Nigel P. Field

CONTINUING BONDS IN BEREAVEMENT: AN ATTACHMENT THEORY BASED PERSPECTIVE

ABSTRACT An attachment theory based perspective on the continuing bond to the deceased (CB) is proposed. The value of attachment theory in specifying the normative course of CB expression and in identifying adaptive versus maladaptive variants of CB expression based on their deviation from this normative course is outlined. The role of individual differences in attachment security on effective versus ineffective use of CB in coping with bereavement also is addressed. Finally, the moderating influence of type of loss (e.g., death of a spouse vs. child), culture, and religion on type of CB expression within an overarching attachment framework is discussed.

Self-Enhancement as a Buffer Against Extreme Adversity: Civil War in Bosnia and Traumatic Loss in the United States

In a challenge to traditional views of mental health, Taylor and Brown argued that an overly positive or enhanced perception of the self was adaptive, particularly in conditions of extreme adversity. Researchers have tempered this view with evidence linking self-enhancing biases to negative social consequences. This article reports studies examining self-enhancement in the context of civil war in Bosnia (Study 1) and premature conjugal loss (Study 2). In both studies, mental health experts rated self-enhancing individuals as better adjusted than other participants. Self-enhancement proved particularly salutary for bereaved participants who suffered more adverse losses. These effects were evidenced regardless of whether global judgments or structured clinical interviews were used, whether ratings were collected cross-sectionally or longitudinally, and when negative affect was statistically controlled. However, consistent with previous studies, self-enhancers also evoked negative impressions among untrained observers. Limitations and implications for future research are discussed.

Relationships of perceived stress to coping, attachment and social support among HIV-positive persons

The purpose of this study was to examine the relationships of coping, attachment style and perceived social support to perceived stress within a sample of HIV-positive persons. Participants were 147 HIV-positive persons (80 men and 67 women). Multiple regression analysis was used to examine the relationships of the demographic variables, AIDS status, three coping styles, three attachment styles and perceived quality of general social support with total score on the Perceived Stress Scale (PSS). PSS score was significantly associated with less income, greater use of behavioural and emotional disengagement in coping with HIV/AIDS, and less secure and more anxious attachment styles. These results indicate that HIV-positive persons who experience the greatest stress in their daily lives are those with lower incomes, those who disengage behaviourally/ emotionally in coping with their illness, and those who approach their interpersonal relationships in a less secure or more anxious style.

The relation of continuing attachment to adjustment in conjugal bereavement.

The role of continuing attachment in adjustment to conjugal loss was examined. At 6 months postloss, 70 midlife bereaved participants were interviewed to assess different forms of continuing attachment. They also engaged in a monologue role-play with their deceased spouse, providing a behavioral measure of grief-related distress. In addition, they completed general and grief-specific symptom inventories at 6 months and again at 14 and 25 months postloss. The results indicated that use of the deceaseds possessions to gain comfort was positively correlated with concurrent distress in the role-play and predictive of less of a decrease in grief-specific symptoms over time in a growth curve analysis. In contrast, attachment through fond memories was related to less distress in the role-play. The results, therefore, suggest that whether continuing attachment is adaptive or not depends on its form.

CONTINUING BONDS IN COPING WITH THE DEATH OF A HUSBAND

This study examined the continuing bond (CB) to the deceased in coping with the death of a husband. Fifteen early-bereaved widows whose husband had died 4 months previously and 15 later-bereaved widows whose husband had died more than 2 years ago were electronically signaled every 3 hours to complete a set of measures that included the PANAS positive and negative mood scales and CB coping. Participants completed these measures 4 times each day for 14 successive days. Following from an attachment theory perspective on the role of CB in providing felt security, it was hypothesized that CB would be effective as a way of coping in mood regulation, but that its effectiveness would be moderated by time since the death. Consistent with predictions, a positive within-person relationship was found between CB coping and positive mood for the later-bereaved group, but not for early-bereaved widows. CB coping was also positively related to negative mood for both early, and later-bereaved widow groups, however. Finally, in a lagged analysis, greater use of CB was predictive of a shift toward more negative mood among early-bereaved widows, but not for later-bereaved widows. The results were discussed in the context of previous literature on the function of CB in adaptation to bereavement.

Continuing Bonds, Risk Factors for Complicated Grief, and Adjustment to Bereavement

This study examined type of continuing bonds (CB) expression in relation to risk factors for complicated grief and measures of bereavement-related adjustment. Externalized CB expressions involving illusions and hallucinations with the deceased were distinguished from internalized CB expressions involving use of the deceased as an autonomy promoting secure base. 502 bereaved participants completed over the internet a CB measure assessing externalized and internalized CB along with various known risk-factor measures that included cause of death (i.e., violent vs. non-violent death), responsibility for the death, and attachment style as well as measures of psychological adjustment that included complicated grief symptoms, perceived physical health, and personal growth. As predicted, externalized CB was positively associated with violent death and responsibility for the death, whereas internalized CB was negatively associated with these risk factors as well as uniquely positively linked to personal growth. The implications of the findings for the role of CB in adjustment are discussed.

Unresolved Grief and Continuing Bonds: An Attachment Perspective

Much of the contemporary bereavement literature on the continuing bond to the deceased (CB) has emphasized its adaptiveness and given limited attention to when it may be maladaptive. The attachment literature on disorganized–unresolved attachment classification in relation to loss, or “unresolved loss,” is informative in identifying CB expressions that are indicative of failure to integrate the death of a loved one. In this article, an important linkage is identified between a prominent indicator of unresolved loss that involves a lapse in the monitoring of reasoning implying disbelief that the person is dead and the clinical writings of J. Bowlby (1980) and V. D. Volkan (1981) on maladaptive variants of CB expression. The aim is to highlight the value of the attachment literature on unresolved loss in clarifying the conditions under which CB is likely to be maladaptive.

Interpersonal Problems and Their Relationship to Sexual Revictimization Among Women Sexually Abused in Childhood

This study examined the relationship between sexual revictimization and interpersonal problems in a sample of adult survivors of childhood sexual abuse diagnosed with post-traumatic stress disorder. Fifty-two treatment-seeking women participated in this study. Research participants completed the Sexual Experiences Survey to assess sexual revictimization within the past 6 months and completed the Inventory of Interpersonal Problems (IIP). Revictimized participants reported overall greater interpersonal problems compared with nonrevictimized participants. Post hoc analyses showed significantly higher interpersonal problem scores for revictimized participants on the Hard to Be Assertive and Too Responsible subscales. On the circumplex IIP, revictimized participants were more socially avoidant, nonassertive, and overly nurturant.

Examining the Delayed Grief Hypothesis Across 5 Years of Bereavement

Traditional bereavement theories emphasize that it is crucial to work through the emotional meanings of a loss and that the failure to do so typically results in delayed grief symptoms. This article reports data examining these assumptions prospectively across the first 5 years of bereavement. Based on previous validity data, elevated symptoms were defined in terms of 6-month median scores for each measure. Delayed elevations were observed on isolated measures for 3 (7%) participants. However, these elevations were more parsimoniously explained by random measurement error. Furthermore, when a weighted grief-depression composite score was used to maximize the probability of capturing the true (latent) grief variable, not a single case of delayed symptom elevations was observed. Finally, data on emotional processing of the loss at 6 months failed to support the traditional assumption that minimal emotional processing of the loss would lead to delayed grief.

Role of Attachment in Response to Pet Loss

This study examined the impact of attachment on grief severity following the death of a pet. Seventy-one participants who had lost a dog or cat within the past year completed a set of measures that included an attachment measure assessing individual differences in attachment anxiety and avoidance, strength of the past attachment to the pet, the continuing bond with the deceased pet, social support, and complicated grief symptoms. Attachment anxiety and strength of the past attachment to the pet were each uniquely predictive of more severe grief. Furthermore, the continuing bond to the deceased pet partially mediated the impact of strength of the past attachment to the pet on grief severity. No significant mediators of the effect of attachment anxiety on grief were found, however. The results highlight the importance of distinguishing strength of attachment from attachment security in examining the effect of attachment on response to pet loss.