6. Death, dying and bereavement Flashcards
what is the effect of adjustment?
adjustment to an illness/injury that is life threatening/potentially disabling may require considerable coping effort - it threaten’s the customary view of oneself and it shows that one is vulnerable and that life is uncertain
what is the social cognitive transition model of adjustment?
- experiences shape our mind and expectations - when an expectation isn’t confirmed the first things that happens is protective buffering (denial - we all want to hold on to our assumptions and expectations) - to adapt, there is discomfort and threat - after a while with support people adjust and assumptions are adjusted
what is the self-regulatory model?
- the common sense model of illness self-regulation - the model describes the processes of adaptation internally in someone when they experience symptoms
what are the stages of the self-regulatory model?
STAGE 1: interpretation - what is this? this is processed both cognitively (cause, consequence, time-line, cure) and emotionally (fear, anxiety, depression) the concrete things are implicit things that we have absorbed from the world around us the abstract things are the explicit things that we are told directly and have to consider STAGE 2: coping STAGE 3: appraisal
what is Kubler-Ross’s stage theory for death and dying?
DABDA
- DENIAL - “this isn’t really happening”, lying about the situation, telling themselves it is temporary
- ANGER - “why me?”, rage at the world for letting this happen, feel isolated and furious and think its unfair
- BARGAINING - “if i do this, i can make it better, i can fix things”, may feel guilt and feel its their responsibility to fix problems, make an attempt to strike bargains with God/spouses/parents
- DEPRESSION - “my heart is broken”, intense emotional pain, overwhelmed with feelings of helplessness and sadness
- ACCEPTANCE - “this occurred but i have great memories”, loss is accepted
what are the weaknesses of stage theories?
- prescriptive and place patients in a passive role -
- do not account for variability in response -
- focus on emotional responses and neglect cognitions and behaviour -
- fail to consider social, environmental or cultural factors -
- pathologise people who don’t pass through stages
what is the problem with pathologising?
- distress/depression is not inevitable: many report significant and valuable changes from the experience of illness - “acceptance” may not be achieved - reaching a state of resolution may not be possible - complex cognitive and emotional responses may continue to be present
define bereavement
the situation of a person who has recently experienced the loss of someone significant in their life through that person’s death.
85 per cent of people will usually adjust by the second year of bereavement
what is the dual process model of coping with bereavement?
- there is the idea that the right thing to do is to leave someone behind (get detached) - detachment should not be the objective in bereavement - there is a continuous, balanced process between loss-oriented actions (grief, breaking bonds, relocation, denial) and restoration-oriented actions (attending to life changes, distraction from grief, new roles/relationships)
what are the responses to bereavement?
- immediately after loss some people experience minimal grief while most experience common grief - after 1 or 2 years of bereavement most people will experience minimal grief while some will experience chronic grief (major depression, anxiety, PTSD)
what does the duration of severity of a person’s grief depend on?
- how attached they were to the deceased person - the circumstances of death and the situation of loss - how much time the had to work through anticipatory mourning
when is chronic grief more likely?
- the death was sudden or unexpected - the deceased was a child - there was a high level of dependency in the relationship - the bereaved person has a history of psychological problems, poor support and additional stress
how can grief be better understood?
- further development of cross-cultural theoretical approaches - sound observational testing - more focused efforts to understand those who suffer extremely - continued development of effective psychological interventions to help support those who experience chronic grief
What are 5 myths of coping with loss (wortman and silver)
what are the 5 dimensions of illness represenation
Identity – e.g. ‘I have a cold, with a sore throat and a runny nose’
Cause – e.g. ‘my cold was caused by being run down’
Consequences – e.g. ‘my cold will prevent me from doing sport this week’
Timeline – e.g. ‘my cold will be gone in a few days’
Curability/Controllability – e.g. ‘if I rest my cold will resolve quickly’
Patients’ beliefs about their illness comprise 5 key domains, used to aid understanding of illness and guide a coping response.
