Describe the process of normal bereavement and pathological grief

Question 1

What is grief and what is bereavement?

Answer 1

Grief: the human reaction to loss

Bereavement: the psychological process through which people adapt to loss

Question 2

What is chronic grief?

Answer 2

grief that lasts for a prolonged or extended period of time

Question 3

What are 3 behavioural responses to complicated grief?

Answer 3

1. unable to work
2. avoid reminders of loss
3. lack of social engagement

Question 4

What is the dual process model used to predict?

Answer 4

good vs. poor adaption to loss

Question 5

What is compounded grief?

Answer 5

grief that occurs following multiple losses

Question 6

According to Bowlby’s phase model of grief, what is the integrated grief phase and what does it consist of?

Answer 6

• it is the gradual shift to the ‘restitution’ phase, when attention shifts back to reengaging in the world
• adaption and recovery

Question 7

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?

1. Acceptance of her loss
2. Oscillation between loss-orientation and Restoration-orientation
3. Experience of pain and grief
4. Seeking specialist support
5. A shift from initial shock to integrated grief

Answer 7

2: oscillation between loss-orientation and restoration-orientation

Question 8

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?

1. Refer Luke to children and young people’s psychological services for support
2. Give Luke a break from school - he needs to stay at home and recover
3. Talk about Luke’s mum openly; explain why she died; share emotions and thoughts
4. Keep a strict routine as a way of maintaining a sense of normality
5. Use distraction as a way of managing emotional pain/distress

Answer 8

3: Talk about Luke’s mum openly; explain why she died; share emotions and thoughts

Question 9

What are 3 emotional responses to complicated grief?

Answer 9

1. intense sadness
2. intense distress
3. anger

Question 10

What are the 4 tasks that lead to a better adaption to loss, according to the grief work model?

Answer 10

1. accept the reality of the loss
2. experience the pain of the loss
3. adjust to the new environment without the lost person
4. reinvest in the new reality

Question 11

What is disenfranchised grief?

Answer 11

grief that may be seen as socially difficult to relate to or are negated

Question 12

What is normal grief?

Answer 12

Adaption and integration to loss over a time, usually 6 months - 1 year

Question 13

What is delayed grief?

Answer 13

grief that has been postponed

Question 14

What is complicated grief characterised by?

Answer 14

1. unshakeable grief that does not improve over time
2. experiences of persistent and intense emotions/moods,
3. that impair major areas of functioning,
4. or that cause extreme distress.

Question 15

What are 3 normal cognitive reactions to grief?

Answer 15

1. poor concentration/short attention span
2. memory loss
3. hallucinations

Question 16

According to Bowlby’s phase model of grief, what is the acute grief phase, what does it consist of, and when does it begin?

Answer 16

• 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

Question 17

What is the difference between normal grief and persistent complex bereavement disorder?

Answer 17

pathological grief usually lasts longer and interferes with the sufferer’s functioning long after death

Question 18

What is the principle of oscillation in relation to the dual process model?

Answer 18

at times the bereaved will confront aspects of loss and other times avoid them

Question 19

When do we experience loss?

Answer 19

when a person we are attached to becomes permanently unavailable

Question 20

What are the 5 types of complex grief?

Answer 20

1. chronic grief
2. delayed grief
3. disenfranchised grief
4. compounded grief
5. anticipatory grief

Question 21

What is loss orientation, according to the dual process model?

Answer 21

when people are preoccupied with their experience of grief

Question 22

What are 3 normal behavioural reactions to grief?

Answer 22

1. crying
2. social withdrawal
3. difficulty in fulfilling normal roles

Question 23

What are 3 physical responses to complicated grief?

Answer 23

1. digestive issues
2. fatigue
3. depressions

Question 24

What are 3 cognitive responses to complicated grief?

Answer 24

1. constantly ruminating on death
2. suicidal ideation/desire to be with the deceased
3. self-blame

Question 25

What does the grief work model describe?

Answer 25

• 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

Question 26

What are the 3 phases of grief according to Bowlby’s phase model of grief?

Answer 26

1. initial period of shock, disbelief and denial
2. acute grief
3. integrated grief

Question 27

What are 3 normal emotional reactions to grief?

Answer 27

1. depression
2. anxiety
3. helplessness

Question 28

What is restoration orientation, according to the dual process model?

Answer 28

when people focus on restoration and on reorienting themselves in a changed world without the deceased person

Question 29

What is anticipatory grief?

Answer 29

grief that occurs prior to a known future loss

Question 30

What are 3 normal physical reactions to grief?

Answer 30

1. appetite changes
2. shortness of breath
3. fatigue

Question 31

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?

1. Re-engagement with aspects of everyday life
2. Worrying about the future
3. Crying and remembering happier times with her husband
4. Being frightened by the thought she is a widow
5. All of these responses are normal reactions to loss

Answer 31

5: all these responses are normal reactions to loss