My summary of the articles and my notes on the lectures of the loss and psychotrauma course. Written in 2022.
Also includes the article on NET. This is not part of the exam material, but could be helpful in understanding NET.
I passed the exam with a 9.0 using this summary.
Week 1: Death and bereavement
Article: Health outcomes of bereavement 3
Lecture: Introduction & death & grief 5
Week 2: PTSD
Article: Complex PTSD and Phased Treatment in Refugees: A Debate Piece 8
Article: Post-Traumatic Stress Disorder: A State-of-the-Art Review of Evidence and Challenges 9
Lecture: PTSD and Beyond 12
Week 3: (Coping with) grieving
Article: Models of coping with bereavement: An updated overview 18
Lecture: Theoretical Approaches to Grief & Grieving 21
Week 4: EMDR and PTSD
Article: EMDR vs CBT for adult PTSD 27
Lecture: Evidence-Based Psychological Interventions for PTSD 28
Week 5: Diversity in trauma
Article: Association of Torture and Other Potentially Traumatic Events With Mental Health
Outcomes Among Populations Exposed to Mass Conflict and Displacement 32
Article: Mental Health Interventions for Traumatised Asylum Seekers and Refugees: What Do We
Know About Their Efficacy? 33
Lecture: A Diversity Perspective on Trauma 35
Week 6: Prevention and help
Article: The Prevention and Treatment of Complicated Grief: A Meta-Analysis 39
Lecture: Does Help Really Help? 40
Week 7: Interventions
Article: Prolonged Grief Disorder 46
Article: CBT for PGD in Children: Feasibility and Multiple Baseline Study 50
Lecture: Interventions for Complicated Grief (PCBD and PGD) 53
Week 8
Article: Psychological and Psychosocial Interventions For Refugee Children Resettled in
High-Income Countries 66
Article: Parental PTSD, adverse parenting and child attachment in a refugee sample 68
Lecture: Child, family & trauma 70
Article on NET therapy 78
2
, Week 1: Death and bereavement
Henk Schut (15 november)
Article: Health outcomes of bereavement
Bereavement: the situation of having recently lost a significant person through death.
● Intense suffering, increased risk of developing mental and physical health problems
● Is associated with excess risk or mortality, particularly in the early weeks/months after loss
The cumulative effect of life-events are measured with the Social Readjustment Rating Scale (SRRS)
→ most readjustment: death of spouse → bereavement is highly stressful.
Grief: the mainly emotional reaction to bereavement, incorporating diverse psychological and
physical reactions.
The research in the study → seeks to develop ways to identify and provide preventive care for
individuals at risk for bereavement-related health problems.
“Can counsellors and therapists help to reduce the health problems of bereaved people?”
The mortality of bereavement
Longitudinal investigations showed that the bereaved spouse has a higher early excessive risk of
mortality. In some studies it was found that this risk persisted longer than 6 months after
bereavement.
● There are subgroup differences like:
○ Higher risk of bereavement-related mortality in white people than in black people.
○ Sex differences: male have higher risk than women
■ Depends on kind of loss: child affects mothers more
The way bereaved people die is diverse and it is related to the duration of the bereavement.
The excess mortality is highest in the early months after the death and decreases when the duration
of the bereavement increases.
● In bereaved parents: excess risk of mortality in mothers is extended for 18 years (death
attributed to natural and/or unnatural causes). Fathers only have a higher risk early in the
bereavement and death from unnatural causes.
Physical ill health
There have been physical health problems reported in bereaved people:
● Headaches, dizziness, indigestion, chest pain → due to medical services
● Physical health is poorer in mothers than fathers, but fathers deteriorated rather than
improved over time.
● Self-medication is higher amongst bereaved individuals.
● Weight loss is associated with bereavement.
● Higher rate of disabilities, medication use and hospitalisation.
Psychological symptoms and ill health
There are psychological illnesses associated with bereavement → most intense in early bereavement.
● Relations between grief-specific symptoms and: depression, anxiety, distress, somatic
symptoms, insomnia, social dysfunction → at 6 months’ bereavement duration.
3
, ● Depression and grief might represent distinct, but are related → clusters of reactions to
bereavement.
The experience of bereavement is different for different types of people → some suffer intensely and
prolonged and others tolerable.
● Psychological reactions to bereavement differ per person/culture.
● Reactions vary in nature and intensity according to the type of the lost relationship.
○ Child’s death: grandparents feel sadness and pain for their grieving adult child.
The process of bereavement → changes in bereavement used to be described as the stages of grief,
but now as tasks (grief task model): (1) accepting the loss, (2) experiencing pain of grief, (3)
adjusting, (4) relocating and (5) moving on.
● Complicated grief: Complications in the grieving process (deviation from ‘normal’ grieving
in cultural and societal terms):
○ Other mental-health difficulties
○ Separation distress/traumatic distress
● Most people show resilience after a few months. MDD can not be diagnosed within 2 months
after a death.
● Sometimes, PTSD can be developed, also in combination with MDD → very complicated.
Additional medical implications
● Impaired memory performance
● Nutritional problems
● Work and relationship difficulties
● Concentration difficulties
● Decrease in social participation
● Biological link: immune system, changes in endocrine, autonomic nervous and
cardiovascular systems
Risk factors
Situational, intrapersonal, interpersonal and coping factors affect bereavement outcomes. Risk
factors can be divided into four categories:
1. Situation and circumstances of death
2. Intrapersonal risk or protective factors
3. Interpersonal or non-personal
resources and protective factors
4. Coping styles, strategies and processes
Dual process model of coping with
bereavement (see picture on the right)
Intervention efficacy
Because bereavement increases the risk of
negative health outcomes, it needs to be
established whether interventions are to be
recommended and effective.
● The focus should be on psychological
interventions and not medical/pharmacological.
● No evidence that all bereaved people will benefit from counselling.
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