Jason M. Holland

Sense-Making, Grief, and the Experience of Violent Loss: Toward a Mediational Model

Bereavement following violent loss by accident, homicide or suicide increases the risk for complications in grieving. This is the first study to examine a constructivist model of grief that proposes that sense-making, or the capacity to construct an understanding of the loss experience, mediates the association between violent death and complicated grief symptomatology. An ethnically diverse sample of 1,056 recently bereaved college students completed the Inventory of Complicated Grief (ICG) and questions assessing the degree of sense-making and the circumstances surrounding their losses. Consistent with this studys primary hypothesis, sense-making emerged as an explanatory mechanism for the association between violent loss and complications in grieving. Specifically, the results revealed that sense-making explained this relation, even when the element of sudden bereavement was shared by all of the participants. Overall, this study provides initial support for a model of grief in which failure to find meaning in a loss is conceptualized as a crucial pathway to complicated grief symptomatology.

The Effectiveness of Bereavement Interventions With Children: A Meta-Analytic Review of Controlled Outcome Research

Grief therapies with children are becoming increasingly popular in the mental health community. Nonetheless, questions persist about how well these treatments actually help with childrens adjustment to the death of a loved one. This study used meta-analytic techniques to evaluate the general effectiveness of bereavement interventions with children. A thorough quantitative review of the existing controlled outcome literature (n = 13) yielded a conclusion akin to earlier reviews of grief therapy with adults, namely that the child grief interventions do not appear to generate the positive outcomes of other professional psychotherapeutic interventions. However, studies that intervened in a time-sensitive manner and those that implemented specific selection criteria produced better outcomes than investigations that did not attend to these factors.

Meaning Reconstruction in the First Two Years of Bereavement: The Role of Sense-Making and Benefit-Finding

Contemporary grief theories have highlighted the role of meaning-making in adaptation to bereavement, focusing on two major construals of meaning: making sense of the loss and finding benefit in the experience. The current investigation attempted a conceptual replication of the findings of Davis, Nolen-Hoeksema, and Larson (1998) that suggested that sense-making predicts adaptation to loss in the early period of bereavement, whereas benefit-finding primarily plays an ameliorative role as time progresses. To this end, an ethnically diverse sample of 1,022 recently bereaved college students completed the Inventory of Complicated Grief (ICG) as well as questions that assessed sense-making, benefit-finding, and the circumstances surrounding their losses. Results only partially replicated the findings of Davis and his colleagues, demonstrating that: 1) time since loss bore no relation to grief complications; 2) sense-making emerged as the most robust predictor of adjustment to bereavement; and 3) benefit finding interacted with sense making, with the fewest complications predicted when participants reported high sense, but low personal benefit, in the loss.

Reducing the risk of burnout in end-of-life care settings: The role of daily spiritual experiences and training

OBJECTIVEnIndividuals in the helping professions are subject to unique stressors that may lead to burnout, and research has shown that those who work with dying or bereaved individuals might be particularly at-risk. This study explores how factors such as spirituality and level of training might buffer the stress of working with terminally ill clients and their families.nnnMETHODnA total of 80 medical and mental health practitioners attending palliative care seminars were surveyed, with each completing validated measures of daily spiritual experiences and caregiver burnout, as well as assessments of demographic factors, their general education and training experiences specific to working in end-of-life care and bereavement settings.nnnRESULTSnFindings indicate that daily spiritual experiences might mitigate physical, cognitive, and emotional forms of burnout in the workplace. In addition, a negative correlation was found between the amount of end-of-life training received and burnout in the physical and cognitive domains. However, training was not related to professionals level of emotional exhaustion.nnnSIGNIFICANCE OF THE RESEARCHnResults reinforce a growing literature on the salutary effects of spirituality, and underscore its relevance as one possible form of constructive coping for professionals attending to the needs of the dying and bereaved. The study carries further implications for how the stresses of such work might be ameliorated by enhanced training efforts, as well as creative facilitation of diverse spiritual expressions (e.g., inclusive forms of ritual recognition of loss) in the workplace.

An Examination of Stage Theory of Grief among Individuals Bereaved by Natural and Violent Causes: A Meaning-Oriented Contribution:

Despite its popularity, few attempts have been made to empirically test the stage theory of grief. The most prominent of these attempts was conducted by Maciejewski, Zhang, Block, and Prigerson (2007), who found that different states of grieving may peak in a sequence that is consistent with stage theory. The present study aimed to provide a conceptual replication and extension of these findings by examining the association between time since loss and five grief Indicators (focusing on disbelief, anger, yearning, depression, and acceptance), among an ethnically diverse sample of young adults who had been bereaved by natural (n = 441) and violent (n = 173) causes. We also examined the potential salience of meaning-making and assessed the extent to which participants had made sense of their losses. In general, limited support was found for stage theory, alongside some evidence of an “anniversary reaction” marked by heightened distress and reduced acceptance for participants approaching the second anniversary of the death. Overall, sense-making emerged as a much stronger predictor of grief Indicators than time since loss, highlighting the relevance of a meaning-oriented perspective.

Outcomes from the Resources for Enhancing Alzheimer's Caregiver Health (REACH) program for bereaved caregivers.

Although preventive efforts for bereaved individuals have not been shown to be particularly effective in past studies, it has been suggested that intervention effects might be underestimated due to methodological issues such as short follow-up assessments. Thus, the present study aimed to assess the efficacy (as whole intervention packages and as component parts) of the Resources for Enhancing Alzheimers Caregiver Health (REACH) interventions in preventing complicated grief, normal grief, and depressive symptoms at a longer term follow-up assessment among bereaved caregivers (N = 224). On average, active interventions showed a statistically significant effect on normal grief symptoms (d = 0.28), exhibited a trend toward improvement on complicated grief symptoms (d = 0.25), and demonstrated little impact on depressive symptoms (d = 0.09). Interestingly, the examination of intervention components revealed differential effects, whereby cognitive and behavioral strategies were most effective at reducing levels of complicated grief, information and emotional support were most effective for addressing normal grief, and environmental modifications were most effective for ameliorating depressive symptoms. These findings suggest that different preloss interventions might be warranted depending on a caregivers unique clinical presentation and combination of risk factors.

Intraclass Correlation Associated with Therapists: Estimates and Applications in Planning Psychotherapy Research

It is essential that outcome research permit clear conclusions to be drawn about the efficacy of interventions. The common practice of nesting therapists within conditions can pose important methodological challenges that affect interpretation, particularly if the study is not powered to account for the nested design. An obstacle to the optimal design of these studies is the lack of data about the intraclass correlation coefficient (ICC), which measures the statistical dependencies introduced by nesting. To begin the development of a public database of ICC estimates, the authors investigated ICCs for a variety outcomes reported in 20 psychotherapy outcome studies. The magnitude of the 495 ICC estimates varied widely across measures and studies. The authors provide recommendations regarding how to select and aggregate ICC estimates for power calculations and show how researchers can use ICC estimates to choose the number of patients and therapists that will optimize power. Attention to these recommendations will strengthen the validity of inferences drawn from psychotherapy studies that nest therapists within conditions.

Assumptive Worldviews and Problematic Reactions to Bereavement

Forty-two individuals who had lost an immediate family member in the prior 2 years and 42 nonbereaved matched controls completed the World Assumptions Scale (Janoff-Bulman, 1989) and the Symptom Checklist-10-Revised (Rosen et al., 2000). Results showed that bereaved individuals were significantly more distressed than nonbereaved matched controls, and those grievers with weaker beliefs in the meaningfulness of the world and lower perceptions of self-worth had greater distress symptoms than those who perceived the world and themselves in more positive terms. Assumptive worldviews were not related to differences in psychological distress in the control group. The present findings suggest that problematic reactions to bereavement may reflect the influence of negative belief systems, which do not seem to have the same detrimental impact for individuals not dealing with a significant interpersonal loss.

fMRI Activation During Executive Function Predicts Response to Cognitive Behavioral Therapy in Older, Depressed Adults

OBJECTIVESnTo test our hypothesis that pre-treatment executive function and brain regional activation during executive function would discriminate between responders and non-responders to cognitive behavioral therapy (CBT) in elderly depressed outpatients.nnnDESIGNnClinical cohort study.nnnSETTINGnUniversity-affiliated hospital.nnnPARTICIPANTSnSixty outpatients (age 59 years and older) completed 12 weeks of CBT between July 2010 and December 2011. Forty-four completed fMRI procedures.nnnMEASUREMENTSnThe main outcome consisted of a conversion from a clinical diagnosis (Mini-International Neuropsychiatric Interview) of depression to no clinical diagnosis of depression or a significant improvement in diagnostic criteria. Brain activation measured by functional magnetic resonance imaging during the Wisconsin Card Sorting task (WCST) was the primary predictor variable.nnnRESULTSn67% of patients had a positive response to CBT. Decreased activation in the left inferior frontal triangle and right superior frontal gyrus as well as increased activity in the right middle frontal gyrus and left superior frontal gyrus predicted a positive response to CBT. Demographic and neurocognitive measures of WCST performance were not significant predictors of a positive CBT outcome, whereas the measure of WCST-induced activity in the prefrontal cortex was a significant predictor.nnnCONCLUSIONSnThese data are among the first to suggest that measures of prefrontal brain activation during executive functioning predict response to CBT in older adults. Further exploration of the specific underlying processes that these prefrontal cortical regions are engaging that contributes to better CBT outcomes is warranted in larger, randomized studies.

Factorial Validity of the Texas Revised Inventory of Grief-Present Scale among Bereaved Older Adults

The Texas Revised Inventory of Grief-Present scale (TRIG-Present) is one of the most widely used grief measures; however, researchers have only empirically examined the validity and underlying factor structure of TRIG-Present scores in a few studies. Hence, in the present investigation, we sought to examine the factorial validity of the TRIG-Present (those scores that index current grief) among 2 samples of bereaved older adults--a community-dwelling sample of 162 individuals who experienced a diverse set of losses in terms of relationship to the deceased and time since loss, and a recently widowed sample of 212 individuals who were assessed at 2-months and 12-months postloss. Across both samples, we found support for a 3-factor model, composed of clusters of items representing Emotional Response, Thoughts, and Nonacceptance regarding a loss. Additionally, this 3-factor model exhibited significant invariance from 2-months to 12-months postloss in the recently widowed sample. Analyses examining the convergent validity of these 3 factors also suggest that this conceptualization of the TRIG-Present could have practical advantages and potentially influence the way in which clinicians and/or researchers assess grief and evaluate bereavement interventions.