicated grief. This study explored the feasibility and acceptability of an innovative storytelling intervention for bereaved family caregivers of cancer patients. Twenty-one participants engaged in the intervention, and eleven were interviewed about their experience. Results indicated study feasibility and intervention acceptability. Suggestions for future intervention were also provided.

Effectiveness of a Cancer Bereavement Therapeutic Group

This study examined the effectiveness of a novel cancer bereavement group. Twenty-seven participants attended a sixsession cancer bereavement therapeutic group. Data were collected at baseline, intervention completion, and three-month follow-up. Grief intensity and symptoms of posttraumatic stress disorder (PTSD), depression, and anxiety were reduced postintervention, and self-compassion increased. At follow-up, improvement remained for grief, PTSD, and depression. A small quasi-experimental waiting-list comparison group showed no change on any measure between baseline and waiting-list end. This study provides preliminary evidence that a brief therapeutic group is an effective intervention for cancer bereavement.

Prolonged grief symptomatology following violent loss: the mediating role of meaning

Background: Prolonged Grief Disorder (PGD) is over-represented among those who have lost loved ones to violent causes. To tailor PGD interventions for this vulnerable population it is critical to examine the aetiology of PGD specifically in the context of violent death bereavement. Previous studies have suggested that violent loss increases symptoms of PGD by hindering the mourner's ability to make meaning of the death or its aftermath. However, these studies have relied on cross sectional data that preclude genuine prediction and have not differentiated among specific themes of meaning. Objective: This study aimed to identify specific themes of meaning that mediate the detrimental impact of violent loss on subsequent emergence of PGD symptomatology among the violently bereft. Method: A longitudinal, prospective design (N = 171) was used to assess violent loss and themes of meaning an average of six months post-loss allowing for prediction of PGD symptoms an average of eight months later. Results: Violent loss had a significant indirect effect on PGD symptomatology when meaning themes focusing on sense of peace and continuing bonds served as mediators. Conclusions: This study demonstrates the mediating role that specific meaning themes play in the development of PGD symptomatology following violent loss. These findings highlight the potential benefits of applying a meaning-based intervention approach with the violently bereft.

The central role of meaning in adjustment to the loss of a child to cancer: implications for the development of meaning-centered grief therapy

PURPOSE OF REVIEW

This review describes research on meaning and meaning-making in parents who have lost a child to cancer, suggesting the need for a meaning-centered therapeutic approach to improve their sense of meaning, purpose, and identity and help with management of prolonged grief symptoms.

RECENT FINDINGS

Several studies have demonstrated that parents bereaved by cancer experience unique meaning-related challenges associated with the caregiving and illness experience, including struggles with making sense of their loss, benefit-finding, their sense of identity and purpose, disconnection from sources of meaning, and sustaining a sense of meaning in their child's life. Meaning-centered grief therapy, adapted from meaning-centered psychotherapy, directly addresses these issues, highlighting the choices parents have in how they face their pain, how they honor their child and his/her living legacy, the story they create, and how they live their lives.

SUMMARY

Given the important role that meaning plays in adjustment to the loss of a child to cancer, a meaning-focused approach such as meaning-centered grief therapy may help improve parents' sense of meaning and grief symptoms. It seems particularly appropriate for parents who lost a child to cancer because it does not pathologize their struggles and directly targets issues they frequently face.

A Pilot Study of Meaning-Based Group Counseling for Bereavement

Scientific studies demonstrating either the efficacy or effectiveness of interventions for uncomplicated bereavement are lacking. This study reports the results of a novel meaning-based group counseling (MBGC) intervention developed for bereaved adults. MBGC was built on previous scholarly critiques using a formative evaluation methodology within a group of bereaved adults ( n = 11). The primary research questions were as follows: (a) How do bereft individuals respond to MBGC? and (b) What refinements are needed to MBGC to ensure feasibility? A secondary research question was: (c) Is collection of quantitative outcome measures at baseline and postintervention feasible? Analysis of multiple qualitative data sources resulted in numerous refinements to MBGC. Results indicate that the majority of participants found the meaning-based intervention beneficial. Limitations included concurrent external therapies and a small sample size that was largely homogenous. There were no major counterindications to proceeding with a pilot randomized controlled trial (RCT).

Reconstructing Meaning with Others in Loss: A Feasibility Pilot Randomized Controlled Trial of a Bereavement Group

More effective psychosocial interventions that target uncomplicated bereavement are needed for those actively seeking support. The objective of this study was to assess the feasibility of evaluating a unique meaning-based group counseling (MBGC) intervention with a randomized controlled trial (RCT) design. Twenty-six bereft individuals were randomly assigned to either MBGC or a control bereavement support group. Twenty participants (11 experimental, nine control) completed all aspects of the study including self-report measures at baseline, postintervention, and 3-month follow-up of meaning in life, anxiety, depression, and grief. Results support the feasibility of an RCT with MBGC.

The Grief and Meaning Reconstruction Inventory (GMRI): Initial Validation of a New Measure

Although increasing numbers of grief theorists, researchers, and therapists have begun to focus on the quest for meaning in lives disrupted by loss, no convenient and psychometrically validated measure of meanings made specifically in bereavement has been available to guide their efforts. To construct such a measure, the authors began with a systematic content analysis of sense-making, benefit finding, and identity reconstruction themes gleaned from the narrative responses of a sample of 162 adults who were diverse in their age, ethnicity, relationship to the decedent, cause of death, and severity of their grief response. These were then formulated into a set of 65 candidate items in a Likert scale format representing the level of the respondent's endorsement of the item in the past week. Subsequent administration to a second sample of 300 bereaved respondents permitted factor analysis of this pilot version of the Grief and Meaning Reconstruction Inventory (GMRI), and reduced the items to 29, which loaded on 5 distinct factors, labeled Continuing Bonds, Personal Growth, Sense of Peace, Emptiness and Meaninglessness, and Valuing Life. Both the overall GMRI and its constituent factors showed good internal consistency and strong convergent validity in the form of negative correlations with established measures of bereavement-related negative emotions, symptoms of complicated grief, and more general psychological distress and mental health symptomatology, and positive correlations with grief related personal growth. The authors close by noting several specific research and clinical applications of the measure, which could play a useful role in testing and refining contemporary models of meaning made in the wake of loss.

Illustrating an integrated typology of meaning reconstruction in discourse: grief-related disclosures

A typology of meaning reconstruction in grief-related discourse is offered as an extension to extant approaches to meaning making as a factor in relieving distress. Sensemaking, acceptance or resignation without understanding, realization of benefits via positive reappraisal, and realignment of roles and relationships are advanced as the 4 types of meaning reconstruction that are formed by the 4 intersections of Park's ( 2010 ) categorical distinctions in meaning making (i.e., searching for comprehensibility/searching for significance and assimilation/accommodation). Interpretive analysis of grief-related texts from an emotional disclosure study reveals 25 themes across the 4 types. Related theoretical insights and practical implications are discussed.

The meaning of loss codebook: construction of a system for analyzing meanings made in bereavement

Recent research on grieving populations has emphasized the role of meaning making in adaptation to bereavement, typically relying on simple self-reports of the extent to which respondents have been able to find sense or benefit in their loss. The present article reports the development of a reliable and comprehensive coding system for analyzing meanings made in the wake of the death of a loved one, yielding a 30-category codebook demonstrating excellent reliability, and comprising both negative and positive themes that arise as grievers attempt to make sense of loss. Based on an intensive qualitative analysis of a diverse sample of 162 adults mourning the natural or violent death of a variety of loved ones, the Meaning of Loss Codebook could prove useful in process-outcome studies of grief therapy, analysis of naturalistic first-person writing about bereavement experiences in grief diaries and blogs, and clinical assessment of meanings made in the course of bereavement support or professional intervention.

Meaning-based group counseling for bereavement: bridging theory with emerging trends in intervention research

A growing body of scholarship has evaluated the usefulness of meaning-based theories in the context of bereavement counseling. Although scholars have discussed the application of meaning-based theories for individual practice, there is a lack of inquiry regarding its implications when conducting bereavement support groups. The objective of this article is to bridge meaning-based theories with bereavement group practice, leading to a novel intervention and laying the foundation for future efficacy studies. Building on recommendations specified in the literature, this article outlines the theoretical paradigms and structure of a short-term meaning-based group counseling intervention for uncomplicated bereavement.

On Being a Psycho-Oncologist

This special issue of TCP focuses on the psychological and psychosocial components of coping with cancer and its aftermath. Psycho-oncology, a subspecialty within professional psychology, is a multidisciplinary field emphasizing the psychological and social aspects of cancer. In this introductory article, I show the congruence between counseling psychology and psycho-oncology, indicate how counseling psychologists can expand their parameters of practice to include cancer patients and families, and explain what evidence-based resources are needed to acquire relevant background knowledge. Health care reform changes—in general and oncology-specific—are explained as they currently open new opportunities for counseling psychologists in psycho-oncology. Finally, the five articles that make up this special issue are previewed. Psycho-oncology is a challenging yet rewarding subspecialty within counseling psychology, congruent with its values and parameters of practice, and now is an opportune time to expand one’s practice to include psycho-oncology and help those coping with cancer and its aftermath.