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This randomized clinical trial investigates the effectiveness of integrative cognitive behavioral therapy vs present-centered therapy in patients with prolonged grief disorder. Key Points: Question: Is integrative cognitive behavioral therapy for prolonged grief (PG-CBT) more effective than present-centered therapy (PCT) in patients with prolonged grief disorder (PGD)? Findings: In a multicenter randomized clinical trial with 212 participants, PG-CBT resulted in greater improvement in blinded rater-assessed PGD severity after treatment, but at follow-up, this effect was only visible on a trend level. PG-CBT was superior at follow-up in terms of reductions in self-reported comorbid symptoms. Meaning: Both treatments were shown to be effective and acceptable, showing the potential for dissemination and increasing patient choice. Importance: Prolonged grief disorder (PGD) is included as a new diagnosis in international classification systems. Treatments following a cognitive behavioral model are most effective, but comparisons with active control treatments are scarce. Objective: To examine whether integrative cognitive behavioral therapy for prolonged grief (PG-CBT) is superior to present-centered therapy (PCT). Design, Setting, and Participants: This was a rater-blinded, multicenter, randomized clinical trial (stratified by center and relationship to the deceased) with enrollment from April 2017 to May 2022. The setting included 4 university outpatient clinics in Germany. Eligible participants were aged 18 to 75 years and had PGD based on the Prolonged Grief Disorder 13 (PG-13) interview. Participants were randomized 1:1 to PG-CBT and PCT. Interventions: PG-CBT focused on the exposure to the worst moment of the loss and cognitive restructuring of grief-related cognitions in combination with solution-focused and experiential methods (eg, walk to the grave exercise). PCT was adapted in session length and number to PG-CBT and focused on a supportive relationship and coping with daily problems that may have arisen from the loss or grief symptoms. Main Outcomes and Measures: All outcomes were assessed at baseline, after treatment, and 12 months after randomization at follow-up. The primary outcome was a blinded assessment of the PG-13 severity score at follow-up. Secondary outcomes were self-reported depressive, somatic, and overall psychopathological symptoms. Results: Of 544 treatment-seeking individuals experiencing bereavement, 212 eligible participants (mean [SD] age, 51.8 [13.3] years; 173 female [82%]) with PGD based on the PG-13 interview were randomized to PG-CBT and PCT (n = 106 in each condition). In the intention-to-treat analysis, both treatments yielded high reductions in PGD severity at follow-up (PG-CBT: Cohen d = 1.64; 95% CI, 1.31-1.97; PCT: Cohen d = 1.38; 95% CI, 1.09-1.66). After treatment, participants receiving PG-CBT demonstrated significantly greater reductions in PGD severity than those receiving PCT (Cohen d = 0.31; 95% CI, 0.03-0.57). At follow-up, this effect was only visible on a trend level (Cohen d = 0.28; 95% CI, −0.02 to 0.57), whereas participants in the PG-CBT group had significantly less depressive and general psychopathological symptoms. Twenty-three participants (20%) discontinued PG-CBT treatment, and 17 participants (16%) discontinued PCT. Conclusion and Relevance: This randomized clinical trial demonstrates that PG-CBT was superior to PCT after treatment and at follow-up with regard to comorbid symptoms. Both treatments were shown to be effective and acceptable, showing the potential for dissemination and increasing patient choice. Trial registration: German Clinical Trials Register (DRKS) identifier: DRKS00012317 [ABSTRACT FROM AUTHOR]

Background: Psychotherapy for Prolonged Grief Disorder (PGD), a condition characterized by an intense and persistent grief response, has received increased attention over the past decades. Evidence-based approaches to prevent PGD are currently scarce, and not always effective. This paper introduces a protocol for a clinical trial exploring the effectiveness of a Meaning Reconstruction psychotherapy approach (MR) assisted with ayahuasca, a traditional indigenous medicine. Method: The outlined protocol is a three-arm, non-randomized controlled trial focused on reducing normal and pathological grief symptoms, comparing the effectiveness of Ayahuasca-assisted MR therapy (A-MR), MR therapy alone (MR) and No Treatment (NT). At least 69 people who lost a first-degree relative during the prior year, and with a Texas Revised Inventory of Grief score up 39 (TRIG ≥ 40), will participate in the trial. Participants will be allocated to an A-MR (n ≥ 23), MR (n ≥ 23) or NT (n ≥ 23) group. Those from the A-MR and MR therapy groups will undergo a therapeutic process involving 9 sessions of online psychotherapy. In addition, the A-MR condition involves 2 group sessions of ayahuasca. The primary outcomes will be normal and pathological grief severity as measured by the TRIG and Traumatic Grief Inventory Self-Report (TGI-SR), administered at baseline, post-treatment, and 3-month follow up. Measures of quality of life, post-traumatic growth, meaning-made, psychological flexibility, and self-belief consistency will be also included. In addition, subjective effects of ayahuasca and acceptance-avoidance promoting effects will be assessed following ayahuasca administration. Finally, we will analyze the potential mediating effect of meaning-made, psychological flexibility and self-belief consistency in grief symptoms (as measured by the TRIG and TGI). Discussion: This trial is the first to empirically examinate the potential of psychedelic-assisted psychotherapy for grief, as well as the potential processes of change that may account for it. Clinical trial registration: https://clinicaltrials.gov , identifier NCT06150859. [ABSTRACT FROM AUTHOR]

The ‘Hello Again’ letter-writing intervention is sometimes used in grief counselling to facilitate continuing bonds with the deceased. Family member caregivers of those with dementia often experience a ‘long goodbye’, as the relationship with their loved one gradually changes through serial losses before they have physically died, making the relationship markedly different than the one before the dementia. There are limited interventions to support caregivers with this pre-death grief. This study aimed to address this lack by offering the ‘Hello Again’ intervention to dementia family caregivers, exploring the perceived helpfulness of the task, and attempting to understand the meanings of the ongoing relationship as expressed through letter writing. Two dementia caregivers were recruited to the study. Each participant met with the researcher on several occasions, completed two interviews, which were audio-recorded, and two take-home letter-writing tasks. The audio recordings were transcribed, and both interview data and letters were analysed using Dialogical Narrative Analysis. The analysis revealed positive perceptions of the task, and participants described individual journeys of rediscovery and forgiveness. It was concluded that this study provides initial evidence for a promising innovative intervention to address pre-death grief experiences. Further development and testing of the intervention with a wider range of dementia caregivers is recommended. [ABSTRACT FROM AUTHOR]

Objective: Sudden gains describe large and stable reductions in symptoms between two consecutive treatment sessions and have not yet been investigated in prolonged grief disorder (PGD), a new disorder in the 11th edition of the International Classification of Diseases and text revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders characterized by separation distress and accompanying symptoms beyond 6 months of bereavement. The study aimed to examine the occurrence of sudden gains and their relation to treatment outcome and content during cognitive behavioral therapy (CBT) and supportive counseling for children and adolescents with PGD symptoms. Method: We used data from 118 patients (50% female; age: M = 12.93, SD = 2.81) who were randomized to receive either nine individual sessions of CBT or nondirective supportive counseling. Session-by-session PGD symptoms were assessed using the Grief Checklist. We identified sudden gains using the original criteria by Tang and DeRubeis (1999) and compared treatment outcomes between sudden gainers and nonsudden gainers using linear mixed models. Results: Nine patients (7.63%) experienced a total of 10 sudden gains. Most sudden gains occurred during CBT. We found no differences between sudden gainers and nonsudden gainers regarding PGD symptoms, posttraumatic stress, and depressive symptoms, but problem behaviors declined toward the follow-up assessments in sudden gainers. Conclusions: Sudden gains seem to be a rare event with limited clinical relevance in the treatment of PGD symptoms in children and adolescents. Results imply future research into predictors of sudden gains and other forms of symptom change during PGD treatment. What is the public health significance of this article?: This study is the first examination of large improvements between two sessions in the treatment of children and adolescents with prolonged grief. Sudden gains were a rare event with limited importance for treatment outcomes. This may indicate that for the majority of patients, change in prolonged grief symptoms happened in a gradual way over the course of the whole treatment. [ABSTRACT FROM AUTHOR]

This paper focuses on a single case of ayahuasca-assisted grief therapy for the prevention of complicated grief, conducted within a clinical trial. The participant, a woman in her thirties who lost her father to cancer, completed a 9-session process of Meaning Reconstruction Therapy (MRT) organised around two ayahuasca sessions. Following each psychedelic experience, she also completed a psychedelic integration session. The case study investigates the effect of the intervention, the observed changes in the participant, and the potential processes of change which may account for this improvement. The analysis relies on a qualitative narrative approach to examine the content of each therapy session, as well as on the psychometric measures completed at baseline, post-treatment, and at the three-month follow-up. These results are linked to emerging theories in the field, with a particular focus on the role of meaning reconstruction, psychological flexibility, and a continuing bond with the deceased. [ABSTRACT FROM AUTHOR]

• Grief-focused CBTs have the strongest evidence to support their use in treating PGD. • Effects of PGD psychotherapies for racially/ethnically diverse populations are unclear. • Uniform diagnoses/measures of grief will support efforts to improve PGD treatments. Prolonged grief disorder (PGD) is a distinct diagnostic entity that has recently garnered considerable attention as it describes an intense, enduring, distressing and disabling bereavement reaction experienced by a small minority of community-based mourners. In recent decades, research has exploded to address how best to treat PGD with different psychotherapeutic interventions. In this state-of-the-science review, the strength of the evidence will be discussed regarding common psychotherapeutic interventions used to treat grief. Specifically, we focus on the most commonly used interventions, cognitive behavioral (CB)-based therapies, bereavement and support groups, and brief contact interventions (BCIs), in an effort to summarize the relevant clinical takeaways of the current available research. A discussion of the use of these therapies in specific clinical populations is also included, with a focus on those traumatically bereaved, pediatric populations, communities of color, and underserved communities. Important foci and directions for future research are also discussed. [ABSTRACT FROM AUTHOR]

Bereavement counseling is often offered as a referral following an adverse event or after identification of lingering grief. This article proposes the value of prospective bereavement counseling when a person can reasonably anticipate loss to support anticipatory grief and facilitate supportive continuous care planning for patients experiencing loss. This article positions bereavement counseling as care aimed at finding peace by offering a framework of dimensions of peace, opportunities to foster peace in clinically important moments, and guiding questions to facilitate this clinical outcome in health care settings. [ABSTRACT FROM AUTHOR]

Background: The transition of family caregivers of patients with end-of-Life cancer receiving palliative care from hospital to home is a complex and challenging process. This phase of care involves not only the physical and psychological health of the patient but also the role adaptation and emotional support of the family caregivers. To gain a deeper understanding of the various experiences and feelings during this process, we conducted a qualitative study. Methods: This study employed a descriptive phenomenological research method. The interviews focused on the specific experiences, challenges faced, support received, and coping strategies of family caregivers of patients with end-of-life cancer during the transition from hospital to home palliative care. All data were treated with strict confidentiality, and recordings and transcriptions were made with the participants' consent. Results: A total of 15 family caregivers participated. Four main themes and nine sub-themes were identified: complex transition process (anxiety about uncertainty, resistance to transition), discontinuity in care (insufficient discharge guidance, lack of continuous communication mechanisms), post-discharge continuous care needs (need for home care knowledge and skills, social and emotional support, grief counselling and death education), and personal growth and gains (enhanced coping ability, increased psychological resilience). Conclusion: Family caregivers face numerous emotional, cognitive, practical, and social support challenges during the transition from hospital to home care. To improve the caregiving experience and quality of life, appropriate training and support should be provided to better meet the caregivers' needs. [ABSTRACT FROM AUTHOR]

AbstractMost therapists do not receive formal graduate training in grief counseling and may rely on outdated knowledge and questionable skills when working with grieving clients (Dodd et al., 2022; Jankauskaite et al., 2021). This study aimed to develop a virtual intervention to educate psychology graduate students about grief counseling and evaluate whether this training can increase knowledge in grief and grief counseling and self-efficacy in working with grieving individuals. This mixed-methods study compared participants in three conditions (full video intervention, partial video intervention, and control). When controlling for prior grief counseling training and experience, those randomized to the full video intervention had higher grief and grief counseling knowledge and self-efficacy in working with bereaved individuals than those in the partial intervention and control groups. Further, qualitative results highlighted the assessment and treatment approaches that therapists-in-training would use with a bereaved client across conditions. Overall, the full intervention is a feasible and efficacious way to teach psychology doctoral students about grief counseling and increase their confidence in working with bereaved clients. Future research considerations and recommendations are discussed. [ABSTRACT FROM AUTHOR]

Suicide is one of the leading causes of death worldwide, affecting numerous individuals close to the person who died by suicide, including family members, friends, and colleagues. Those affected by the suicide of someone are referred to as "suicide survivors", and the psychological consequences they face are particularly severe. One of these consequences is grief, which is more complicated in survivors of suicide compared with those grieving deaths from other causes, mainly because of the stigma that continues to surround them. Therefore, psychotherapeutic intervention for suicide loss survivors is crucial. This study examines the efficacy of cognitive-behavioral programs for addressing grief and other related variables in suicide loss survivors. The search was conducted in databases including Psycinfo, Academic Search Premier, Medline, APA PsycArticles, E-Journals, Scopus, and PubMed. Five randomized controlled trials were selected, one of which focused exclusively on minors. The results reveal that cognitive-behavioral therapy is effective, although the methodological quality of these studies is not adequate, and the representativeness of the samples is very low. More RCTs are needed on the application of cognitive-behavioral programs to treat grief in suicide loss survivors. [ABSTRACT FROM AUTHOR]

Interpersonal psychotherapy (IPT) is an empirically validated treatment for mood disorders, anxiety disorders, eating disorders, and trauma. IPT is based on the concept of "relational frame"—that an individual's experience of psychological distress impacts those around them, and that their social support network impacts the distressed individual. This concept, along with the specific techniques and tools that flow from it and the theoretical bases of IPT (attachment and interpersonal theory) make IPT unique. In this article we review the theoretical bases of IPT (attachment and communication) and provide a brief history of IPT, as well as the evidence supporting its use for a variety of disorders. We also describe its application to groups, adolescents, and other diverse populations. Future directions for research and treatment development are proposed, particularly research in the area of combining IPT with other psychotherapeutic modalities. [ABSTRACT FROM AUTHOR]

This study explored the effectiveness of a counselling program in reducing the death anxiety and improving self-efficacy among a sample of female middle-aged teachers recovered from COVID-19 virus in Jordan. The latter program is based on cognitive behavioural therapy. The sample consists from 22 female middle-aged teachers recovered from COVID-19 virus. The ages of those children range between 35 and 50 years. The study was carried out during the year 2020–2021. The chosen teachers were divided into two groups randomly (i.e. control and experimental groups). The experimental group consists from 11 teachers who were enrolled in the proposed counselling program that is based on cognitive behavioural therapy. This program consists from 16 sessions. The control group consists from 11 teachers who were not enrolled in the proposed counselling program. The death anxiety and self-efficacy scales were used before and after implementing the program. They were used after 4 weeks since the date of finishing the implementation of the program. The researchers found that there are significant differences – at the significance level of (a ≤ 0.05) – between the control and experimental groups in terms of the death anxiety and self-efficacy levels for the favour of the experimental group. The researchers found that there is a need to use this program due to the impact of this program on the experimental group after 1 month since the date of finishing the implementation of the program. [ABSTRACT FROM AUTHOR]

The shared loss of a child can present challenges to couple relationships as both partners attempt to cope with their own grief and their partner's grief. In this longitudinal qualitative study, five bereaved parent couples participated in 13 total interviews, revealing coregulatory interactions surrounding their shared loss. Using thematic coding and grounded theory analysis, their reflections were organized into three interrelated process themes: regulating self, regulating other, and forming our grief rhythm. This article explores the complexity of the last theme “forming our grief rhythm” in‐depth, and a new theoretical orientation, the relational window of tolerance, is introduced to examine how couples coregulate both fragile and stable states within their shared grief. The reflections of bereaved parents indicated that prolonged “dual fragile states” and prolonged “imbalanced states” may hinder relationship quality. In order to regain relationship stability, couples learned to trade off supporting one another and/or to resonate with one another in their shared pain. Implications for future research and clinical practice are discussed, focusing especially on how to integrate individual and relational needs into grief therapy frameworks. [ABSTRACT FROM AUTHOR]

Losing a beloved pet can be difficult on the human psyche. In Western societies, many bereaved pet owners often suffer alone and in private, due to the unease or embarrassment surrounding their grief expression, as is especially the case among Asian Americans because of various sociocultural reasons. Incorporating the Reasoned Action Approach (RAA), a well-known theory in Health Communication, this study surveyed 600 Asian American adults and identified theory-driven and empirically tested intervention strategies that aim to increase Asian Americans' intention to seek counseling upon pet loss. Our study found that age and ethnic differences were significantly associated with counseling intention. We also identified three salient control beliefs under the RAA (e.g., the ability to make appointments online, participating in counseling/therapy over the phone, and the immediate availability of counselors/therapists) that significantly heighten Asian Americans' counseling intention upon pet loss through self-efficacy. Theoretical implications and practical contributions of this study are also discussed. [ABSTRACT FROM AUTHOR]

Complex grief patterns are associated with significant suffering, functional impairments, health and mental health problems, and increased healthcare use. This burden may be even more pronounced among veterans. Behavioral Activation and Therapeutic Exposure (BATE-G) and Cognitive Therapy for Grief (CT-G) are two evidence-based interventions for grief. The goal of this study was to use a precision medicine approach to develop a personalized treatment rule to optimize assignment among these psychotherapies. We analyzed data (N = 155) from a randomized clinical trial comparing BATE-G and CT-G. Outcome weighted learning was used to estimate an optimal personalized treatment rule. Baseline characteristics including demographics, social support, variables related to the death, and psychopathology dimensions were used as prescriptive factors of treatment assignment. The estimated rule assigned 72 veterans to CT-G and 56 to BATE-G. Assigning participants according to this rule was estimated to lead to markedly lower mean grief level following 6 months from treatment compared to assigning everyone to either BATE-G (V d opt – V BATE-G = −18.57 [95 % CI: −29.41, −7.72]) or CT-G (V d opt – V BATE-G = −20.89 [95 % CI: −30.7, −11.07]) regardless of their characteristics. Participants were primarily male veterans, and identified with Black or White race. The estimated rule was not externally validated. The estimated rule used relatively simple, easily accessible, client characteristics to personalize assignment to treatment using a precision medicine approach based on machine learning and causal inference. Upon further validation, such a rule can be easily implemented in clinical practice to prescriptively maximize treatment benefits. • The average effect of BATE-G compared to CT-G for grief did not differ overall. • A personalized treatment rule based on individual characteristics was estimated. • The personalized treatment rule performed better than the one-size-fits-all rules. • Upon further validation such a rule can be easily implemented in clinical practice. [ABSTRACT FROM AUTHOR]

Grief, a common reaction to loss, can frequently become problematic or impairing. Available treatments for prolonged grief disorder are promising but leave room for considerable improvement. Qualitative accounts of psychedelic experiences after bereavement reveal themes that parallel core components of prolonged grief disorder therapy. However, few studies have investigated the therapeutic potential of psychedelics for symptoms of grief. The present study surveyed recreational psychedelic users (N = 363) who had suffered a bereavement event. They reported retrospective grief symptoms before and after the psychedelic experience as well as subjective reactions to the psychedelic, including emotional breakthroughs and challenging experiences. Results indicate improvements in grief symptoms after a psychedelic experience, with a large effect size (Cohen's d = 0.83). The occurrence of emotional breakthroughs was positively associated with improvements in symptoms of grief, while the converse relation was observed for challenging experiences. Findings provide preliminary evidence that support the development of a psychedelic-assisted therapy protocol to target symptoms of grief. Psychedelic-assisted therapy might offer an alternative to current grief treatment options. [ABSTRACT FROM AUTHOR]

The article combines current grief research with maps of transactional analysis and shows possible topics in the counselling and support of bereaved people. Based on a case history, the author describes the course of grief counselling after a traumatic loss. In doing so, she spans the arc from psychodynamics in acute crisis to resilience factors and the development of autonomy in the face of death. [ABSTRACT FROM AUTHOR]

Recognizing and addressing the social determinants of mental health (SDoMH) for posttraumatic stress disorder (PTSD) is essential for the effective practice of psychiatry. Experiencing traumatic events and subsequent development of PTSD profoundly affects individuals, families, and society, making it one of the most common mental health disorders with substantial psychiatric comorbidity. This article delves into the bidirectional aspects of the SDoMH in PTSD and reviews the diagnostic criteria, prevalence rates, and repercussions of PTSD on both an individual level and within society. PTSD assessment, interventions, and treatment are reviewed, including Prolonged Exposure, Cognitive Processing Therapy, Eye Movement, Desensitization and Reprocessing, trauma-focused and grief therapy. Primary prevention of PTSD, public health considerations, and positive psychiatry tenets are reviewed. [Psychiatr Ann. 2024;54(7):e209–e215.] [ABSTRACT FROM AUTHOR]

Background: COVID-19 disrupted access to bereavement support. The objective of this study was to identify the bereavement supports used by Australians during the COVID-19 pandemic, perceived helpfulness of supports used, prevalence and areas of unmet support need, and characteristics of those with unmet support needs. Methods: A convenience sample of bereaved adults completed an online questionnaire (April 2021-April 2022) about their bereavement experiences including support use and perceived helpfulness, unmet support needs and mental health. Multiple logistic regression was conducted to determine sociodemographic correlates of unmet needs. Open-ended responses were examined using content analysis to determine key themes. Results: 1,878 bereaved Australians completed the questionnaire. Participants were mostly women (94.9%) living in major cities (68%) and reported the death of a parent (45%), with an average age of 55.1 years (SD = 12.2). The five most used supports were family and friends, self-help resources, general practitioners, psychologists, and internet/online community groups. Notably, each was nominated as most helpful and most unhelpful by participants. Two-thirds (66%) reported specific unmet support needs. Those with unmet needs scored lower on mental health measures. Correlates of unmet needs included being of younger age, being a spouse or parent to the deceased; reporting more impacts from public health measures, and not reporting family and friends as supports. The most frequent unmet need was for social support after the death and during lockdown. Conclusions: This study demonstrates the complexity of bereavement support needs during a pandemic. Specialised grief therapy needs to be more readily available to the minority of grievers who would benefit from it. A clear recommendation for a bereavement support action plan is to bolster the ability of social networks to provide support in times of loss. The fostering of social support in the wake of bereavement is a major gap that needs to be addressed in practice, policy, and research. [ABSTRACT FROM AUTHOR]

Background: An important first step in enhancing professional palliative care training is to investigate the educational needs of pediatric clinicians in this field. The aims of this research were to analyze the extent of end-of-life care experience of Chinese pediatric clinicians and identify the differing educational needs of physicians and nurses as well as associated impact factors. Methods: A cross-sectional descriptive survey via a structural questionnaire was used in this research. Results: In total, 187 clinicians, comprising 52 physicians and 135 nurses, participated in this study. The topics "pain management", "symptom management", and "discussing the prognosis with family members" were the most expressed educational needs among both physicians and nurses. Compared to nurses, physicians placed greater emphasis on the importance of "communication" and "pain and symptom management" (p < 0.05). Clinicians with more extensive end-of-life care experience more strongly felt the importance of learning about pain management and communication regarding end-of-life care (p < 0.05). Conclusions: Research showed that the education currently provided to pediatric clinicians does not meet their distinctive needs. Future palliative care education must be a continuing multi-level, interdisciplinary program and different education should be provided to physicians and nurses based on their respective needs. [ABSTRACT FROM AUTHOR]

This case study illustrates the grieving journey of a 40-year-old Malaysian Chinese man who experienced physical and mental complications after the death of his loved one from lung cancer. This study included a description of a grieving individual with a clinical history of diagnoses and treatments to address his grief. The intervention integrated several modalities and techniques to facilitate behavior change and the healthy grieving process including pharmacotherapy and culturally-sensitive grief-focused therapies. This case study elucidates the integrative strategies while working with a client who had complicated grief. The outcome of the study provides evidence in support of the combination of pharmacotherapy and counseling. Recommendations and conclusions of the study are presented. [ABSTRACT FROM AUTHOR]

Objective: To describe the implementation of a test-negative design case-control study in California during the Coronavirus Disease 2019 (COVID-19) pandemic. Study design: Test-negative case-control study Methods: Between February 24, 2021 ‐ February 24, 2022, a team of 34 interviewers called 38,470 Californians, enrolling 1,885 that tested positive for SARS-CoV-2 (cases) and 1,871 testing negative for SARS-CoV-2 (controls) for 20-minute telephone survey. We estimated adjusted odds ratios for answering the phone and consenting to participate using mixed effects logistic regression. We used a web-based anonymous survey to compile interviewer experiences. Results: Cases had 1.29-fold (95% CI: 1.24–1.35) higher adjusted odds of answering the phone and 1.69-fold (1.56–1.83) higher adjusted odds of consenting to participate compared to controls. Calls placed from 4pm to 6pm had the highest adjusted odds of being answered. Some interviewers experienced mental wellness challenges interacting with participants with physical (e.g., food, shelter, etc.) and emotional (e.g., grief counseling) needs, and enduring verbal harassment from individuals called. Conclusions: Calls placed during afternoon hours may optimize response rate when enrolling controls to a case-control study during a public health emergency response. Proactive check-ins and continual collection of interviewer experience(s) and may help maintain mental wellbeing of investigation workforce. Remaining adaptive to the dynamic needs of the investigation team is critical to a successful study, especially in emergent public health crises, like that represented by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Aim: The factors of complicated grief are unclear, and many studies have referred to it as a socio-cultural phenomenon. Therefore, the present research aims to study the risk factors of complicated grief qualitatively. Method: This investigation's theoretical framework and research methodology were based on quality and phenomenology type. The study included grieving participants (n=15) and psychologists (n=4) who specialized in grief and loss counseling. Data was collected through in-depth interviews from December 10, 2022, to April 30, 2023, using purposive sampling (n = 19), and data saturation determined the sample size. Interviews were conducted either online or faceto- face by one well-trained researcher, depending on the participants’ convenience. The interviews were conducted in 4 sessions, each lasting about 60–90 min, and simultaneously collected and analyzed the data. The analysis approach of this study was grounded theory, encompassing three distinct phases: open coding, axial coding, and selective coding. Results: After transcribing and documenting the interview content, revisited the coding process, yielding 230 distinct codes, and carried out the selective and axial coding processes after extracting the codes. Researchers categorized the codes whittled down to 52 primary codes. These were then divided into three theme clusters (psychological factors, social and family factors, and cultural factors). psychological factors such as loss, social factors such as lack of social support, and cultural factors such as wrong comforting behaviors can be effective in complicated grief. Conclusion: This study suggests that various psychological, cultural, and social determinants contribute to the evolution of grief into a pathological condition, making it a cultural and social phenomenon. [ABSTRACT FROM AUTHOR]

The death of President John F. Kennedy in November 1963 drew a mass outpouring of public and private grief. Thousands of people from all over the world sent condolence messages to his widow, Jacqueline Kennedy. They also sent pieces of music, sometimes hurriedly composed, in response to their overwhelming grief. Most of these pieces have never been heard and sit in a silent archive. This essay examines the condolence music composed for Kennedy, focusing especially on the lay material in the condolence archive, and discovers men, women, and children who found solace in the songwriting process, pre-empting what we now know to be an effective form of grief therapy. It reveals the characteristics of lay music production in response to Kennedy's death, and how the people who sent music to Jacqueline Kennedy explained what they were doing and why they were doing it. [ABSTRACT FROM AUTHOR]

Prolonged Grief Disorder occurs within 7-10% of the bereaved population and is a more complicated and persistent form of grief which has been associated with suicidality, mental health disorders, sleep disturbance, poor health behaviors, and work and social impairment. EMDR is a fitting treatment option for those with Prolonged Grief, focusing on processing past memories, blocks, current triggers, future fears, and preparing the person for living life beyond the loss in line with the Adaptive Information Processing Model and grief frameworks. This paper discusses the theory, research regarding the application of EMDR with prolonged grief, and gives insight and guidance to clinicians working in this area including a case example. [ABSTRACT FROM AUTHOR]

Background: Studies suggest that cognitive behavioral therapies (CBTs) may be efficacious in reducing symptoms of prolonged grief disorder (PGD), but no comprehensive overview and pooled estimate of CBTs' effect on PGD in adulthood exist. We conducted a systematic review and meta-analysis of randomized controlled trials. Method: Studies were selected independently by two researchers based on a systematic literature search in Pubmed, APA PsycInfo, Web of Science, and Embase. Meta-analyses provided pooled effect sizes for the effects of CBTs on PGD symptoms and secondary outcomes. We explored potential moderators of effect, risk of bias of included studies, and evaluated the quality of the meta-analytical evidence through the Grading of Recommendations, Assessment, Development, and Evaluation system. Results: The meta-analysis included 22 studies of 2,602 bereaved adults (averaged study Mage = 49 years). CBTs had a statistically significant medium effect on PGD symptoms at postintervention (K = 22, g = 0.65, 95% CI [0.49, 0.81]), and a large effect at follow-up (K = 7, g = 0.90, 95% CI [0.37, 1.43]). Statistically significant small-to-medium effects were found at postintervention on posttraumatic stress symptoms (K = 10, g = 0.74, 95% CI [0.49, 0.98]), depression (K = 19, g = 0.53, 95% CI [0.36, 0.71]), and anxiety (K = 9, g = 0.35, 95% CI [0.22, 0.49]). The effects on PGD remained unchanged when adjusted for possible outliers. None of the moderator analyses reached statistical significance. Conclusion: This review suggests that CBTs are efficacious in reducing PGD symptoms in adulthood. Generalization of findings should be done with caution due to considerable inconsistency and indirectness of meta-analytic evidence. What is the public health significance of this article?: This review suggests that grief-focused cognitive behavioral therapies are efficacious in reducing prolonged grief disorder symptoms in adulthood and to some extent also bereavement-related depression, anxiety, and posttraumatic stress symptoms. [ABSTRACT FROM AUTHOR]

The paper discusses ecological grief as a particular affective phenomenon. First, it offers an overview of several philosophical accounts of grief, acknowledging the heterogeneity and complexity of the experience that responds to particular personal points of importance, concern and one's identity; the loss triggering grief represents a blow to these. I then argue that ecological grief is equally varied and personal: responding to what the grieving person understands as a loss severe enough to present intelligibly a degradation of her life and the world, to their meaningfulness or even sustainability. More specifically, both personal and ecological grief may manifest in an eroded sense of the future as a space in which one would invest oneself with plans, projects, ideas, desires, and endeavours. On the other hand, personal grief is, in some cases, conceptualised as having embedded the inherent possibility to come to closure or "move on" (e.g., by marrying again), while with ecological grief, the intelligibility of overcoming (replacing) the loss may be, depending on its scale, severely limited. I argue that this erosion of the future need not take the shape of paralysing sadness but rather of a disruption of taking some options of projecting oneself into the future seriously or as real. [ABSTRACT FROM AUTHOR]

The Journal for Transactional Analysis (ZTA) focuses on the connection between theory and practice in transactional analysis in its current issue. The various articles cover topics such as grief counseling, the power of metaphors, integrating different concepts in therapy, working with autistic individuals, further education courses for school principals, and the importance of learning space design for self-directed learning. Additionally, two book reviews are presented. The issue aims to provide joy and inspiration to readers. [Extracted from the article]

The mystery of death, dying and funerals has been a universal phenomenon in the lives of almost all human beings, from humanity's fall from grace to today. Death visits every culture, clan and family, and yet it continues to be a terrifying, unexpected stranger and the most feared enemy of human beings. People from different cultures use different coping mechanisms to fight off the pain of death, but for some people in the Collins Chabane Municipality, a particular Christian religious belief has been shown to be the most reliable asset during the battle. It is questionable whether alternative traditions besides Christianity can compete with Christianity in bringing healing from the pain of death. Various methods of healing, like African grief therapy and psychological healing, are offered to bereaved family members after death and even after burial, but are they enough for Africans to return to their normal lives? This article discusses why (Christian) religious belief is essential during and after the burial of a loved one. This is carried out within the context of colonialism having eroded all African traditions, creating a space for Christianity alone to be a remedy in death and burying. [ABSTRACT FROM AUTHOR]

Background: Grieving is a life-long process, and children in the grieving process are faced with memories of a loved one, which act as a trigger for emotional reactions that may hinder the grieving process. Most children are able to cope with loss and complete the grieving process with the support of people close to them, however, some grieving children need the help of experts during the grieving process and adjustment to their loss, because they are at risk of developing long-term psychological difficulties. Aims: The aim of this paper is to provide information to experts in the field of mental health on effective counselling and psychotherapeutic methods and techniques, as well as practical guidelines in work with grieving children. Methods: Four databeses were searched on November 1, 2023 for peer-reviewed literature on therapeutic approaches for working with bereaved children. The key search terms were: “Child” OR “Children” OR “Adolescents” AND “Grief” OR “Grieving process” OR “Childhood bereavement” OR “Loss and trauma” OR “Traumatic grief” AND “Therapeutic techniques” OR “Psychotherapy” OR “Counselling” OR “Therapy” OR “Interventions”. The search was conducted in English. Twenty-eight articles/books published up until November 2023 that matched the inclusion requirements were found. Results: Two “category” of psychotherapy approach were identified, namely, evidence-based psychotherapy techniques and creative (expressive) techniques. The psychotherapy techniques are based on individual or group treatment, psycho-education and work with family members and peers. Alongside evidence-based psychotherapy treatments, it is useful to use creative or expressive techniques as a supplement. Conclusion and implications: The effectiveness of psychotherapy and counselling intervention has been proven beyond doubt through a great deal of research, and therefore counselling and psychotherapy should be seen as the first choice in treatment of children in the grieving process. The presented review results could guide clinicians in selectively implementing grief therapy in a way that will be the most helpful to bereaved children, adolescents, and their families. [ABSTRACT FROM AUTHOR]

Emerging theories of grief over the last 30 years have represented a shift from the healing of pathology to a focus on the adaptation to loss. Recently, however, there has been an alarming resurgence for a medicalized model of grief, most saliently evident in the removal of the bereavement exclusion from the diagnosis of major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM- 5; American Psychiatric Association [APA], 2013) and the inclusion of prolonged grief disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR ; APA, 2022). These have predictably opened up opportunities for the pursuit of pharmacological treatment including antidepressants and medication usually offered for recovery from alcohol and drug addiction. A pathologizing approach to grief can have a significant and detrimental impact on individuals and compromises the core humanistic values that underpin my professional identity as a counselling psychologist. I propose that we need a radically different lens, and the power–threat–meaning framework (PTMF), an alternative to psychiatric diagnosis developed by psychologists in the United Kingdom, offers us such an opportunity. Consideration is given to how the PTMF may be applied to grief therapy where it can embrace the uniqueness of grief responses and reframe it as an entirely understandable response to trauma and loss. [ABSTRACT FROM AUTHOR]

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This article centers around my work as a critical race feminista; an academic experiencing consistent attacks on the scholarship I produce while also being a tía (aunt), an active griever, and a godmother to my eldest nephew, Solano Garcia. This is the first time that my nephew and I will have shared our most private papelitos guardados (intimate guarded papers). In this article, we respond to the paucity of Black, Indigenous, and People of Color-centered death, grief, and well-being in academia. Using a critical race feminist epistolary methodology, we document our epistolary exchanges that contain dehumanizing attempts on our bodymindspirit matrices as active grievers of color confronting the premature death of my brother, who died at the age of 37 in the summer of 2021. Unlike the 'western' psychotherapeutic tradition of overcoming death and grief, we stake a claim, sit with it, and affirm it as an ongoing process. We argue that recognizing and affirming death and grief is a life-making process that creates spaces for healing through our epistolary offerings. This article aims to offer BIPOC faculty, staff, students, and their families life-affirming strategies towards radical self-care, love, and intergenerational collective healing within a sociopolitical context that operates as a surveillance mechanism. [ABSTRACT FROM AUTHOR]

Background On July 28, 2022, floods in eastern Kentucky displaced over 600 individuals. With the goal of understanding mental health needs of affected families, we surveyed households living in flood evacuation shelters after the 2022 Kentucky floods. Methods Families experiencing displacement from the 2022 Kentucky floods currently living in three different temporary shelter locations were surveyed via convenience sampling. A rapid community needs assessment involving in-person interviews using modified two stage cluster methodology (CASPER) was conducted between September 6-9, 2022. Results Teams conducted 61 household interviews. Since the flood, 27.7% reported that their household received services from behavioral health and 19.6% received grief counseling. Experiencing agitation (36.7%), difficulty concentrating (47.5%), nightmares (62.3%), or suicidal thoughts/self-harm (6.6%) were reported by households surveyed. Over one-fourth (27.0%) of individuals surveyed reported being depressed nearly every day. Over 20% reported anhedonia (inability to feel pleasure) nearly every day. Over 75% of individuals surveyed reported being anxious several days or more over the last two weeks. Over one-third of individuals (34.0%) reported being unable to stop worrying nearly every day. Of those individuals surveyed, 36.1% reported barriers to mental health services. Conclusions Symptoms of depressed mood, anhedonia, anxiety, and nightmares were prevalent in displaced families six weeks after the 2022 Kentucky floods. Providing and encouraging access to mental health services are important priorities during disaster recovery. [ABSTRACT FROM AUTHOR]

Background: Minimally invasive tissue sampling (MITS) has increasingly been used to improve the diagnosis of disease and identification of the cause of death, particularly in underserved areas. However, there are multiple barriers to accessing those who die within the community, our study aimed to explore the perceptions and insights of community members and healthcare providers regarding the feasibility of implementing MITS in community settings. Methods: A qualitative exploratory study was conducted. A total of twenty one in-depth interviews were conducted with deceased infants' parents, elders of the family, religious leaders, community leaders, and funeral workers. Focus group discussions were conducted with health care providers (n = 14) in two peri-urban slum areas of Karachi, Pakistan. The duration of this study was from August to October 2020. Data was analyzed using thematic analysis and was coded and merged into categories forming eight major themes. Results: In general, participants viewed minimally invasive tissue sampling (MITS) as beneficial for improving child health, though some had concerns about disrespecting the deceased during sample collection. Misinformation, fear of needles, and medical procedures were major barriers to MITS implementation. To enhance acceptance, community and religious leaders suggested using religious rulings, obtaining parental consent, ensuring confidentiality, and increasing efforts of community engagement. Community healthcare providers, along with funeral workers, recommended providing community members with grief counseling to increase study participation. Besides concerns about sampling interfering with respect for the decease, community members also raised concerns about misinformation. Further, participants provided feedback on the design and appearance of the mobile van used to collect MITS samples from children under the age of five. Conclusion: This study is critical for understanding the challenges associated with implementation of community-based MITS sampling in Pakistan. Integrating the use of a mobile van for sample collection, grief counseling along with community engagement sessions and advocacy will help address community-based misinformation and develop community trust. [ABSTRACT FROM AUTHOR]

In psychotherapy, ambivalence may be conceptualized as a conflict between two distinct motivations: one that is favorable to change (pro-change) and another that favors the maintenance of a problematic pattern (pro status quo). Previous studies identified two processes by which clients resolve this conflict: imposing the innovative part and silencing the problematic one (dominance), and establishing negotiations between the innovative and the pro status quo parts (negotiation). The present exploratory study examined ambivalence resolution in a sample of clients diagnosed with complicated grief. Results revealed that, in recovered cases, negotiation increases and dominance decreases from the beginning until the middle sessions of therapy and the opposite tendency is observed from the middle to the final sessions. Unchanged cases reveal an overall high proportion of dominance and an overall low proportion of negotiation. These results are partially divergent from those reported in previous studies with samples of clients diagnosed with major depression. [ABSTRACT FROM AUTHOR]

Objective: To explore the grief experiences of family members of patients with advanced malignant tumors before and after death. Methods: This study used both quantitative and qualitative research methods. A total of 10 people with family members with terminal malignant tumors were chosen and assessed five times according to a specific non-invasive mortality index and the Distress Thermometer scale. Additionally, the participants attended an in-depth interview. Results: The grief experiences of the bereaved included their knowledge of and attitude towards death, the physical and mental conditions of the family members of patients in the terminal stage, the needs of family members, and the response to death and growth of those family members. Conclusions: The grief experience interviews of family members of patients with advanced malignant tumors are universal. It is suggested that the nursing staff should pay attention to the emotional experience of the bereaved after the death of the patient throughout the whole nursing process, including the continuous follow-up during the home period. It is hoped that the implementation of grief counseling methods in the later stage can help the bereaved to successfully go through the grieving period, prevent grief disorders, and help them return to society. [ABSTRACT FROM AUTHOR]

Prolonged grief disorder, a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Prolonged grief symptoms can be effectively treated with face-to-face or internet-delivered cognitive behavioral therapy. Traumatic losses may elicit higher prevalence of severe grief reactions. While face-to-face cognitive behavioral therapy appears efficacious in treating prolonged grief symptoms in traumatically bereaved individuals, it is not yet clear if internet-based cognitive behavioral therapy is efficacious for this population. Therefore, we investigated the efficacy of a 12-week internet-delivered cognitive behavioral therapy for people bereaved through traffic accidents in a randomized waitlist-controlled trial (registration number: NL7497, Dutch Trial Register). Forty adults bereaved though a traffic accident were randomized to internet-based cognitive behavioral therapy (n = 19) or a waitlist control condition (n = 21). Prolonged grief, post-traumatic stress, and depression symptoms were assessed at baseline, post-treatment, and 8-week follow-up. Dropout in the treatment condition was relatively high (42%) compared to the control condition (19%). Nevertheless, multilevel analyses showed that internet-based cognitive behavioral therapy strongly reduced prolonged grief, post-traumatic stress, and depression symptoms relative to the control condition at post-treatment and follow-up. We conclude that internet-based cognitive behavioral therapy appears a promising treatment for traumatically bereaved adults. [ABSTRACT FROM AUTHOR]

After-death communication (ADC) is the phenomenon of perceiving spontaneous and direct contact by a deceased loved one. Evidence suggests that ADC is a widespread human experience, particularly for bereaved individuals. Many people who have ADCs report them to be comforting, suggesting therapeutic potential. However, many individuals in Western cultures choose not to disclose their ADCs to mental health providers, citing fears of pathologization, disenfranchisement due to gender expectations, negative ADC encounters, or minimization by clinicians. For others, ADCs are deeply personal and people may keep the experiences to themselves for fear that providers might explain the ADCs away by framing them in purely psychological terms. As such, there is a paucity of literature on how therapists should best approach the topic of ADC with clients. The following narrative review offers clinical interview and assessment strategies from theoretical papers and empirical studies to guide this process. Clinicians are encouraged to self-reflect on their natural inclinations around ADC, assess general psychological functioning, normalize and validate the ADC experience, assess client feelings and explanations, and inquire about spiritual beliefs. Clinicians can also help clients to explore the meaning and personal significance of their ADCs as well as clients' perceived relationships with the deceased. [ABSTRACT FROM AUTHOR]