An attachment-based model of complicated grief including the role of avoidance

Abstract

Introduction-Complicated grief is a prolonged grief disorder with elements of a stress response syndrome. We have previously proposed a biobehavioral model showing the pathway to complicated grief. Avoidance is a component that can be difficult to assess and pivotal to treatment. Therefore we developed an avoidance questionnaire to characterize avoidance among patients with CG.

Anxious and Depressive Avoidance and Symptoms of Prolonged Grief, Depression, and Post-Traumatic Stress Disorder

“…For instance, in several studies we ourselves found distinct measures of cognitive avoidance (e.g., thought suppression, rumination) and behavioural avoidance (avoidance of places that remind of the loss) to be correlated with CG/PGD severity and related symptoms (e.g., Boelen, 2009;Boelen & van den Hout, 2008;. Likewise, in studies of Bonanno, Keltner, Holen, and Horowitz (1995) and Shear, Monk, Houck, Melhem, Frank, Reynolds et al (2007) generic measures of deliberate avoidance of loss-related stimuli have been found to be significantly associated with loss-related distress. However, the distinct role of depressive and anxious avoidance as conceptualised in our CB model has not yet been studied .…”

“…Research has shown that different forms of deliberate avoidance behaviours in the aftermath of the death of a close loved one are related to emotional complications following loss (e.g., Boelen & van den Hout, 2008;Bonanno et al, 1995;Shear et al, 2007). In line with these findings, in our recently developed CB model of CG/PGD, avoidance behaviour is regarded as one of three processes that are critical to the development and maintenance of this condition -the other two processes being a lack of integration of the loss with the autobiographical knowledge base and negative thinking .…”

Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability

“…Disordered grief has also been conceptualized in terms of depression (Clayton, 1990), relational or attachment related (Rubin et al, 2008; Shear et al, 2007) or as subtypes of responses to loss (delayed, unresolved or absent grief) (Stroebe et al, 2000). These various conceptualizations provided valuable insight and strong foundations for the current ICD-11 conceptualization of PGD as distinct from depression with no subtypes and as a stress-related disorder, as discussed in detail in Section 3.…”

“…An analysis of a sample of 317 individuals from the Yale Bereavement Study (Prigerson et al, 2009) generated sensitive and specific items for the PGD-2009 criteria (Table 1). Around the same time as the refinement of the PGD-2009 criteria, Shear and colleagues built on the earlier conceptualization of disordered grief as CG and proposed important mechanisms for the behavioural and biological aetiology (Shear et al, 2007; Zisook & Shear, 2009). Shear and colleagues proposed alternative diagnostic criteria for CG developed from a large clinical sample of treatment-seeking individuals and from a consensus with clinical experts (Reynolds et al, 2017; Shear, 2015; Shear, Jackson, Essock, Donahue, & Felton, 2006; Shear et al, 2011).…”

The Longitudinal and Cross-Sectional Associations of Grief and Complicated Grief With Sleep Quality in Older Adults

“…After the loss of a loved one, there are profound changes in lifestyle, often accompanied by reductions in financial security, perceived personal safety, and freedom of action , all of which are likely to lead to sleep disruption. Also, the loss of a loved one is associated with psychological problems such as rumination or anxiety, which are shown to impair sleep (Carney, Edinger, Meyer, Lindman, & Istre, 2006;K. Shear et al, 2007).…”