Viviendo el duelo: preguntas y respuestas sobre la pérdida y el duelo

El campo de las terapias de duelo está evolucionando rápidamente, mientras las nuevas teorías, modelos y hallazgos de investigación inspiran nuevas comprensiones sobre la pérdida y sobre cómo las personas se adaptan a ella. Este artículo resume algunos de estos desarrollos contemporáneos enfatizando la búsqueda de sentido en el duelo, e ilustra cómo estas nuevas perspectivas pueden ofrecer orientación a las personas que buscan asesoramiento para enfrentar las pérdidas bajo circunstancias complicadas. Las enfermeras por su trabajo están en contacto con la muerte y el dolor, por lo que ocupan una posición privilegiada para extender el cuidado compasivo e informado tanto a lo pacientes como a las familias que enfrentan tales transiciones existencialesThe field of grief therapy is rapidly evolving, as new theories, models and research findings inspire new understandings of loss and how people accommodate it. This article summarizes some of these contemporary developments, emphasizing the search for meaning in bereavement, and illustrates how these fresh perspectives can offer guidance to real people seeking consultation on how to manage very real losses under complicating circumstances. Nurses occupy many roles that bring them into contact with death and grief, leaving them well positioned to extend knowledgeable and compassionate care for patients and families facing such existential transitions

Innovative moments in grief therapy: reconstructing meaning following perinatal death

This article presents an intensive analysis of a good outcome case of constructivist grief therapy with a bereaved mother, using the Innovative Moments Coding System (IMCS). Inspired by M. White and D. Epston’s narrative therapy, the IMCS conceptualizes therapeutic change as resulting from the elaboration and expansion of unique outcomes (or as we prefer, innovative moments), referring to experiences not predicted by the problematic or dominant self-narrative. The IMCS identifies and tracks the occurrence of 5 different types of innovative moments: action, reflection, protest, re-conceptualization, and performing change. Results documented the process of meaning reconstruction over the 6 sessions of treatment, and demonstrated the feasibility and reliability of analyzing narrative change in this form of grief therapy, opening it to comparison with other approaches

Historia de pérdidas y sintomatología depresiva.

En la literatura científica se ha dado importancia a la relación existente entre las pérdidas, la muerte de un ser querido y la depresión. Objetivos. Identificar la prevalencia de las pérdidas de seres queridos y otros tipos de pérdidas, la percepción de los participantes de haberse adaptado satisfactoriamente o no a cada una de las pérdidas y la relación que dichas pérdidas y su posible superación tienen con la sintomatología depresiva. Método. Utilizando el Inventario de Historia de Pérdidas (IHP) y el BDI-II se evaluó una muestra comunitaria incidental de 288 participantes. Resultados. El 42,71% de la muestra mencionó alguna pérdida que consideraba no haber superado. Se encontró que la intensidad de los síntomas correlacionaba con el número total de pérdidas, con el número de pérdidas de ser querido no superadas y con las pérdidas no superadas de otra índole. Conclusiones. Sería conveniente explorar la historia de pérdidas tanto de participantes en estudios de investigación como de los pacientes que se atienden ya desde el primer contacto, dado que las pérdidas pueden ser un factor de predisposición en la presentación de sintomatología diversa, y un aspecto a considerar en la planificación del tratamiento. El IHP es un instrumento breve y adecuado que cumple con ese propósito

Toward the Development of a Monitoring and Feedback System for Predicting Poor Adjustment to Grief

Losing a loved one is a fundamental and ubiquitous life experience that is often characterized by a certain period of grief and emotional distress. Although the majority of the bereaved can cope with grief resiliently, around 1 of 10 individuals could experience an unusually protracted and intense response referred to as prolonged grief disorder (PGD) following death of a loved one. PGD is associated with work and social impairment and heightened risk of severe medical and psychological conditions. Current means of diagnosis requires a minimum of 6 months to confirm and identify PGD and is discrepant with the fact that the bereaved may need psychotherapeutic intervention in a more timely manner. Contemporary studies have outlined prospective risk factors that could cause poor bereavement outcome, which can potentially contribute to early identification and prevention of problematic response to grief. Self-monitoring applications have been developed and broadly implemented in a vast spectrum of mental and health-related interventions and self-managing processes. This study presents the conceptualization and development of an Internet-based screening method designed by the researchers and psychotherapists that aims to provide meaningful and quantitative feedback in the early phase of the grief and to support decision making in the bereavement process through monitoring the susceptibility to problematic grief outcome

Experiences of Norwegian Mothers Attending an Online Course of Therapeutic Writing Following the Unexpected Death of a Child

The unexpected death of a child is one of the most challenging losses as it fractures survivors’ sense of parenthood and other layers of identity. Given that not all the bereaved parents who have need for support respond well to available treatments and that many have little access to further intervention or follow-up over time, online interventions featuring therapeutic writing and peer support have strong potential. In this article we explore how a group of bereaved mothers experienced the process of participating in an online course in therapeutic writing for the integration of grief. Our research questions were: How do parents who have lost a child experience being part of an online course in therapeutic writing? What are the perceived benefits and challenges of writing in processing their grief? We followed an existential phenomenological approach and analyzed fieldwork notes (n = 13), qualitative data from the application and assessment surveys (n = 35; n = 21), excerpts from the journals of some participants (n = 3), and email correspondence with some participants (n = 5). We categorized the results in three meaning units: (1) where does my story begin? The “both and” of their silent chaos; (2) standing on the middle line: a pregnancy that does not end; (3) closures and openings: “careful optimism” and the need for community support. Participants experienced writing as an opportunity for self-exploration regarding their identities and their emotional world, as well as a means to develop and strengthen a bond with their children. They also experienced a sense of belonging, validation, and acceptance in the online group in a way that helped them make sense of their suffering. Online writing courses could be of benefit for bereaved parents who are grieving the unexpected death of a child, but do not replace other interventions such as psychotherapy. In addition to trauma and attachment informed models of grief, identity informed models with a developmental focus might enhance the impact of both low-threshold community interventions and more intensive clinical ones. Further studies and theoretical development in the area are needed, addressing dialogical notions such as the multivoicedness of the self.publishedVersio

Restorative Retelling for Processing Psychedelic Experiences : Rationale and Case Study of Complicated Grief

Many psychedelic experiences are meaningful, but ineffable. Engaging in meaning-making regarding emerging symbolic content and changing previous schemas have been proposed as mechanisms of change in psychedelic therapy. Firstly, we suggest the implementation of a Restorative Retelling (RR) technique to process and integrate the psychedelic experience into autobiographical memory, in a way that fosters meaning-making. We also show how ayahuasca has the potential to evoke key psychological content in survivors, during the process of grief adjustment following the death of a loved one. The rationale for the implementation of RR to process psychedelic experiences and a case study of a woman suffering from Complicated Grief (CG) after her mother's suicide are presented. Evaluations conducted before the ayahuasca experience and after RR suggest the effectiveness of ayahuasca and RR in reducing symptoms of CG and psychopathology. This case report illustrates an effective adaptation of the RR technique for processing the psychedelic experience. The significance of the study and its limitations are discussed

Cultural Influences in the Processing of Emotion Schemas Related to Death and Violence: A Pilot Study

Culture is a key element in determining emotions that people experience when facing death. Recent studies revealed a specific emotion schema for the affective response to death (in comparison with unpleasant/violence-related stimulus), influenced by differences in the personalities and learning processes of the individuals, on the one hand, and differences in the cultural and social contexts of the two groups, on the other. The objective of the research was to compare the English participants’ affective response to pictures of death to those of the Spanish participants, who viewed other types of affective pictures (pleasant, unpleasant/violence-related and neutral). A total of 38 young adults took part in an emotional assessment using a set of pictures from the International Affective Picture System (IAPS) database. They indicated the values of valence, arousal and dominance for each affective image. The results show that the images related to death were less unpleasant and caused a lower activation in the English population, while there were no differences in the two group’s responses to unpleasant/violent images

Serum neurofilament dynamics predicts neurodegeneration and clinical progression in presymptomatic Alzheimer's disease

Neurofilament light chain (NfL) is a promising fluid biomarker of disease progression for various cerebral proteopathies. Here we leverage the unique characteristics of the Dominantly Inherited Alzheimer Network and ultrasensitive immunoassay technology to demonstrate that NfL levels in the cerebrospinal fluid (n = 187) and serum (n = 405) are correlated with one another and are elevated at the presymptomatic stages of familial Alzheimer's disease. Longitudinal, within-person analysis of serum NfL dynamics (n = 196) confirmed this elevation and further revealed that the rate of change of serum NfL could discriminate mutation carriers from non-mutation carriers almost a decade earlier than cross-sectional absolute NfL levels (that is, 16.2 versus 6.8 years before the estimated symptom onset). Serum NfL rate of change peaked in participants converting from the presymptomatic to the symptomatic stage and was associated with cortical thinning assessed by magnetic resonance imaging, but less so with amyloid-β deposition or glucose metabolism (assessed by positron emission tomography). Serum NfL was predictive for both the rate of cortical thinning and cognitive changes assessed by the Mini-Mental State Examination and Logical Memory test. Thus, NfL dynamics in serum predict disease progression and brain neurodegeneration at the early presymptomatic stages of familial Alzheimer's disease, which supports its potential utility as a clinically useful biomarker