Psychology - Death Flashcards
Compared to the non-bereaved, bereaved people have
Higher mortality after the loss of a spouse (elderly)
Higher levels of morbidity and mortality (elderly)
Increased risk of accidents
Increased physical and emotional problems - aches and pains, disturbed sleep, panic attacks, depression
Higher suicide rates
Loss
We experience loss when a person we are attached to becomes permanently unavailable
Grief
The human reaction to loss. Acute – integrated – complicated
Bereavement
The psychological processes through which people adapt to loss
Normal grief reactions can be …
Physical
Emotional
Behavioural
Cognitive
What do 85% of bereaved people do
Adapt to a new reality without the deceased by the 2nd year of bereavement
Physical grief response - normal
Fatigue Sleep disturbances Appetite changes Aches and pains SOB Palpitations Restlessness Illness vulnerability Digestive problems
Emotional grief responses - normal
Depression Anxiety Anger Guilt Priming/ yearning Lineliness Sense of detachment Helplessness Numbness
Behavioural grief responses - normal
Crying Irritability Restlessness Searching Social withdrawal Difficulty in fulfilling normal roles
Cognitive repsones in normal grief
Poor conc Short attention span Memory loss Confusion Preoccupation Search for meaning Hallucinations Disturbances of identity
What does the duration and severity of someones grief depend on
1) How attached they were to the diseased person
2) The circumstances of the death (for example was it a sudden, traumatic or unexplained death; was it the death of child)
3) The amount of time to work through anticipatory mourning
4) Previous unresolved losses that the bereaved person might have experienced that can interfere with the process of normal grief
Anticipatory mourning
That is the grief some people go through when they expect the death of someone such as a person with a terminal illness
Theoretical approaches to grief
Phase model
Grief work
Dual-process model
Phases of Grief (Bowlby, 1980)
Initial period of shock, disbelief and denial
Acute grief
Integrated grief
Acute grief
Intermediate acute mourning period of physical and emotional discomfort, yearning and mourning, social withdrawal.
Impact of loss is registered cognitively and emotionally.
Integrated grief
Gradual shift to the ‘restitution’ phase when attention shifts back to reengaging with the world.
Adaptation and recovery
Basis for Phases of grief model
Grief is not a linear process with concrete stages but a fluid process with phases that are overlapping
Grief work model (Worden, 1991)
Describes 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. People who engage with these tasks, adapt better than those who don’t
Tasks of grief
To accept reality of the loss
Experience the pain of loss
Adjust to new environment without the lost person
Reinvest in the new reality
What does the Dual-Process model describe
How people cope with loss and to predict good versus poor adaptation to such a stressful life event
What was the Dual-Process model developed as
Direct response to the idea that we should do ‘grief work’ and go through grief stages before we are able to reengage with the world.
Loss orientated vs restoration orientated
Loss-orientated focuses on confrontation of loss and restoration-orientated focuses on avoidance of loss
Key element of Dual Process model
Oscillation
Coping with bereavement according to this model is a complex process that combines confrontation and avoidance, and oscillation is vital for adaptive coping
What may pathological grief result from
Complete lack of oscillation
Best model for understanding grief process
Dual-process model
How do children express grief
Feeling of sadness – on and off – over a long period of time
Fear of being alone
Anger, boisterous play, nightmares, irritability, bed-wetting
Regression to earlier developmental stages – acting younger than their age, needing more attention, unreasonable demands
When extreme and long lasting, some of these responses indicate poor coping and may require psychological support
Key protective factor for good adjustment in bereaved children
Open and timely communication about death
Time period for normal grief
Adaption and integration over time 6 months
Physical responses - complicated grief
Digestive issues
Fatigue
Depressions
Cognitive responses - complicated grief
Constantly ruminating on death Emptiness Hallucinations of the deceased Suicidal ideation Thinking about the person Self-blame Desire to be with deceased
Emotional response - complicated grief
Intense sadness
Intense distress
Loneliness
Anger
Behavioural responses -complicated grief
Withdrawn Not functioning Unable to work Avoid reminders of loss Lack of social engagement
Diagnosing complicated grief
Unshakeable grief that does not improve over time
Experience persistent and intense emotions or moods & usual, severe symptoms that impair major areas of functioning, or that cause extreme distress
How many people are affected by complicated grief
4% - translates to about 2.4 million current CG sufferers in the UK
CG prevalence in older people
4.8% in 55+
7% in 75-85
Associated condns with CG
Elevated rates of suicidal ideation and suicide attempts
Increased incidence of cancer, htn and cardiac events after several years
Immune disorders and dysfunction more frequent
Increased adverse heath behaviours
Higher health service use and higher sick leave rates
Types of complex grief
Chronic Delayed Disenfranchsied Compounded Anticipatory
Chronic grief
Grief that lasts for a prolonged or extended period
Delayed grief
Grief that has been postponed
Disenfranchised grief
Grief that may be seen as socially difficult to relate to or are negated by others
Compounded grief
Grief that occurs following multiple losses
Anticipatory grief
Grief that occurs prior to a known future loss
Persistent Complex Bereavement Disorders
PCBD
Grief disorder for those who are significantly and functionally impaired by prolonged grief symptoms for at least one month after 6 months of bereavements
Normal grief as a ddx for PCBD
Persistent complex bereavement disorder usually lasts longer, however, interfering with the sufferer’s functioning long after the death.
Depressive disorder as a ddx for PCBD
Persistent complex bereavement disorder shares features like sadness with major or persistent depressive disorder but this depressed mood is characterized by a focus on the loss.
PTSD as a ddx for PCBD
Individuals with post-traumatic stress disorder may suffer intrusive thoughts about a traumatic event, while those with persistent complex bereavement disorder may suffer thoughts about the deceased or the circumstances of their death.
Separation Anxiety Disorder as a ddx for PCBD
Separation anxiety disorder relates to separation from a living individual, whereas sufferers of persistent complex bereavement disorder experience anxiety when separated from the deceased
Pre-loss risk factors for CG
Pre-existing mental health problems or few adequate coping mechanisms
Children and adolescents, young spouses and older people in long-term relationships
Lack of knowledge and info about death
Previous experience of trauma and loss or multiple stressors
Conflict and difficult relationships between the person and the deceased
Risk factors for CG - who loss occurs
The loss is the result of violence, trauma or accident e.g. suicide, accident
Others are unable to offer to offer support and comfort for whatever reason
The person died from an inherited disease or suffered a long illness
The death is associated with stigma, or shame e.g. AIDS
Post-loss risk factors for CG
Inadequate family or community supports or physical and emotional care
Traumatic reminders, anniversaries, and other significant events
Secondary stresses that seriously disrupt family functioning
Further losses or bereavements
Barriers to seeking bereavement support linked to complicated grief
Seeking bereavement support appears to be difficult for older LGBT people in the UK
The complexity of undisclosed relationships and -ve responses from faith communities can result in the bereavement of LGBT people not being acknowledged
Culturally sensitive bereavement support
Migrants in the UK may experience increased loneliness and social isolation following a death of a loved one.
Loneliness exacerbated by previous experiences of upheavals in their lifetime such as migration, revolution, and unhappy marriages
Bereavement for people with Learning Disability
Assessment tool consists of 10 main questions with sub questions with 3 main areas of support - practical issues, social issues, emotional issues
Practical issues - bereavement for people with learning difficulties
Has this person’s ability to communicate with others been affected by this loss?
Social issues - bereavement for people with learning difficulties
What impact has this death had on the person’s familial network?
Emotional issues - bereavement for people with learning difficulties
Does this person recognise their emotions and can they express them?
Treating complicated grief
Combi of talking therapy and medications (SSRI) – cognitive restructuring, psychoeducation, CG-CBT, ACT
Complicated grief group therapy
Self-referrals – better outcomes
Organisations resources for grief
Cruse bereavement care
“End of Life”
Refers to last year of life
“Last days of life”
Usually refers to “active dying” phase and last days to 2 weeks of life
Legislation involving terminal illness
Individuals can refuse treatment where they have the capacity to do so, by they cannot compel a dr to provide interventions
In England and Wales, it is a criminal offence to assist someone to commit suicide
A death can be certified by a dr or may need referral to the coroner under particular circumstances e.g., sudden and unexpected, asbestos, exposure, following surgery
Benefits of talking about end of life
Person talking about dying and end of life preferences can help with acceptance
Psychosocial needs - terminal illness
Good interaction with hcp’s and the quality of professional
Good quality of care systems and procedures (accessibility, rapidity of treatment and other interventions)
Active involvement in treatment and healthcare decisions
Quality info requirements and opportunities
Involvement with social support networks
Managing challenges to self-identify
Carers psychosocial needs - terminal illness
Carers played a crucial role, undertaking vital care work and emotion management
Carer’s success in managing their own psychosocial needs impacts their ability to support the pt
Carers often wanted to be alongside the pt in medical settings, and in receipt of info about treatments and care
