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BackgroundEvidence-based treatment and age-specific services are required to address the needs of trauma-affected older populations. Narrative exposure therapy (NET) may present an appropriate treatment approach for this population since it provides prolonged exposure in a lifespan perspective. As yet, however, no trial on this intervention has been conducted with older adults from Western Europe.AimsExamining the efficacy of NET in a sample of older adults.MethodOut-patients with post-traumatic stress disorder (PTSD), aged 55 years and over, were randomly assigned to either 11 sessions of NET (n = 18) or 11 sessions of present-centred therapy (PCT) (n = 15) and assessed on the Clinician-Administered PTSD Scale (CAPS) pre-treatment, post-treatment and at follow-up. Total scores as well as symptom scores (re-experience, avoidance and hyperarousal) were evaluated.ResultsUsing a piecewise mixed-effects growth model, at post-treatment a medium between-treatment effect size for CAPS total score (Cohen's d = 0.44) was found, favouring PCT. At follow-up, however, the between-treatment differences were non-significant. Drop-out rates were low (NET 6.7%, PCT 14.3%) and no participant dropped out of the study because of increased distress.ConclusionsBoth NET and PCT appear to be safe and efficacious treatments with older adults: PCT is non-intrusive and NET allows for imaginal exposure in a lifespan perspective. By selectively providing these approaches in clinical practice, patient matching can be optimised.Declaration of interestNone.

Het bestuur van de VGCt is voornemens de grondslag van de vereniging te verbreden. Het wil de VGCt maken tot een vereniging van EST's, en op termijn wellicht komen tot een federatie of fusie met andere verenigingen die deze grondslag delen. In deze bijdrage wordt beargumenteerd dat er geen reden is voor een grondslagverbreding, omdat de grondslag al breed is. Daarnaast kan het onderhavige voorstel eerder als een grondslagversmalling worden gekenschetst die negatieve gevolgen zal hebben. Ten slotte wordt gesteld dat dit voorstel haaks staat op belangrijke wereldwijde nieuwe ontwikkelingen binnen CGT.

Ruminative coping has been associated with negative outcomes in bereavement. Rather than assuming it to be a problematic confrontation process, researchers have recently suggested rumination to be maladaptive through its links with avoidance processes. The main aim of this study was to examine, for the first time, whether the relationship between ruminative coping and symptoms of complicated grief and depression is mediated by avoidance processes (suppression, memory/experiential avoidance, behavioral avoidance, loss-reality avoidance). A sample of 282 adults (88% female, 12% male), bereaved on average 18 months previously, filled out three questionnaires at 6-month intervals. We assessed symptom levels, grief rumination, and trait rumination at baseline; avoidance processes after 6 months; and symptom levels after 12 months. When controlling for initial symptom levels, experiential avoidance mediated the link between grief rumination and complicated grief, and experiential avoidance and behavioral avoidance mediated the link between grief rumination and depression. Post hoc analyses showed suppression may also mediate the link between grief rumination and symptoms of complicated grief, but not depression. Loss-reality avoidance was no significant mediator of these relationships. This study provides initial evidence that rumination during bereavement increases and perpetuates symptoms of psychopathology, because it is linked with specific avoidance processes. Bereaved individuals with problematic grief and (chronic) rumination may benefit from therapy focused on countering avoidance tendencies. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Symptoms of psychopathology are associated with overgeneral memory retrieval. Overgeneral memory is hypothesized to be the result of an emotion regulatory process, dampening emotional reactions associated with retrieval of distressing specific memories. However, higher post-loss symptom severity has been related to higher specificity of loss-related memories recalled on the Autobiographical Memory Test. This may imply that such memories are ‘immune’ to the reduced specificity effect. We aimed to test this idea by investigating, for the first time, associations of depressive and complicated grief symptoms and depressive and grief rumination with autobiographical memory specificity on a sentence-completion task (SCEPT) in a bereaved sample. One hundred ninety-one adult mourners (89% women) filled out questionnaires and the SCEPT. A main finding was that higher depressive and complicated grief symptom and grief rumination levels were associated with reduced specificity of non-loss-related memories but not with specificity of loss-related memories. Implications of these results are discussed. Copyright © 2015 John Wiley & Sons, Ltd.

Ruminative coping has been associated with negative outcomes in bereavement. Rather than assuming it to be a problematic confrontation process, researchers have recently suggested rumination to be maladaptive through its links with avoidance processes. The main aim of this study was to examine, for the first time, whether the relationship between ruminative coping and symptoms of complicated grief and depression is mediated by avoidance processes (suppression, memory/experiential avoidance, behavioral avoidance, loss-reality avoidance). A sample of 282 adults (88% female, 12% male), bereaved on average 18 months previously, filled out three questionnaires at 6-month intervals. We assessed symptom levels, grief rumination, and trait rumination at baseline; avoidance processes after 6 months; and symptom levels after 12 months. When controlling for initial symptom levels, experiential avoidance mediated the link between grief rumination and complicated grief, and experiential avoidance and behavioral avoidance mediated the link between grief rumination and depression. Post hoc analyses showed suppression may also mediate the link between grief rumination and symptoms of complicated grief, but not depression. Loss-reality avoidance was no significant mediator of these relationships. This study provides initial evidence that rumination during bereavement increases and perpetuates symptoms of psychopathology, because it is linked with specific avoidance processes. Bereaved individuals with problematic grief and (chronic) rumination may benefit from therapy focused on countering avoidance tendencies.

Bereavement research has focused on individual rather than interdependent processes in coping with loss. Yet bereavement takes place in a social context, and relationship partners are likely to influence each other's grieving process. We examined the impact of a dynamic, interpersonal phenomenon, partner-oriented self-regulation (POSR): the avoidance of talking about loss and remaining strong in the partner's presence to protect the partner. Two hundred nineteen couples who had lost a child participated 6, 13, and 20 months after their loss. Consistent with predictions, results showed that one partner's POSR was associated not only with an increase in his or her own grief, but also with an increase in the other partner's grief. These relationships persisted over time: Self-reported and partner-reported POSR predicted later grief. These results are paradoxical: Although parents try to protect their partners through POSR, this effort has the opposite of the desired outcome. These findings underline the importance of further investigating interpersonal dynamics of coping with bereavement. © The Author(s) 2013.

A basic motive in compiling this volume has been to try to gain understanding of complicated grief, at a time in history when this seems particularly pertinent. In general terms, complicated grief (CG) can be understood as something like a “derailing” of the normal, usually painful process of adapting to the loss of a significant person. However, it will become evident to readers of the current volume that different definitions and criteria have been adopted to try to describe the concept more precisely, for both scientific and clinical purposes. To provide some basis for comparison: our earlier definition of CG has been along the lines of a clinically-significant deviation from the (cultural) norm (i.e., that could be expected to pertain, according to the extremity of the particular bereavement event) in either (a) the time course or intensity of specific or general symptoms of grief and/or (b) the level of impairment in social, occupational, or other important areas of functioning. (Stroebe, Hansson, Schut, & Stroebe, 2008, p. 7) However, such an apparently detailed characterization has shortcomings (e.g., it does not explicitly specify different types of complications that have been suggested, such as absent, delayed, or chronic grief). Further difficulties in operationalizing and applying such a definition will become apparent through the pages of this book.