臨床心理学者として歩んできた道 <特別講演>

特集2 広島心理臨床大学院合同研究会 第4回大

Grief and Coping with the Death of the Beloved: An Exploratory Analysis

In order to investigate the coping behaviors related to bereavement-induced grief, we administered an open-ended questionnaire to a sample of 52 adults inquiring about psychological adjustment to and coping with the death of a loved one, STAI T-form was also used as a personality assessment devise. Grief reactions were categorized into (a) psychological shock and denial, (b) depression and sadness, (c) anger, (d) anxiety, (e) guilty feeling, (f) images and thoughts of the lost person, (g) acceptance, and (h) others. Psychological shock and depression appeared immediately after the death, but subsided over time. Images and thoughts of the lost person occasionally delayed in appearing long after the death. As compared to participants low in trait anxiety, those high in trait anxiety were less likely to accept the death of the loved one, and more likely to keep negative emotions relevant to the death. Acceptance of the death was less likely to be adopted by the participants who experienced sudden death than those who experienced the death after suffering from diseases for a long time. Coping behaviors were classified into (a) religious activity, (b) avoidance or acceptance, (c) distraction, (d) meaning of personal life, (e) ruminative response, (f) support-seeking behavior, and (g) others. Although some participants adapted religious activity and distraction with successful adjustment, others suffered from grief by rumination and sought emotional support. These results indicated that Japanese people often have bereavement-induced grief reactions, suggesting that it is indispensable for mental health professionals to support those who are suffering from grief.本研究の目的は52人の成人を対象に、死刑による悲嘆反応と対処行動について検討することであった。悲嘆反応と対処行動について、自由記述の質問紙を用いて検討し、同時にSTAIのT-formを実施した。はじめに心理的反応を、心理的ショックや否認、抑うつと悲しみ、怒り、不安、罪悪感、亡くした人のイメージや想起、受容、その他の8つのカテゴリーに分類した。その結果、心理的ショックと抑うつは死別直後に増加するが、以後は時間経過とともに減少していく傾向にあった。亡くなった人のイメージは病的悲嘆の特徴の一つであるが、死別後時間が経過してから現れるケースがみられた。特性不安の高い人は低い人より死を受け容れにくく、死別に関する否定的な感情を持続させる傾向にあった。突然の死別を経験した人は長期闘病の末に亡くなった場合よりも死を受付容れにくくなる傾向にあった。さらに、特性不安は死刑に対する現在の否定的な感情と関連があった。第三に、対処行動を、宗教関連行動、回避的対処と受容、気晴らし、人生の意味、考え込み、援助希求、その他の7つのカテゴリーに分類した。気晴らしと宗教関連行動で適応的な対処をする人もみられたが、考え込みにより悲嘆で苦しみ、情緒的援助を希求する人もあった。これらの結果から、悲嘆に苦しむ人に対する専門家の援助が不可欠であることを示唆した

Psychological Process of Parents of Children with Progressive Muscular Dystrophy and Factors Influencing Their Acceptance of Children\u27s Disease and/or Death

The purpose of this study was to investigate the psychological process of parents whose children were cases of progressive muscular dystrophy and the factors related to their acceptance of the children\u27s disease and/or death. The fifteen couples were interviewed to explore their feelings and behavior at different stages of pre-diagnosis, diagnosis, illness, as well as at the time of their child\u27s death. The influence of the children\u27s disease on their families was also investigated through the interview. The following results were found in this study. (1) Parents are greatly shocked when their children are diagnosed with progressive muscular dystrophy. (2) As time goes by，they can accept their children\u27s disease and live positively. (3) In the case of unexpected sudden bereavement, mothers cannot accept children\u27s death at ease, and they have depressive emotion. (4) For accepting theirchildren\u27s disease and/or death, their families and peer parents, whose children are cases of same disease play a very important role. (5) If the father can support the mother, she can accept her child\u27s disease and/or death relatively at easy. Therefore, it was suggested that parents were in need of mental care at the time of diagnosis and/or bereavement, and that the interventions for parents functioning as support resources to each other are effective

Grief Process and Strategies of Psychological Helpings: A Review

Grief for bereavement influence the psychosomatic status of the bereaved negatively. This paper aimed at reviewing studies on the psychological process of grief, psychological interventions and help for the bereaved. First, we reconsidered and evaluated two basic theories: psychoanalytical grief theory (attachment theory) and stress theory. The grief theory, Freud\u27s traditional theory, induced a number of studies on grief. ln this theory, the bereaved must experience grief work，the task of mourning. To go through this task is essential for identification. However, there are many unsettled questions. On the contrary, the stress theory focuses on social support. Second, we reviewed the influence of grief on psychosomatic responses, considering the buffering effect of social support on stress responses. Third, we considered strategies of intervention and help with grief: focusing on behavior therapy, cognitive behavior therapy and group approach

The Relationship between Individual Difference in Repressive Stles and Grief Reaction Coping Behaviors, and Onset of Pathological Grief, Anxiety and Mood Disorders after Child Loss

We examined the relationship between parental repressive styles, grief reaction/post-bereavement coping behavior and psychiatric symptoms in parents who had lost young children, In Study I, we administered a set of questionnaires to a sample of 177 parents who had experienced bereavement of children within the past several years in order to inquire about grief response, coping behavior, repressive styles, and social support .After controlling for sex, age, income, and self esteem, 1) subjects who had high anxiety (sensitizer and repressive-anxiety) showed stronger grief response whereas those with low anxiety (repressor and low-anxiety) showed weak response; 2) repressors were more likely to accept death and resolute grief after the loss than others; 3) those who had higher anxiety were more likely to ruminate after death; and 4) sensitizers were less likely to satisfy perceived social support. In Study II we interviewed 60 bereaved parents using a semi-structured diagnostic interview schedule to yield diagnoses of the parents based on the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM-IV). Parents with repressive-anxiety were more likely to manifest pathological grief and those parents recognized as sensitizers were more likely to have an onset of DSM-IV Major Depression or Social Phobia after the child\u27s death.抑圧様式と悲嘆反応、死別後の対処行動、精神症状との関連性について検討した。研究Iでは幼い子どもと死別した親177名を対象に悲嘆反応、対処行動、抑圧様式、ソーシャルサポートを測定した。性別、年齢、収入などを統制し分析した結果、①不安水準の高い sensitizer, repressive Anxiety 各群では悲嘆反応が強心不安水準の低い repressor, low-anxiety各群では悲嘆反応が弱い、②repressor群では悲嘆がすでに解決したことと認知し、死別体験を肯定的に捉える傾向が強い、③不安水準が高いと死別後に内的に考え込む対処を多く行う、④sensitizer群では知覚されたソーシャルサポートに対する満足度が低い傾向にあった。研究IIでは60名に半構造化面接を行い、死別後に罹患した精神疾患の診断を行った。その結果，⑤病的悲嘆はrepressive- anxiety傾向と，⑥大うつ病性障害や社会恐怖はsensitization傾向とそれぞれ関連することが示された

The Measurement of Grief and Coping after Loss of a Child

We administered Grief Response Scale (GRS), Japanese translation of "Core Bereavement Items," and a set of newly developed coping　behavior items (Scale for Coping with　Bereavement; SCB) to 48 fathers and 127　mothers who experienced the loss of a child within several years. Although a confirmatory factor analysis of GRS did not support the original seven-factor model byBurnett et al., an exploratory factor analysis yielded four factors: lmage and sorrow, Sense of presence， Non-resolution and conflict, and Resolution of grief. Grief reaction was significantly greater in mothers than in fathers. An exploratory factor analysis of SCB produced five factors: Distraction, Ruminative response, A cceptance and overcome, Support-seeking behavior, and Religious activity and existential meaning. As compared to fathers, mothers ruminated, sought support from others, and had religious activity more frequently. These results suggest that different aspects of grief were related with coping with bereavement after controlling for age, sex, income, and level of manifest anxiety

Experimental-clinical psycholgical study about pain control (5) : Pain sensation and skin temperature change induced by cold pressor test

Experimentally induced pain by cold pressor test was investigated using subjective and physiological measures. Seven subjects immersed their dominant hands in cold water of 5°C, 10°C and 15°C and the skin temperatures of both hands were measured. Their pain sensation was then evaluated using 80 adjectives. Pain estimation by adjectives revealed distinctions between water temperatures including severity and mildness. Skin temperature reduced more during immersion and increased more quickly after withdrawing in colder water conditions