Complicated Grief (CG) has been identified as a potential consequence of bereavement that is associated with unique and debilitating outcomes. This thesis investigated autobiographical memory in CG. This program of research focused on the specificity and content of autobiographical memories in the context of CG. Study 1 investigated memory retrieval specificity using a cue word paradigm. Bereaved individuals with CG displayed an overgeneral retrieval style (OGM) compared to bereaved individuals without CG. Study 2 found that CG participants were also less specific in imagining future events in response to positive cues. Further, there was a significant independent relationship between memory retrieval specificity and the specificity of future imaginings. Study 3 investigated the relationship between overgeneral memory and social problem solving. CG participants performed more poorly on this task; however, there was no independent relationship with memory retrieval style. Study 4 investigated the impact of treatment on OGM. Results indicated that as symptoms of CG reduced following treatment, individuals retrieved more specific memories to positive cues. Studies 5-7 examined proposed relationships between self construct and autobiographical remembering in CG, as outlined in Conway and Pleydell-Pearce??s (2000) self memory system model. In Study 5, individuals with CG were more likely than bereaved controls to view their self-identity as being related to the deceased. Study 6 investigated the relationship between self-discrepancy, personal goals and memory content. CG individuals were more likely to recall loss-related memories, and there was a relationship between personal goals and memory content. Study 7 extended examination of these factors to future-related thinking. Finally, the program recognised the importance of investigating the impact of the cognitive strategies that individuals may adopt to manage painful memories. Using an experimental Stroop procedure as a measure of thought accessibility, Study 8 investigated thought suppression in CG. The results suggested that CG individuals experienced greater interference from death-related cues. In summary, these studies highlighted some of the key memory processes that may be involved in the maintenance, and potentially the resolution, of CG.

A central goal of this study is to better understand why some mothers become unresolved with respect to experiences of loss whereas others do not. Adults are considered to be unresolved with respect to loss if they display signs of mental disorganization while discussing an attachment-related loss due to death – for example, talking in the present tense about a deceased person as if the person is still alive (Main, Goldwyn, & Hesse, 2002). Studies have accumulated documenting the negative consequences of being unresolved. Researchers have linked unresolved attachment to frightened/frightening maternal behavior (Jacobvitz, Leon, & Hazen, 2006), drug/alcohol abuse (Riggs & Jacobvitz, 2002), and other Axis I and II disorders (Ward, Lee, & Polan, 2006; Fonagy et al., 1996); as well as anxiety, anger, (Busch, Cowan, & Cowan, 2008) and controlling behavior (Creasey, 2002) in romantic relationships. Less is known about the conditions under which a person becomes unresolved. This study will be one of the first to examine the comprehensive effects of several risk factors known to influence a person’s ability to resolve a loss including kinship, cause of death, and suddenness as well as primary attachment pattern. Other factors included in this study are social support and lifestyle changes. Although attachment theory provides a thorough explanation for an individual’s inability to resolve a loss, it is only one of many theoretical explanations of this phenomenon (Rando, 1993). One theory that is conceptually similar to unresolved loss is the theory of complicated grief, the process of painful searching and yearning for a deceased person (Prigerson et al., 1995b). Like those who study unresolved loss, complicated grief researchers are still seeking to understand what factors can predict whether an individual will experience prolonged symptoms of grief (van der Houwen et al., 2010). Also similar to unresolved loss, complicated grief involves irregular patterns of mental processes following a loss; however, complicated grief seems to be a conscious process, whereas unresolved loss has non-conscious components. Hence, this dissertation also examined whether complicated grief was related to unresolved loss and, if so, whether the origins for complicated grief were similar to unresolved loss. / text

Complicated Grief (CG) has been identified as a potential consequence of bereavement that is associated with unique and debilitating outcomes. This thesis investigated autobiographical memory in CG. This program of research focused on the specificity and content of autobiographical memories in the context of CG. Study 1 investigated memory retrieval specificity using a cue word paradigm. Bereaved individuals with CG displayed an overgeneral retrieval style (OGM) compared to bereaved individuals without CG. Study 2 found that CG participants were also less specific in imagining future events in response to positive cues. Further, there was a significant independent relationship between memory retrieval specificity and the specificity of future imaginings. Study 3 investigated the relationship between overgeneral memory and social problem solving. CG participants performed more poorly on this task; however, there was no independent relationship with memory retrieval style. Study 4 investigated the impact of treatment on OGM. Results indicated that as symptoms of CG reduced following treatment, individuals retrieved more specific memories to positive cues. Studies 5-7 examined proposed relationships between self construct and autobiographical remembering in CG, as outlined in Conway and Pleydell-Pearce??s (2000) self memory system model. In Study 5, individuals with CG were more likely than bereaved controls to view their self-identity as being related to the deceased. Study 6 investigated the relationship between self-discrepancy, personal goals and memory content. CG individuals were more likely to recall loss-related memories, and there was a relationship between personal goals and memory content. Study 7 extended examination of these factors to future-related thinking. Finally, the program recognised the importance of investigating the impact of the cognitive strategies that individuals may adopt to manage painful memories. Using an experimental Stroop procedure as a measure of thought accessibility, Study 8 investigated thought suppression in CG. The results suggested that CG individuals experienced greater interference from death-related cues. In summary, these studies highlighted some of the key memory processes that may be involved in the maintenance, and potentially the resolution, of CG.

Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2009.

Complicated Grief is a relatively new concept that is globally debated by psychiatrists and psychologists. The time has come for social workers to join this debate and to develop and implement programmes to address the consequences following complicated grief, specifically which results in impaired social functioning. Complicated Grief, prolonged grief and traumatic grief are all synonyms. The term 'complicated grief is the preferred concept used in this research. Article 1 is a literature overview on factors leading to complicated grief and at the same time attempts to link these factors to the South African circumstances. South African citizens are not exempted from experiencing complicated grief. Cultural beliefs on death and dying, AIDS and cancer-related deaths, crime and sociopolitical deaths are but some of the risk factors. She furthermore highlights complicated grief as a matter to be assessed by social workers. The normality of grief is questioned when the grief experience prohibits the individual to regain a state of social functioning as close as possible to the pre-loss state. Complicated grief is regarded by many researchers as a specific condition in need of specific intervention. The efficacy of bereavement intervention in the case of normal grief is questioned, and it seems that individuals who experience complicated grief benefit more from bereavement intervention. Article 2 attempts to clarify the necessity to screen clients prior to including them in a complicated grief intervention programme by discussing the Inventory of Traumatic Grief as developed by Prigerson and colleagues. The researcher furthermore introduces the Grief Assessment Guide (GASsG) as an assessment tool during the screening process. In article 3 the researchers tabulate some of the most important models/approaches to bereavement and discuss its applicability to Complicated Grief. Specific attention is given to the Dual Process Model (Stroebe & Schut, 1999) and the task-centred approach (a social work approach to therapy) in an attempt to develop a model for Complicated Grief Intervention. This article furthermore proposes the Complicated Grief Intervention Model (CGIM) through the integration of the dual process model and the task-centred approach, while drawing on intervention techniques from other therapeutic approaches. Article 4 explains the implementation of the Complicated Grief Intervention Programme (CGIP) with the CGIM as framework for intervention. The researchers briefly discuss some of the intervention techniques, such as desensitization, visualization, client-log, miracle question, metaphors, rituals and humour. These techniques assist the social worker and the client towards achieving the goal. The CGIP is a time-limited interventions programme. It consists of, and is based on, the three steps of the CGIM: assessment, implementation and evaluation/termination. Although the CGIP has not been scientifically tested, it holds the potential to serve as a guided programme for social workers in the field of grief and bereavement. Article 5 is a discussion of the empirical findings of the research. This article describes the implementation of the proposed CGIP in the South African context. This article furthermore aims at evaluating the feasibility of implementing the CGIP rather than testing the effectiveness of the programme. Section C summarizes and evaluates the research and makes recommendations regarding its value and the value of possible future research on complicated grief in the South African context. / Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2009.

Complicated Grief is a relatively new concept that is globally debated by psychiatrists and psychologists. The time has come for social workers to join this debate and to develop and implement programmes to address the consequences following complicated grief, specifically which results in impaired social functioning. Complicated Grief, prolonged grief and traumatic grief are all synonyms. The term 'complicated grief is the preferred concept used in this research. Article 1 is a literature overview on factors leading to complicated grief and at the same time attempts to link these factors to the South African circumstances. South African citizens are not exempted from experiencing complicated grief. Cultural beliefs on death and dying, AIDS and cancer-related deaths, crime and sociopolitical deaths are but some of the risk factors. She furthermore highlights complicated grief as a matter to be assessed by social workers. The normality of grief is questioned when the grief experience prohibits the individual to regain a state of social functioning as close as possible to the pre-loss state. Complicated grief is regarded by many researchers as a specific condition in need of specific intervention. The efficacy of bereavement intervention in the case of normal grief is questioned, and it seems that individuals who experience complicated grief benefit more from bereavement intervention. Article 2 attempts to clarify the necessity to screen clients prior to including them in a complicated grief intervention programme by discussing the Inventory of Traumatic Grief as developed by Prigerson and colleagues. The researcher furthermore introduces the Grief Assessment Guide (GASsG) as an assessment tool during the screening process. In article 3 the researchers tabulate some of the most important models/approaches to bereavement and discuss its applicability to Complicated Grief. Specific attention is given to the Dual Process Model (Stroebe & Schut, 1999) and the task-centred approach (a social work approach to therapy) in an attempt to develop a model for Complicated Grief Intervention. This article furthermore proposes the Complicated Grief Intervention Model (CGIM) through the integration of the dual process model and the task-centred approach, while drawing on intervention techniques from other therapeutic approaches. Article 4 explains the implementation of the Complicated Grief Intervention Programme (CGIP) with the CGIM as framework for intervention. The researchers briefly discuss some of the intervention techniques, such as desensitization, visualization, client-log, miracle question, metaphors, rituals and humour. These techniques assist the social worker and the client towards achieving the goal. The CGIP is a time-limited interventions programme. It consists of, and is based on, the three steps of the CGIM: assessment, implementation and evaluation/termination. Although the CGIP has not been scientifically tested, it holds the potential to serve as a guided programme for social workers in the field of grief and bereavement. Article 5 is a discussion of the empirical findings of the research. This article describes the implementation of the proposed CGIP in the South African context. This article furthermore aims at evaluating the feasibility of implementing the CGIP rather than testing the effectiveness of the programme. Section C summarizes and evaluates the research and makes recommendations regarding its value and the value of possible future research on complicated grief in the South African context. / Thesis (Ph.D. (Social Work))--North-West University, Potchefstroom Campus, 2009.

Persistent intense yearning for the deceased is a core clinical feature of complicated grief (CG) that distinguishes it from other mental disorders that develop following loss. The Yearning in Situations of Loss Scale (YSL) is a recently developed assessment of yearning. To assess the psychometric properties of the YSL in those with CG, we administered the YSL, Inventory of Complicated Grief, and Quick Inventory of Depression Symptomatology to 303 treatment-seeking bereaved adults with CG. Our results suggest the YSL is a reliable assessment with acceptable convergent and discriminant validity as a measure of yearning in those with CG.

The diagnosis of Complicated Grief (CG) is being proposed for inclusion in DSM–5. As such, it has been the focus of several studies purporting to build evidence of its validity and its conceptual and statistical distinction from Posttraumatic Stress Disorder (PTSD) and depression (Bonanno et al., 2007; Golden & Dalgleish, 2010; Prigerson et al., 1995b). However, previous research has focused predominantly on bereavement caused by non-violent means (e.g., prolonged terminal illness). This study attempts to explore the nature of CG among a sample of students who survived a mass shooting. Exploratory and confirmatory factor analytic procedures were used to examine and confirm the factor structure of CG as reported in previous studies (e.g., Boelen & van den Bout, 2005; Dillen, Fontaine, & Verhofstadt-Denève, 2008). A refined CG scale was then used as a criterion to demonstrate how different types of traumatic exposure contribute to symptoms of CG and/or posttraumatic stress (PTS). It was hypothesized that exposure items related to bereavement would be more related to CG than to PTS, whereas direct exposure to the shootings would be more closely related to PTS than to CG. Results of exploratory and confirmatory factor analyses supported CG as a unitary construct distinct from PTS and from anxiety/depression. Logistic regression results demonstrated that bereavement status was significantly predicted by CG but not PTS: Participants who scored 1 standard deviation above the mean on the CG scale were 14.64 times more likely to have been bereaved than were those who scored at the mean. SEM analyses were used to provide an additional test of this hypothesis. The final model had acceptable fit as assessed by RMSEA = .046, CI = .043–.049, SRMR = .048, and CFI = .990; however, the Satorra-Bentler Scaled Ï 2 = 1507.82, df = 589, p < .001, did not support the model. Overall, results of SEM suggested that interpersonal loss (i.e., whether a friend was killed, injured, or escaped from the shootings) predicted CG but not PTS, whereas perceived threat predicted both CG and PTS. / Ph. D.

This dissertation examined the relationship between attachment insecurity and complicated grief by testing a path model of variables that were hypothesized to mediate this relationship. Three meaning-making variables were tested as potential mediators: benefit-finding, sense-making, and positive reappraisal. First, a series of principal components analyses were performed to determine the factor structure of these meaning-making variables. After these constructs were identified, a series of hierarchical regression analyses were conducted to determine the unique contribution of each of the primary variables in predicting either complicated grief or one of the meaning-making variables. As hypothesized, some of the attachment and meaning-making variables were highly associated with complicated grief. Attachment insecurity variables were also associated with some of the meaning-making variables suggesting that attachment may have some influence on how individuals use meaning-making strategies in the midst of a loss. These variables were then entered into a path analysis that accounted for other relevant risk factors. It was found that, contrary to the main hypothesis, the meaning-making variables did not appear to mediate the relationship between attachment insecurity and complicated grief. Multiple regression was used to determine the relative impact of meaning-making and attachment variables on complicated grief because these variables have not been previously included in one statistical model. The results suggested that both meaning-making and attachment insecurity variables can play an important role as risk factors for complicated grief and that these relationships are still present after accounting for the closeness that an individual reported towards the deceased. It was concluded that both sets of variables, attachment and meaning-making, should be included in models of the development of complicated grief and that both may have clinical implications in terms of how to approach counseling for individuals struggling with complicated grief. More research on this topic is needed to look at similar research questions within specific populations. It was also suggested that in the future, researchers need to find better ways to measure meaning-making constructs because the current findings suggest that meaning-making may be even more multifaceted than has been suggested in previous literature. / text

Complicated grief, or persistent complex bereavement disorder, is a condition that affects approximately 10% of bereaved individuals and is marked by intense longing and yearning for the deceased. Little is known about the neurocognitive mechanisms contributing to this syndrome, but previous research suggests that reward pathways in the brain may play a role. The present study was designed with this theory in mind, aiming to understand reward processing in those experiencing complicated and non-complicated grief as well as to differentiate the "wanting" and "liking" phases of reward processing in bereavement. Twenty-five older adults were categorized based on grief severity into one of three groups: complicated grief (CG), non-complicated grief (NCG) and non-bereaved married controls (NB). Neural activation was examined using fMRI while participants viewed a countdown on the screen (anticipation) followed by a photo of their (living or deceased) spouse. There was no significantly differential activation between the three groups for the spouse v. stranger photo contrast, nor for anticipation period v. spouse photo. However, these two contrasts were also run separately in the three groups. Each group produced significant activation, in similar and distinct regions, primarily associated with emotion and visual processing. In addition, post-hoc analyses were conducted using self-reported yearning scores as a regressor across all bereaved participants, which revealed that greater symptoms of yearning predicted greater activation in the subgenual anterior cingulate cortex (sgACC). This region of the brain has been previously linked to depression and suggests that symptoms of yearning may present an opportune place to intervene to improve outcomes in CG.