Prenatal twin-less twins: The congenital loss experience of individuals who lost a twin sibling in utero.

Congenital loss involves the loss of an immediate family member, specifically a parent or sibling, either during or prior to birth, and bears unique bereavement-related challenges. The current study investigated the unique congenital loss experiences of those who lost a twin sibling in utero. Through analysis of interviews with 18 Jewish Israeli participants who encountered this type of twin loss, a more comprehensive understanding of their experiences was attempted. The research employed a hybrid methodology, combining two qualitative thematic analysis methods: deductive and data-driven inductive approaches. The analysis revealed four themes: incoherency and uncertainty, ownership over a limited story, continuing an unborn bond, and the identity of a "twin-less" twin. The findings underscore the unique nature of twin loss in utero.

Parent-child triangles and family loyalties as psychological arenas of grief manifestation among adults who lost a parent at a young age.

The current qualitative interpretative phenomenological study explored the intricate experiences of Israeli adults who lost a parent during childhood and subsequently navigated the challenges of adapting to a stepfamily dynamic. Through semistructured interviews, nine participants revealed three key themes: "Unbreakable Bonds: Loyalty to the Deceased Parent," illustrating efforts to preserve the original family structure amid changes; "Replacement Bonds: Loyalty to the New Parent," depicting the loyalty conflicts arising when connecting with a stepparent; and "Harmonic Bonds: Loyalties to All Three Parents," showcasing instances in which bereaved children successfully maintained connections with their deceased parent while forming meaningful relationships with their stepparent and living biological parent. The study findings informed a model elucidating the dialectical stance family members may adopt in response to such complexities. The model emphasizes the prioritization of orphaned children's emotional needs in a pyramid-shaped family structure, in which the psychological presence of the deceased parent remains integral.

Navigating the paradox: Strategies utilized by pregnant widows in an attempt to reconcile life and death.

Losing a spouse is a traumatic experience, especially at a younger age. This experience is arguably more intense and complex if the woman becomes a widow while pregnant. In the current study, we examined the strategies Israeli women who became widows while pregnant utilized to reconcile life and death. Twelve adult women who became widows while pregnant participated in this study, which involved in-depth semi-structured interviews. A thematic analysis of the interview content revealed four main strategies utilized to reconcile their simultaneous paradoxical experience of both life and death: Passiveness - focusing on neither life nor death; Segregation - focusing on either life or death; Continuum - perceiving life and death are the same; and Integration - coming to terms with both life and death. The women commonly utilized multiple strategies while navigating this paradox, with most participants using all four at some point during their attempted reconciliation process.

Congenital loss: Loss of an immediate family member prior to or during one's birth.

The loss of a family member is often conceptualized as a disruption in one's life story. However, when a loss occurs prior to, or during, one's birth, the bereaved life stories are not interrupted by the loss, but rather begin with loss. The paper offers a new conceptualization of these losses as "congenital losses" and captures the core aspects of this phenomenon. A qualitative phenomenological analysis of 34 in-depth semi-structured interviews with offspring and siblings whose family members died before/during their birth revealed four main challenges presented by congenital loss: incoherency and fragmentation; story-ownership; bond-establishment, and; identity challenges.

Intolerance to uncertainty and self-efficacy as mediators between personality traits and adjustment disorder in the face of the COVID-19 pandemic.

In April 2020, early in the COVID-19 outbreak, governments restricted public gatherings and ordered social distancing. These demands led to challenging adaptations, which in some cases resulted in mental health issues, including adjustment disorder. Guided by the transactional stress model, the current study aimed to examine the relations between personality traits and adjustment disorder in crisis situations and vagueness and the role of intolerance to uncertainty and self-efficacy in these relations. During Israel's first lockdown, 673 Israeli adults completed self-reported e-version questionnaires regarding Big Five personality traits, adjustment disorder, intolerance to uncertainty, self-efficacy, and background variables. The study was designed to examine the association between personality traits and adjustment disorder and the potential mediation of intolerance to uncertainty and self-efficacy in associations. The findings revealed that intolerance to uncertainty and self-efficacy mediated the association between personality traits and adjustment disorder. The results are consistent with the transactional stress model. They shed light on the role of intolerance to uncertainty and self-efficacy as cognitive mechanisms that promote the development of adjustment disorder. Recommendations for future studies and practice are discussed.

Adjustment Disorder in the Face of COVID-19 Outbreak: The Impact of Death Anxiety, Media Exposure, Fear of Contagion and Hypochondriasis Symptoms.

Based on the theoretical view of Terror Management Theory, the current research examines whether higher levels of death anxiety symptoms, in the face of the COVID-19 outbreak, increase the extent to which participants are exposed to information regarding the spread of the pandemic, as well as the fear of contagion and symptoms of hypochondriasis, which all in turn increase symptoms of adjustment disorder. A total number of 302 participants filled out self-report questionnaires regarding death anxiety, adjustment disorder, the extent of exposure to information regarding COVID-19, fear of contagion, hypochondriasis, and demographic information. Structural Equation Modeling analysis indicated a very good fit of the theoretical model with the data, confirming the mediation effect of exposure to information, fear of contagion, and symptoms of hypochondriasis on the association between death anxiety and adjustment disorder symptoms. Implications for practice are discussed.

Neither here nor there and a little bit of both: The ambiguous loss experience of parents who lost a baby to sudden infant death syndrome.

Losing a baby to Sudden Infant Death Syndrome (SIDS) triggers a severe loss reaction. The severity of the loss may be attributed to the baby's age, the lack of satisfactory explanation for the death, and a lack of social recognition. The current study aimed to examine the loss experience of Israeli parents (N = 12) who lost a baby to SIDS through the theoretical lens of ambiguous loss. A deductive and inductive thematic analysis revealed that, for these bereaved parents, entities of the baby-physical and psychological-are unclear. Thus, the parents' loss is likewise unclear and ambiguous.

"You did not desert me my brothers in arms": The continuing bond experience of men who have lost a brother in arms.

This qualitative study provides an in-depth account of the continuing bond experience of bereaved Israeli men who have lost a comrade with whom they served in mandatory military service (a brother in arms). Our study findings indicate that bereaved men experienced continuing bond relationships with their deceased brothers in arms on two axes-an internal axis and an external axis. Together, the two axes connected the bereaved to the deceased. Furthermore, the bereaved constantly (re)negotiated these connecting axes vis-a-vis Israeli social norms and expectations. Implications for practice are outlined.

"Out of the Depths Have I Called Thee": Jewish Israeli Undertakers' Management of Death Anxiety.

According to Terror Management Theory, there are three common buffers that minimize the anxiety of mortality salience: affirmation of one's cultural worldview, the self and one's personal values, and one's significance in the context of close personal relationships. The current study aimed to explore the manner by which Jewish Israeli undertakers manage their constant exposure to death and buffer against death anxiety. A deductive and inductive thematic analysis captured a dialectical movement between, and within, two conflicting worldviews participants were engaged in, in their attempt to manage the mortality salience effect they experience and buffer against death anxiety.

"Empty Chairs at Empty Tables": Disenfranchisement by Association.

The rise in research publications over the last few decades about disenfranchised grief has deepened our understanding of this field. Importantly, it raises awareness and validates human experiences of bereavement, which are often socially ignored, muted, and stigmatized. However, while researchers in the field actively engage in the task of "enfranchisement," as they present their work at scientific conferences, they might experience what we term disenfranchisement by association in the academic sphere. Based on our own experience, this article will demonstrate the parallel pathways between disenfranchisement of bereaved individuals and disenfranchisement of disenfranchised grief researchers, as it emerges in three main expressions of disenfranchisement: reluctance to listen, shame and guilt inflicting, and demand for euphemism. A conclusive note on how to address this kind of disenfranchisement is suggested.

Meanings attributed by bereaved unmarried intimate partners of fallen soldiers to their loss.

The death of a partner may be stressful for unmarried intimate partners as they lack legal status vis-à-vis the partner, and, thus, lack sufficient cultural support. This qualitative study examined the meaning attributed to the loss by 12 Israeli bereaved intimate partners of fallen soldiers. Through applying a constructivist-narrative methodology, we derived three clusters from interviews with the intimate partners: (a) The relationships never ended - "an unfinished business," (b) The need to conceal the relationships - "a hidden wound," and (c) The relationship guides their lives - "a compass." Practical implications were discussed.

"If only ": Counterfactual thinking in bereavement.

When grief over the death of a loved one becomes complicated, protracted and circular, ruminative counterfactual thinking in which the bereaved relentlessly but vainly seeks to somehow reverse the tragedy of the loss often plays a contributory role in sustaining the person's suffering. In this article we summarize the growing evidence implicating this cognitive process in interfering with meaning reconstruction following loss, and identify four foci for counterfactual, "if only" cognition, directed at the self, the deceased, relevant others, or the circumstances of the death itself. We then illustrate each with an actual case vignette, along with approaches to resolving, dissolving, mitigating, or redirecting such rumination, and conclude with a general principle of practice for other therapists whose clients struggle with similarly anguished and entrenched counterfactual preoccupations.

Designing in-depth semi-structured interviews for revealing meaning reconstruction after loss.

The recent upsurge in the use of qualitative empirical studies, aiming to provide a deeper understanding of human reactions to loss, requires a methodological account of how to conduct better qualitative research with regard to data collection. This paper offers six general interview guidelines aimed at assisting researchers to achieve quality interviews in qualitative bereavement studies, based on the theoretical framework of meaning (re)construction in loss.

Death anxiety and psychological distress post-donation in non-directed living kidney donors.

The current study sought to assess death anxiety and psychological distress among kidney donors, in comparison to a control population. Seventy-eight non-directed living kidney donors were recruited through the Israeli voluntary kidney donation association. This sample was compared to 396 participants from a control population. The results revealed that non-directed living kidney donors had higher levels of death anxiety in comparison to the control population while their psychological distress was lower in comparison to the control population. The results of this study highlight the importance of relating to non-directed living kidney donors' death anxiety.

Body Perception and Organ Donation: Bereaved Parents' Perspectives.

The view of the body in sociological, psychological, and gender studies may be broadly summarized to three metaphors: (a) the body as a machine, (b) the body as Self, and (c) the body as sacred and sanctified entity. Each of these philosophical views has an impact on organ donation. The current study aimed at revealing body perception of bereaved Israeli parents who agreed to donate organs of their deceased child. A deductive and inductive thematic analysis captured an ongoing perceptual change that bereaved donor parents experienced in their view of the child's body. Parents' ability to move between two positions (the body as Self, the body as a machine) allowed them to agree with and protect their decision to donate as well as to maintain an ongoing bond with their deceased child. The view of the body as scared entity was not evident in the bereaved parents' narratives.

Evoked Death-Related Thoughts in the Aftermath of Terror Attack: The Associations Between Mortality Salience Effect and Adjustment Disorder.

ICD-11 has provided a revised definition for adjustment disorder (AjD). The current study examined whether mortality salience effect, a possible consequence of a terror attack, may serve as a significant predictor associated with each of the AjD subscales. Using an online survey, 379 adult participants were recruited and filled out self-reported questionnaires dealing with adjustment disorder symptoms as well as mortality salience effect. Findings revealed that mortality salience effect was a significant predictor of all AjD subscales. The importance of mortality salience effect for AjD is discussed in light of terror management theory.

Concern and death anxiety during an ongoing terror wave: The moderating role of direct vs. indirect exposure.

The current study examined whether emotional concern over one's security situation is connected with death anxiety during an ongoing terror wave, and whether type of exposure (media exposure vs. contact with witnesses) moderates this connection. A total of 345 individuals, aged 18-70, were sampled during an ongoing wave of terror in Israel and filled out scales measuring death anxiety, concern over security situation, and type of exposure. Results indicated that increased concern was connected with enhanced death anxiety. Moreover, this connection was more pronounced among individuals exposed to the events through the media, in comparison with individuals who had first-hand contact with witnesses.

Social Workers' Perceptions of the Association Between Role Playing Games and Psychopathology.

Whereas role-playing and table-top role-play games (RPGs) have been proven to have potential as therapeutic tools, playing RPGs is often stereotypically associated with social incompetence and psychiatric disorders. Knowledge regarding the stereotype and its implications is very scarce specifically among mental health practitioners. Therefore the present study aimed to narrow this gap in knowledge by examining the perception of Social Workers that are considered to be the forefront of mental health-care, in regard to the association between playing RPGs and mental health. A convenience sample of 130 Social Workers, recruited through social networks (e.g. Facebook, WhatsApp etc.), responded to an on-line survey dealing with their perception of their own knowledge on RPGs, the importance of such knowledge and the association between playing RPGs and mental illness. Results indicated an association between having higher knowledge of RPGs and lower perception of a link between playing RPGs and psychopathology. The study's findings emphasize the false stigma and its potential harmful implication on professionals' practice, especially in the context of intake process and primary diagnostic. The effect of familiarity is also discussed in light of the study's findings. HIGHLIGHTS: • The perception of mental health professionals toward role playing games such as Dungeons and Dragons is understudied. • Social Workers' perception was measured in regard to the connection between use of RPGs and DSM-IV-TR psychopathology. • Greater knowledge of RPGs was found to be associated with lower perception of the connection between use of RPGs and DSM-IV-TR psychopathology.

Mothers' Continuing Bond With the Baby: The Case of Feticide.

The nature of the ongoing bond maintained by the bereaved with the deceased has attracted considerable attention, but studies have generally ignored postdeath relationships when loss occurs in utero. The goal of this research was to reach an interpretive understanding of the continuing bond experience among Israeli mothers who underwent feticide, examining the strategies they use in maintaining a postdeath relationship with a child they did not know, whose death they chose and witnessed, within a social context that ignores their loss and forces them to silence their grief. The results highlight two themes: (a) strategies for relinquishing connection with the baby and (b) strategies for maintaining a postdeath relationship. These processes partially correspond with two theoretical views that shed light on interpretation of the results: the dual process of coping with bereavement and relational dialectic theory. Implications of the results to the practice of health providers are outlined.

The experience of women carriers of BRCA mutations following risk-reducing surgery: A cultural perspective.

In this qualitative study, we examine the experience of 13 Jewish Israeli women carriers of BRCA mutations following risk-reducing surgery. Thematic analysis of in-depth, semi-structured interview texts yielded three themes: (a) dialectic of vulnerability and control, (b) presentation of self as a "normal" woman, and (c) genetic chain of negative life events and guilt. Aspects of Israeli culture impacting participants' experiences are: personal and collective responsibility, the shift toward consumerism, and pro-natal ideology. The findings may be useful for health practitioners working with other nationalities with similar cultural characteristics and to prompt practitioners to explore their own and their patients' perceptions regarding women's risk-reducing surgery and genetic illnesses.