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6. Associations of Dimensions of Anger With Distress Following Traumatic Bereavement

Author

Lenferink, L.I.M., Nickerson, A., Kashyap, S., de Keijser, J., Boelen, P.A., Lenferink, L.I.M., Nickerson, A., Kashyap, S., de Keijser, J., and Boelen, P.A.

Abstract

Objective: A prior study with people exposed to a traumatic event indicated that posttraumatic anger is a multidimensional construct that consists of five factors comprising anger at (a) the criminal justice system, (b) other people, (c) the self, and (d) a perpetrator and (e) a desire for revenge. Preliminary evidence shows that anger at the self and perpetrators is related to posttraumatic stress disorder (PTSD) symptoms. Expanding the focus from trauma victims to people exposed to a traumatic loss of a significant other, for example, due to road traffic accidents, may enhance our knowledge on factors that are amenable to change in the treatment of prolonged grief disorder (PGD) and PTSD. Method: We examined the (a) factor structure of the 20-item Posttraumatic Anger Questionnaire in 209 Dutch people bereaved by road traffic accidents using confirmatory factor analysis and (b) associations between the posttraumatic anger factors and PGD and PTSD using structural equation models. Results: The expected five-factor structure of the Posttraumatic Anger Questionnaire was supported. Anger at the self was related to greater PGD (b =.35) and PTSD (b =.50) symptoms over and above known risk factors of distress. A desire for revenge (b =.20) was uniquely and positively associated with PTSD symptoms. Conclusion: Pending replication of our findings in longitudinal studies, we conclude that anger subtypes relate differently to distress after traumatic loss. Anger toward the self seems the most detrimental type of anger and may therefore be an important target in treatment.

Published
2024

7. Corrigendum to “The mediating role of state anger in the associations between intentions to participate in the criminal trial and psychopathology in traumatically bereaved people” [International Journal of Law and Psychiatry volume 85 (2022) 101840] (International Journal of Law and Psychiatry (2022) 85, (S0160252722000668), (10.1016/j.ijlp.2022.101840))

Author

Buiter, M. Y., Boelen, P. A., Kunst, M., Gerlsma, C., de Keijser, J., Nijborg, L. C.J., Lenferink, L. I.M., Buiter, M. Y., Boelen, P. A., Kunst, M., Gerlsma, C., de Keijser, J., Nijborg, L. C.J., and Lenferink, L. I.M.

Published
2024

12. Assessing DSM-5-TR and ICD-11 prolonged grief disorder in children and adolescents: development of the Traumatic Grief Inventory–Kids–Clinician-Administered

Author

Van Dijk, I., Boelen, P. A., de Keijser, J., Lenferink, L.I.M., Van Dijk, I., Boelen, P. A., de Keijser, J., and Lenferink, L.I.M.

Abstract

Background: Around 10% of bereaved youths experience symptoms of prolonged grief disorder (PGD). Recently, PGD was included in the two main classification systems for mental disorders: the ICD-11 and DSM-5-TR. Assessing PGD symptoms in youth is currently hindered by the lack of instruments for ICD-11 and DSM-5-TR criteria. To fill this gap, we developed an instrument to assess PGD symptoms in children and adolescents, the Traumatic Grief Inventory–Kids–Clinician-Administered (TGI-K-CA), based on input of grief experts and bereaved children. Methods: Five experts rated the items on alignment with DSM-TR and ICD-11 PGD symptoms and comprehensibility. The adjusted items were then presented to seventeen bereaved youths (Mdnage = 13.0 years, range = 8–17 years). Using the Three-Step Test Interview (TSTI), children were asked to verbalize their thoughts while answering the items. Results: Issues raised by experts were mostly related to alignment with the DSM-5-TR/ICD-11 symptom, ambiguous formulation of the items, or low comprehensibility for children and adolescents. Items raising fundamental issues according to experts were adjusted. The TSTI showed that children encountered relatively few problems with the items. Frequently reported problems with some of the items (e.g. regarding comprehensibility) led to final adjustments. Conclusion: With input from grief experts and bereaved youths, an instrument to assess PGD symptoms as defined in DSM-5-TR and ICD-11 in bereaved youths was finalized. Further quantitative research is currently undertaken to evaluate the instrument’s psychometric qualities.

Published
2023

13. Online cognitive behavioral therapy for prolonged grief after traumatic loss: a randomized waitlist-controlled trial

Author

Lenferink, L.I.M., Eisma, M.C., Buiter, M.Y., de Keijser, J., Boelen, P.A., Lenferink, L.I.M., Eisma, M.C., Buiter, M.Y., de Keijser, J., and Boelen, P.A.

Abstract

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.

Published
2023

17. Treatment gap in bereavement care: (Online) bereavement support needs and use after traumatic loss

Author

Lenferink, L.I.M., de Keijser, J., Eisma, M.C., Smid, G.E., Boelen, P.A., Leerstoel Boelen, Trauma and Grief, Clinical Psychology and Experimental Psychopathology, Humanist Chaplaincy Studies for a plural society, A meaningful life in a just and caring society, and A just and caring society

Subjects
Male, 050103 clinical psychology, Bereavement support, medicine.medical_specialty, media_common.quotation_subject, prolonged grief, 03 medical and health sciences, 0302 clinical medicine, Pharmacotherapy, Intervention (counseling), Psychological support, medicine, Humans, 0501 psychology and cognitive sciences, grief, Bereavement Care, Psychiatry, Road traffic, Research Articles, intervention, media_common, therapy, 05 social sciences, Accidents, Traffic, bereavement, Middle Aged, humanities, 030227 psychiatry, Death, Psychotherapy, Self-Help Groups, Traumatic loss, Clinical Psychology, trauma, Female, Grief, Self Report, internet, Psychology, Research Article
Abstract

People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self‐report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important.

Published
2021
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18. 'Only One Way Out'-Partners' Experiences and Grief Related to the Death of Their Loved One by Suicide or Physician-Assisted Dying Due to a Mental Disorder

Author

Snijdewind, M.C., de Keijser, J., Casteelen, G., Boelen, P.A., Smid, G.E., Trauma and Grief, and Leerstoel Boelen

Subjects
physician-assisted dying (PAD), Psychiatry and Mental health, mental disorder, grief/loss, mental health, suicide
Abstract

Background: Previous research has provided insight into the grief of suicide survivors, but little is known about grief following physician-assisted dying (PAD), and no prior study specifically focused on grief following PAD due to a mental disorder. The current study aims to increase insight into experiences preceding PAD or suicide of a loved one due to a mental disorder and their impact on mental health symptoms. Methods: We performed a survey study and in-depth interviews with 27 bereaved life partners. The deceased had been in treatment for mental disorders and had died by PAD (n = 12) or suicide (n = 15). Interviews explored grief experiences and experiences with mental health care. In the survey, we assessed self-reported symptoms of grief, post-traumatic stress, anxiety, depression, quality of life, and impairments in social, and occupational functioning. Results: All participants reported generally low levels of mental health symptoms. Longer time since death and death by PAD were associated with lower grief intensity. Interviews showed various degrees of expectedness of the partners' death, and a varying impact of being present at the death on bereaved partners. Conclusion: Expectedness of the death of the partner, absence of suffering of the partner at the time of dying, and presence of physician support may in part explain the protective effects of PAD against severe grief reactions. Physicians considering their position regarding their personal involvement in PAD due to a mental disorder could take grief reactions of the bereaved partner into account.

Published
2022

19. Grief Shortly after Suicide and Natural Death: A Comparative Study among Spouses and First-Degree Relatives

Author

de Groot, M. H., de Keijser, J., and Neeleman, J.

Abstract

Chronic dysfunction after complicated grief is not rare and emphasizes the need to identify bereaved individuals at risk. Three months following bereavement, self-reported psychiatric and general health of 153 relatives of 74 suicides was worse than of 70 relatives of 39 natural deaths. Moreover, the felt need for professional help was higher among the former, even after adjustment for expectedness of death, sociodemographic differences, and relatives'/spouses' neuroticism. This suggests that suicide-bereaved individuals may constitute a high-risk group of mourners in need of targeted postvention.

Published
2006
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20. Concurrent associations of dimensions of anger with posttraumatic stress, depression, and functional impairment following non-fatal traffic accidents

Author

Boelen, P.A., Eisma, M.C., de Keijser, J., Lenferink, L.I.M., Boelen, P.A., Eisma, M.C., de Keijser, J., and Lenferink, L.I.M.

Abstract

Background: Anger is associated with dysfunction following potentially traumatic events. It is still unclear to what extent different types of anger are differentially related to poor outcomes. To advance knowledge in this area, the Posttraumatic Anger Questionnaire (PAQ) was designed, measuring anger directed at (i) the justice system, (ii) other people, (iii) the self, (iv) people held accountable for the potential traumatic event, and (v) a desire for revenge to those held responsible. Preliminary evidence shows that these types of anger are distinguishable and differentially associated with posttraumatic stress (PTS). No studies have yet examined whether such findings can be generalized to victims of non-fatal traffic accidents, one of the most common potentially traumatic events. Objective: This study’s aims were (i) to establish if the five-factor structure of the PAQ found in prior studies could be replicated, (ii) to explore whether the intensity of emerging types of anger differed, and (iii) to explore the associations of anger-types with levels of PTS, depression, and functional impairment. Method: Two-hundred and fifty adults who experienced a traffic accident completed the PAQ and instruments measuring PTS, depression, and functional impairment. They also answered questions about their socio-demographic characteristics and features of the accident. Results: Confirmatory factor analysis confirmed that the PAQ measures five types of anger. Levels of anger at people held accountable were the highest. Structural equation modelling showed that both anger at others and anger at the self, but not the other three anger types, were associated with PTS, depression, and functional impairment, when controlling for the shared variance between the anger types, socio-demographic variables, and features of the accident. Conclusions: Findings illustrate the potential importance of considering different types of anger whe

Published
2022

21. Traumatic stress, depression, and non-bereavement grief following non-fatal traffic accidents: Symptom patterns and correlates

Author

Boelen, P.A., Eisma, M.C., De Keijser, J., Lenferink, L.I.M., Boelen, P.A., Eisma, M.C., De Keijser, J., and Lenferink, L.I.M.

Abstract

Non-fatal traffic accidents may give rise to mental health problems, including posttraumatic stress (PTS) and depression. Clinical evidence suggests that victims may also experience grief reactions associated with the sudden changes and losses caused by such accidents. The aim of this study was to examine whether there are unique patterns of symptoms of PTS, depression, and grief among victims of non-fatal traffic accidents. We also investigated associations of emerging symptom patterns with sociodemographic variables and characteristics of the accident, and with transdiagnostic variables, including self-efficacy, difficulties in emotion regulation, and trauma rumination. Participants (N = 328, Mage = 32.6, SDage = 17.5 years, 66% female) completed self-report measures tapping the study variables. Using latent class analysis (including symptoms of PTS, depression, and grief), three classes were identified: a no symptoms class (Class 1; 59.1%), a moderate PTS and grief class (Class 2; 23.1%), and a severe symptoms class (Class 3; 17.7%). Summed symptom scores and functional impairment were lowest in Class 1, higher in Class 2, and highest in Class 3. Psychological variables were similarly ordered with the healthiest scores in Class 1, poorer scores in Class 2, and the worst scores in Class 3. Different sociodemographic and accident related variables differentiated between classes, including age, education, and time since the accident. In a regression including all significant univariate predictors, trauma rumination differentiated Class 2 from Class 1, all three psychological variables differentiated Class 3 from Class 1, and difficulties with emotion regulation and trauma rumination differentiated Class 3 from Class 2. This study demonstrates that most people respond resiliently to non-fatal traffic accident. Yet, approximately one in three victims experiences moderate to severe mental health symptoms. Increasing PTS coincided with similarly increasing grief, ind

Published
2022

22. Valid measurement of DSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder: The Traumatic Grief Inventory-Self Report Plus (TGI-SR+)

Author

Lenferink, L. I.M., Eisma, M. C., Smid, G. E., de Keijser, J., Boelen, P. A., Lenferink, L. I.M., Eisma, M. C., Smid, G. E., de Keijser, J., and Boelen, P. A.

Abstract

Introduction: When grief reactions after bereavement are so intense that they impair daily functioning, a diagnosis of disturbed grief may apply. Slightly differing criteria-sets for disturbed grief are included in the ICD-11, the DSM-5, and its forthcoming text revision, DSM-5-TR. We examined psychometric properties of a new self-report measure, the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+), that assesses these criteria sets for Persistent Complex Bereavement Disorder (PCBD) as per DSM-5, and Prolonged Grief Disorder (PGD) as defined in ICD-11 and DSM-5-TR. Material and methods: We examined the: i) factor structure, ii) internal consistency, iii) temporal stability, iv) convergent validity, v) known-groups validity, vi) probable caseness, and vii) optimal clinical cut-off scores in two Dutch bereaved samples. Sample 1 consisted of 278 adults, bereaved by various causes. Sample 2 included 270 adults who lost loved ones in a traffic accident. Results: We found support for a 3-factor PCBD model, 1-factor DSM-5-TR model, and 1-factor ICD-11 PGD model. The DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD items demonstrated good internal consistency and temporal stability. Associations between disturbed grief symptoms and posttraumatic stress and depression levels supported convergent validity. Associations between demographic/loss-related variables and disturbed grief symptoms supported known-groups validity. Optimal clinical cut-offs for the TGI-SR+ total score were ≥ 75, ≥71, and ≥ 75 for probable caseness of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD, respectively. Discussion: While replication of our findings in diverse bereaved samples is needed, we conclude that the TGI-SR+ is a reliable and valid measure to assess symptoms of DSM-5 PCBD, DSM-5-TR PGD, and ICD-11 PGD.

Published
2022

30. Further validation of the Traumatic Grief Inventory-Self Report (TGI-SR): A measure of persistent complex bereavement disorder and prolonged grief disorder

Author

Boelen, P.A., Djelantik, A.A.A.M.J., de Keijser, J., Lenferink, L.I.M., Smid, G.E., Trauma and Grief, Leerstoel Boelen, and Clinical Psychology and Experimental Psychopathology

Subjects
Male, 050103 clinical psychology, Attitude to Death, media_common.quotation_subject, Prolonged grief disorder, 03 medical and health sciences, 0302 clinical medicine, Traumatic grief, POSTTRAUMATIC-STRESS-DISORDER, Arts and Humanities (miscellaneous), medicine, Developmental and Educational Psychology, Humans, CRITERIA, 0501 psychology and cognitive sciences, Airplane crash, Self report, Persistent complex bereavement disorder, Depression (differential diagnoses), SCALE, media_common, COMPLICATED GRIEF, 05 social sciences, Middle Aged, medicine.disease, DEPRESSION, Complicated grief, humanities, 030227 psychiatry, Clinical Psychology, ROC Curve, Female, Grief, Self Report, HEALTH, Psychology, Stress, Psychological, Clinical psychology
Abstract

The Traumatic Grief Inventory Self-Report version (TGI-SR) is an 18-item self-report measure. It was designed to assess symptoms of Persistent Complex Bereavement Disorder (PCBD) included in Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and Prolonged Grief Disorder (PGD) proposed by an international group of experts in grief. The research in this article used data from a bereaved patient sample and people who lost loved ones in the Ukrainian airplane crash in July 2014. Findings indicated that the TGI-SR is a reliable and valid tool to assess disturbed grief in research and to identify people needing a more comprehensive assessment of their grief in clinical settings.

Published
2019

31. Remotely Delivered Cognitive Behavior Therapy for Disturbed Grief During the COVID-19 Crisis: Challenges and Opportunities

Author

Boelen, P.A., Eisma, M.C., Smid, G. E., De Keijser, J., Lenferink, L.I.M., Trauma and Grief, Leerstoel Boelen, Humanist Chaplaincy Studies for a plural society, A meaningful life in a just and caring society, and University of Humanistic Studies

Subjects
Psychiatry and Mental health, videoconferencing, Social Psychology, persistent complex bereavement disorder, novel coronavirus, COVID-19, Phychiatric Mental Health, Prolonged grief disorder, intervention, Social Sciences (miscellaneous)
Abstract

Cognitive behavior therapy (CBT) interventions are effective in alleviating disturbed grief. CBT is typically delivered face-to-face. Government policy during the coronavirus (COVID-19) pandemic (quarantine and social distancing) may impede access to face-to-face therapy. Psychotherapy is now widely delivered remotely. In this article, various points of attention related to the application of CBT for disturbed grief using telephone or videoconferencing (or video calling) services are discussed. Additionally, we explore possible ways in which individual risk factors and stressors connected with COVID-19 can be addressed in treatment. Remote treatment brings challenges but also opportunities to help people in shifting from unhealthy to healthy grieving.

Published
2021

32. DSM-5-TR prolonged grief disorder and DSM-5 posttraumatic stress disorder are related, yet distinct: confirmatory factor analyses in traumatically bereaved people

Author

Lenferink, L.I.M., van den Munckhof, M.J.A., de Keijser, J., Boelen, P. A., Trauma and Grief, Leerstoel Boelen, Trauma and Grief, Leerstoel Boelen, Clinical Psychology and Experimental Psychopathology, and Psychology, Health & Technology

Subjects
Adult, Male, 创伤性丧失, UT-Gold-D, pérdida traumática, RC435-571, Psychological Trauma, traumatic loss, behavioral disciplines and activities, Stress Disorders, Post-Traumatic, mental disorders, Humans, prolonged grief disorder, Aged, Psychiatry, Basic Research Article, duelo, bereavement, Middle Aged, respiratory system, posttraumatic stress, Diagnostic and Statistical Manual of Mental Disorders, 延长哀伤障碍, Psychiatry and Mental health, estrés post traumático, Female, trastorno de duelo prolongado, lipids (amino acids, peptides, and proteins), 创伤后应激, 丧亲, Factor Analysis, Statistical, Research Article
Abstract

Background Prolonged grief disorder (PGD) is newly included in the text revision of the DSM-5 (DSM-5-TR). So far, it is unknown if DSM-5-TR PGD is distinguishable from bereavement-related posttraumatic stress disorder (PTSD). Prior research examining the distinctiveness of PTSD and pathological grief focused on non-traumatic loss samples, used outdated conceptualizations of grief disorders, and has provided mixed results. Objective In a large sample of traumatically bereaved people, we first evaluated the factor structure of PTSD and PGD separately and then evaluated the factor structure when combining PTSD and PGD symptoms to examine the distinctiveness between the two syndromes. Methods Self-reported data were used from 468 people bereaved due to the MH17 plane disaster (N = 200) or a traffic accident (N = 268). The 10 DSM-5-TR PGD symptoms were assessed with the Traumatic Grief Inventory-Self Report Plus (TGI-SR+). The 20-item Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) was used to tap PTSD symptoms. Confirmatory factor analyses were conducted. Results For PTSD, a seven factor, so-called ‘Hybrid’ model yielded the best fit. For PGD, a univariate factor model fits the data well. A combined model with PGD items loading on one factor and PTSD items on seven factors (associations between PGD and PTSD subscales r ≥ .50 and ≤.71), plus a higher-order factor (i.e. PTSD factors on a higher-order PTSD factor) (association between higher-order PTSD factor and PGD factor r = .82) exhibited a better fit than a model with all PGD and PTSD symptom loading on a single factor or two factors (i.e. one for PGD and one for PTSD). Conclusions This is the first study examining the factor structure of DSM-5-TR PGD and DSM-5 PTSD in people confronted with a traumatic loss. The findings provide support that PGD constitutes a syndrome distinguishable from, yet related with, PTSD., HIGHLIGHTS This is the first factor analytic study on PGD and PTSD after traumatic loss.PTSD and PGD factors are related, but distinguishable.DSM-5-TR PGD is distinct from DSM-5 PTSD.

Published
2021

33. Online treatment of persistent complex bereavement disorder, posttraumatic stress disorder, and depression symptoms in people who lost loved ones during the COVID-19 pandemic: study protocol for a randomized controlled trial and a controlled trial

Author

Reitsma, L., Boelen, P. A., de Keijser, J., Lenferink, L.I.M., Reitsma, L., Boelen, P. A., de Keijser, J., and Lenferink, L.I.M.

Abstract

Background: Losing a loved one during the COVID-19 pandemic is a potentially traumatic loss that may result in symptoms of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression. To date, grief-specific cognitive-behavioural therapy (CBT) has mostly been delivered through individual face-to-face formats, while studies have shown that online treatment also yields promising results. Offering treatment online is now more than ever relevant during the pan demic and may offer important benefits compared with face-to-face CBT, such as lower costs and higher accessibility. Our expectation is that grief-specific online CBT is effective in reducing PCBD, PTSD, and depression symptoms.Objective: Our aim is to evaluate the short-term and long-term effectiveness of grief-specific online CBT in reducing PCBD, PTSD, and depression symptom-levels for adults who lost a loved one during the COVID-19 pandemic. Method: This study consists of two parts. In part 1, a two-armed (unguided online CBT versus waitlist controls) randomized controlled trial will be conducted. In part 2, a two-armed (guided online CBT versus unguided online CBT) controlled trial will be conducted. Symptoms of PCBD, PTSD, and depression will be assessed via telephone interviews at pre-treatment/pre-waiting period, post-treatment/post-waiting period, and six months post-treatment. Potential participants are people who lost a loved one at least three months earlier during the COVID-19 pandemic with clinically relevant levels of PCBD, PTSD, and/or depression. Analysis of covariance and multilevel modelling will be performed. Discussion: This is one of the first studies examining the effectiveness of online grief-specific CBT. More research is needed before implementing online grief-specific CBT into clinical practice.

Published
2021

39. Remotely Delivered Cognitive Behavior Therapy for Disturbed Grief During the COVID-19 Crisis: Challenges and Opportunities

Author

Boelen, P.A., Eisma, M.C., Smid, G.E., de Keijser, J., Lenferink, L.I.M., Trauma and Grief, Leerstoel Boelen, and Clinical Psychology and Experimental Psychopathology

Subjects
050103 clinical psychology, Psychotherapist, Social Psychology, persistent complex bereavement disorder, media_common.quotation_subject, Psychological intervention, novel coronavirus, Prolonged grief disorder, computer.software_genre, Videoconferencing, videoconferencing, Intervention (counseling), 0501 psychology and cognitive sciences, intervention, media_common, Social distance, 05 social sciences, Stressor, COVID-19, Cognition, Psychiatry and Mental health, Phychiatric Mental Health, Grief, Pshychiatric Mental Health, Psychology, computer, Social Sciences (miscellaneous)
Abstract

Cognitive behavior therapy (CBT) interventions are effective in alleviating disturbed grief. CBT is typically delivered face-to-face. Government policy during the coronavirus (COVID-19) pandemic (quarantine and social distancing) may impede access to face-to-face therapy. Psychotherapy is now widely delivered remotely. In this article, various points of attention related to the application of CBT for disturbed grief using telephone or videoconferencing (or video calling) services are discussed. Additionally, we explore possible ways in which individual risk factors and stressors connected with COVID-19 can be addressed in treatment. Remote treatment brings challenges but also opportunities to help people in shifting from unhealthy to healthy grieving.

Published
2020
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41. Trajectories of grief, depression, and posttraumatic stress in disaster-bereaved people

Author

Lenferink, L.I.M., Nickerson, A., de Keijser, J., Smid, G.E., Boelen, P.A., Trauma and Grief, Leerstoel Boelen, Humanist Chaplaincy Studies for a plural society, A meaningful life in a just and caring society, University of Humanistic Studies, Trauma and Grief, Leerstoel Boelen, and Clinical Psychology and Experimental Psychopathology

Subjects
Male, DISORDER, TRAUMATIC GRIEF, INVENTORY, Logistic regression, Disasters, Stress Disorders, Post-Traumatic, stress, 0302 clinical medicine, Traumatic grief, Surveys and Questionnaires, PTSD/posttraumatic stress disorder, PROLONGED GRIEF, grief, HETEROGENEITY, PREDICTORS, Depression (differential diagnoses), Research Articles, media_common, Aged, 80 and over, Depression, bereavement, PTSD, Middle Aged, IMPAIRMENT, PREVALENCE, Death, Distress, Clinical Psychology, Psychiatry and Mental health, Mental Health, trauma, Latent Class Analysis, posttraumatic stress disorder, Female, Psychology, MENTAL-HEALTH, Clinical psychology, Research Article, Adult, media_common.quotation_subject, 03 medical and health sciences, Young Adult, Humans, Persistent complex bereavement disorder, Aged, Mental health, 030227 psychiatry, Posttraumatic stress, INDIVIDUALS, Accidents, Aviation, Grief, 030217 neurology & neurosurgery
Abstract

Background Previous latent trajectory studies in adult bereaved people have identified individual differences in reactions postloss. However, prior findings may not reflect the complete picture of distress postloss, because they were focused on depression symptoms following nonviolent death. We examined trajectories of symptom-levels of persistent complex bereavement disorder (PCBD), depression, and posttraumatic stress disorder (PTSD) in a disaster-bereaved sample. We also investigated associations among these trajectories and background and loss-related factors, psychological support, and previous mental health complaints. Methods Latent class growth modeling was used to identify distinct trajectories of PCBD, depression, and PTSD symptoms in people who lost loved ones in a plane disaster in 2014. Participants (N = 172) completed questionnaires for PCBD, depression, and PTSD at 11, 22, 31, and 42 months postdisaster. Associations among class membership and background and loss-related variables, psychological support, and previous mental health complaints were examined using logistic regression analyses. Results Two PCBD classes emerged: mild (81.8%) and chronic (18.2%) PCBD. For both depression and PTSD, three classes emerged: mild (85.6% and 85.2%), recovered (8.2% and 4.4%), and chronic trajectory (6.2% and 10.3%). People assigned to the chronic PCBD, depression, or PTSD class were less highly educated than people assigned to the mild/recovered classes. Conclusions This is the first latent trajectory study that offers insights in individual differences in longitudinal symptom profiles of PCBD, depression, and PTSD in bereaved people. We found support for differential trajectories and predictors across the outcomes.

Published
2020

42. Online cognitive-behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial

Author

Lenferink, L.I.M., de Keijser, J., Eisma, M., Smid, G., Boelen, P., Trauma and Grief, Leerstoel Boelen, Humanist Chaplaincy Studies for a plural society, A meaningful life in a just and caring society, University of Humanistic Studies, Trauma and Grief, Leerstoel Boelen, and Clinical Psychology and Experimental Psychopathology

Subjects
Adult, medicine.medical_specialty, Waiting Lists, Poison control, Suicide prevention, Occupational safety and health, law.invention, Stress Disorders, Post-Traumatic, Cognition, Randomized controlled trial, law, Injury prevention, medicine, Avoidance Learning, Humans, Psychiatry, Depression (differential diagnoses), Randomized Controlled Trials as Topic, Medicine(all), Cognitive Behavioral Therapy, business.industry, public health, Human factors and ergonomics, General Medicine, Mental health, psychiatry, Mental Health, Medicine, adult psychiatry, business
Abstract

IntroductionThe traumatic death of a loved one, such as death due to a traffic accident, can precipitate persistent complex bereavement disorder (PCBD) and comorbid post-traumatic stress disorder (PTSD) and depression. Waitlist-controlled trials have shown that grief-specific cognitive–behavioural therapy (CBT) is an effective treatment for such mental health problems. This is the first study that will examine the effectiveness of online CBT (vs waitlist controls) in a sample exclusively comprised of people bereaved by a traumatic death. Our primary hypothesis is that people allocated to the online CBT condition will show larger reductions in PCBD, PTSD and depression symptom levels at post-treatment than people allocated to a waitlist. We further expect that reductions in symptom levels during treatment are associated with reductions of negative cognitions and avoidance behaviours and the experience of fewer accident-related stressors. Moreover, the effect of the quality of the therapeutic alliance on treatment effects and drop-out rates will be explored.Methods and analysisA two-arm (online CBT vs waiting list) open-label parallel randomised controlled trial will be conducted. Participants will complete questionnaires at pretreatment and 12 and 20 weeks after study enrolment. Eligible for participation are Dutch adults who lost a loved one at least 1 year earlier due to a traffic accident and report clinically relevant levels of PCBD, PTSD and/or depression. Multilevel modelling will be used.Ethics and disseminationEthics approval has been received by the Medical Ethics Review Board of the University Medical Center Groningen (METc UMCG: M20.252121). This study will provide new insights in the effectiveness of online CBT for traumatically bereaved people. If the treatment is demonstrated to be effective, it will be made publicly accessible. Findings will be disseminated among lay people (eg, through newsletters and media performances), our collaborators (eg, through presentations at support organisations), and clinicians and researchers (eg, through conference presentations and scientific journal articles).Trial registration numberNL7497.

Published
2020

46. Rechters en raadsheren over Bayes

Author

Horselenberg, R., van Koppen, V., de Keijser, J., Prakken, Henry, Horselenberg, R., van Koppen, V., de Keijser, J., and Prakken, Henry

Published
2020

47. Treating complicated grief and posttraumatic stress in homicidally bereaved individuals: A randomized controlled trial

Author

van Denderen, M., de Keijser, J., Stewart, R., Boelen, P.A., Trauma and Grief, Leerstoel Boelen, Trauma and Grief, Leerstoel Boelen, and Clinical Psychology and Experimental Psychopathology

Subjects
DISORDER, 050103 clinical psychology, medicine.medical_treatment, media_common.quotation_subject, eye movement desensitization and reprocessing, behavioral disciplines and activities, CLINICAL-TRIAL, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, law, PSYCHOTHERAPY, mental disorders, Eye movement desensitization and reprocessing, PROLONGED GRIEF, medicine, 0501 psychology and cognitive sciences, COGNITIVE-BEHAVIORAL THERAPY, TRAUMA, media_common, SURVIVORS, OUTCOMES, homicide, 05 social sciences, bereavement, loss, Cognition, cognitive behavioural therapy, medicine.disease, Mental health, Complicated grief, 030227 psychiatry, Cognitive behavioral therapy, Clinical trial, Clinical Psychology, VIOLENT LOSS, Grief, Psychology, MENTAL-HEALTH, Clinical psychology
Abstract

Homicidally bereaved individuals may experience symptoms of Complicated Grief (CG) and Posttraumatic Stress Disorder (PTSD). This Randomized Controlled Trial examined the effectiveness of an 8-session treatment encompassing Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) to reduce self-rated CG and PTSD symptoms in 85 Dutch adult homicidally bereaved men and women. We compared changes in symptoms of CG (assessed using the Inventory of Complicated Grief) and PTSD (assessed using the Impact of Event Scale) between an intervention group and a waitlist control group. The treatment was effective in reducing CG and PTSD symptoms. from pretreatment to posttreatment. It can be concluded that EMDR and CBT seem promising treatments for homicidally bereaved individuals for both men and women, and regardless of the time since the loss. Further research is needed to examine whether a combined treatment of EMDR and CBT together is of added value in situations where grief and trauma are intertwined over offering only one of the two treatment modalities.

Published
2018
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48. I've changed, but I'm not less happy

Author

Lenferink, L.I.M., de Keijser, J., Piersma, E., Boelen, P.A., Trauma and Grief, Leerstoel Boelen, and Clinical Psychology and Experimental Psychopathology

Subjects
Adult, 050103 clinical psychology, medicine.medical_specialty, STRESS, media_common.quotation_subject, MEDLINE, FAMILIES, Ambiguous loss, 03 medical and health sciences, Social support, 0302 clinical medicine, Arts and Humanities (miscellaneous), BEREAVEMENT, Adaptation, Psychological, Developmental and Educational Psychology, medicine, PROLONGED GRIEF, Humans, Family, 0501 psychology and cognitive sciences, Disengagement theory, Psychiatry, Aged, media_common, Aged, 80 and over, COMPLICATED GRIEF, 05 social sciences, Social Support, Middle Aged, Resilience, Psychological, medicine.disease, Complicated grief, 030227 psychiatry, Term (time), MODEL, Clinical Psychology, Grief, Psychological resilience, Psychology, AMBIGUOUS LOSS, Stress, Psychological, Clinical psychology
Abstract

Twenty-three nonclinical relatives of long-term missing persons were interviewed. Patterns of functioning over time were studied retrospectively by instructing participants to draw a graph that best described their pattern. Patterns most frequently drawn were a recovery and resilient/stable pattern. Participants were also asked to select five out of fifteen cards referring to coping strategies, which they considered most helpful in dealing with the disappearance. Acceptance, emotional social support, mental disengagement, and venting emotions were most frequently chosen. This study provided some indication of coping strategies that could be strengthened in treatment for those in need of support.

Published
2018
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