Strategies for Coping With Complicated Grief in Relatives of Patients Who Are Critically Ill: An Observational Single-Center Cohort Study.

BACKGROUND: Relatives of patients who are critically ill who die are at high risk for symptoms of complicated grief (CG) with potential individual and social burdens. The prevalence and predictors of CG, and in particular the involvement of individual facets of relatives' coping strategies, are not well understood. RESEARCH QUESTION: How high is the prevalence and what are the predictors of CG, and how are coping strategies associated with CG symptoms? STUDY DESIGN AND METHODS: In this observational single-center cohort study, relatives of patients who are critically ill who died while in the ICU were surveyed 6 months later, using the Inventory of Complicated Grief (ICG) and the Brief COPE questionnaire, to assess CG symptoms and coping strategies, respectively. Patients' and relatives' characteristics were obtained. The primary outcome was the ICG sum score. RESULTS: Relatives of 89 of the 298 patients who died in the ICU during the study period were included. The mean ± SD ICG sum score was 41.6 ± 10.9. Eighty-four relatives (94.4%) had an ICG score ≥ 25. Multivariable analysis revealed that being a partner significantly affected the ICG sum score (coefficient, 4.9; 95% CI, 1.8 to 8.0; P = .003), as did the coping strategies self-distraction (coefficient, 4.4; 95% CI, 2.5 to 6.3; P < .001), acceptance (coefficient, -4.4; 95% CI, -6.3 to -2.5; P < .001), and self-blame (coefficient, 3.8; 95% CI, 1.4 to 6.3; P = .002). INTERPRETATION: Almost all relatives of deceased patients who are critically ill exhibit symptoms of CG. Relatives' functional and dysfunctional coping strategies may be associated with their CG symptoms. Knowledge of individual relatives' coping strategies may be helpful in supporting them. Adequate supportive interventions should be developed.

Bereavement due to COVID-19 pandemic among school-going adolescents - A cross-sectional study in district Dehradun.

BACKGROUND: Millions of people lost their loved ones due to the COVID-19 pandemic; this dire situation had an impact on almost every aspect of the daily life of every person. However, most of the individuals adapted to their losses nearly 2-10% of the population experienced dysfunctional grief in which adolescents were also affected. Aims and Objectives: Prime objective of the study was to assess dysfunctional grief due to loss from COVID-19 Pandemic among adolescents and to find out the coping strategies used by them to overcome this grief. MATERIALS AND METHODS: The study was conducted among school-going adolescents of District Dehradun. A pre-designed, pre-tested, self-administered, semi-structured questionnaire including socio-demographic details, COVID-19-related questions and Pandemic Grief Scale (Cronbach alpha-0.77) was used in the offline survey. RESULTS: Out of 690 study participants, a total of 151 (21.8%) adolescents lost their loved ones due to the COVID-19 pandemic. Of these, 9.93% were facing dysfunctional grief due to their loss. To overcome this grief, coping strategies used by study participants were mainly phone and internet usage (78%) followed by watching TV (73.8%) and sleeping (68.1%). CONCLUSION: Adolescents who experienced loss and were grieved are more at high risk of developing psychological disorders, particularly depression, anxiety, and physical illness, that might affect their education and overall development. Though to tackle the mental health crisis in the country Tele-Mental Health Assistance and Networking Across States (Tele-MANAS) has been initiated, still there is a lack of clarity regarding the structure and range of services provided by Tele-MANAS centers set up under the National Tele-Mental Health Program (NTMHP). Timely intervention and research to take solid steps to diminish the potential adverse effects of bereavement on adolescents' mental health is necessary.

Nursing Interventions in Primary Care for the Management of Maladaptive Grief: A Scoping Review.

Grief is a natural and self-limited adaptation process to a new reality that emerges after a significant loss (whether real or perceived), with a broad variety of manifestations that exert an impact on a grieving person's health. The study aim was to synthesize the evidence available about the interventions carried out by Primary Health Care nurses, by means of an individual approach to reduce maladaptive grief or maladaptive grief risk. A scoping review was conducted (November and December 2023) through searches in Medline, Cinahl, Web of Science, ProQuest and Scopus using MeSH terms combined with Booleans. Primary research of any design in adult people undergoing grief situations and receiving professional assistance by nurses in the primary, home and community care contexts published after 2009 in English, Spanish or Portuguese languages were included. Excluded publications were those conducted in in-hospital clinical settings and which did not correspond to research designs or the gray literature. The screening process was carried out by two reviewers using the appropriate JBI critical appraisal tools for each design and discrepancies were resolved by a third reviewer. A total of n = 10 studies were included (n = 4 qualitative, n = 2 RCTs, n = 1 quasi-experimental, n = 2 cross-sectional observational, and n = 2 mixed methods). The qualitative studies identified topics and subtopics of professionals' and families' experiences of grief. The observational studies analyzed symptoms and factors associated with the grieving process. Interventions consisted of cognitive-behavioral therapies delivered by psychological specialists who assessed the severity of grief in a range of cultural contexts using different instruments. The evidence retrieved from the studies that address the reduction in maladaptive grief or maladaptive grief risk is not conclusive. There is a need to increase both the number and the methodological quality of studies assessing the effectiveness of Nursing care in Primary Health Care for individuals experiencing maladaptive grief or maladaptive grief risk. Further research should focus on experimental studies, developing specific interventions conducted by nurses to address individual's grief and prevent maladaptive grief.

What do suicide loss survivors think of physician-assisted suicide: a comparative analysis of suicide loss survivors and the general population in Germany.

BACKGROUND: Physician-assisted suicide (PAS) and voluntary euthanasia remain highly debated topics in society, drawing attention due to their ethical, legal, and emotional complexities. Within this debate, the loss of a loved one through suicide may shape the attitudes of survivors, resulting in more or less favorable attitudes towards this topic. AIMS: This study aims to explore and compare the attitudes towards PAS and voluntary euthanasia in a population of suicide loss survivors and the general population, while also considering socio-demographic factors. METHODS: A total of 529 participants, 168 of whom were survivors of suicide loss, completed an online questionnaire on their attitudes (NOBAS) and opinions (open response format) towards PAS and voluntary euthanasia, as well as regarding their legalization in Germany. The analysis consisted of both quantitative and qualitative components. RESULTS: The entire sample showed positive attitudes towards PAS and voluntary euthanasia in terminally ill persons. Participants were more divided in their attitudes towards PAS in the case of a mental health disorder. Individuals without experienced suicide loss were more liberal regarding legalization in Germany and were more likely to understand the wish for PAS. Survivors of suicide loss were mainly concerned about the consequences for relatives. However, differences between both groups are small. DISCUSSION: The experience of a loss by suicide influences attitudes towards PAS and voluntary euthanasia. Both groups showed an accepting attitude towards PAS and voluntary euthanasia, but also expressed concerns and fears regarding easy accessibility and consequences for grieving relatives.

Grief on pain and quality of life in combat veterans with PTSD.

Background: Persistent Complex Bereavement Disorder (PCBD) comprises a set of grief symptoms that are often linked to other psychological conditions such as PTSD and depression, may be prevalent in Veterans with combat experience, and may also impact general health.Objective: This study investigated the association between grief and sleep, pain, PTSD, and depression, among Veterans participating in a clinical trial for PCBD treatment.Method: Data from 155 Veterans receiving treatments for PCBD were analysed to explore the association between PCBD and symptoms of sleep pain, PTSD, and depression. Veterans experiencing grief reported symptoms related to physical health, emotional problems, energy, and fatigue, emotional well-being, social functioning, presence of pain, and general health. PCBD appeared to have a specific association with pain and physical functioning, independent of other variables.Conclusions: This study examined the potential independent association of PCBD on physical and mental health in Veterans with PTSD. PCBD appeared to have a very specific and significant association with pain and physical functioning. In other words, the pain of grief was related to ratings of physical pain. Future research on PCBD should address the potentially bidirectional association with bodily pain, particularly chronic pain, in relation to loss, with specific attention to potential mechanisms underlying this relationship.

This study explored the distinct relationship of PCBD on aspects of physical, as well as mental health among Veterans with Persistent Complex Bereavement Disorder (PCBD).Findings underscore the importance of addressing comorbid conditions of PCBD, such as PTSD, emphasising the need for tailored approaches that consider this intricate interaction between grief and other mental health and even physical health conditions.This study calls for further research into the mechanisms underlying the relationship between PCBD and bodily pain and physical functioning as the most affected areas associated with PCBD.

Atrophy in the supramarginal gyrus associated with impaired cognitive inhibition in grieving Chinese Shidu parents.

Background: The loss of an only child, known as Shidu in China, is a profoundly distressing experience, often leading to Prolonged Grief Disorder (PGD). Despite its impact, the structural brain alterations associated with PGD, potentially influencing cognitive impairments in Shidu parents, remain understudied.Objective: This study aims to identify brain structural abnormalities related to prolonged grief and their relation with cognitive inhibition in Shidu parents.Methods: The study included 40 Shidu parents and 42 non-bereaved participants. Prolonged grief was evaluated using the Prolonged Grief Questionnaire (PG-13). We employed voxel-based morphometry (VBM) and diffusion tensor imaging (DTI) to assess brain structural alterations and their correlation with cognitive inhibition, as measured by Stroop interference scores.Results: Findings suggest that greater prolonged grief intensity correlates with reduced grey matter volume in the right amygdala and the left supramarginal gyrus (SMG). Additionally, enhanced amygdala-to-whole-brain structural connectivity showed a marginal association with prolonged grief, particularly with emotional-related symptoms. Furthermore, a decrease in SMG volume was found to mediate the relation between prolonged grief and Stroop Time Inference (TI) score, indicating an indirect effect of prolonged grief on cognitive inhibition.Conclusions: The study provides insight into the neural correlates of prolonged grief in Shidu parents, highlighting the SMG's role in cognitive inhibition. These findings emphasise the need for comprehensive grief interventions to address the complex cognitive and emotional challenges faced by this unique bereaved population.

The Shidu parents had a delay in cognitive inhibition when performing the Stroop test, compared to the control group.Prolonged grief intensity was linked to decreased grey matter in the right amygdala and a potential increase in amygdala-to-whole-brain structural connectivity. These volumes were associated with prolonged grief symptoms related to emotions.A higher level of prolonged grief was also associated with reduced grey matter volume in the left supramarginal gyrus, mediating the relationship between prolonged grief and Stroop Time Inference score, which indicates cognitive inhibition.

Redemption or Manipulation? Revisiting the Art of a Serial Killer-A Dialogue.

This article revisits an ongoing dialogue between the co-authors, examining their divergent perspectives on whether the art of serial killers was used to perpetuate their psychopathic cycles after their murderous sprees were interrupted, or whether the art-particularly a piece done by one serial killer, Glen Rogers-reflects remorse and redemption. The two art therapists draw from their own clinical and professional experiences to argue their respective outlooks. After explaining what art therapy is, re-examining the concept of murderabilia, and underscoring psychopathy, this article provides an in-depth evaluation of two art pieces done by the serial killer through both of their viewpoints. Ultimately, while neither author completely changed their overall conclusions, elements from both sides of the argument were found relevant. Ultimately, this article emphasized the chaotic and messy connections between art and violence, yet through new perspectives explored on the complexities and motivations within the mayhem, mutual understandings emerged.

Community engagement in a seaside town: evaluation of Good Grief Weston festival.

Background: Festivals play an important role in improving death and grief literacy, enabling members of the public to engage with these often-sensitive topics. Good Grief Weston festival was co-designed and delivered with the community in Weston-super-Mare, a coastal town in South-West England with high levels of socioeconomic disadvantage but rich community assets. It was held in person over 8 days in May 2023. Objectives: To evaluate the reach and impact of Good Grief Weston festival and gather data to inform future festivals. Design: Mixed methods evaluation (survey and focus groups). Methods: Online and paper surveys assessing participants' characteristics and experiences were administrated during and after the festival. Survey participants who indicated their willingness to participate were invited to attend a focus group. Focus groups were recorded, transcribed and analysed using thematic analysis. Data were collected by trained community co-researchers. Results: Approximately 3000 people attended the festival. Of 204 completed surveys, 64.5% were from women, age range ⩽15 to ⩾75 years; 88.2% identified as White; 14.9% deaf, disabled/with a chronic condition; 18.9% neurodivergent; 9.0% gay, bisexual or queer. Festival participants were entertained (70.9%), inspired (68.5%), felt part of a like-minded community (54.3%), talked to someone new (49.2%), learnt about grief/bereavement (34.3%), shared or expressed experiences (30.3%) and found out about local support (19.7%). 71.3% reported that they felt more confident talking about grief after attending. Median experience rating was 5 (IQR 0; possible range 1 = poor to 5 = excellent). In free-text comments, participants expressed appreciation for the festival and described benefits in attending. Two focus groups were conducted (n = 8 participants, all women), lasting c.1.5 h. Focus groups added rich descriptions of the festival's value, and data to inform the next festival. Conclusion: Findings suggest festivals of this nature can play a central role in a public health approach.

What was the impact of Good Grief Weston festival? Why was the study done? Previous studies have shown that many people feel unsupported by their community after the death of a loved one. We designed a festival to improve knowledge and support for bereaved people. We did this study to assess how the festival affected the people who attended. What did the researchers do? The team included researchers and people and organisations from the local community. Together, we designed and ran a festival on the topic of death, grief and bereavement in Weston-super-Mare, a coastal town with areas of high deprivation. The festival took place over an eight-day period in May 2023 and included creative, interactive and educational events. The team collected feedback on attendees' experiences of the festival. We did this using online and paper feedback forms, postcards, and focus groups to collect as many opinions as possible. What did the researchers find? We found that a wide range of people attended the festival. Most people who took part in the research rated the festival as 'excellent'. They told us they learnt about grief and bereavement and found out about local support services. Attendees met new people, shared their experiences, and felt that the festival built community spirit. They also made suggestions to improve any future festivals. What do the findings mean? The findings show that in-person festivals can effectively engage the public on the topic of death, grief and bereavement. They can also help develop connections between people and organisations in communities. These connections and learning opportunities may help communities to support their members through bereavement.

Prolonged Grief, Posttraumatic Stress and Depression Symptoms Before and After COVID-19 in Brazil.

This study aims to explore the differences in prolonged grief (PDG), posttraumatic stress (PTSD), and depression symptoms (MDD) following the loss of a loved one before and after the COVID-19 pandemic. Using a cross-sectional design, 888 bereaved individuals were classified on different groups according to the cause of death. Results indicate that participants who experienced a loss during the pandemic, regardless of the cause, presented higher levels of prolonged grief, posttraumatic stress and depression when compared to those who lost a loved one before the pandemic. This study sheds light on the environmental influences (ex: the COVID-19 pandemic) on the grieving process, emphasizing the need to take the context into account when tailoring interventions in bereavement and mental health care.

Healthcare Workers and Patient Loss During the COVID-19 Pandemic: Interaction Between Grief, Viral Anxiety, and Depression.

OBJECTIVE: Coronavirus disease-2019 (COVID-19) had a significant impact on the mental health of healthcare workers. Related assessments should be included in plans for future pandemics. We investigated the connections between grief, viral anxiety, depression, and preoccupation in the context of COVID-19 in healthcare workers, to determine which factors will need to be incorporated. METHODS: A total of 267 healthcare workers who had experienced the death of at least one patient during the COVID-19 pandemic were asked to respond to questionnaires assessing grief, viral anxiety, depression, loneliness, and preoccupation with COVID-19, based on their emotional state during the 2 weeks immediately after the death. Multivariate linear regression, causal mediation analysis and structural equation modeling were used to examine the psychological processes underlying grief. RESULTS: Linear regression showed that viral anxiety (ß=0.287, 95% confidence interval [CI]: 0.235-0.338, p<0.001) and depression (ß= 0.157, 95% CI: 0.073-0.241, p<0.001) had independent associations with preoccupation with COVID-19. Causal mediation analysis revealed that both viral anxiety (proportion mediated: 0.51, 95% CI: 0.37-0.66, p<0.001) and depression (proportion mediated: 0.77, 95% CI: 0.50-1.08, p<0.001) were mediators between grief and preoccupation with COVID-19. In a structural equation model, viral anxiety and depression mediated most of the effects of grief on preoccupation with COVID-19, and loneliness was a mediator between grief and depression. CONCLUSION: Contingency plans for the next pandemic are being formulated. Effective measures to protect the mental health of healthcare workers should be included, and such measures should consist of assessments for grief, viral anxiety, depression, and loneliness.

Interpersonal Psychotherapy: A Review of Theory, History, and Evidence of Efficacy.

Interpersonal psychotherapy (IPT) is an empirically validated treatment for mood disorders, anxiety disorders, eating disorders, and trauma. IPT is based on the concept of "relational frame"-that an individual's experience of psychological distress impacts those around them, and that their social support network impacts the distressed individual. This concept, along with the specific techniques and tools that flow from it and the theoretical bases of IPT (attachment and interpersonal theory) make IPT unique. In this article we review the theoretical bases of IPT (attachment and communication) and provide a brief history of IPT, as well as the evidence supporting its use for a variety of disorders. We also describe its application to groups, adolescents, and other diverse populations. Future directions for research and treatment development are proposed, particularly research in the area of combining IPT with other psychotherapeutic modalities.

Understanding the needs for support and coping strategies in grief following the loss of a significant other: insights from a cross-sectional survey in Sweden.

Background: Grief has previously been described in pathological terms, characterized by several stages. In the past three decades, new perspectives on grief as a reaction to the loss of a significant other have emerged. It shows that grief is an individual process based on circumstances surrounding the death and the bereaved person's life situation, rather than being predetermined. Objective: The aim of the study was to show how grief is perceived by people who have lost a significant other, and it focuses on bereavement support, how the death affects the bereaved person's living conditions, how the bereaved person deals with grief, and if grief is expressed differently depending on whether it was an expected death (ED) or an unexpected death (UED). Design: A cross-sectional design was used with data collected anonymously using an online survey with semi-structured answers and options for participants to add their own comments, and it was analyzed descriptively. Result: Support in grief was mainly given by family and friends, and the perceived need was primarily for emotional support or emotional support combined with practical support, and to a greater extent for UEDs and women. For some bereaved persons, health caregivers and religious institutions provided support outside their own network. Grief can affect how people socialize with others and change social relationships. People can deal with grief in social as well as religious ways in the company of friends, through everyday conversations, spending time in nature, and having a spiritual outlook on life, and with the help of pets. Conclusion: The results can contribute to an increased understanding of grief after the loss of a significant other and how grief affects the bereaved person's life depending on whether it is an ED or a UED. There was a difference between the genders, with women perceiving a need for and receiving different forms of support and to a greater extent than men.

Understanding support and coping in grief Grief has long been described as a mental health disorder and characterized by multiple stages. In the last three decades, research has shown new perspectives on grief as a normal reaction to the loss of a significant other. It has shown that grief is an individual process based on the circumstances surrounding the death, the bereaved person's social life situation, different forms of support and how the bereaved person deals with their changed life situation. The aim of this study was to investigate what support in grief can look like and the coping strategies that are used. The grieving process can vary depending on how the death affects the bereaved person's living conditions, how they deal with grief, and whether it was perceived as an expected death (ED) or an unexpected death (UED). The study took the form of an online survey with data collected as anonymous semi-structured answers, with options for participants to add their own comments, and it was analysed descriptively. The results showed that support in grief was mainly provided by family and friends, regardless of whether it was an ED or a UED. For some bereaved persons, health caregivers and religious institutions provided support outside their own network. The participants mainly reported a need for emotional support and emotional support combined with practical support. Grief can influence how people socialize with others and lead to changes in social relationships. People can cope with grief in social and religious ways, by socializing with friends, and through everyday conversations, spending time in nature and having a spiritual outlook on life, and with the help of pets. The conclusions drawn from the results can contribute to a greater understanding of the bereavement of a significant other and how grief influences the life circumstances of a bereaved person in many ways.

A protocol for a pilot randomised controlled trial of unguided internet cognitive behaviour therapy for grief in adolescents.

Grief is highly prevalent in adolescents, however, there have been no studies investigating internet delivered cognitive behaviour therapy for grief in adolescents (ICBT-G-A). In this paper, the co-design of an unguided ICBT-G-A intervention is described, and a protocol outlined for a pilot randomised controlled trial of the intervention. Participants will be randomised to the intervention (delivered via eight modules over a four-week period) or a four-week waitlist control. Intervention participants will complete a follow-up assessment at one-month post-intervention (eight weeks from the pre-intervention assessment). The intervention outcomes assessed at pre-intervention, post-intervention and follow-up include wellbeing and symptoms of anxiety, depression, post-traumatic stress, and prolonged grief. User feedback on experiences and acceptability of the intervention will be sought and feasibility assessed via programmatic data on recruitment and attrition.

Perinatal Grief Counseling and Its Effect on Grief Levels in Women Who Underwent Pregnancy Termination: A Comparative Experimental Study.

This study was designed as a two-group pre-test post-test comparative experimental study to examine the effects of grief counseling on perinatal grief levels in women who underwent pregnancy termination before discharge from the clinic. This study was conducted with 70 women who underwent medical termination of pregnancy. The intervention group (n = 35) received perinatal grief care, while the control group (n = 35) received only routine hospital care. In this study, the Introductory Information Form, Perinatal Grief Scale, and evaluation form of the care received were completed. While the perinatal grief level of the intervention group decreased after the application of grief care, a significant difference between the groups was detected only in women with a history of medical termination according to obstetric characteristics (p < .05). The findings obtained from this study showed that perinatal grief care support decreased grief scores on perinatal grief instruments and their sub-dimensions in the intervention group.

"That Is What We Have Left of Her": The Significance of Transitional Objects After the Death of an Infant in a Norwegian Context.

When an infant dies in a neonatal intensive care unit in Norway, healthcare professionals provide bereaved parents with objects intended to help them processing their loss. Such objects can be clothes, blankets, soft animal toys, hand- and footprints, hair, as well as scrapbooks where the short life is documented through text and photo. By interviewing bereaved parents in three focus groups, we investigated the parents' use of these objects. Applying the method of reflexive thematic analysis, we developed three themes from the data material: (i) the importance of preserving objects, (ii) the approach to the objects, and (iii) the ambivalence concerning the objects. Pertinent to all themes was the parents' feeling of ambivalence toward the objects. On the one hand, the parents experienced the objects to affirm parenthood and manifest that the infant existed as a family member. Further, the objects were important in ritualization while according the child its status as deceased. Also, the objects helped the bereaved establish and keep continuing bonds with the deceased and to integrate their traumatic experience of losing a child. On the other hand, the bereaved parents shared that they were ambivalent toward the objects as they stirred up both good and painful emotions. The objects reminded them of their shocking and traumatic loss and the bereaved did not want to be confronted with this all the time. Therefore, through a preference for some objects and indifference toward others as time passed, the parents worked on transforming their bonds with the lost infant.

Personalized fMRI tasks for grief severity in bereaved individuals: Emotional counting Stroop and grief elicitation protocols.

Approximately 7-10% of people experiencing bereavement following a death develop prolonged grief disorder, a psychiatric disorder included in the DSM-5-TR. Prolonged grief disorder encompasses core symptoms of intense yearning/longing for and preoccupation with thoughts or memories of the deceased person experienced to a clinically significant degree for at least the last month, other key associated symptoms (e.g., avoidance, emotional pain), and the death must have occurred at least one year prior to diagnosis. Extant research has shown a relationship between activation in the reward pathway (e.g., nucleus accumbens) and grief severity. To date, functional MRI studies have primarily utilized the Emotional Counting Stroop task (ecStroop) and the Grief Elicitation task to explore these relationships. However, these prior studies are not without limitations, including small sample sizes and absence of a unified task protocol, hindering meaningful comparisons between studies. This protocol paper describes the ecStroop task and the Grief Elicitation task, which will be vital for facilitating multisite studies and enabling comparisons across studies. This will aid to advance the field by identifying neurophysiological measures that may, in the future, serve as potential biomarkers of prolonged grief disorder.

Sibling Bereavement Among Young Indian Adults.

This qualitative study explores the bereavement experiences of 12 surviving siblings in India, focusing on familial, societal, and cultural influences. Six themes emerged: "The Demanding Familial Role," "Isolation That Accompanies the Grief," "Damaging Impact of Society," "Positive Role of Friends and Family," "Support Systems," and "Continuing Bonds." Participants often felt the burden of supporting their parents, leading to personal grief suppression and isolation, exacerbated by societal stigmas. Conversely, empathetic friends, supportive extended family, and professional resources like therapy provided crucial coping mechanisms. Continuing bonds with the deceased offered comfort and connection. The study highlights the need for comprehensive support systems tailored to cultural and societal contexts. It emphasizes the importance of public awareness and education to foster a supportive response to bereavement. Further research with larger, more diverse samples is recommended.

Reflective functioning mediates the relationship between insecure adult attachment and the severity of prolonged grief symptoms.

Background: This study aimed to investigate the mediation role of reflective functioning (i.e., certainty and uncertainty about mental states) in the relationship between insecure attachment (i.e., attachment avoidance and attachment anxiety ) and the severity of prolonged grief symptoms. Methods: A cross-sectional study was conducted with 329 bereaved participants (51.7% females, mean age= 46.94 ± 14.62 years). Participants completed the Prolonged Grief Scale (PG-13), the Attachment Style Questionnaire (ASQ), and the Reflective Functioning Questionnaire (RFQ). Demographic and bereavement-related information were also collected. Results: Certainty about mental states fully mediated the relationship between both the attachment avoidance and attachement anxiety and severity of prolonged grief symptoms. Conclusions: The findings of this study indicate that reflective functioning impairment, specifically certainty about mental states of self and others, mediate the paths from insecure attachment to prolonged grief symptoms. This suggests that improving reflective functioning may contribute to the treatment bereaved individuals at risk of PGD.

Accelerated Resolution Therapy for Early Maladaptive Grief Study Protocol.

The objective of this manuscript is to present the protocol of a study aiming to test the effects of Accelerated Resolution Therapy® (ART) on pre-loss grief and prolonged grief among older adult family caregivers. This study also aims to better understand predictors of response to ART®, and cognitive processes that occur among grieving individuals following ART®. DESIGN: The study is a double-blinded, randomized clinical trial. SETTING: This study takes place at both inpatient and outpatient palliative care and hospice programs at two Mayo Clinic sites. PARTICIPANTS: Participants include older adult (≥ 60 years) immediate family members who are primary caregivers of someone with an advanced illness and life expectancy of less than 12 months. INTERVENTION: Participants are randomized to either the ART® intervention group or the attention control group. In the ART® intervention, caregivers engage in imaginal exposure, lateral eye movements, and imagery rescripting via 4 sessions lasting 1-1.5 hours each. The attention control group receives a standard social work intervention, including education, resources, and active listening, which is matched for time and attention. Both interventions will longitudinally follow caregivers from active caregiving into bereavement. OUTCOMES MEASURED: The primary outcomes of pre-loss grief and prolonged grief will be measured with the Pre-Loss Grief 12 item (PG-12-R) before the care recipient's death, and with the Prolonged Grief-13 (PG-13-R) afterwards.

Exploring the journey of supporters in bereavement support groups: Experiences, sense-making, and social connections.

This study aimed to explore facilitators' experiences in bereavement support groups as they relate to their experiences of personal loss. Semi-structured interviews were conducted with nine facilitators who had experienced such grief, and data were analyzed qualitatively using a modified grounded theory approach (M-GTA). The analysis revealed two categories and nine subcategories: (i) 'Experiences in group activities,' encompassing positive and negative experiences during activities, and (ii) 'Structuring of Meaning,' the process of deciphering for oneself in relation to one's experience of loss and life. These two categories interacted with each other, and it was important for facilitators to find meaning in their activities, loss experiences, and lives for the stable continuation of bereavement support group activities. These findings underscore the importance of facilitators following and supporting the sense-making process.