When hope and grief intersect: Rates and risks of prolonged grief disorder among bereaved individuals and relatives of disappeared persons in Colombia

Heeke, Carina; Stammel, Nadine; Knaevelsrud, Christine

doi:10.1016/j.jad.2014.10.038

Cited by 46 publications

(69 citation statements)

References 26 publications

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“…Focus of treatment often needs shifting towards dealing with feelings of ambiguity (Boss, 2006). Ambiguous loss may be associated with severe mental health distress comparable to confirmed traumatic losses (Lenferink, de Keijser, Wessel, de Vries, & Boelen, 2017), and symptoms following ambiguous loss have been found to be more severe in relatives holding on to hope that the loved one will return (Heeke, Stammel, & Knaevelsrud, 2015). Future research should take ambiguous loss into account as a moderating factor on symptom severity in patients with traumatic grief.…”

Section: Discussionmentioning

confidence: 99%

Day patient treatment for traumatic grief: preliminary evaluation of a one-year treatment programme for patients with multiple and traumatic losses

Heus

Hengst

Rie

et al. 2017

European Journal of Psychotraumatology

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Background: Bereaved individuals who have lost a loved one under traumatic circumstances can develop symptoms of Persistent Complex Bereavement Disorder (PCBD) and/or Posttraumatic Stress Disorder (PTSD). This is particularly common in refugees, as they frequently have been confronted with multiple traumatic losses. For patients with severe PTSD and traumatic grief a treatment programme was developed, embedding individual traumatic grief focused therapy in a group-based multidisciplinary day patient treatment programme. The day patient treatment comprised a weekly five-hour programme consisting of three phases with a duration of four months each. Objective: To evaluate the feasibility and potential effectiveness of the treatment programme. Method: Data were analyzed from 16 participants treated between October 2013 and March 2014. PTSD severity and PTSD/PCBD diagnoses were measured during the initial and final phases of treatment using the Clinician-Administered PTSD Scale for DSM-IV (CAPS) and the Traumatic Grief Inventory Self Report (TGI-SR). One clinical case is presented in more detail. Treatment attendance was also registered and therapist satisfaction was evaluated in a focus group. Results: Thirteen patients (81%) completed the treatment. Each day of the treatment programme was attended by a mean of 76% of the participants. In the focus group, therapists noted symptom reduction in their patients and they therefore regarded Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) as an effective therapy for their patients. During treatment, significant decreases in PTSD severity as well as diagnosable PTSD and PCBD were observed. Conclusions: Results support the feasibility and potential effectiveness of the day patient treatment programme for traumatic grief. The programme appears to be particularly suitable for refugees with severe PTSD and PCBD psychopathology, who may not benefit enough from usual care.

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Section: Discussionmentioning

confidence: 99%

Day patient treatment for traumatic grief: preliminary evaluation of a one-year treatment programme for patients with multiple and traumatic losses

Heus

Hengst

Rie

et al. 2017

European Journal of Psychotraumatology

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“…For instance, prevalence rates of clinically significant symptom levels of PG (23.3%), depression (68.5%), and PTS (67.1%) were high among people whose relative disappeared in the context of political repression on average 13 years earlier (Heeke, Stammel, & Knaevelsrud, 2015). Another study also showed high prevalence rates of PG (47.0%) and PTS (23.1%) among people whose relative disappeared due to various reasons (e.g.…”

mentioning

confidence: 99%

“…It has been proposed that rumination might also be an important cognitive strategy that causes and/or maintains psychopathological symptomatology in relatives of missing persons (Boss, 2006; Heeke et al, 2015; Lenferink, Wessel, de Keijser, & Boelen, 2016). To our knowledge, this notion has never been studied.…”

mentioning

confidence: 99%

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

Lenferink

Eisma

Keijser

et al. 2017

European Journal of Psychotraumatology

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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.

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“…To the best of our knowledge, this hypothesis was tested in only four quantitative studies [3, 5, 6, 17] and was confirmed in two of them [5, 6]. For example, a study among women with unconfirmed and confirmed loss of their husband in a war-related context showed that the former group was more at risk to experience severe MDD symptoms compared to the latter group [5].…”

Section: Introductionmentioning

confidence: 99%

“…For example, a study among women with unconfirmed and confirmed loss of their husband in a war-related context showed that the former group was more at risk to experience severe MDD symptoms compared to the latter group [5]. In contrast, two other studies did not show significant differences in the severity of symptoms of psychopathology [3, 17]. For example, relatives of Colombians who had disappeared or died in an armed conflict reported similar levels of PCBD, MDD, and PTSD symptoms [3].…”

Section: Introductionmentioning

confidence: 99%

Cognitive behavioural therapy for psychopathology in relatives of missing persons: study protocol for a pilot randomised controlled trial

Lenferink

Wessel

Keijser

et al. 2016

Pilot Feasibility Stud

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BackgroundIt is hypothesized that the grieving process of relatives of missing persons is complicated by having to deal with uncertainty about the fate of their loved one. We developed a cognitive behavioural therapy (CBT) with mindfulness that focuses on dealing with this uncertainty. In this article, we elucidate the rationale of a pilot randomised controlled trial (RCT) for testing the feasibility and potential effectiveness of this CBT for reducing symptoms of psychopathology in relatives of missing persons.MethodsA pilot RCT comparing participants of the CBT condition (n = 15) with waiting list controls (n = 15) will be executed. Individuals suffering from psychopathology related to the long-term disappearance of a loved one are eligible to participate. The treatment consists of eight individual sessions. Questionnaires tapping psychological constructs will be administered before, during, and after the treatment. The feasibility of the treatment will be evaluated using descriptive statistics (e.g., attrition rate). The primary analysis consists of a within-group analysis of changes in mean scores of persistent complex bereavement disorder from baseline to immediately post-treatment and follow-up (12 and 24 weeks post-treatment).DiscussionA significant number of people experience the disappearance of a loved one. Surprisingly, an RCT to evaluate a treatment for psychopathology among relatives of missing persons has never been conducted. Knowledge about treatment effects is needed to improve treatment options for those in need of help. The strengths of this study are the development of a tailored treatment for relatives of missing persons and the use of a pilot design before exposing a large sample to a treatment that has yet to be evaluated. Future research could benefit from the results of this study.Trial registration NTR4732 (The Netherlands National Trial Register (NTR))

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When hope and grief intersect: Rates and risks of prolonged grief disorder among bereaved individuals and relatives of disappeared persons in Colombia

Cited by 46 publications

References 26 publications

Day patient treatment for traumatic grief: preliminary evaluation of a one-year treatment programme for patients with multiple and traumatic losses

Day patient treatment for traumatic grief: preliminary evaluation of a one-year treatment programme for patients with multiple and traumatic losses

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

Cognitive behavioural therapy for psychopathology in relatives of missing persons: study protocol for a pilot randomised controlled trial

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