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.

Introdução: Apesar de a toracoscopia ser o procedimento preconizado em crianças com derrame pleural parapneumônico complicado (DPPC) na fase fibrinopurulenta, a grande maioria dos trabalhos citados na literatura é de relato de casos ou revisão de pequeno número de pacientes. Este estudo interinstitucional foi realizado para determinar a eficácia deste procedimento em número significativo de crianças com DPPC na fase fibrinopurulenta. Métodos: Estudo retrospectivo de 99 crianças (0,4 a 11 anos; idade média 2,6 anos) submetidas à toracoscopia para tratamento de DPPC na fase fibrinopurulenta, operadas em três hospitais diferentes e com mesmo algoritmo de tratamento, no período de novembro de 1995 a julho de 2005. Resultados: A toracoscopia foi eficaz em 87 crianças (87%); 12 (13%) necessitaram de outro procedimento cirúrgico - 6 novas toracoscopias e 6 toracotomia/pleurostomia. O tempo médio de drenagem após a toracoscopia foi de 3 dias naqueles em que a toracoscopia foi efetiva e de 10 dias nos reintervidos (P < 0,001). Todos resolveram a infecção pleural. As complicações da toracoscopia foram enfisema subcutâneo na inserção do trocater em duas crianças (2%), infecção da ferida operatória em outras duas (2%), sangramento pelo dreno torácico em 12 (12%) e fístula bronco pleural em 16 (16%). Nenhuma necessitou intervenção cirúrgica, Conclusões: A efetividade da toracoscopia em crianças com DPPC na fase fibrinopurulenta foi de 87%. O procedimento mostrou-se seguro, com baixa incidência de complicações graves, devendo ser considerada como primeira opção em crianças com DPPC na fase fibrinopurulenta. / Introduction: Although Thorachoscopy being a procedure used to treat children with complicated parapneumonic pleural effusion (DPPC) in fibrinopurulent stage, most of the works presented in literature are case reports of only a few patients. The purpose of this work is to carry on a cross institutional study to determine the method’s effectiveness on a significant number of children with DPPC in its purulent stage. Methods: This is a retrospective case study of 99 children (ages 0,4 to 11; average age 2,6), from November 1009 to July 2005, submitted to thorachoscopy for the treatment of DPPC in fibrinopurulent stage, operated in three different hospitals and with the same treatment algorithm. Results: Thorachoscopy was effective for 87 children (87%). 12 (12%) needed to be submitted to another surgery – 6 to another thorachoscopy and 6 to thorachotomy/pleurostomy. The average draining time after thorachoscopy was 3 days for those whose thorachoscopy was effective and 10 days for those who were submitted to a new surgery (P< 0,001). In all cases, the pleural infection was successfully treated. Complications of the thorachoscopy were subcutaneous emphysema in the trocater insertion on two patients (2%), infection of the surgery incision on two other patients, bleeding through drain on 12 patients (12%) and bronchialpleural fistula on 16 patients (16%). None of them needed surgical treatment. Conclusion: The effectiveness of thorachoscopy on children with DPPC in fibrinopurulent stage was 87%. The procedure had low incidence of serious complications, and should be considered the first treatment option for children with DPPC in fibrinopurulent stage.

Introdução: Apesar de a toracoscopia ser o procedimento preconizado em crianças com derrame pleural parapneumônico complicado (DPPC) na fase fibrinopurulenta, a grande maioria dos trabalhos citados na literatura é de relato de casos ou revisão de pequeno número de pacientes. Este estudo interinstitucional foi realizado para determinar a eficácia deste procedimento em número significativo de crianças com DPPC na fase fibrinopurulenta. Métodos: Estudo retrospectivo de 99 crianças (0,4 a 11 anos; idade média 2,6 anos) submetidas à toracoscopia para tratamento de DPPC na fase fibrinopurulenta, operadas em três hospitais diferentes e com mesmo algoritmo de tratamento, no período de novembro de 1995 a julho de 2005. Resultados: A toracoscopia foi eficaz em 87 crianças (87%); 12 (13%) necessitaram de outro procedimento cirúrgico - 6 novas toracoscopias e 6 toracotomia/pleurostomia. O tempo médio de drenagem após a toracoscopia foi de 3 dias naqueles em que a toracoscopia foi efetiva e de 10 dias nos reintervidos (P < 0,001). Todos resolveram a infecção pleural. As complicações da toracoscopia foram enfisema subcutâneo na inserção do trocater em duas crianças (2%), infecção da ferida operatória em outras duas (2%), sangramento pelo dreno torácico em 12 (12%) e fístula bronco pleural em 16 (16%). Nenhuma necessitou intervenção cirúrgica, Conclusões: A efetividade da toracoscopia em crianças com DPPC na fase fibrinopurulenta foi de 87%. O procedimento mostrou-se seguro, com baixa incidência de complicações graves, devendo ser considerada como primeira opção em crianças com DPPC na fase fibrinopurulenta. / Introduction: Although Thorachoscopy being a procedure used to treat children with complicated parapneumonic pleural effusion (DPPC) in fibrinopurulent stage, most of the works presented in literature are case reports of only a few patients. The purpose of this work is to carry on a cross institutional study to determine the method’s effectiveness on a significant number of children with DPPC in its purulent stage. Methods: This is a retrospective case study of 99 children (ages 0,4 to 11; average age 2,6), from November 1009 to July 2005, submitted to thorachoscopy for the treatment of DPPC in fibrinopurulent stage, operated in three different hospitals and with the same treatment algorithm. Results: Thorachoscopy was effective for 87 children (87%). 12 (12%) needed to be submitted to another surgery – 6 to another thorachoscopy and 6 to thorachotomy/pleurostomy. The average draining time after thorachoscopy was 3 days for those whose thorachoscopy was effective and 10 days for those who were submitted to a new surgery (P< 0,001). In all cases, the pleural infection was successfully treated. Complications of the thorachoscopy were subcutaneous emphysema in the trocater insertion on two patients (2%), infection of the surgery incision on two other patients, bleeding through drain on 12 patients (12%) and bronchialpleural fistula on 16 patients (16%). None of them needed surgical treatment. Conclusion: The effectiveness of thorachoscopy on children with DPPC in fibrinopurulent stage was 87%. The procedure had low incidence of serious complications, and should be considered the first treatment option for children with DPPC in fibrinopurulent stage.

Introdução: Apesar de a toracoscopia ser o procedimento preconizado em crianças com derrame pleural parapneumônico complicado (DPPC) na fase fibrinopurulenta, a grande maioria dos trabalhos citados na literatura é de relato de casos ou revisão de pequeno número de pacientes. Este estudo interinstitucional foi realizado para determinar a eficácia deste procedimento em número significativo de crianças com DPPC na fase fibrinopurulenta. Métodos: Estudo retrospectivo de 99 crianças (0,4 a 11 anos; idade média 2,6 anos) submetidas à toracoscopia para tratamento de DPPC na fase fibrinopurulenta, operadas em três hospitais diferentes e com mesmo algoritmo de tratamento, no período de novembro de 1995 a julho de 2005. Resultados: A toracoscopia foi eficaz em 87 crianças (87%); 12 (13%) necessitaram de outro procedimento cirúrgico - 6 novas toracoscopias e 6 toracotomia/pleurostomia. O tempo médio de drenagem após a toracoscopia foi de 3 dias naqueles em que a toracoscopia foi efetiva e de 10 dias nos reintervidos (P < 0,001). Todos resolveram a infecção pleural. As complicações da toracoscopia foram enfisema subcutâneo na inserção do trocater em duas crianças (2%), infecção da ferida operatória em outras duas (2%), sangramento pelo dreno torácico em 12 (12%) e fístula bronco pleural em 16 (16%). Nenhuma necessitou intervenção cirúrgica, Conclusões: A efetividade da toracoscopia em crianças com DPPC na fase fibrinopurulenta foi de 87%. O procedimento mostrou-se seguro, com baixa incidência de complicações graves, devendo ser considerada como primeira opção em crianças com DPPC na fase fibrinopurulenta. / Introduction: Although Thorachoscopy being a procedure used to treat children with complicated parapneumonic pleural effusion (DPPC) in fibrinopurulent stage, most of the works presented in literature are case reports of only a few patients. The purpose of this work is to carry on a cross institutional study to determine the method’s effectiveness on a significant number of children with DPPC in its purulent stage. Methods: This is a retrospective case study of 99 children (ages 0,4 to 11; average age 2,6), from November 1009 to July 2005, submitted to thorachoscopy for the treatment of DPPC in fibrinopurulent stage, operated in three different hospitals and with the same treatment algorithm. Results: Thorachoscopy was effective for 87 children (87%). 12 (12%) needed to be submitted to another surgery – 6 to another thorachoscopy and 6 to thorachotomy/pleurostomy. The average draining time after thorachoscopy was 3 days for those whose thorachoscopy was effective and 10 days for those who were submitted to a new surgery (P< 0,001). In all cases, the pleural infection was successfully treated. Complications of the thorachoscopy were subcutaneous emphysema in the trocater insertion on two patients (2%), infection of the surgery incision on two other patients, bleeding through drain on 12 patients (12%) and bronchialpleural fistula on 16 patients (16%). None of them needed surgical treatment. Conclusion: The effectiveness of thorachoscopy on children with DPPC in fibrinopurulent stage was 87%. The procedure had low incidence of serious complications, and should be considered the first treatment option for children with DPPC in fibrinopurulent stage.

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.