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Samenvatting literatuur loss and psychotrauma
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Literature Loss and psycho traumaBoerner, Stroebe, Schut, Worthman
Bereavement: the objective situation of a person who has experienced the death of someone
significant. This word is derived from the Latin word ‘rupture’ meaning ‘to breath, to carry of to tear
away.
Grief: refers to the emotional experience of the psychological, behavioral, social and physical
reactions the bereaved person might experience as a result of this death. Is derived from the latin
‘gravare’ which means to weigh down.
Mourning: refers to actions expressive of grief which are shaped by social and culture; practices
and expectations. Derived from the Latin ‘memoir’ which means mindful.
It is important to come to terms with personal loss because it is a critical part of successful adult
development. Also, losses tend to accumulate in later life. This place survivors in a state of chronic
stress and undermine their capacity to deal with any particular loss.
Different models and approaches most influential to the current understanding of bereavement and
grief:
1. Classic psychoanalytic view: the primary task of mourning is the gradual surrender of
one’s psychological attachment to the deceased. According to Freud distancing from
someone you love involves a painful internal struggle (missing versus no getting the person
back). He refers to ‘the work of mourning’ as gradually letting go of memories and thoughts
to gradually withdraw from the persons absence. This takes a lot of time and energy. The
mourning is finished when the person freed himself from the intense attachment with the
unavailable person.
Not empirically proven.
2. Attachment theory: Bowlby believed that the biological functions of protest when
withdrawing from a loved one function to reunion. However, with permanent loss the
biological function of retaining proximity becomes dysfunctional. The person struggles
between activated attachment behavior and the reality of the loved one’s absence. To deal
with this Bowlby created 4 stages of grief:
a. Initial numbness/disbelief/shock
b. Yearning or searching for the deceased accompanied by anger and protest, despair
and disorganization as the bereaved gives up the search, accompanied by feelings
of depression and hopeless.
c. Reorganization or recovery as the loss is accepted.
Empirical research confirms the important of attachment security.
3. Stage models of bereavement: Kübler and Ross explains how dying persons react to
their own impending death. It states that people go through denial, anger, bargaining,
depression and ultimately acceptance. Weaknesses of this model are:
a. Do not account for variability in response that follows major loss
b. Place grievers in passive role when in fact grieving requires the active involvement
of the survivor.
c. No consideration of social and cultural factors.
d. Too much focus on emotion, not on cognitions and behavior.
e. Pathologize reactions of the majority of the people who do not cross these stages.
Evidence suggest that reactions to loss vary considerably, few people pass through the
stages in the expected fashion.
, 4. Model of stress response syndromes: Horowitz. Traumatic experiences disrupt a
person’s life via blockage of cognitive and emotional processing. Notion of grief is a
necessary step to recovery. So, the trauma has to be processed before the person will be
able to move on. Failure in processing results in somatic an psychiatric disorders. Major
losses challenge a person’s sense of identity and narrative coherence (=does a story make
sense). To restore coherence between past and future.
Meaning making: to rebuilt shattered beliefs. Making sense of the loss and finding benefit.
evidence is hard because it is difficult to sperate the process from the outcome, beliefs
from adjustment.
5. Stress and coping approach: cognitive coping approach from Lazarus. Stress and coping
theorists maintain that life changes such as death become distressing if a person appraises
the situation as taxing or exceeding his or her resources. Marks the role of cognitive
appraisal.
empirical research: The appraisal of the loss, as well as the magnitude of physical and
mental consequences that result from the loss are thought to depend on protective and risk
factors.
6. Three perspectives on caregiving and bereavement:
a. Cumulative stress perspective “wear and tear”: the combined effects of the
stress of caregiving and the death deplete (=uitputten) peoples coping resources
and result in greater adjustment difficulties following the loss. DEPLETION
b. Stress reduction perspective: death brings relief because it puts an end to the
caregiving. RELIEF
c. Caregivers expect to be bereaved which allows at least some degree of
anticipatory processing and preparation that may benefit the person after death.
ANTICIPATION
Empirical research shows that it is a combination of the three. Also, it is found that high
levels of distress before death are also at risk of adjustment difficulties post death.
7. Bereavement specific theory: To understand individual differences in grieving. He found
four primary components of grieving process:
a. The context in which the loss occurs: sudden or expected, timely or untimely
b. The subjective meaning: was the person resentful or had it had to care prior to the
death.
c. Changes in the representation of the loved one over time: does the bereaved
person maintain a continuing connection with the deceased.
d. The role of coping and emotion reflating processes: negative emotions regulated,
positive emotions investigated and enhanced.
8. Dual-process model of coping with bereavement: Stroebe and Schut. Bereaved
people alternate between two kinds of coping:
a. Loss oriented coping: the bereaved person focuses on and attempts to process or
resolve some aspects of the loss itself. Dealing with intrusive thoughts about the
death is an example of loss-oriented coping.
b. Restoration oriented coping: involves attempting to adapt to or master the
challenges inherent in daily life, including life circumstances that may have
changed as result of the loss (doing new thinks/mastering new skills).
Conclusion: focusing on the symptoms alone does not help us understand why a person’s response
to loss may develop into a derailed adaptation process and perhaps even how this development
could be prevented.
Sareen
4 key features of PTSD have always remained the same:
1. Experiencing or witnessing a stressful event
2. Re-experiencing symptoms of the event that include nightmares and/or flashbacks.
3. Efforts to avoid situations, places, and people that are reminders of the traumatic event.
4. Hyperarousal symptoms, such as irritability, concentration problems and sleep
disturbances.
, PTSD is highly comorbid with other mental disorders aside from trauma exposure, that
differentiates PTSD from other disorders is the re-experiencing symptoms.
Most recent DSM counts a traumatic experience if it is experienced as traumatic, not important
whether it is actually traumatic for everyone.
25% of people with PTSD had delayed-onset PTSD (symptoms 6 months after the trauma).
90% of people with PTSD has comorbidity. Pre-trauma, trauma and post trauma risks have to be
taken into account for interventions maximizing clinical outcomes.
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