Motivation and emotion/Book/2018/Bereavement and emotion

Overview
Focus questions
 * What is bereavement?
 * What emotions are felt through Bereavement?
 * What are the theories surrounding bereavement and emotion?
 * How can people who experience bereavement manage their emotions?.

Bereavement Emotion
"‘‘Grieving is crucial, necessary and unavoidable for successful adaptation.‘‘ (Malkinson, 1996 as cited in Schut & Storebe, 2010) Bereavement has been defined as the action of losing a loved one which can affect the emotional wellbeing of the individual. Studies on bereavement mainly focus on losing a spouse or partner (Martikainen & Valkonen, 1996), experiencing perinatal loss (Killeen, 2014) and losing a family member (Coombs, Mitchell & Wetzig, 2016).



What is Bereavement Emotion?
Emotions are reactions to the environment, which generate feelings, arouses the body to action, generates motivational states and produces recognisable facial expressions (Reeve, 2015). Emotions are experienced on an everyday basis where some emotions may be stronger than others and are organised around two motivation systems. One being appetitive and the other being defensive where both are for survival purposes (Bradley, Codispoti, Cuthbert & Lang, 2001. Cross-cultural research has demonstrated that emotions are universal and can be identified by people living in different cultures. The six emotions that are universal include disgust, sadness, happiness, surprise, fear and anger (Reeve, 2015). There give bereavement emotion are Grief, Sadness, Disbelief, Guilt, Anger and Fear (Robinson, Segal, Smith & 2018). These are the bereavement emotions as they are emotions which are felt during the bereavement process.

Grief
Grief is the most common emotion that is felt when one experiences bereavement. Grief can lead onto the development of other emotions such as guilt, feeling of loss and anger. The grieving process can continue for long periods of time and the amount of time depends on each person. There are five types of grief that an individual may experience when going through the bereavement process.

Types of Grief
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Prolonged Grief
Prolonged grief is primarily known as Prolonged Grief Disorder (PGD) as it's officially classified as a disorder within the Diagnostic and Statistical Manual V (DSM V). People who suffer from PGD will experience bereavement difficulties such as having a history of prior trauma or loss, mood and anxiety disorders and insecure attachment styles (Litz & Jordan, 2014). Since symptoms of PGD may be similar to any depressive disorder, the DSM provides a section classifying the differences between the two. This is incorporated for health care professionals to not misinterpret a disorder or to diagnose the wrong disorder. Although, there is a dedicated section within the DSM V for PGD, the criteria is still developing where many studies emphasise on proposing new criteria for PGD (Aslan, Block, Boelen, First, Horowitz,Jacob, Johnson, Kissane, Litz, Maercker, Neimeyer, Prigerson & Raphael, 2009).


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Disenfranchised Grief
Doka (2004) defines this form of grief as the grief experienced by those who incur a loss that is not or cannot be openly acknowledged, publicly mourned or socially supported. This can lead to the bereaver to socially isolate themselves from others due to no social support. Examples of disenfranchised grief include the loss of a pet, death of a friend and the loss of a home. It can be difficult for society to understand this form of grief, as on a social level, norms acknowledge that every society has grieving rules which determine who may grieve losses and in what ways (Doka, 2002). In this case, it may not suitable for a person to grieve over the loss of a pet or home.
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Complicated Grief
Complicated grief is a form of grief where individuals may experience grief for periods of longer than one year. Schemas are ‘categories’ or ‘folders’ in our minds which hold information on things, people and situations. Studies have investigated the effects of maladaptive schemas (EMSs) in relation to complicated grief and bereavement. Since complicated grief is a long term form of grief, researchers have suggested that this may be due to the cognition of the individual. Holland & Thimm (2017) found that negative EMSs are associated with elevated complicated grief systems and as a result lead to difficulties integrating with the loss.


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Traumatic Grief
Traumatic grief is form of grief that is unexpectedly experienced such as the sudden death of a close family member. This form of grief can severely impact the bereavers life as it will cause significant psychological trauma that may lead to stress reactions due the loss of the family member. This may be experienced when witnessing the death of a family member and can be linked to Post Traumatic Stress Disorder (PTSD). In fact, traumatic grief has been considered as a risk factor for mental and physical morbidity (Beery, Bierhals, Day, Kasl, Jacobs, Jason Newsom, Prigerson, Reynolds & Shear, 1997). Symptoms of traumatic grief include insomnia or nightmares, difficulty socilaising or functioning and strong feelings of personal responsibility for the death (Brake, 2013).
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Anger & Aggression
The emotion of anger can transform into the behaviour of aggression. Aggression is a violent behaviour that can cause physical harm to others and due to this behavioural management programs are developed for those who suffer from aggression. There is little research detailing the relationship of aggression with bereavement, as most psychological studies focus on bereavement with the emotions of sorrow, sadness and grief (Hasui & Kitamura, 2004). Bereavement is also known to occur for individuals who are older, however a child may also experience bereavement of a parental figure. Where, the loss of a parental figure can lead to teen aggression (Brent, Hamdon, Mazariegos, Melhem & Porta, 2012). Although, aggression isn’t the most researched emotion throughout the bereavement process it is important to consider this emotion as the signs of aggression are highly linked towards mental disorders.

Aggression and guilt during the mourning by parents who lost an infant by Hasu & Kitamura (2004)
 * A study was conducted focusing on the behaviour of aggression within parents who previously experienced the loss of an infant. Thirty-eight women and men were recruited in this study through random sampling. A clinical interview was utilised to determine that the participants were suffering from bereavement symptoms and to identify past psychiatric history. The results of the study suggested that the emotions of guilt, grief and aggression were present. But, since this study focused on aggression the main finding was that aggression was a strong behaviour and did not persist over a long period of time as it was mainly due to impulses and was used as an adaptive process rather than a maladaptive process.



Theoretical Frameworks
Theories are responsible for examining information based on facts which are then backed up with appropriate hypothesis and research. There are two theoretical frameworks which have been applied towards bereavement. The first theoretical framework is the Dual Process Model of Coping (DPM of Coping) and the second being the Kubler-Ross Model of Grief.

Dual Process Model of Coping
This model was developed to provide a better account for the coping processes that are involved with bereavement (Fasse & Zach, 2016). The grief work hypothesis states that people need to confront their loss in order to go over the events before and after the death (Stroebe & Schut, 2008). Coping refers to the processes, strategies or styles of managing the situation when bereavement is being experienced (Schut & Stroebe, 2008). There are two types of coping mechanisms in the DPM of coping and are loss orientation and restoration orientation coping mechanisms. Loss orientation coping involves dealing with and working on the loss itself (e.g., crying about the death), whereas restoration-oriented coping is utilising coping mechanisms by mastering individual processes (e.g., reorganising life) (Stroebe & Schut, 2008). The process of oscillation occurs where the individual experiencing bereavement will either face reality or avoid reality. It is up to the decisions made by the individual on whether they will undergo a loss-oriented or restoration - orientation behaviour. By choose either of these behaviours, will determine whether the individual will successfully move on from the loss. There are a few studies that focus on the DPM of coping, where one study applied the DPM model to the concept of coping flexibility. Coping flexibility is how adaptable a person is when coping towards certain situations. In this case, how flexible a person is with developing and creating coping strategies to deal with the loss. Where, Cheng (2003) found that participants who were motivated to seek coping strategies were more likely to encode stressful situations in a differentiated way. It is important to consider how adaptable a person is and how flexible they are affectively, cognitively and behaviourally. As it provides an insight to how they function psychologically and how psychologically ‘healthy’ they are.

Kübler-Ross Model of Grief (1969)
The Kubler-Ross theory of Grief is responsible for determining the stages of grief that individuals may face. Health professionals such as nurses and midwives may have particular interest within this theory. As, it may be used as a learning material to guide them into understanding the stages of grief in older individuals. There are five stages to this theory and are denial, anger, bargaining, depression and acceptance. These stages follow through the emotional and psychological journey of the bereaver.

1. Denial Denial is as a defence mechanism to help the individual survive the loss and may lead to psychotic refusal (Baumeister, Dale & Sommer, 1998). Freud developed a concept known as defence mechanisms, id, ego and superego. All of which are a part of the psyche a part of the mind and are involved with instincts and drives. Defence mechanisms are created by the ego and unconsciously occur without the person’s awareness. The most common form of denial involves negative feedback or failure, in this case a person who has lost a family member (negative feedback or failure) leads to thoughts of ‘If I treated the person better they wouldn’t have passed away’ (external attributions for the failure) (Baumeister, Dale & Sommer, 1998).

2. Anger Anger is another common emotion that is felt during the grieving process. Usually the emotion of anger can also lead to the development of the behaviour aggression.

3. Bargaining Bargaining is behaviour that is expressed after feeling a loss or when you are about to lose something. A person who has felt a loss may say after losing someone ‘I will never do this again, as it may have been influenced the reason as to why that person passed away’. Whereas, a person who is about to lose their life may pray to an external source to let them live such as ‘dear god, please let me live another year I will do better’. Promises are made within the bargaining process for an extension of life but promises are never kept which leads to depressive symptoms to develop (Avioli, Kubler-Ross & Wessler, 1976). 

4. Depression All the emotions that are felt during the bereavement process such as grief and anger can revert to depression. There are three interpretations that puts a person at risk for depression: Within this DSM V there is a section dedicated to depressive disorder where some disorders include major depressive disorder, premenstrual dysphoric disorder and other specified depressive disorder (American Psychiatric Association, 2016). This can help determine what form of depression the bereaver may be developing.
 * 1) Attribution of events to stable and global causes
 * 2) Inference or negative or catastrophic consequences of events
 * 3) Inference of negative characteristics of the self (Rubinstein, 2004).

5. Acceptance Acceptance is the last stage of the grieving process, this involves with the bereaver to accept the loss. Although, the bereaver may never fully accept the death, the bereaver will have to in order to adapt and move on. If acceptance is fully acquired then the bereaver may have the possibility of making peace with themselves especially if they believed they had a significant part of the death (Maciejewski & Prigerson, 2008). However, Maciejewski & Prigerson (2008), found that the individuals who are about to pass away have high cognitive and emotional acceptance this can lead to advance care-planning, better physical and mental health in the last week of life and surviving relatives had significantly better quality of life six months after death. Therefore, it is not only important for the bereaver to accept the death but also the person who is about go pass away to accept death as well.


 * Amy is a Twenty year old and has lost her mother due to ovarian cancer over two years ago. Amy feels upset all the time and has developed complicated grief, as a result of the death of her mother. She has had a difficult time with coping and has socially isolated herself from her friends, work colleagues and family. This led to the loss of her full time nursing job which was her dream career. Currently, she is living with her father and little brother and is not studying nor working. What restoration-oriented behaviour techniques could she use to overcome her grief?

Emotional Management Techniques and Counselling
There are two techniques that people who are experiencing bereavement may use. The first being family centred and grief counselling, where both can be used together to assist the individual experiencing bereavement. These two counselling methods are more focused on therapists or counsellors providing support and being understandable. While the other technique, emotional management focuses more on the bereaver to manage their own emotions.



Family centred Counselling and Grief Counselling
Bereavement will usually effect more than one person, for example if a family which consists of a mother, father, son and daughter has lost their mother then this can lead to stress onto the whole family. Family centred counselling is counselling or therapy that involves the whole family with the use counselling techniques to resolve the problem. Family centred counselling is not only used on individuals who are experiencing bereavement but also those in different circumstances. Grief counselling involves a therapist or counsellor which will assist the bereaver by providing daily tasks, providing support and understanding their situation. Tasks are given to distract the bereaver from reminding themselves about the death. While the bereaver is still receiving support from the therapist or counsellor to ensure that they are not alone. The goal in grief counselling is not to produce absolute improvement that will endure over time but to accelerate natural healing process (Hoyt & Larson, 2009). Both family centred and grief counselling can be used together to support the bereaver or bereavers and to ensure there is no development of a mental disorder.

Grief counselling in African Indigenous Churches: A case of the zion apolstolic church in veda by Selepe & Edwards (2008)
 * This study looks upon grief counselling within South-African individuals by identifying the counselling techniques South Africans use. The funeral and grieving process that takes place involves church members and the community attending to the family that is experiencing bereavement. Ritual services are also used following the death and involve beliefs such as death being an inevitable experience and the widower to be claimed as having a new life. The grief counselling follows collective participation through the use of rituals, giving time to heal and the reincorporation of the bereaver into the community. This study follows the process of grief counselling as it details the different methods of grief counselling other cultures utilise.

Emotional Differentiation
Emotional differentiation is having knowledge of your own emotional experiences which can lead to healthy psychological functioning (Ceulemans, Erbas, Houben, Kalokerinos, Koval & Leuvan 2018). It involves managing, understanding and recognising your own and other people's emotions which can assist with coping during bereavement. Research suggests that when a person experiences their emotions with more granuality they are less likely to show maladaptive self-regulatory activities such as aggression and binge drinking (Barrett, Kashdan & Mcknight, 2015). Furthermore, emotion differentiation has also been used to determine how people who are diagnosed with mental disorders understand their emotions. This is completed through the techniques of self-report methods across situations of emotions during the mental disorder (Kang & Shaver, 2004 as cited in Barrett, Kashdan & Mcknight, 2015). Teaching individuals to understand their emotions and others can assist with the bereavement process. So that, the bereavers emotions such as anger or grief does not become a problem where it effects their psychological functioning. If, the emotions are not controlled then it can lead to the development of mental disorders. This is demonstrated as many studies focusing on emotional differentiation look at this within anxiety and depressive disorders.

Conclusion

 * Bereavement is an event throughout a person's life which will produce negative emotions, where these emotions can affect the psychological well-being of the mourner
 * Emotions are experienced on an everyday basis where some emotions may be stronger than others. They are organised around two motivation systems one being appetitive and the other being defensive where both are for survival purposes
 * A variety of emotions are felt throughout this period but the main few are grief, distress, sadness and anger
 * Theories focus either on the stages of bereavement or how to cope with bereavement. These theories are the DPM of coping and Kubler-Ross Model of Grief.
 * Counselling and emotional differentiation are two treatment methods that can be used for those who are suffering from Bereavement.
 * In the future, if studies were to focus on bereavement and emotion it is suggested that there is a focus on anger and the bereavement process.

Quiz
{ What is Bereavement? { Bereavement has been defined as the action of losing a loved one which may affect the emotional wellbeing of the individual }
 * type="{}"}

{ What is Emotional Regulation?. { Emotional regulation is learning how to control one's emotions }
 * type="{}"}

{Aggression is.. + A violent behaviour that may cause physical harm to others. - A violent behaviour. - An Ecstatic behaviour which cannot be stopped. - An Emotion.
 * type="[]"}

{ The { Dual Process model } & { Dual Process model } are two theories that can be applied to bereavement.
 * type="{}"}

{Common emotions felt during the bereavement process are sadness, anger, guilt, grief and content. - TRUE. + FALSE.
 * type=""}

{Disenfranchised grief is grief that is fully understood by society - TRUE. + FALSE.
 * type=""}

{Which one of the following below answers is a restoration oriented behaviour - Chucking out photos of the deceased person. - Discussing life. + Reorganising life. - Crying about the death.
 * type="[]"}

{Family centred counselling and Grief counselling can be used together. + TRUE. - FALSE.
 * type=""}

{Emotions..? - are reactions to the environment - generate feelings - arouse the body to action - generate motivational states and produce recognisable facial expressions. + All of the Above
 * type="[]"}