An Examination of Stage Theory of Grief among Individuals Bereaved by Natural and Violent Causes: A Meaning-Oriented Contribution

Center for Health Care Evaluation, VA Palo Alto Health Care System and Stanford University Medical Centerm, Menlo Park, CA 94025, USA.
OMEGA--Journal of Death and Dying (Impact Factor: 0.44). 10/2010; 61(2):103-20. DOI: 10.2190/OM.61.2.b
Source: PubMed


Despite its popularity, few attempts have been made to empirically test the stage theory of grief. The most prominent of these attempts was conducted by Maciejewski, Zhang, Block, and Prigerson (2007), who found that different states of grieving may peak in a sequence that is consistent with stage theory. The present study aimed to provide a conceptual replication and extension of these findings by examining the association between time since loss and five grief Indicators (focusing on disbelief, anger, yearning, depression, and acceptance), among an ethnically diverse sample of young adults who had been bereaved by natural (n=441) and violent (n=173) causes. We also examined the potential salience of meaning-making and assessed the extent to which participants had made sense of their losses. In general, limited support was found for stage theory, alongside some evidence of an "anniversary reaction" marked by heightened distress and reduced acceptance for participants approaching the second anniversary of the death. Overall, sense-making emerged as a much stronger predictor of grief Indicators than time since loss, highlighting the relevance of a meaning-oriented perspective.

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    • "These emotions include those identified by traditional stage models: disbelief, denial, depression, anger, and acceptance (Maciejewski et al., 2007), as well as guilt and blame (Guarnaccia & Hayslip, 1978), yearning (Stroebe, Schut, & Stroebe, 2007; Van der Houwen, Stroebe, Stroebe, Schut, van den Bout, & Wijngaards-de Meij, 2010), and sadness (Horowitz & Wakefield, 2007; Stroebe et al., 2007). To make things yet more complicated, recent research on bereavement has demonstrated that such emotions do not progress in orderly stages as long believed (Holland & Neimeyer, 2010). Rather than a lockstep progression of grief recovery, for most people deviation from a straight path is the norm, not an aberration. "
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    • "We speculate that despite the significant correlation between IMs of " Integration " and RPMs, the emergence of reconceptualization may have stimulated a more flexible perception of Emily's ability to change, fostering a decrease in ambivalence, which is congruent with findings from previous studies (Cunha, Gonçalves, Valsiner, Mendes, & Ribeiro, in press; Cunha, Gonçalves , & Valsiner, 2011; Gonçalves, Ribeiro, Stiles, et al., 2011). It is also congruent with previous bereavement studies indicating the capacity to integrate loss as a strong predictor of successful grief adaptation (Holland, Currier, & Neimeyer, 2006; Holland & Neimeyer, 2010; Keesee et al., 2008), as the client progressively transforms the previous relationship with the deceased into a more symbolic and comfortable connection (Neimeyer, 2006a). "
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    • "Grief and grief communication is a process in time. The intensity of grief processing (thinking about the deceased, searching for meaning and positive memories of the deceased) declines with time (Holland & Neimeyer, 2010; Pressman & Bonanno, 2007). "
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