Treating Prolonged Grief Disorder

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.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Milman

Neimeyer

Fitzpatrick

et al. 2017

“…Its guidelines can be used for assessment and treatment, particularly the recommendations that the management of grief symptoms should include the discussion of culturally appropriate adjustment and mourning rituals. In addition, there have been several successful randomized controlled trials of treatments for CG (Shear, Frank, Houck, & Reynolds, 2005; Shear et al, 2016, 2014) and PGD (Bryant et al, 2014; Kersting et al, 2013; Litz et al, 2014; Rosner, Pfoh, Kotoučová, & Hagl, 2014). These treatments pull valuable techniques from PTSD interventions, narrative therapy and cognitive behavioural therapy, and could be incorporated into the WHO mhGAP guidelines (Rosner, Bartl, Pfoh, Kotoučová, & Hagl, 2015; Shear, 2015).…”

Section: Evidence For the Clinical Utility Of Icd-11 Pgd In The Fieldmentioning

confidence: 99%

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

Killikelly

Maercker

2017

143

114

A new mental health disorder, prolonged grief disorder (PGD), will be included in the 11th edition of the International Classification of Diseases (ICD-11). We provide a brief overview of the historical conceptualizations of disordered grief and the previous research efforts to assess and define this condition. We describe the new ICD-11 PGD symptom criteria and how they are conceptualized in terms of the World Health Organization’s call for improved clinical utility. Finally, we review the research evidence for the clinical utility of the new ICD-11 PGD symptom structure and usability in the international arena.

“…558). Exposure to loss-related stimuli is a critical ingredient of effective grief treatment (Bryant et al, 2014). Similarly, theoretical (Boelen, van den Hout, & van den Bout, 2006; Maccallum & Bryant, 2013; Stroebe & Schut, 1999) and empirical work (Boelen, de Keijser, & Smid, 2015; Boelen & van den Bout, 2010; Eisma et al, 2013; Schnider, Elhai, & Gray, 2007) emphasized that strategies to avoid and minimize engagement with painful feelings and thoughts associated with the loss are key to the onset and maintenance of psychopathology following the loss of a loved one.…”

mentioning

confidence: 99%

Grief rumination mediates the association between self-compassion and psychopathology in relatives of missing persons

Lenferink

Eisma

Keijser

et al. 2017

Background: The disappearance of a loved one is a unique type of loss, also termed ‘ambiguous loss’, which may heighten the risk for developing prolonged grief (PG), depression, and posttraumatic stress (PTS) symptoms. Little is known about protective and risk factors for psychopathology among relatives of missing persons. A potential protective factor is self-compassion, referring to openness toward and acceptance of one’s own pain, failures, and inadequacies. One could reason that self-compassion is associated with lower levels of emotional distress following ambiguous loss, because it might serve as a buffer for getting entangled in ruminative thinking about the causes and consequences of the disappearance (‘grief rumination’). Objective: In a sample of relatives of missing persons we aimed to examine (1) the prediction that greater self-compassion is related to lower symptom-levels of PG, depression, and PTS and (2) to what extent these associations are mediated by grief rumination. Method: Dutch and Belgian relatives of long-term missing persons (N = 137) completed self-report measures tapping self-compassion, grief rumination, PG, depression, and PTS. Mediation analyses were conducted. Results: Self-compassion was significantly, negatively, and moderately associated with PG, depression, and PTS levels. Grief rumination significantly mediated the associations of higher levels of self-compassion with lower levels of PG (a*b = −0.11), depression (a*b = −0.07), and PTS (a*b = −0.11). Specifically, 50%, 32%, and 32% of the effect of self-compassion on PG, depression, and PTS levels, respectively, was accounted for by grief rumination. Conclusions: Findings suggest that people with more self-compassion experience less severe psychopathology, in part because these people are less strongly inclined to engage in ruminative thinking related to the disappearance. Strengthening a self-compassionate attitude using, for instance, mindfulness-based interventions may therefore be a useful intervention to reduce emotional distress associated with the disappearance of a loved one.