Abstract
The loss of a loved one is an inevitable part of the human experience. Normal grieving may be characterized by an acute, time-limited experience of yearning, emotional distress, and intrusive thoughts related to the deceased that tends to remit within 4–6 months of the loss (Bonanno, 2005). Normal grieving may be also characterized by brief, transient distress, continuing to experience and express positive emotion, and a quick return to functioning (Bonanno et al., 2002; Bonanno, Papa, Lalande, Westphal, & Coifman, 2004). Regardless of level of intensity, grief is typically a transitory experience in which a person either continues to function or returns to previous function after a period of time. Despite a return to functioning, many individuals still report sadness when reminded of the deceased throughout the lifetime. As such, categorizing grief as a mental disorder has often been considered controversial for fear of pathologizing a normal human phenomenon. While most bereaved individuals experience a wide range of responses that are considered healthy and normal, research suggests that for a certain group of individuals, the experience of losing a loved one can result in significant levels of unrelenting distress and impairment that may benefit from clinical intervention. These reactions can include a number of issues that require clinical evaluation and monitoring including pathological grief (see below), major depressive disorder (MDD), posttraumatic stress disorder (PTSD), poor sleep, substance abuse, suicidal ideation, physical disease, poor health behaviors, underutilization of mental health services, and an overall reduction in quality of life and social isolation (e.g., Lannen, Wolfe, Prigerson, Onelov, & Kreicbergs, 2008; Lee, 2015; Lichtenthal et al., 2011; Papa, Lancaster, & Kahler, 2013; Prigerson et al., 1995; Simon et al., 2007; Stahl & Schulz, 2014). These risks indicate an important need for clinical intervention given the considerable impact they may have on quality of life, health behaviors, and functional impairment in important domains such as social relationships and occupational functioning. However, interventions for grief when pathological grief is not present have been shown to be ineffective and potentially iatrogenic (Schut & Stroebe, 2005). Thus, effectively distinguishing normal reactions to loss from those that require treatment is imperative in an integrated care setting.
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References
Acierno, R., Rheingold, A., Amstadter, A., Kurent, J., Amella, E., Resnick, H., … Lejuez, C. (2012). Behavioral activation and therapeutic exposure for bereavement in older adults. American Journal of Hospice and Palliative Medicine, 29(1), 13–25.
Addis, M. E., & Martell, C. R. (2004). Overcoming depression one step at a time. Oakland, CA: New Harbinger.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, DC: American Psychiatric Association.
Balk, D., Cook, A. S., Doka, K., Hall, M., Hansson, R. O., Klass, D., & Shapiro, E. R. (2004). Report on bereavement and grief research. Death Studies, 28(6), 491–575.
Barry, L. C., Kasl, S. V., & Prigerson, H. G. (2002). Psychiatric disorders among bereaved persons: The role of perceived circumstances of death and preparedness for death. The American Journal of Geriatric Psychiatry, 10(4), 447–457.
Boelen, P. A., de Keijser, J., van den Hout, M. A., & van den Bout, J. (2011). Factors associated with outcome of cognitive–behavioural therapy for complicated grief: A preliminary study. Clinical Psychology & Psychotherapy, 18(4), 284–291.
Bonanno, G. A. (2005). Resilience in the face of potential trauma. Current Directions in Psychological Science, 14(3), 135–138.
Bonanno, G. A., & Field, N. P. (2001). Examining the delayed grief hypothesis across 5 years of bereavement. American Behavioral Scientist, 44(5), 798–816.
Bonanno, G. A., & Kaltman, S. (2001). The varieties of grief experience. Clinical Psychology Review, 21, 705–734.
Bonanno, G. A., & Keltner, D. (1997). Facial expressions of emotion and the course of conjugal bereavement. Journal of Abnormal Psychology, 106(1), 126.
Bonanno, G. A., Moskowitz, J. T., Papa, A., & Folkman, S. (2005). Resilience to loss in bereaved spouses, bereaved parents, and bereaved gay men. Journal of Personality and Social Psychology, 88, 827–843.
Bonanno, G. A., Papa, A., Lalande, K., Westphal, M., & Coifman, K. (2004). The importance of being flexible the ability to both enhance and suppress emotional expression predicts long-term adjustment. Psychological Science, 15(7), 482–487.
Bonanno, G. A., Wortman, C. B., Lehman, D. R., Tweed, R. G., Haring, M., Sonnega, J., … Nesse, R. M. (2002). Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology, 83(5), 1150.
Brown, L. F., Reynolds, C. F., Monk, T. H., Prigerson, H. G., Dew, M. A., Houck, P. R., … Kupfer, D. J. (1996). Social rhythm stability following late-life spousal bereavement: Associations with depression and sleep impairment. Psychiatry Research, 62(2), 161–169.
Bui, E., Nadal-Vicens, M., & Simon, N. M. (2012). Pharmacological approaches to the treatment of complicated grief: Rationale and a brief review of the literature. Dialogues in Clinical Neuroscience, 14(2), 149–157.
Cohen, M., Granger, S., & Fuller-Thomson, E. (2015). The association between bereavement and biomarkers of inflammation. Behavioral Medicine, 41(2), 49–59.
Cohen, S., & Hoberman, H. M. (1983). Positive events and social supports as buffers of life change stress. Journal of Applied Social Psychology, 13(2), 99–125.
Currier, J. M., Neimeyer, R. A., & Berman, J. S. (2008). The effectiveness of psychotherapeutic interventions for bereaved persons: A comprehensive quantitative review. Psychological Bulletin, 134, 648–661.
Dyregrov, K., Nordanger, D., & Dyregrov, A. (2003). Predictors of psychosocial distress after suicide, SIDS and accidents. Death Studies, 27, 143–165.
Eisma, M. C., Boelen, P. A., van den Bout, J., Stroebe, W., Schut, H. A., Lancee, J., & Stroebe, M. S. (2015). Internet-based exposure and behavioral activation for complicated grief and rumination: A randomized controlled trial. Behavior Therapy, 46(6), 729–748.
Ekers, D., Richards, D., McMillan, D., Bland, J. M., & Gilbody, S. (2011). Behavioural activation delivered by the non-specialist: Phase II randomised controlled trial. The British Journal of Psychiatry, 198(1), 66–72.
Fleming, S., & Robinson, P. (2001). Grief and cognitive-behavioral therapy. In M. S. Stroebe, R. O. Hansson, W. E. Stroebe, & H. E. Schut (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 647–669). Washington, DC: American Psychological Association.
Floyd, M. (2003). Bibliotherapy as an adjunct to psychotherapy for depression in older adults. Journal of Clinical Psychology, 59(2), 187–195.
Forstmeier, S., & Maercker, A. (2007). Comparison of two diagnostic systems for complicated grief. Journal of Affective Disorders, 99(1), 203–211.
Fujisawa, D., Miyashita, M., Nakajima, S., Ito, M., Kato, M., & Kim, Y. (2010). Prevalence and determinants of complicated grief in general population. Journal of Affective Disorders, 127(1), 352–358.
Gameroff, M. J., Wickramaratne, P., & Weissman, M. M. (2012). Testing the short and screener versions of the social adjustment scale-self-report (SAS-SR). International Journal of Methods in Psychiatry Research, 21(1), 52–65.
Gros, D. F., & Haren, W. B. (2011). Open trial of brief behavioral activation psychotherapy for depression in an integrated veterans affairs primary care setting. The Primary Care Companion to CNS disorders, 13(4). pii: PCC.11m01136.
Hall, M., & Irwin, M. (2001). Physiological indices of functioning in bereavement. In M. S. Stroebe, R. O. Hansson, W. E. Stroebe, & H. E. Schut (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 473–492). Washington, DC: American Psychological Association.
Hardison, H. G., Neimeyer, R. A., & Lichstein, K. L. (2005). Insomnia and complicated grief symptoms in bereaved college students. Behavioral Sleep Medicine, 3(2), 99–111.
Johnson, J. G., Zhang, B., Greer, J. A., & Prigerson, H. G. (2007). Parental control, partner dependency, and complicated grief among widowed adults in the community. The Journal of Nervous and Mental Disease, 195(1), 26–30.
Kersting, A., Brähler, E., Glaesmer, H., & Wagner, B. (2011). Prevalence of complicated grief in a representative population-based sample. Journal of Affective Disorders, 131(1), 339–343.
Lannen, P. K., Wolfe, J., Prigerson, H. G., Onelov, E., & Kreicbergs, U. C. (2008). Unresolved grief in a national sample of bereaved parents: Impaired mental and physical health 4 to 9 years later. Journal of Clinical Oncology, 26(36), 5870–5876.
Lee, S. A. (2015). The Persistent Complex Bereavement Inventory: A measure based on the DSM-5. Death Studies, 39(7), 399–410.
Levy, L. H., Derby, J. F., & Martinkowski, K. S. (1993). Effects of membership in bereavement support groups on adaptation to conjugal bereavement. American Journal of Community Psychology, 21, 361–381.
Lichtenthal, W. G., Nilsson, M., Kissane, D. W., Breitbart, W., Kacel, E., Jones, E. C., & Prigerson, H. G. (2011). Underutilization of mental health services among bereaved caregivers with prolonged grief disorder. Psychiatric Services, 62(10), 1225–1229.
Litz, B. T., Schorr, Y., Delaney, E., Au, T., Papa, A., Fox, A. B., … Prigerson, H. G. (2014). A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder. Behaviour Research and Therapy, 61, 23–34.
Luecken, L. J., & Roubinov, D. S. (2012). Pathways to lifespan health following childhood parental death. Social and Personality Psychology Compass, 6(3), 243–257.
McIntosh, J. L., Santos, J. F., Hubbard, R. W., & Overholser, J. C. (1994). Elder suicide: Research, theory, and treatment. Washington, DC: American Psychological Association.
Mizuno, Y., Kishimoto, J., & Asukai, N. (2012). A nationwide random sampling survey of potential complicated grief in Japan. Death Studies, 36(5), 447–461.
Monk, T. H., Germain, A., & Reynolds, C. F. (2008). Sleep disturbance in bereavement. Psychiatric Annals, 38(10), 671–675.
Monk, T. H., Houck, P. R., & Shear, K. M. (2006). The daily life of complicated grief patients—What gets missed, what gets added? Death Studies, 30(1), 77–85.
Murphy, S. A., Johnson, C., Cain, K. C., Das Gupta, A., Diamond, M., Lohan, J., & Baugher, R. (1998). Broad-spectrum group treatment for parents bereaved by the violent deaths of their 12-to 28-year-old children: A randomized controlled trial. Death Studies, 22(3), 209–235.
Nam, I. S. (2016). Effects of psychoeducation on helpful support for complicated grief: A preliminary randomized controlled single-blind study. Psychological Medicine, 46(1), 189–195.
Neria, Y., & Litz, B. T. (2004). Bereavement by traumatic means: The complex synergy of trauma and grief. Journal of Loss and Trauma, 9(1), 73–87.
Newson, R. S., Boelen, P. A., Hek, K., Hofman, A., & Tiemeier, H. (2011). The prevalence and characteristics of complicated grief in older adults. Journal of Affective Disorders, 132(1), 231–238.
Papa, A., Lancaster, N. G., & Kahler, J. (2014). Commonalities in grief responding across bereavement and non-bereavement losses. Journal of Affective Disorders, 161, 136–143.
Papa, A., Sewell, M. T., Garrison-Diehn, C., & Rummel, C. (2013). A randomized open trial assessing the feasibility of behavioral activation for pathological grief responding. Behavior Therapy, 44(4), 639–650.
Porter, J. F., Spates, C. R., & Smitham, S. (2004). Behavioral activation group therapy in public mental health settings: A pilot investigation. Professional Psychology: Research and Practice, 35(3), 297–301.
Prigerson, H. G., Bierhals, A. J., Kasl, S. V., Reynolds, C., Shear, M. K., Day, N., … Jacobs, S. (1997). Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry, 154, 616–623.
Prigerson, H. G., Frank, E., Kasl, S. V., Reynolds, C. F., Anderson, B., Zubenko, G. S., … Kupfer, D. J. (1995). Complicated grief and bereavement-related depression as distinct disorders: Preliminary empirical validation in elderly bereaved spouses. American Journal of Psychiatry, 152(1), 22–30.
Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., … Bonanno, G. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine, 6(8), e1000121.
Prigerson, H., & Maciejewski, P. (2008). Prolonged grief disorder (PG-13) scale. Boston, MA: Dana-Farber Cancer Institute.
Rosner, R., Lumbeck, G., & Geissner, E. (2011). Effectiveness of an inpatient group therapy for comorbid complicated grief disorder. Psychotherapy Research, 21(2), 210–218.
Schulz, R., Boerner, K., Shear, K., Zhang, S., & Gitlin, L. N. (2006). Predictors of complicated grief among dementia caregivers: A prospective study of bereavement. The American Journal of Geriatric Psychiatry, 14(8), 650–658.
Schut, H., Stroebe, M. S., van den Bout, J., & Terheggen, M. (2001). The efficacy of bereavement interventions: Determining who benefits. In M. S. Stroebe, R. O. Hansson, W. Stroebe, & H. Schut (Eds.), Handbook of bereavement research: Consequences, coping, and care (pp. 705–737). Washington, DC: American Psychological Association.
Shear, K., & Essock, S. (2002). Brief grief questionnaire. Pittsburgh, PA: University of Pittsburgh.
Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., … Gorscak, B. (2011). Complicated grief and related bereavement issues for DSM-5. Depression and Anxiety, 28(2), 103–117.
Sikkema, K. J., Hansen, N. B., Ghebremichael, M., Kochman, A., Tarakeshwar, N., Meade, C. S., & Zhang, H. (2006). A randomized controlled trial of a coping group intervention for adults with HIV who are AIDS bereaved: Longitudinal effects on grief. Health Psychology, 25(5), 563.
Silverman, G. K., Johnson, J. G., & Prigerson, H. G. (2001). Preliminary explorations of the effects of prior trauma and loss on risk for psychiatric disorders in recently widowed people. The Israel Journal of Psychiatry and Related Sciences, 38(3/4), 202.
Simon, N. M., Shear, K. M., Thompson, E. H., Zalta, A. K., Perlman, C., Reynolds, C. F., … Silowash, R. (2007). The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Comprehensive Psychiatry, 48, 395–399.
Stahl, S. T., & Schulz, R. (2014). Changes in routine health behaviors following late-life bereavement: A systematic review. Journal of Behavioral Medicine, 37(4), 736–755.
Stroebe, M., & Schut, H. (2005). To continue or relinquish bonds: A review of consequences for the bereaved. Death Studies, 29(6), 477–494.
Stroebe, W., Schut, H., & Stroebe, M. S. (2005). Grief work, disclosure and counseling: Do they help the bereaved? Clinical Psychology Review, 25(4), 395–414.
Stroebe, M., Schut, H., & Stroebe, W. (2007). Health outcomes of bereavement. The Lancet, 370(9603), 1960–1973.
Szanto, K., Prigerson, H. G., & Reynolds, C. F., III. (2001). Suicide in the elderly. Clinical Neuroscience Research, 1(5), 366–376.
Vanderwerker, L. C., Jacobs, S. C., Parkes, C. M., & Prigerson, H. G. (2006). An exploration of associations between separation anxiety in childhood and complicated grief in later life. The Journal of Nervous and Mental Disease, 194(2), 121–123. https://doi.org/10.1097/01.nmd.0000198146.28182.d
Vanderwerker, L. C., & Prigerson, H. G. (2004). Social support and technological connectedness as protective factors in bereavement. Journal of Loss and Trauma, 9(1), 45–57.
Wagner, B., Knaevelsrud, C., & Maercker, A. (2006). Internet-based cognitive-behavioral therapy for complicated grief: A randomized controlled trial. Death Studies, 30(5), 429–453.
Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30, 473–483.
Wittouck, C., Van Autreve, S., De Jaegere, E., Portzky, G., & van Heeringen, K. (2011). The prevention and treatment of complicated grief: A meta-analysis. Clinical Psychology Review, 31(1), 69–78.
Zisook, S., & Kendler, K. S. (2007). Is bereavement-related depression different than non-bereavement-related depression? Psychological Medicine, 37(6), 779–794.
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Zimmermann, M., Papa, A. (2018). Bereavement. In: Maragakis, A., O'Donohue, W. (eds) Principle-Based Stepped Care and Brief Psychotherapy for Integrated Care Settings. Springer, Cham. https://doi.org/10.1007/978-3-319-70539-2_7
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