How reminiscing about deceased close others together with continuing bonds relates to grief severity and personal growth: a cross-sectional study with bereaved adults.

OBJECTIVES: One of the reasons why people engage in reminiscences about their past is to maintain intimacy with deceased close others. Although previous research alerts to the negative effects of reminiscence for intimacy maintenance on mental health, little is known about its relation to individuals' reactions to loss (i.e. grief severity and personal growth). In two samples, we focus on time since loss and continuing bonds, to elucidate the role of reminiscence for intimacy maintenance in grief. METHOD: The samples comprised 111 and 198 bereaved adults. All participants rated the frequency of reminiscence for intimacy maintenance and loss-related variables, such as time since loss, continuing bonds, and grief severity. Sample 2 additionally completed measures of personal growth, loss-centrality, and their interconnectedness with the deceased. RESULTS: Reminiscence on intimacy maintenance was positively related to grief severity. This relation was independent of time since loss and partly driven by externalized bonds. Internalized bonds mediated the relation between reminiscence for intimacy maintenance and grief severity (in sample 1) and personal growth (in sample 2). CONCLUSION: Continuing bonds help explain why reminiscing for intimacy maintenance can be harmful in terms of grief severity but also fosters personal growth after the loss.

"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.

Continuing Bonds in Marriage, Death and Divorce: Conceptual and Clinical Considerations in the Relationship to Self and Spouse.

The shift from the detachment model of mourning to the continuing bonds paradigm in bereavement placed relationships to the deceased alongside relationships to the living. This emphasis on the continuation of the connection to the other person after death paradoxically narrowed the gap between relationships in life and after death. We explore and expand the concept of continuing bonds as it is now used in the field of loss and bereavement by comparing spousal relationships in the living, deceased and divorced. The Two-Track Model of Loss and Bereavement is a framework and clinical paradigm that clarifies similarities and differences in these three pair-bond relationships. The focus on continuing bonds adds and deepens theory, clinical and research aspects of assessing spousal relationship for the living as well as the bereaved and divorced.

Bereaved Individuals Attempts to Explain Their Unexplainable Experiences Related to the Death of Their Loved one Through Attribution Thinking.

Continuing bond manifesting as unexplainable experiences reflects bereaved´s attempts to restore connection with the deceased. As an experience unaligned with a person's overall schemas of meaning unexplainable experiences are a source of anxiety that individuals aim to alleviate by attribution thinking. This study describes how bereaved aim to explain unexplainable experiences related to the death of their loved ones. The study analysed 408 narratives of 181 bereaved individuals. Bereaved individuals (1) described the meaning of their experience to be receaving information, emotions or support by the experience and communicating about crossing the boundary between life and death. As (2) reflections on the cause of their experiences bereaved individuals described certain and uncertain explanations of the phenomenon, ruling out explanations and the compatibility or incompatibility of the experience with their prior worldviews. The process of attribution thinking must be perceived as meaningful regardless of the outcome of the bereaved person's reflection.

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.

Continuing bonds following stillbirth: protective and risk factors associated with parental bereavement adaptation.

OBJECTIVE: To investigate any association between expressions of parents' continuing bond with their stillborn baby and bereavement adaptation. BACKGROUND: Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents' everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents' relationship with their stillborn baby, social support for the relationship, and bereavement adaptation. METHODS: Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents' relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation. RESULTS: Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on. CONCLUSION: Key aspects of parents' ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation.

"He's Still There": How Facebook Facilitates Continuing Bonds With the Deceased.

This study explored the processes involved when the bereaved use Facebook to continue bonds with the deceased. Grounded theory was used to analyze Facebook pages and interviews with bereaved Facebook users. Individual attempts at connection, such as posting about the deceased person, were bolstered by others witnessing and replying to the posts. Collective reminiscence occurred through the sharing of memories about the deceased, which sometimes led to learning new things about them. These individual and collective processes helped to maintain and transform a connection with the deceased person, who for some participants was "still there" on Facebook.

"I Want My Loved One Back Virtually": Exploring the Desire of Bereaved People to Create and Maintain Digital Bonds With Their Deceased Loved Ones.

With the rapid development of digital technology in recent years, virtual funerals and the reproduction of deceased persons in digital spaces have become possible. However, few empirical studies have been conducted on this topic. This study assessed the attitudes of bereaved people toward digital bonds with their deceased relatives, and explored related factors. A survey was administered to bereaved, middle-aged Japanese citizens who had lost a first-degree relative within the previous 10 years. The results showed that most respondents did not seek digital bonds, but nearly 20% wanted to be reunited with their deceased in a digital space. The desire to maintain digital bonds was significantly related to other variables, such as the deceased's age and years since their death. Regression analysis revealed that the desire for digital bonds predicted complicated grief 5 months later. The findings suggest that digital bonds may influence post-bereavement maladjustment.

Continuing Bonds in the Existential, Phenomenological, and Cultural Study of Grief: Prolegomena.

The essay makes the case that continuing bonds is a useful perspective for bereavement studies based in existential, phenomenological, and cultural philosophy. First, the idea of continuing bonds has explanatory power for many phenomena in individual and family grief and in the multiple interactions between individual/family grief and larger social/cultural dynamics. Second, in the study of continuing bonds we find concepts that are akin to those in phenomenology and existentialism. Using some of my own scholarship and the scholarship of many others, the essay is structured by themes Edith Marie Steffen and I found in our 2018 anthology on developments in the continuing bonds model in the two decades after it was introduced: Continuing bonds (1) are inter-subjective, (2) are central in constructing meaning, (3) raise questions about the ontological status of our interactions with the dead, and (4) are best understood within their cultural setting.

Prevalence and Phenomenology of Sensory Experiences of a Deceased Spouse: A Survey of Bereaved Older Adults.

Sensory and quasi-sensory experiences of the deceased (SED), also called bereavement hallucinations, are common in bereavement, but research detailing these experiences is limited. Methods: An in-depth survey of SED was developed based on existing research, and 310 older adults from the general Danish population participated in the study 6-10 months after their spouse died. Results: SED were reported by 42% of the participants with wide-ranging phenomenological features across sensory-modalities. In particular, seeing and hearing the deceased spouse was experienced as very similar to the couple's everyday contacts before death. SED were endorsed as positive by a majority of experiencers, and the experiences were often shared with family and friends. Discussion: SED are conceptualized as social and relational phenomena, which may comfort the surviving spouse in late-life bereavement, but also provide tangible help to some experiencers. In clinical practice, SED may be considered a potential resource for the therapeutic grief process.

Fathers' Relational Experiences of Stillbirth: Pre-natal Attachment, Loss and Continuing Bonds Through Use of Objects.

This study aimed to investigate fathers' lived experiences of stillbirth through the lens of continuing bonds and use of objects. Semi-structured interviews were conducted with six fathers who had experienced stillbirth from 20 weeks gestation. Interpretative phenomenological analysis revealed five themes: loss and continued bonds in a mother-mediated dynamic, objects as manifestations of relational and meaningful memories, exerting existence and continued connection to others, continued bond through physical presence and evolving expressions of love and fatherhood. Findings offer a novel understanding of the relationship between objects and continued bonds, where objects are seen to facilitate this bond through varying means, including physical manifestation of the deceased and representation of the father-infant relationship. The study places importance on fathers' involvement in creating objects permeated with meaning and memories, and of validating fathers' experiences of loss rather than considering these men merely as partners of a mother who lost their own baby.

Conflicted or close: Which relationships to the deceased are associated with loss-related psychopathology?

OBJECTIVES: Prior studies have shown that pre-loss closeness and conflict with a deceased person are associated with the severity of symptoms of prolonged grief and/or depression. Nevertheless, mechanisms underlying these relationships are not well understood. We propose a theoretical model in which past closeness and conflict are related to prolonged grief and depression via concrete and symbolic continuing bonds (CB). The aim of our study was to test this model in a sample of bereaved family members. METHODS: Individuals (N = 244) who had lost a family member from 0.5 to 8.0 years before the survey completed the Quality of Relationships Inventory-Bereavement Version, the Continuing Bonds Scale, the Prolonged Grief Disorder-13 scale, and the Patient Health Questionnaire-9. RESULTS: The findings partially confirmed our model. Closeness was positively and moderately associated with symptoms of prolonged grief but not with symptoms of depression. Conflict was positively and weakly associated with symptoms of depression and prolonged grief. All of these relationships were only partially mediated by concrete/maladaptive and symbolic/adaptive CB. CONCLUSIONS: The differences in the relationship of past closeness and conflict to prolonged grief and depression symptoms suggest that inter- and intrapersonal mechanisms of prolonged grief and depressive symptoms may be distinct. If future, especially longitudinal studies, confirm our model, CB would be a possible target for interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience loss-related psychopathology. PRACTITIONER POINTS: Continuing bonds (CB) are a potential target of interventions for bereaved persons who had a close and/or conflicted relationship with a deceased family member and experience symptoms of prolonged grief and/or depression. Internalization of the capacity to care for yourself and feel autonomous in a safe and stable therapeutic relationship may lead to increased self-confidence, promote working through past experiences in the relationship with the deceased, and gradual reduction of concrete forms of CB. Increasing awareness and acceptance of emotional experiences may contribute to the appreciation of past relationship with a deceased person and the growth of symbolic forms of CB. Future research should focus on verifying the effectiveness of the attachment-informed therapeutic approach to working with CB.

Investigation of the relationship between continuing bonds and adjustment after the death of a first-degree family member by using the Multidimensional Continuing Bonds Scale.

OBJECTIVES: The study aims to develop a continuing bonds scale, investigate the relationship between continuing bonds and adjustment after loss, and test the moderating role of meaning reconstruction in this relationship. METHODS: Data were collected from two different samples of 306 (Study 1) and 271 (Study 2) bereaved adults. RESULTS: The four factors structure of the Multidimensional Continuing Bonds Scale (MCBS) was explored and confirmed. Hierarchical regression analysis revealed that continuing bonds showed a significant relationship with prolonged grief symptoms after controlling the risk factors such as gender, age of the deceased, time since loss, and cause of death. Meaning reconstruction moderated the relationship between continuing bonds and prolonged grief symptoms. CONCLUSION: The results revealed that the MCBS can be used as a valid and reliable scale to assess the continuing bonds construct. The relationship between continuing bonds and prolonged grief symptoms varies according to the levels of meaning reconstruction.

The Impact of Continuing Bonds Between Pet Owners and Their Pets Following the Death of Their Pet: A Systematic Narrative Synthesis.

When a pet dies, owners can experience similar levels of grief as when a human dies. Previous research indicates the role of continuing bonds (CB) when a pet is alive. To understand the impact of these bonds after the pet has died, we conducted a systematic narrative synthesis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Findings were heterogenous, yet there were still parallels in the literature. CB can sometimes aggravate and intensify grief experiences, particularly when pet grief is perceived as disenfranchised grief. However, identifying appropriate bonds can be useful to moderate the intensity of grief and be a valuable mechanism of support. CB can also help post-traumatic growth of owners.

"What's Inside of You Now is Just Bones and Skin": The Tension between Restorative Meaning-Making and Deliberate Detachment in Maternal Experiences of Stillbirth.

This article explores the ways in which bereaved mothers framed experiences of continuing bonds with their stillborn child and aims to enrich an understanding of maternal sense-making. Four interviews were carried out with bereaved mothers and approached using Interpretative Phenomenological Analysis, so as to offer deeper insight into their individual experiences. Themes which arose from the analysis include: "Continuing bonds and the female body;" "Conflicted bonding with the shape-shifting baby;" and "Experiencing connection in the life beyond loss." These findings point to a tension between restorative meaning-making and detachment in maternal sense-making following stillbirth and have implications for clinicians working with bereaved mothers.

Ethical Bonds Transformation in Bereaved Taiwanese Families: A Preliminary Study.

Ethical bonds transformation is a cultural phenomenon in Taiwanese bereaved families. When the death event occurs, the absent status of the deceased invokes spontaneous change in whole family to cope with the irreparable loss. In the present study, 283 bereaved individuals were recruited to develop the ethical bonds transformation scale. Exploratory factor analysis has generated two factors: ethical bonds and symbolic bonds. Partial correlation has shown that ethical bonds was positively correlated with post-grief growth and negatively correlated with most of the grief related symptoms, indicating that ethical bonds might be a protective factor in the family grief process.

Still With Me? Assessing the Persisting Relationship to a Deceased Loved-One - Validation of the "Continuing Bonds Scale" in a German Population.

Continuing the bond (CB) to a deceased loved one plays a clinically significant role in grief. We validated the Continuing Bonds Scale (CBS) examining externalized CB (illusions and hallucinations) versus internalized CB (use of the deceased as a secure base) in relation to risk factors of complicated grief and bereavement-related adjustment. Data from 364 bereaved German participants on CBS, Inventory of Complicated Grief (ICG), and Posttraumatic Personal Growth Inventory (PPGI) entered an exploratory factor analysis. This yielded a two-factor-solution representing externalized and internalized CB (KMO = .89, χ2 = 2100.5, df = 120). Both factors demonstrated high internal consistency (Cronbach's α = .87). ICG and PPGI highly correlated with externalized and internalized CB. Cause of death and feelings of responsibility were associated with externalized CB. In the future, the use of the CBS could help predict problems in grief processing and consequently implement early interventions.

Uses and Gratifications of Music in Bereavement: A Qualitative Inquiry.

This study investigates the role of music during bereavement. Music plays a role in peoples' bereavement experiences and gets associated with numerous memories. Despite widespread recognition of the importance of music, little research has considered what bereaved individuals "gain" through their musical selections. This study takes a uses and gratifications approach to analyze interview data about how bereaved individuals incorporate music in their grief journey. Interviews were conducted with 28 participants. Two coders analyzed the data to identify common themes regarding uses of music during bereavement. Data show 5 reasons the bereaved offer for using music: creating connections, co-presence, positive and negative mood management, and projection. The findings demonstrate everyday ways that individuals process their grief in a way that has been largely ignored in the bereavement literature and offer insight into the ways that music can be strategically used by laypeople to process grief.

Bereaved College Students: Social Support, Coping Style, Continuing Bonds, and Social Media Use as Predictors of Complicated Grief and Posttraumatic Growth.

Many college students experience the death of someone close to them and could be at risk for complicated grieving. Their primary sources of support may be unavailable as family members may live far away and their peers may be unprepared to respond to their grief. In addition, college students are exposed to a variety of stressors that could result in maladaptive coping. Furthermore, although most college-aged students use social media, little is known about its impact on grieving. The purpose of this study was to examine the degree to which social support, coping, continuing bonds, and social media use predicted complicated grief and posttraumatic growth in a sample of college students who had experienced an interpersonal loss. Participants (N = 258; 77.5% female, M age = 19.98, SD = 1.41) completed an online survey assessing the aforementioned constructs using Likert-type scales. Findings from two hierarchical regressions indicated that coping variables accounted for the greatest percentage of variance in grieving outcomes with avoidant-emotional coping being the most robust predictor of complicated grief and problem-focused coping accounting for considerable variance in posttraumatic growth (both were associated positively with the outcomes). As hypothesized, continuing bonds explained variance in both grieving outcomes with externalized continuing bonds and maintaining continuing bonds on social media predicting complicated grief and internalized continuing bonds contributing to posttraumatic growth (also all positively associated). Social support from family also was predictive of posttraumatic growth in the positive direction. Future research directions and implications for practice are discussed with the hope that this research might inform the development of interventions to assist college students who are grieving.

Comforting Versus Distressing Dreams of the Deceased: Relations to Grief, Trauma, Attachment, Continuing Bonds, and Post-Dream Reactions.

Why are some dreams of the deceased experienced as comforting, while others are distressing? We propose that there are different types of dreams serving diverse functions. In particular, we considered three: processing trauma, maintaining a continuing bond, and regulating emotion. We also examined the impact of post-dream reactions on the bereaved's experience of their dreams. Participants were 216 individuals whose romantic partner or spouse had died. They provided reports of dreams of the deceased that were content analyzed and completed measures of grief intensity, posttraumatic symptoms, attachment style, internalized versus externalized continuing bonds, as well as questions about the death, and ratings of how they experienced the dream after awakening. Support was found for the three proposed functions, suggesting dreams of the deceased can actively facilitate adjustment to bereavement. In addition, there was evidence that post-dream reactions can impact both the perception of the dream and grief.