Moving Forward: A Close Look at Healing Process After Traumatic Parental Death

Recovery from traumatic grief after parental loss is a challenging and gradual process. The current study aimed to capture the rich and nuanced experiences of adolescents' healing process after traumatically losing their parent(s). A phenomenological approach was utilized for data collection and analysis. To reach the research aim, interviews with 15 Iranian adolescents who had lost their parent(s) at least three-year ago were conducted. Two main themes from Colaizzi's analysis including Grief work and Rebuilding new life were extracted from data. Findings highlight an understanding of how adolescents with an experience of traumatic parental death would heal and could provide valuable insights into creating successful interventions and support systems tailored to help them cope with the devastating effects of traumatic loss and grief.

Somatic symptoms and insomnia among bereaved parents and siblings eight years after the Utøya terror attack

Background: Levels of prolonged grief symptoms (PGS) and post-traumatic stress symptoms (PTSS) can be high, many years following bereavement after terror, but knowledge concerning somatic health is scarce. Terrorism is a serious public health challenge, and increased knowledge about long-term somatic symptoms and insomnia is essential for establishing follow-up interventions after terrorism bereavement.Objective: To study the prevalence of somatic symptoms and insomnia and their association with PGS, PTSS, and functional impairment among terrorism-bereaved parents and siblings.Methods: A cross-sectional quantitative study included 122 bereaved individuals from the Utøya terror attack in Norway in 2011. The sample comprised 88 parents and 34 siblings aged 19 years and above (Mage = 49.7 years, SDage = 13.8 years, 59.8% females). The participants completed questionnaires 8 years after the attack assessing somatic symptoms (Children's Somatic Symptoms Inventory) and insomnia (Bergen Insomnia Scale) along with measures of PGS (Inventory of Complicated Grief), PTSS (Impact of Event Scale-Revised), and functional impairment (Work and Social Adjustment Scale).Results: Fatigue was the most frequently reported somatic symptom (88% of females and 65% of males). Females reported statistically significantly more somatic symptoms than males. In total, 68% of the bereaved individuals scored above the cut-off for insomnia. There were no statistically significant gender differences for insomnia. Female gender, intrusion, and arousal were associated with somatic symptoms. Intrusion and somatic symptoms were associated with insomnia. Somatic symptoms, avoidance, and hyperarousal were associated with functional impairment.Conclusion: Many bereaved parents and siblings report somatic symptoms and insomnia eight years after the terror attack. Somatic symptoms are associated with functional impairment. Long-term follow-up and support after traumatic bereavement should focus on somatic symptoms and insomnia.

The Impact of Patient Suicide on Clinicians

The experience of patient suicide on clinicians is associated with complex affective states that include grief, guilt, shame, and fear and distressing subjective experiences of incompetence and helplessness. The authors review the literature of the subject and highlight the work of Rajagopalan and colleagues in Singapore, who implemented a one-time reflective group session to help clinicians process the experience of patient suicide to reduce psychological distress and prevent burnout and moral injury.

Interpersonal psychotherapy for traumatic grief following a loss due to COVID-19: a case report

Interpersonal psychotherapy (IPT) is a highly regarded evidence-based psychotherapy that aims to alleviate the suffering of clients and improve their interpersonal functioning. Research has demonstrated the effectiveness of IPT in depressive, bipolar and eating disorders. IPT also focuses on grief and loss as a problem area to help clients address and process their grief symptoms, leading them to reach a phase of finding meaning. However, traumatic grief which is characterized by someone who has both symptoms of trauma and grief can further complicate treatment. As for Posttraumatic Stress Disorder (PTSD), IPT can be a choice of treatment by addressing perceived isolation and emotional dysregulation through mobilizing adequate social support. This case study highlights the efficacy of IPT in treating complicated grief with traumatic experiences caused by the loss of a loved one during the COVID-19 pandemic, without undergoing exposure-based therapy. The treatment course consisted of 12 sessions scheduled twice weekly, and the client received antidepressant medication augmented with antipsychotic medication. After undergoing IPT, the client experienced an improvement in symptoms, gradual recovery of functional disability, and more meaningful interpersonal relationships. The case study presented provides evidence to suggest that IPT is a promising treatment approach for individuals struggling with trauma related to grief.

Psychosocial Intervention on the Dual-Process Model for a Group of COVID-19 Bereaved Individuals in Wuhan: A Pilot Study

Wuhan was the first large city where the initial breakout of COVID-19 took numerous lives. A group of social workers and mental health specialists coordinated the "Be Together Program" (BTP), a psychosocial grief intervention program to help a group of Wuhan COVID-19 bereaved people. Under the Dual-process model framework, BTP used the internet and social media as the main tools, combined with group and individual intervention. Additionally, it employed a "Supermarket Mode" with abundant intervention themes and approaches for BTP participants to choose according to their special needs. Additionally, Chinese cultural elements are integrated into the program. At the end of the program, the grief scores of participants in the qualified sample reduced significantly, and the prevalence of the potential Prolonged Grief Disorder diagnosis reduced from 75% to 12%. The study also found that the BTP was especially effective for those who had high levels of grief reaction.

Bereavement Needs Assessment in Nurses: Elaboration and Content Validation of a Professional Traumatic Grief Scale

The COVID-19 pandemic has caused a series of biopsychosocial repercussions among nursing professionals. The impossibility of anticipating the events, the numerous deaths, the excessive workload, the lack of personal health and the necessary means of protection made it difficult to regulate the impact and the elaboration of grief to the point of becoming, on many occasions, a traumatic grief whose physical and psychological manifestations are becoming more and more evident. The main objective of this research was to develop a scale for a group of symptoms based on professional traumatic grief. The development consisted of two phases: (I) instrument design through a literature review and focus groups of bereavement experts and healthcare professionals who experience the grief process in their work; and (II) validation of the content of the instrument. A total of 25 final items were established as suitable for inclusion in the instrument. It is expected that the experiences and results obtained through the development and validation of a scale of specific symptomatology of professional traumatic grief in health professionals will allow the assessment and detection of symptomatology in order to develop programs and strategies for early intervention and prevention.

Validation of the Content of the Diagnostic Label Professional Traumatic Grief

(1) Background: The Covid-19 pandemic has put our healthcare systems to the test, exposing their vulnerability and demanding a high degree of commitment and dedication from healthcare teams to confront and contain the disease. In this sense, nursing professionals have played a prominent role in the treatment of complex cases that have required hospitalisation and have manifested pre-existing health complications or mortality. This unprecedented situation made it difficult to regulate the emotional impact and manage grief, often turning it into a traumatic grief whose psychological and emotional manifestations are increasingly evident but very little researched in the current context. (2) Purpose: Validation of the definition, defining characteristics and related factors for the proposal of the nursing diagnosis of professional traumatic grief. (3) Method: Based on Fehring's content validation model, the label name, defining characteristics and other related factors were agreed upon by Spanish experts. (4) Results: The content validity index was 0.9068. A total of 21 defining characteristics were validated by the experts, as all of them scored above 0.6. With respect to the related factors of the proposed 10, all were validated. (5) Conclusion: The present study supports the proposal to develop a nursing diagnosis for professional traumatic grief. The use of standardised language is only the first step in establishing professional traumatic grief as a diagnostic category.

Dealing with bereaved children: a case study

Introduction:

A personal reflection on managing bereaved children (BC) following unexpected death of a parent.

Questions:

What evidence is available to assist ambulance clinicians when supporting BC?

Methods:

A literature search on BC in pre-hospital environments was undertaken.

Results:

Paucity of literature necessitated search expansion beyond pre-hospital/ambulance focus, and use of supplementary sources of credible information from registered bereavement charities and help groups.

Conclusion:

More research is needed to better support this vulnerable, unique demographic. It is hoped that this article will encourage further discussion and research into this topic.

Ritual in Therapy for Prolonged Grief: A Scoping Review of Ritual Elements in Evidence-Informed Grief Interventions

The aim of this article of to analyze ritual in evidence-informed treatments for prolonged and traumatic grief. A scoping review is conducted in order to give an overview of existing literature on ritual and symbolic interventions in grief therapies for prolonged grief and the type of evidence supporting these interventions. The 22 studies reported in this review reveal a variety of ritual elements ranging from symbolic expression and interaction, writing assignments, dialogue with the deceased or an imaginary person, to farewell ceremonies at the end of the treatment. The interventions are studied within different populations (e.g., bereaved spouses, perinatal loss, grief after violent death, and genocide). Almost all studies show significant effects of the grief treatment, trauma and related symptoms. However, the effects are mostly measured for the entire treatment and not separately for the ritual intervention. In the discussion we focus on the role of ritual and culture in prolonged grief treatment.

FEASIBILITY AND EFFECTIVENESS OF DYADIC PROLONGED EXPOSURE INTERVENTION FOR PREVENTING POSTTRAUMATIC GRIEF IN YOUNG CHILDREN: A CASE REPORT OF TWO SIBLINGS

This article highlights the feasibility of a dyadic prolonged exposure (DPE) intervention (L. Rachamim, I. Mirochnik, L. Helpman, N. Nacasch, & E. Yadin, ) in a 3-year-old preschooler and in a 6-year-old kindergartener immediately following the traumatic death of their younger sibling. It presents a detailed case description of the DPE treatment addressing traumatic grief and includes transcribed treatment dialogue. At the time of treatment termination, both children and caregivers resumed normal functioning. The results suggest that DPE intervention may ameliorate posttraumatic grief symptoms in young children. Controlled studies of preventive interventions for this population are clearly warranted.

The use of pathological grief outcomes in bereavement studies on African Americans

Pathological bereavement outcomes (i.e., complicated grief, traumatic grief, prolonged grief disorder) are a robust and growing research area in the psychological and medical sciences. Although grief is considered to be a universal phenomenon, it is well documented that grieving processes and outcomes are culturally and contextually bound. The objectives of this study were: (a) to examine representations of African Americans in the grief and mourning literature and to assess the extent to which this research utilizes pathological grief outcomes; and (b) to examine the characteristics of pathological grief constructs in the literature to assess their relevance for African American populations. We conducted comprehensive searches of three scientific databases including PsycNET, Medline, and CINAHL, which contain the majority of grief and mourning literature published between January 1998 and February 2014. We found 59 studies addressing grief and mourning in African Americans. Thirteen of these studies used pathological grief outcomes. Pathological grief outcomes that were constructed and validated on White populations were frequently used as outcome variables with African American participants. We discuss the implications for the grief and mourning field and argue that the failure to use culturally sensitive outcome measures in research studies is a form of epistemological violence that may have negative research and clinical implications for African Americans and other ethnic minorities.

Children's perspectives on life and well-being after parental intimate partner homicide

Background: While there is no doubt that parental intimate partner homicide is associated with strong grief and post-traumatic stress reactions among the children who have been bereaved, there is little in-depth insight into how children and young people see and describe their circumstances and needs. Objective: Our aim was to shed light on children's and young people's perspectives on their life after parental intimate partner homicide. In particular, we were interested in how they experienced their living arrangements, social environment, and general well-being. Method: We conducted semi-structured interviews with 23 children and young people (8-24 years old; 15 females and eight males) who had been younger than 18 years when one of their parents killed the other (21 children lost their mother, two children lost their father). We used thematic analysis to synthesize the findings. Results: While most participants were fairly content with themselves and their living arrangements, they also expressed substantial and persistent difficulties, including distress, conflicts between family members, and feelings of unsafety. Most importantly, children's self-image, their perspectives on their biological parents, and their views on their broader (family) environment varied considerably from participant to participant, and also between siblings. Conclusions: It is unlikely that straightforward guidelines can be given with regard to where the children should live after parental homicide, or whether they should be in contact with the perpetrating parent. Rather, this study's findings underline the need to explore children's individual viewpoints carefully during decision-making processes.

Complicated grief therapy as a new treatment approach

Complicated grief therapy (CGT) is a relatively new psychotherapy model designed to address symptoms of complicated grief. Drawn from attachment theory and with roots in both interpersonal therapy (IPT) and cognitive-behavioral therapy, CGT includes techniques similar to prolonged exposure (repeatedly telling the story of the death and in vivo exposure activities). The treatment also involves focusing on personal goals and relationships. CGT has been demonstrated to be effective in a trial in which participants with complicated grief were randomly assigned to CGT or IPT; individuals receiving CGT responded more quickly and were more likely to respond overall (51% vs 28%). This article briefly summarizes the conceptual underpinnings of CGT, discusses the empirical evidence for its efficacy, describes its techniques, and presents a case example of a client treated in a 16-session manualized CGT protocol. The article concludes with a description of future research directions for CGT.

Complicated grief among individuals with major depression: prevalence, comorbidity, and associated features

BACKGROUND

Growing data suggest that complicated grief (CG) may be common in clinical care settings, but there are few prior reports about CG in outpatients presenting with primary mood disorders.

METHODS

The present study examined rates of bereavement and threshold CG symptoms (defined as a score ≥ 25 on the Inventory of Complicated Grief scale) in 111 outpatients with major depressive disorder (MDD) and 142 healthy controls participating in a study of stress and depression. Clinical and demographic characteristics were also compared for bereaved individuals with CG (MDD+CG) to those without (MDD-CG). Participants completed structured diagnostic interviews as well as measures of CG, depression, anxiety, exposure to traumatic events, and perceived social support.

RESULTS

Lifetime history of a significant loss did not differ for the MDD and control groups (79.3% vs. 76.1%), but bereaved participants with MDD had higher rates of threshold CG (25.0% vs. 2.8%). Among those with MDD, CG was associated with a higher prevalence of lifetime alcohol dependence, greater exposure to traumatic events, and lower perceived social support. Depressed women, but not men, with CG also had higher rates of panic disorder, social anxiety disorder, and posttraumatic stress disorder.

LIMITATIONS

Our findings are limited by the lack of a clinician confirmatory assessment of CG diagnosis, absence of complete information about the nature and timing of the loss, and relatively narrow generalizability.

CONCLUSIONS

We found high rates of CG in a group of psychiatric outpatients with chronic MDD, suggesting that patients with depression should be routinely screened for CG.

Impact of concurrent naturalistic pharmacotherapy on psychotherapy of complicated grief

Complicated grief (CG) is a debilitating syndrome that can be reliably identified, but there is a paucity of research examining treatment of CG. A targeted psychotherapy for complicated grief (CGT) was recently shown to be efficacious [Shear, K., Frank, E., Houck, P.R., Reynolds, C.F., 3rd, 2005. Treatment of complicated grief: a randomized controlled trial. Journal of the American Medical Association 293, 2601-2608]. We provide a detailed examination of the association of naturalistic pharmacotherapy use with treatment response and study completion in the psychotherapy study. Patients on an antidepressant medication were more likely to complete a full course of CGT (91% vs. 58% completed), while antidepressant use had no effect on completion rates for the comparator, interpersonal psychotherapy (70% vs. 77%). Our naturalistic data underscore the need for prospective, randomized controlled studies of CG pharmacotherapy and psychotherapy alone and in combination.

Traumatic grief in Kenyan bereaved parents following the Kyanguli School fire tragedy

Following the death of 67 boys in a fire tragedy at Kyanguli School in rural Kenya, the level of traumatic grief was assessed in a sample of 164 parents and guardians whose sons died in the fire. The study was cross-sectional. Counseling services were offered to all the bereaved parents soon after the tragedy. The subjects were interviewed using the Traumatic Grief Scale. A group of 92 parents/guardians was interviewed 2 months after the event, while the other group of 72 was assessed 7 days later. The second group of bereaved parents also completed the Self Rating Questionnaire (SRQ) and the Ndetei-Othieno-Kathuku scale (NOK). Over 90% of parents from both groups had a yearning for the departed and found themselves searching for him quite often. There was no much difference in terms of symptoms profile or intensity between the two groups. It appears that the counseling offered had minimal impact on the levels of distress.