Challenges in evaluating adult bereavement services

Evaluating the effectiveness of bereavement interventions presents major theoretical, ethical and practical challenges. Based on the extensive research experience of the authors, this article outlines some of the key considerations that must be addressed when seeking to demonstrate the effectiveness of an intervention. These include what methods to use, the recruitment of participants, what to measure to demonstrate effectiveness, adapting measures to reflect cultural and other diversities, and how to deal with variables likely to influence the delivery and outcomes of the intervention

Avoidance processes mediate the relationships between rumination and symptoms of complicated grief and depression after loss

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

Voorlichting bij patiënten met atriumfibrillatie: een gecontroleerde effectstudie

In outpatient care settings, there is often a lack of possibilities to inform patients sufficiently about their diagnosed disease. This is partially due to inefficient time management and a shortage of financial means. The patient is left with many unanswered questions, which can lead to uncertainty about their disease and how to deal with it. In this study the effects of a short patient education program are examined using a pre-posttest control group design and a questionnaire, the effects of a multimedia mode of patient education for patients diagnosed with atrial fibrillation are assessed on well-being, knowlegde, disease acceptance, treatment compliance, uncertainty, physical complaints, anxiety and depression. The patient education program results in a significant stronger decrease of uncertainty within the education group than in the control group. Knowledge about the disease increases significantly more in the experimental group too, compared with the control group. There is no improvement noticeable for any of the other measured variables. All in all, the results are modest, but, considering the small investment needed for such an intervention, it can be considered a valuable additional instrument in cardiology care

Continuing bonds in adaptation to bereavement: Toward a theoretical integration

There is lack of clarity in the scientific literature concerning the adaptive functions of continuing versus relinquishing bonds to deceased persons. It remains unclear what type of bonds or underlying processes are related to (mal)adaptive bereavement outcomes. Furthermore, empirical research has rarely been theoretically-driven. Thus, the purpose of this article is to outline a theoretical model for predicting the (mal)adaptiveness of continuing-relinquishing bonds. Attachment theory provides a generic framework for understanding patterns of individual differences in the impact of continuing bonds. Within this framework, using bereavement-specific models compatible with attachment theory, (1) ways of coping with the bond to the deceased can be linked to outcome (using the Dual Process Model, Stroebe & Schut, 1999), and (2) related cognitions about the deceased person proposed (drawing on Mental Representations Theory, Boerner & Heckhausen, 2003). This integrative model can be used to systematically examine the relationship between continuing bonds and bereavement adaptation

Randomised controlled trial comparing narrative exposure therapy with present-centred therapy for older patients with post-traumatic stress disorder

Background Evidence-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.Aims Examining the efficacy of NET in a sample of older adults.Method Out-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.Results Using 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.Conclusions Both 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 interest None

Effects of social support, counselling, and therapy before and after the loss: Can we really help bereaved people?

Can other persons, personally or professionally, help bereaved individuals deal with the loss of a loved one? An increasing number of empirical studies, as well as qualitative and quantitative reviews, have addressed this question. Here, the main findings are summarised and implications for researchers and practitioners considered. First, provision of help from the informal social network and volunteers/professionals in the post-loss period is examined. Second, and uniquely in this research area, examination is extended to the efficacy of intervention for family members prior to their bereavement (i.e., in the context of palliative/end-of-life care). To what extent do the pre-loss patterns mirror those for post-bereavement intervention efficacy? A main conclusion is that intervention is not effective for bereaved persons in general, either when this is provided before or after the actual loss. It is important to identify and target high-risk persons. Further scientific and clinical implications of the patterns of results are discussed

Imagery Rehearsal Therapy in Addition to Treatment as Usual for Patients With Diverse Psychiatric Diagnoses Suffering From Nightmares: A Randomized Controlled Trial

OBJECTIVE: Nightmares are associated with psychopathology and daily distress. They are highly prevalent in a psychiatric population (30%). Currently, imagery rehearsal therapy (IRT) is the treatment of choice for nightmares. With IRT, the script of the nightmare is changed into a new dream, which is imagined during the day. However, the effects of IRT in a psychiatric population remain unknown. The aim of this study was to determine the effectiveness of IRT in a heterogeneous psychiatric population. METHOD: Between January 2006 and July 2010, 90 patients with psychiatric disorders (DSM-IV-TR) were randomized to IRT or treatment-as-usual conditions. IRT consisted of 6 individual sessions added to the treatment as usual. Nightmare frequency was assessed using daily nightmare logs and the Nightmare Frequency Questionnaire. Nightmare distress was assessed using the Nightmare Distress Questionnaire and the Nightmare Effects Survey. General psychiatric symptoms were assessed using the Symptom Checklist-90 and a PTSD symptom questionnaire. Assessments were administered at the start of the trial, after the IRT and at follow-up 3 months later. RESULTS: IRT showed a moderate effect (Cohen d = 0.5-0.7, P < .05) on nightmare frequency, nightmare distress, and psychopathology measures compared with treatment as usual. These effects were largely sustained at the 3-month follow-up (Cohen d = 0.4-0.6, P < .10). CONCLUSIONS: IRT is an effective treatment for nightmares among patients with comorbid psychiatric disorders and can be employed in addition to the on-going treatment. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00291031