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Summary Loss and Psychotrauma - lectures, articles and book chapters

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  • Vak
  • Loss & Psychotrauma
  • Instelling
  • Universiteit Utrecht (UU)

This document contains a detailed summary of all lectures, book chapters, and articles that were important last year. The following articles are included in this summary: 1. The health consequences of bereavement: A review (Stroebe et al., 2007) 2. Complex PTSD and phased treatment in ...

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Document informatie

  • 2 november 2022
  • 61
  • 2021/2022
  • Samenvatting

Onderwerpen

  • loss
  • trauma
  • ptsd
  • refuges
  • anxiety
  • depression

Geschreven voor

  • Universiteit Utrecht (UU)
  • Clinical Psychology
  • Loss & Psychotrauma
Alle documenten voor dit vak (13)

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Door: sarahvanherk • 1 jaar geleden

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hannahdse

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Voorbeeld van de inhoud

WEEK 1
ARTICLE 1 – HEALTH OUTCOMES OF BEREAVEMENT

Bereavement = the situation of having recently lost a significant person through death

 Normal, natural human experience which becomes part of nearly everyone’s experience
 Period of intense risk of developing mental and physical health problems

 Grief defined as main emotional reaction to bereavement, incorporating diverse psychological and physical reactions

OVERALL PATTERN:

Studies of spousal bereavement have indicated an early excess risk of mortality & some researchers also noted risks
persisting for longer than 6 months after bereavement

SUBGROUP DIFFERENCES:

Skin color Greater risk of bereavement-related mortality in white
people than in black people
Sex differences Widowers at more excessive risk of mortality than widows
 Pattern can vary across type of loss (e.g. death of
child has greater effect on mothers than fathers)
Age differences Greater mortality risk for younger than for older bereaved
people who lost spouse
 Effect more pronounced for widowers

CAUSES OF DEATH & DURATION OF BEREAVEMENT

 Cause is differentially related to the duration of bereavement
 Mortality in widowed is highest in the early month & decreases
with increasing duration
 Highest for accidental, violent and alcohol-related causes
 Moderate for chronic ischemic hearth disease & lung cancer
 Small for other causes of death
 Highest when death by suicide

 mortality of bereavement is attributable in large part to a so-called
broken heart (ie, psychological distress due to the loss, such as
loneliness and secondary consequences of the loss, such as changes in
social ties, living arrangements, eating habits and economic support)

PHYSICAL HEALTH

 physical symptoms, high rates of disability & illness, greater use
of medical services & drug use
 odds of new or worsened illness 1x40 times higher in bereaved
people
 higher medication use
 more likely to report having current strong pain
 bereavement associated with weight loss
 by 6 months, most of these differences had declined




PSYCHOLOGICAL SYMPTOMS

 most intense in early bereavement

,  differences in cultural patterns attributable to religious beliefs & health care systems
 however, fundamental manifestation of grief is universal
 reaction vary in nature & intensity according to the type of lost relationship

task model  four tasks of grieving used to guide counselling and therapy

1. accepting reality of loss
2. experiencing the pain of grief
3. adjusting the environment without the deceased
4. relocating the deceased emotionally & moving on

RESILIENCE VERSUS VULNERABILITY

 bereaved people become resilient over time
 thus: MDD excludes people bereaved for less than 2 months

PSYCHIATRIC DISORDERS

 20-45% have mild level of depressive symptoms
 10-20% have clinical levels of depressive symptoms
 When loss of life has been massive 27% of mothers and 12% of fathers meet criteria for PTSD 5 years afterwards

COMPLICATED GRIEF

= deviation from normal grief experience in either time course, intensity or
both, entailing a chronic and more intense emotional experience or and
inhibited response, which either lacks the usually symptoms or in which
onset of symptoms is delayed  includes separation distress & traumatic
distress

 since most parents meet the criteria the questions raises whether this
cut-off point is a good marker of chronic grief or whether norm scores for
parents need to be reset

ADDITIONAL MEDICAL IMPLICATIONS

 Impaired memory & performance
 Nutritional problems
 Work & relationship difficulties
 Difficulties concentrating
 Decreases in social participation
 May have underlying physiological mechanisms

RISK FACTORS

Situation & circumstances of  Causes of death
death  Circumstances surrounding death or place of death
 Pre-bereavement caregiver strain
 Types of lost relationship
 Ongoing conflicts, concurrent work & legal difficulties, poverty or
economic decline
Intrapersonal risk or protective  Personality or attachment style
factors  Predisposing factors or previous bereavements
 Religious beliefs & other meaning systems
 Sociodemographic variables
Interpersonal or non-personal  Social support, cultural setting
resource & protective factors  Economic resources
 Professional intervention
Coping styles, strategies,  Grief work, appraisal process
processes  Emotion regulation

,Treatment

1. Primary preventive interventions
 Professional help is available to all bereaved individuals irrespective of whether intervention is indicated
2. Secondary preventive intervention
 Designed for bereaved individuals who through screening or assessment, can be regarded as more
vulnerable to the risks of bereavement
3. Tertiary preventive interventions
 Providing therapy for complicated grief, grief-related depression, or post-traumatic disorders




LECTURE – DEATH AND GRIEF: SOCIETAL & SCIENTIFIC POSITIONING

Grief is an inidivual process  not everyone goes through all stages in a specific order

Grief task model:
= grief is about doing work. You need to do certain tasks if you want to continue with your life
1. Accepting the reality of the loss
2. Allowing yourself to experience the emotions
3. Adjusting to life without the deceased
4. Relocating the deceased emotionally & move on

Grief = the primary emotional reaction to the death of a significant other. It is a complex emotional syndrome accompanied
by physical changes and physical symptoms. In addition, it involves a wide range of possible cognitive and behavioral
reactions

DIMENSIONS OF GRIEF:

Emotional:
 Sorrow, loneliness, numbness, anxiety, guilt, aggression, helplessness, pessimism, relief etc.)
Cognitive
Loss of concentration, lowered self-esteem, confusion, intrusive images, preoccupation with the
deceased, hopelessness etc.)
Physical
 Sleep-related problems, decreased appetite, stress, headaches, tension, low energy, similar symptoms
to the deceased etc.)
Behavioral
 Agitated, withdrawn, seeking behavior, avoidance etc.)

MAJOR DETERMINANTS:

1. Background of bereaved person: gender, age, personality, attachment, health, history etc.
2. Characteristics of death: sudden, unexpected, premature death, traumatic circumstances
3. Characteristics of the deceased: kinship, relationship, quality of the relationship with the deceased
4. Situation after loss: lack of support, secondary losses, ways of coping etc.

BACKGROUND (Mortality ration of widows and widowers compared to similar groups of married couples)
 Higher risk of death if you lost your partner
 Higher risk in the early age groups

,  Man are at higher risk of death after loss than women

Why are men at higher risk of dying after partner loss?

 Differences in social support (men have
fewer friends)
 Differences in coping strategies (men are
more problem focused & women are more
emotion focused)
 Differences in types of bereavement
(marriage if different for men and women)

RELIGION
Life philosophy (conflicting result  losing child often results in
losing religion)

CHARACTERISTICS OF DEATH
1. Cause of death: natural, accident, suicide and homicide
 Sudden, untimely, intentional, painful, violent = greater risk
2. Who is deceased?
 Kinship (parent, partner, child etc.)
 Nature of relationship (how often you saw each other etc)
 Quality of the relationship

UNACKNOWLEDGED LOSSES OR “DISENFRANCHISED GRIEF”
 Ex-partners
 In the past: miscarriage, perinatal death etc.
 In some circles: homosexual relationships
 Extramarital affairs

AFTER THE LOSS

 Coping
 Social support
 Secondary losses
 Multiple bereavements
 Family dynamics
 Material resources (change in income, housing etc)
 Etc

CONCLUSION:

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