Grief

Authors
Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Theories of Grief

Denial

  • Manifests as
    • Avoidance, confusion, shock, fear
    • Disbelief in diagnosis
    • Ignoring precautions

Anger

  • Frustration, irritation, anxiety

Bargaining

  • Struggling to find meaning, reaching out

Depression

  • Overwhelmed, helplessness, flight , sadness

Acceptance

  • Patients can regress to previous stages
  • Clinical manifestation:
    • Exploring options
    • Planning for future

Rando’s 6 “R” Theories of Grief

Avoidance

  • Recognize loss1

Confrontation

  • React: Experience emotion1
  • Recollect: Move from how the loss is currently impacting your situation to a place of remembrance1
  • Relinquish: Revising beliefs to realize that the world is forever changed1

Accommodation

  • Readjust
  • Reinvest

Preparatory Grief Theory

Crisis

  • Family life disrupted2
  • Feelings of sadness, anxiety, guilt often unexpressed2

Unity

  • Patient needs are prioritized2
  • Task oriented2

Upheaval

  • Protracted illness disrupts lives, relationships, and routines2

Resolution

  • Acceptance of impending death2
  • Resolution of interpersonal relationships2

Renewal

  • Adjustment to changed roles following death or disability2

Psychosocial Transition Theory of Grief

Grieving is a highly individualized process that varies w family and environmental context, personality, culture and religion3. All grieving individuals experience a psychosocial transition – forced to give up one life view for another within a relatively short period of time3. Successful grieving culminates in the acceptance that life will not be the same but can still be meaningful3.

Coping with Chronic Disability

Disability should be considered as an interaction of the person, task, and environment.

Note

This interaction can be approached using the ICF Model

Stages

Adaptation

Acute physical and psychological adjustments to a disabling event

Adjustment

  • Independence w ADLs, without being preoccupied by disability
  • Personal mastery of physical and social environment
  • Ability to problem solve thru new challenges
  • Positive self concept

Acceptance

Disability no longer reduces self worth or future outlook

Coping with Grief

Most commonly reported coping strategies

  • Talking (aka verbal disclosure)
  • Crying
  • Writing
  • Exercising

Negative appraisals

  • Associated w increased grief and distress 25 months later
    • Contributes to social isolation and loneliness
  • Examples:
    • Blame
    • Anger
    • etc

Positive Appraisals

  • Associated w higher morale and less depression 12 months later, help maintain social bonds
  • Examples
    • “Got to experience that person’s time on earth”
    • “Person would not want me to be sad”
    • Celebration of life (vs maybe funeral)

Dual Process Coping

Loss orientation

  • Breaking bonds
  • Intrusion of grief

Restoration orientation

  • New roles
  • New relationships
  • New activities

Problem focused coping

Practical problem solving to lessen impact of the loss

Emotion focused coping

Emotional regulation to lessen stress response to the bloss

Appraisal focused coping

Altering cognitive perception of the less

Complicated (unresolved) Grief

Characteristic Symptoms (10-20% incidence)

  • Intrusion
  • Denial
    • Substance use often occurs w this
  • Dysfunctional adaptation (Failing to resume work, other activities)
PTSD rates in bereaved spouses

Proportion of bereaved spouses meeting criteria for PTSD:

  • 10% death by natural causes
  • 35% death by suicide or accidents

Spirituality and Religion

Spirituality

  • Human need to find meaning, fulfillment, purpose in life
  • Internal personal expression of the sacred

Religion

  • Cultural system of behaviors, practices, sacred texts, holy places, ethics and world view connecting to God
  • Formal institutional expression of the sacred

Spiritual & Religious Coping styles

  • Self directed: Emphasis of the ability of the individual to impact situation
  • Deferring: Higher associated w dec QOL???
  • Collaborative: ???

References

1.
Rando TA. Grief, Dying, and Death: Clinical Interventions for Caregivers. Research Press; 1984.
2.
Okun BF, Nowinski J. Saying Goodbye: How Families Can Find Renewal Through Loss. 1st ed. Berkley Books; 2011.
3.
Parkes CM, Weiss RS, Weiss RS. Recovery from Bereavement. 1st softcover ed. Aronson; 1995.

Citation

For attribution, please cite this work as: