Research on expressive art interventions for bereavement has burgeoned in recent years. Studies have supported their effectiveness in facilitating participants’ adjustment to loss (e.g., Rosner, Kruse, & Hagl, 2010; Uttley, 2015) and have revealed the frequency with which they are clinically implemented (Thompson & Neimeyer, 2014). Clinicians and recipients of expressive art interventions advocate for their helpfulness in grief processing (e.g., Gamino, 2015). Publications have highlighted particular visual art modules that facilitate adaptive adjustment to loss by providing avenues for self-expression, meaning making and continuing bonds with the deceased (Neimeyer, 2016), but few studies have quantitatively investigated whether they improve bereavement outcomes. Efficacy of treatment modalities are especially warranted for bereaved subgroups at elevated risk for developing symptoms of complicated grief, such as socioeconomically vulnerable older adults, as they are among those most likely to benefit from intervention but face the most barriers to accessible treatment (Ghesquiere, 2013; Newson et al., 2011). This longitudinal study investigated the feasibility and efficacy of a 4-week grief support group with visual art modalities for bereaved older adults residing in government subsidized independent living facilitates in the community. Measured outcomes included meaning made from the loss, continued bonds with the deceased, perceived social support, personal growth, and negative bereavement experiences such as symptoms of complicated grief and depression. Findings from this study support the feasibility and acceptability of implementing an art-based grief support group for socioeconomically vulnerable older adults. Significant improvement was found in meaning made from the loss, personal growth, and negative grief symptoms. Depressive symptoms significantly decreased immediately following completion of the group, but these levels returned closer to baseline levels at one-month follow up. Participants who screened positively for complicated grief at baseline reported greater improvement in their negative grief symptoms and depression, consistent with the extant literature that the bereft in highest distress receive the most benefit from grief intervention. As complicated grief is more prevalent in the older adult population than other age groups, further investigation on the efficacy and effectiveness of targeted bereavement support is warranted.

Background: The death of a spouse is among the most distressing life events faced by older adults and frequently follows long periods of providing extensive care and support. Although many spouses are resilient following loss, a number of bereaved spousal caregivers have poor psychological well-being and may benefit from clinical services. However, it can be difficult to determine who may most benefit from bereavement services and why some individuals are at greater risk for poor bereavement; thus, there is a need for greater understanding of the process of bereavement. Therefore, the purpose of this dissertation was to investigate a number of theoretically relevant factors within the context of bereavement after caregiving as possible predictors of psychological well-being following loss. Specifically, former caregivers' perceptions of loved ones' end-of-life suffering, rumination, and feelings of relief were investigated as possible predictors of caregivers symptoms of depression, grief, and complicated grief following loss. Method: Participants included 61 former spousal caregivers of hospice patients 50 years of age or older who lost a spouse in the last 6-18 months. Individuals completed an interview that included retrospective recall of perceptions of loved ones' physical, emotional, and existential suffering, current frequency of thoughts about loved ones' suffering, stress-reactive rumination, and feelings of relief following the death. Participants also completed measures assessing current symptoms of depression, present feelings of grief, and complicated grief. Descriptive information about care recipients was obtained via retrospective review of hospice electronic medical records following participant interview. Several regression analyses were conducted to investigate the relationship of possible predictor variables to bereavement outcomes and interactions among predictor variables. Results: Findings revealed important relationships between rumination, feelings of relief, and former caregivers' psychological well-being follow loss. Higher rumination and less feelings of relief were associated with worse bereavement outcomes. In addition, interaction analyses revealed that rumination and feelings of relief moderated the relationship between participants' perceptions of their spouses' emotional end-of-life suffering and psychological distress. Other descriptive predictors of depression, grief, and complicated grief were identified. Discussion: Participants were highly distressed former caregivers who were highly engaged in caregiving duties prior to loss. About 40% reported no feelings of relief following the loss, and over one-fourth of participants still had frequent ruminations about their loved ones' suffering. High stress-reactive rumination was an important predictor of bereaved spouses' psychological distress. Clinical interventions, such as cognitive behavioral therapy, could focus on identifying, redirecting, and reducing distressing thoughts or the negative feelings associated with them, such as ruminations associated with loved ones' end-of-life suffering. Future longitudinal research should examine the relationships between rumination, feelings of relief, perceived suffering, and bereavement outcomes in order to identify patterns that may inform clinical interventions.

The diploma thesis "Experiencing the loss of a child" deals with the psychological aspects of adaptation to the loss of a child. Its main objective is to analyse the supporting factors that help the adaptation and to find out how such loss influences individuals and their subsequent life. The theoretical part of the thesis focuses on the issue of the loss of a close person and details the specifics of the loss of a child. Based on available literature the author explores the process of grieving and its manifestations and determines the variables that influence the adaptation to child loss. She also evaluates the impact of the child loss on the individual and the potential for intervention in the process. The empirical part determines the factors that help to cope with such loss, describes, how the loss influences the life of the individual and focuses on the needs of the bereaved parents. The data gathering consisted of ten individual in-depth interviews with women which experienced the loss of a child. These interviews were then qualitatively analysed using the IPA (Interpretative Phenomenological Analysis) method. Based on the results of the qualitative analysis we identified four main support aspects of adaptation to child loss - social support, individual activity, professional help and faith....

Trauma and grief often co-occur, however the degree to which these two constructs overlap or are distinguishable is still poorly understood. Homicidally bereaved individuals are exposed to both trauma and loss-related stressors. Previously collected data were used to explore the relationship between trauma and grief components in homicide bereavement distress, and whether homicide bereavement distress was distinguishable from that of other adverse life events. The overarching research question for this study was: Are event and loss related distress distinguishable among siblings bereaved by homicide,1 as measured on the Impact of Event Scale-Revised (IES-R)? Data from 67 individuals who lost a sibling to murder while growing up (Murder Group) were compared to data from 80 comparison individuals who grew up with a sibling (Comparison Group), but who had no experience of homicide bereavement. A cross-sectional, iterative survey design using group comparisons was used. Participants in the Murder Group reported significantly higher levels of current subjective distress compared with the Comparison Group. Among the siblings bereaved by the homicide loss of a sibling, event- and loss-related subjective distresses were highly and significantly correlated. In addition, both decreased significantly over time (years), and at similar rates. Preliminary findings from exploratory analyses of the IES-R provide insight into the avoidance, intrusion, and hyperarousal components of subjective distress following homicide loss. Findings will inform understanding of the overlap, and distinguishing features, of concurrent trauma and grief. Implications for theory and empirical research are noted, and recommendations for future research and counselling practice are discussed. / Graduate / 2017-09-13 / simpson9@uvic.ca

Student Number : 0204770E - MEd research report - School of Education - Faculty of Humanities / The present study investigates a bereavement training programme with a group of volunteer lay counsellors. In South Africa, the number of orphans resulting from an increase in parental deaths from natural causes, such as AIDS and nonnatural causes, for example violence, is increasing rapidly. The increasing number of bereaved children is creating a demand for professional support services that cannot be met by the present number of trained professionals. To address this imbalance, the training of lay counsellors is proposed. It is thus relevant to train those who are willing to help with the necessary knowledge and skills in a bereavement training programme. The present study involves ten volunteers from a Community Centre. Qualitative research methods are employed to analyse the data that is gained from the preand post-training responses to the interviews and Case Examples. Content analysis is used to elucidate the themes that emerge from the collected data. The results of the present study indicate that perceptual and developmental changes have occurred within the volunteers following the training programme, however, it is evident that further training is necessary because of the limited ability that the volunteers demonstrate in practically transferring the knowledge to new cases. In terms of this finding it is clear that factors such as language, age, educational level and personal experiences of death are important criteria to consider in the selection of volunteers for a bereavement training programme. Furthermore, traditional African perspectives of death, cultural differences and HIV/AIDS awareness need to be incorporated into future bereavement training programmes. In terms of the outcomes of the study, a positive outcome is the revision of the Bereavement Programme for children, taking cognisance of cultural sensitiveness, to make it more applicable within the local context. The results of the study also highlight the limitations and implications of the present research, which are discussed and recommendations for future research are made.

I studien undersöks individers upplevelse av gruppsykoterapeutisk behandling för komplicerad sorg. Genom halvstrukturerade djupintervjuer och kvalitativa enkätfrågor erhålls beskrivningar från olika livsvärldar utifrån individers olika perspektiv. En tolkningsram har tagits fram innehållande tidigare forskning samt teoretiska utgångspunkter vilken utgör verktyg för analys av erhållna resultat. I resultatavsnittet framhålls den oerhörda och ibland avgörande betydelse behandlingen haft för individernas välbefinnande. Det framkommer också tre aspekter som varit avgörande för det positiva resultatet av behandlingen nämligen relationen till terapeuten, den metod som använts samt gemenskapen i gruppen. Vidare undersöktes gemenskapens betydelse på en djupare nivå. Det resultat som framkom var att förståelse från de andra i gruppen, att individerna insåg att de inte vara unika om sin situation samt att en medvetenhet och insikt uppstod i tankeprocesser och det interpersonella beteendet var det som hade störst betydelse i gemenskapen. Denna upptäckt presenteras som en tentativ modell som kan ligga till grund för framtida forskning. Slutligen diskuteras resultat och analys i relation till syfte och tolkningsram samt presenteras slutsatser och ytterligare förslag till framtida forskning. / The study examines individuals' experience of group psychotherapy for complicated grief treatment. Through semi-structured interviews and qualitative survey questions have descriptions of the various life worlds of individuals from different perspectives been obtained. Previous research and theories are presented which constitute tools for analysis of the obtained results. The results present the tremendous and sometimes vital significance the treatment had on individuals' wellbeing. It also presents three aspects that were decisive for the positive outcome of the treatment. These were the relationship to the therapist, the method used and the community in the group. The meaning of community was further examined on a deeper level. The obtained result of this question shows that understanding from the other group members, the fact that the individuals' realized that they’re not unique about their situation and that awareness and insight in thoughts and interpersonal behavior arose were of greatest meaning. This discovery is presented as a tentative model that could provide a basis for future research. The results are discussed and analyzed in relation to the purpose of the study and previous research. Finally, conclusions and further suggestions for future research are presented.

Made available in DSpace on 2016-04-28T20:38:46Z (GMT). No. of bitstreams: 1 Mariana Sarkis Braz.pdf: 618893 bytes, checksum: 1611e2369644aad5db2f2d2aad7695b6 (MD5) Previous issue date: 2013-11-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Palliative care seek quality of life based primarily on prevention and relief of suffering of patients who have life threatening diseases, encompassing the areas of physical, psychosocial and spiritual. Furthermore, extending the post-mortem patient, it offers support the family support in the grieving process. The theme provides discussions of education for death and dying process for health care professionals who are educated mostly geared towards the enhancement of technical knowledge at the expense of a humanist education, which removes the theme of death as the focus of learning. This qualitative study aimed to understand and analyze the training of professionals in relation to dying patient and their perception regarding their contributions to the prevention of complicated grief care unit. The Attachment Theory grounded this research theoretically, providing support for the analysis. Health professionals who integrate palliative care teams voluntarily participated in this research . A questionnaire was used to obtain academic and professional data, besides courses taken. A semi-structured interview allowed us to understand the following topics: the choice of working in palliative care, the strategies used (by oneself and by the care unit) on a daily basis to deal with the issue of the dying process and the perception of its contribution to the prevention of complicated grief of patient and family. The results confirmed that the training of professionals in relation to the dying process is scarce. Moreover, it was observed that health professionals working in palliative care have attachment behaviors, identified as natural in this context, and that ends up to make it harder to realize that those are important contributions to prevent grief from becoming complicated in the care unit / Os cuidados paliativos buscam qualidade de vida baseada principalmente na prevenção e no alívio do sofrimento de pacientes que possuem doenças ameaçadoras de vida, englobando as esferas de ordem física, psicossocial e espiritual. Além disso, estende-se ao pós-morte do paciente, oferecendo suporte e apoio à família no processo de luto. O tema proporciona discussões acerca de educação para morte e processo de morrer para os profissionais de saúde, que têm uma formação em sua maioria voltada para a valorização do saber técnico em detrimento de uma formação humanista, o que afasta o tema da morte como foco de aprendizado. Esta pesquisa qualitativa teve como objetivo compreender e analisar a formação dos profissionais em relação ao processo de morrer do paciente e as percepções daqueles em relação às suas contribuições para a prevenção de luto complicado da unidade de cuidado. A Teoria do Apego fundamentou teoricamente esta pesquisa, oferecendo respaldo para a análise. Participaram voluntariamente desta pesquisa profissionais de saúde, que integram formalmente equipes de cuidados paliativos. Foi utilizado um questionário auto-aplicativo para obtenção de dados acadêmicos, profissionais e de cursos realizados e uma entrevista semiestruturada, que permitiu compreender os seguintes tópicos: a escolha de trabalhar em cuidados paliativos; as estratégias utilizadas (para si mesmo e para com a unidade de cuidado) no dia a dia para lidar com a questão do processo de morrer e a percepção sobre a sua contribuição para a prevenção de um luto complicado de paciente e família. Os resultados confirmaram que a formação dos profissionais em relação ao processo de morrer é escassa. Ademais, observou-se que os profissionais de saúde que trabalham em cuidados paliativos possuem comportamentos de apego, os quais são identificados como naturais nesse contexto, o que acaba por dificultar a percepção de que são importantes contribuições para a prevenção de luto complicado da unidade de cuidado

International studies of disasters indicate the risk for developing posttraumatic stress reactions among survivors is high. Modern life implicates increased traveling. During the last decades a large number of Swedish citizens were confronted with disasters taking place outside of their country. The prevalence of trauma reactions in a population that does not  normally  experience natural disasters, but are able to return to a community unaffected by the catastrophe, is not well studied. In addition, the effects of bereavement after traumatic circumstances have not been satisfactorily explored. Longitudinal studies on the effects of natural disasters are underrepresented and there are few studies investigating the course of recovery after traumatic exposure. The aim for this thesis was to examine long-term post-traumatic stress reactions, mental health, and complicated grief after disaster exposure and traumatic bereavement.  Data from returned questionnaires were analysed from bereaved Italian and Swedish relatives 18 months after the Linate airplane disaster 2001, and at 14 months and three years from Swedish travelers returning from Southeast Asia after the 2004 tsunami disaster, and from home staying bereaved relatives within the second year after the tsunami disaster. The main outcome measures were GHQ-12, IES-R and Inventory of Complicated Grief. The findings indicated many survivors were resilient and had ability to recover, but severe exposure to a disaster had considerable impact on psychological distress. Life threat was associated with higher levels of post-traumatic stress reactions, and increased the risk for affected mental health and suicidal ideation. Loss in combination with severe life threat exposure indicated a further increased risk of posttraumatic stress reactions and for complicated grief; this should be considered a substantial risk factor for general mental health. Loss of close relatives, especially loss of children, was associated with higher levels of posttraumatic stress and created a greater risk for complicated grief. Many survivors recovered over time; however, severe exposure and traumatic loss appeared to slow the recovery process. The findings have implications for government and health agencies, regarding the importance of knowledge and awareness of these risks for health, and for organizational structure, training, and accessibility of support and adequate treatment.

In this study we are verifying aplicability of the tool BNAT for the target group of people with severe, multiple disability and autism in social residential facilities. Next we comment the tool. The research has been conducted by means of interviewing primary care workers. Based on the results of qualitative analysis of interviews we had commented BNAT tool and suggested adjustments, leading towards usability in residential facility conditions, considering target group. The contribution of the study is based on verifying of practicality of the tool that is mapping the needs of users in the moment of loss. The significance is foremost for workers who lead individuals with intellectual disability through the loss of the loved one.

Indiana University-Purdue University Indianapolis (IUPUI) / This essay explores a broad range of literary works that treat long-term grief as a natural response to the death of a child. Literary examples show gaps in the medical and social sciences’ considerations of grief, since these disciplines judge bereaved mothers’ grief as excessive or label it bereavement disorder. By contrast, authors who employ the ancient storyline of child death illuminate maternal grieving practices, which are commonly marked with a vigilance that expresses itself in wildness. Many of these authors treat grief as a forced pilgrimage, but question the possibility of returning to a previous state of psychological balance. Instead, the mothers in their stories and poems resist external pressure for closure and silence and favor lasting memory. Harriet Beecher Stowe, in Uncle Tom’s Cabin, and Emily Dickinson, in letters to bereaved mother Susan Gilbert Dickinson and in the poetry included in these letters, represent maternal child loss as compelling a movement into a new state and emphasize the lasting pain and disruption of this loss.