Describe the process of normal bereavement and pathological grief Flashcards
What is grief and what is bereavement?
Grief: the human reaction to loss
Bereavement: the psychological process through which people adapt to loss
What is chronic grief?
grief that lasts for a prolonged or extended period of time
What are 3 behavioural responses to complicated grief?
- unable to work
- avoid reminders of loss
- lack of social engagement
What is the dual process model used to predict?
good vs. poor adaption to loss
What is compounded grief?
grief that occurs following multiple losses
According to Bowlby’s phase model of grief, what is the integrated grief phase and what does it consist of?
- it is the gradual shift to the ‘restitution’ phase, when attention shifts back to reengaging in the world
- adaption and recovery
Three years after the death of her sister, Mary continues to suffer from insomnia. She cries a lot and visits the cemetery at least once a week. She struggles to focus on her work. The circumstances of her sister’s unexpected death continue to play out in her mind. She rarely sees her friends anymore and shows little interest in what she used to enjoy.
According to the dual-process model, what is not happening during this patient’s grieving process?
- Acceptance of her loss
- Oscillation between loss-orientation and Restoration-orientation
- Experience of pain and grief
- Seeking specialist support
- A shift from initial shock to integrated grief
2: oscillation between loss-orientation and restoration-orientation
Luke is 7 years old. His mother died of cancer 6 months ago. He now lives with grandparents who are devastated by the loss of their daughter. They find it impossible to talk about her and everything feels unreal. They visit the GP concerned about Luke’s behaviour. He often refuses to go to school and is not keen to see his friends. He has been wetting his bed at night, and becomes aggressive and breaks his toys out of the blue. he rarely mentions his mum. What would be your first piece of advice to Luke’s grandparents?
- Refer Luke to children and young people’s psychological services for support
- Give Luke a break from school - he needs to stay at home and recover
- Talk about Luke’s mum openly; explain why she died; share emotions and thoughts
- Keep a strict routine as a way of maintaining a sense of normality
- Use distraction as a way of managing emotional pain/distress
3: Talk about Luke’s mum openly; explain why she died; share emotions and thoughts
What are 3 emotional responses to complicated grief?
- intense sadness
- intense distress
- anger
What are the 4 tasks that lead to a better adaption to loss, according to the grief work model?
- accept the reality of the loss
- experience the pain of the loss
- adjust to the new environment without the lost person
- reinvest in the new reality
What is disenfranchised grief?
grief that may be seen as socially difficult to relate to or are negated
What is normal grief?
Adaption and integration to loss over a time, usually 6 months - 1 year
What is delayed grief?
grief that has been postponed
What is complicated grief characterised by?
- unshakeable grief that does not improve over time
- experiences of persistent and intense emotions/moods,
- that impair major areas of functioning,
- or that cause extreme distress.
What are 3 normal cognitive reactions to grief?
- poor concentration/short attention span
- memory loss
- hallucinations
According to Bowlby’s phase model of grief, what is the acute grief phase, what does it consist of, and when does it begin?
- intermediate acute mourning period
- of physical and emotional discomfort, yearning and mourning, social withdrawal
- starts when denial stops and the impact of loss is registered both cognitively and emotionally
What is the difference between normal grief and persistent complex bereavement disorder?
pathological grief usually lasts longer and interferes with the sufferer’s functioning long after death
What is the principle of oscillation in relation to the dual process model?
at times the bereaved will confront aspects of loss and other times avoid them
When do we experience loss?
when a person we are attached to becomes permanently unavailable
What are the 5 types of complex grief?
- chronic grief
- delayed grief
- disenfranchised grief
- compounded grief
- anticipatory grief
What is loss orientation, according to the dual process model?
when people are preoccupied with their experience of grief
What are 3 normal behavioural reactions to grief?
- crying
- social withdrawal
- difficulty in fulfilling normal roles
What are 3 physical responses to complicated grief?
- digestive issues
- fatigue
- depressions
What are 3 cognitive responses to complicated grief?
- constantly ruminating on death
- suicidal ideation/desire to be with the deceased
- self-blame
What does the grief work model describe?
- the cognitive process of confronting the reality of a loss and adjusting to life with this loss
- this process involves tasks of grief rather than stages
What are the 3 phases of grief according to Bowlby’s phase model of grief?
- initial period of shock, disbelief and denial
- acute grief
- integrated grief
What are 3 normal emotional reactions to grief?
- depression
- anxiety
- helplessness
What is restoration orientation, according to the dual process model?
when people focus on restoration and on reorienting themselves in a changed world without the deceased person
What is anticipatory grief?
grief that occurs prior to a known future loss
What are 3 normal physical reactions to grief?
- appetite changes
- shortness of breath
- fatigue
Nine months after the death of her husband, Sue is starting to enjoy simple things in life again. A cup of coffee with a friend, a film, a walk to the park. She often cries when she thinks of the walking holidays she and her husband enjoyed together and realises how much she misses him. She is anxious about sorting out their finances and worries about the future. The idea of being a widow at the age of 45 depresses and scares her. Which of the following options best describes “normal” responses to loss?
- Re-engagement with aspects of everyday life
- Worrying about the future
- Crying and remembering happier times with her husband
- Being frightened by the thought she is a widow
- All of these responses are normal reactions to loss
5: all these responses are normal reactions to loss
