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403 a Walijarvi Weiss presentation

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403 a Walijarvi Weiss presentation

  1. 1. Difficulties and OpportunitiesNAGC 14th Annual Symposium June 25, 2010 © Bo’s Place 2010<br />Measuring Grief:<br />
  2. 2. Introductions<br />Corrine Walijarvi, MS, MBA, LMSW<br />Clinical Researcher, Bo’s Place<br />PhD student, University of Houston, Graduate College of Social Work<br />Doctoral Associate, University of Houston<br />Ann H. Weiss, MAT, MEd, LPC<br />Program Director, Bo’s Place<br />
  3. 3. Bo’s Place Research Goals <br />Promote quality research<br />Maintain the highest ethical standards<br />Provide results useful to practitioners<br />Provide insights helpful to the bereaved<br />Communicate research and findings<br />Online: NAGSS<br />Conferences<br />
  4. 4. NAGSS<br />Available at bosplace.0rg<br />Summaries of peer-reviewed articles<br />Bibliographical information<br />Summary of key findings<br />Summary of service provider implications<br />Target audience: service providers <br />On-going program<br />
  5. 5. Why is grief research difficult?<br />Ethical concerns<br />Lack of consensus on definitions<br />What is grief?<br />What is recovery? Resilience? Growth?<br />Lack of appropriate measurements<br />Timing issues<br />Control and comparison groups<br />
  6. 6. Ethical Concerns<br />Grief research can be an effective intervention<br />Participants in grief research identify substantial benefits from participation: (Beck & Konnert, 2007)<br /> Tell the story<br />Gain insights into own thoughts, feelings<br />Find meaning in the death<br />Participation contributes to greater understanding of the grief process<br />Normalizes the grief experience<br />
  7. 7. Implications for Research<br />Research with the bereaved can be ethically designed and conducted<br />Cautions and considerations (Williams, Woodbury, Bailey, & Burglo, 2008)<br />Time since death<br />Choice of site<br />Informed consent<br />Empathic, trained interviewers<br />Control over pace<br />
  8. 8. Why is grief difficult to define?<br /><ul><li>Multiple definitions
  9. 9. Work
  10. 10. Processes
  11. 11. Emotions
  12. 12. Stages/tasks/phases
  13. 13. Grief is an abstract construct
  14. 14. Nearly universal experience
  15. 15. Uniquely experienced</li></li></ul><li>Diverse models applied to grief<br />Psychodynamic: search for pathology<br />Existential: search for meaning<br />Cognitive behavioral: search for functioning<br />Systems: search for relationships<br />Constructionist: create on-going story<br />
  16. 16. Grief Patterns<br />
  17. 17. What about time frames?<br />At what point is intense grief pathological?<br />At what point should interventions be offered?<br />How long should interventions last?<br />How long should follow-ups occur?<br />Does grief end?<br />Much debate remains regarding timeframes<br />
  18. 18. Grief as pathology<br /><ul><li>Consensus has grown after years of debate:
  19. 19. 15% -20% of grief is pathological
  20. 20. Grief is a distinct construct
  21. 21. Not depression
  22. 22. Not PTSD
  23. 23. Evolution in conceptualization of pathological grief
  24. 24. Traumatic grief
  25. 25. Complicated grief
  26. 26. Prolonged grief disorder</li></li></ul><li>How has grief been measured?<br /><ul><li>Pathology Measurements
  27. 27. Depression measurements
  28. 28. Anxiety measurements
  29. 29. Stress measurements
  30. 30. Posttraumatic stress measurements
  31. 31. General health measurements
  32. 32. Other Measurements
  33. 33. Continuing bonds measurements
  34. 34. Growth measurements</li></li></ul><li>Criteria Proposed Traumatic Grief (2002)<br />Traumatic Grief<br />More than 2 months<br /> Interferes with functioning<br />Distressing preoccupation is present<br />Other elements:<br />Avoidance<br />Purposelessness<br />Difficulty acknowledging the death<br />Shattered worldview<br />
  35. 35. Criteria ProposedProlonged Grief Disorder (2009)<br />PGD-13 (Prigerson, Horowitz, Jacobs, et al., 2009)<br />More than 6 months<br />Significant impairment in functioning<br />Daily experience of yearning <br />Daily experience of intense feelings of pain, grief, sorrow<br />At least 5 of 9 additional cognitive, emotional, and behavioral elements<br />
  36. 36. PGD, Continued<br /><ul><li>Additional elements (5 of 9):
  37. 37. Avoid reminders
  38. 38. Feel stunned, shocked, dazed
  39. 39. Feel confused (part of self has died?)
  40. 40. Hard to trust others
  41. 41. Trouble accepting the loss
  42. 42. Feel bitter
  43. 43. Moving on is difficult
  44. 44. Emotionally numb
  45. 45. Life is empty, meaningless</li></li></ul><li>Why do the measurements matter?<br />Impact on the bereaved<br />Who is diagnosed<br />Who receives treatment/services<br />Impact on services<br />What services/interventions are offered<br />When services/interventions are offered<br />How services are evaluated<br />
  46. 46. Progress has been achieved<br />Studies have validated concept of PGD<br />Unique construct (Dillen & Fontaine, 2009)<br />Distinct from depression, PTSD, anxiety<br />Studies have begun to evaluate interventions<br />Supportive psychotherapy (Currier, Neimeyer, & Berman, 2008)<br />Cognitive behavioral therapy (Boelen, de Keijser, van den Hout, & van den Bout, 2007)<br />Support groups (Cacciatore, 2007)<br />
  47. 47. Issues Remain<br />PGD as a diagnostic category<br />Will it be overused?<br />What interventions will be developed?<br />Bereaved who are not diagnosed with PGD<br />Will services continue to be offered?<br />What measurements are needed?<br />What interventions are needed?<br />
  48. 48. Research Opportunities<br />Identifying/defining non-pathological forms of grief<br />Developing measurement instruments for progress/growth following bereavement<br />Identifying elements that contribute to progress/growth<br />Identifying interventions that contribute to progress/growth<br />
  49. 49. Opportunities: Progress in Grief<br />Elements contributing to progress in grief<br />Support network (Cacciatore, 2007; Feigelman, Gorman, Beal, & Jordan, 2008)<br />Cognitive and affective processing (Boelen, de Keijser, van den Hout, & van den Bout, 2007; Doughty, 2009; Fleming & Robinson, 2001; Matthews & Marwit, 2004) <br />Meaning making (Neimeyer, Baldwin, & Gilles, 2006)<br />Information and knowledge (Charles-Edwards, 2009; Kinder & Cooper, 2009; Walter, 2009)<br />
  50. 50. Questions?<br />