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The Dual Process Model of Coping with Bereavement: A Decade on

Authors:
  • Utrecht University & University of Groningen

Abstract

The Dual Process Model of Coping with Bereavement (DPM; Stroebe & Schut, 1999) is described in this article. The rationale is given as to why this model was deemed necessary and how it was designed to overcome limitations of earlier models of adaptive coping with loss. Although building on earlier theoretical formulations, it contrasts with other models along a number of dimensions which are outlined. In addition to describing the basic parameters of the DPM, theoretical and empirical developments that have taken place since the original publication of the model are summarized. Guidelines for future research are given focusing on principles that should be followed to put the model to stringent empirical test.
... Although it is not possible to generalize the way grief affects individuals, the 'Dual Process Model of Coping with Bereavement' (Stroebe & Schut, 1999) offers a theoretical framework for understanding the complexity of grief. The grieving process is perceived in the form of two tracks: loss oriented and restorative. ...
... The natural grieving process takes place in a pendulum between these two phases, wherein the loss-oriented and internal emotional processes are mostly present in the beginning, being gradually replaced by the external and problem-oriented restorative process. As BID individuals' relatives attend the ED within the first few hours or days after their loss, their grieving process can be expected to be dominated by internal emotional reactions, such as sadness, meaninglessness, despair, denial and anger (Stroebe & Schut, 1999). ...
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Aims The aim was to explore the experiences of relatives seeing and saying goodbye to brought in dead persons in a Danish emergency department. Design This was a qualitative study based on interpretive description methodology. Methods Data were collected through semi‐structured individual interviews with relatives (n = 11) of brought in dead persons and 30 h of participatory observations of these relatives visiting the emergency department to see and say goodbye to the deceased. Data were collected between February 2019 and December 2020. Results Our analyses revealed internal and external chaos as an overarching theme, covering 4 themes and 10 subthemes. The four themes were traumatic events, restricted access, briefly being together again, and final goodbyes and departures. Conclusion Emergency departments were highly acute and busy settings that prioritized survival more than the care of deceased people and their relatives. The relatives were, in every way, affected by internal and external chaos; the external chaos in the emergency department reinforced the feeling of internal chaos. It is necessary for managers and nurses in emergency departments to organize and practice care for relatives, whilst bringing in deceased individuals in a less chaotic and more caring manner. Impact This study contributes to the knowledge of relatives' experiences regarding brought in dead persons, underpinning the need to care for this subpopulation in emergency departments. Care for relatives of brought in dead individuals has the potential to relieve suffering and prevent diseases, which are core elements of nursing.
... While the data is consistent with many contemporary models, the evident grief patterns are most clearly portrayed by two complementary models: Dual Process, and Reconstructing Meaning. Grief is described by Stroebe and Schut(1999) as an oscillation between dealing with the competing pressures of 'loss' versus 'restoration' of daily life ( Figure 1). Neimeyer (2017) suggests grief is a social process of Reconstructing Meaning through: 'retelling' the loss story repeatedly until it makes sense, 'rebuilding' connection to what has been lost-in this case identity, purpose and meaning, and 'reinventing' ourselves and our lives as we negotiate social roles and relationships. ...
... 5 In a majority of cases, bereaved individuals are gradually able to cope effectively to reduce the grief associated with their loss. 6 However, as with any form of coping, a lack of social or emotional resources and competing stressors can impede the process of coping, including in bereavement. 7,8 While there are evidence-based interventions to reduce grief in bereaved adults, including web-based interventions, 9,10 many involve an extended number of sessions, often with a trained therapist, and are focused on resolving complicated or prolonged grief-persistent and pervasive grief that characterizes a clinical disorder. ...
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Background: The events surrounding the COVID-19 pandemic have created heightened challenges to coping with loss and grief for family and friends of deceased individuals, as well as clinicians who experience loss of their patients. There is an urgent need for remotely delivered interventions to support those experiencing grief, particularly due to growing numbers of bereaved individuals during the COVID-19 pandemic. Objective: To determine the feasibility and acceptability of the brief, remotely delivered StoryListening storytelling intervention for individuals experiencing grief during the COVID pandemic. Setting/Subjects: A single-arm pilot study was conducted in the United States. Participants included adult English-speaking family members, friends, or clinicians of individuals who died during the COVID-19 pandemic. All participants engaged in a televideo StoryListening session with a trained StoryListening doula. Measurements: Participants completed a brief follow-up telephone interview two weeks after the StoryListening session. We describe enrollment and retention data to assess feasibility and conducted a deductive thematic analysis of the follow-up interview data to assess acceptability. Results: Sixteen clinicians and 48 friends/family members enrolled in the study (n = 64; 75% enrollment), 62 completed a StoryListening session; 60 completed the follow-up interview. Participants reported that the intervention was useful and offered a valuable opportunity to process their grief experience. Conclusions: The StoryListening intervention is feasible and acceptable for friends/family members and clinicians who have experienced grief during COVID. Our intervention may offer an accessible first-line option to address the increasing wave of bereavement-related distress and clinician burnout in the United States.
... Sex differences in perceived injustice could be explained by the fact that infertility appears to be experienced as more difficult for women, who report higher levels of guilt, blame, and distress related to self-esteem (Lee, Sun, & Chao, 2001;Péloquin et al., 2018), as well as more depression, anxiety, and stress than men in the context of infertility (Luk & Loke, 2015;Ying et al., 2015). It has been suggested that women tend to be more loss-oriented following bereavement, whereas men tend to be more solution-oriented (Stroebe & Schut, 2010), which seems coherent with women perceiving greater injustice in the context of infertility. The higher levels of perceived injustice in women may also be associated with socialization processes and societal expectations related to sexual roles and maternity (Greil, McQuillan, & Slauson-Blevins, 2011;Péloquin & Lafontaine, 2010). ...
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A Dual Process Model of Bereavement, which considers the impact of loss- and restoration-oriented variables on widowers' levels of well-being, is tested on 200 widowed men during the second year of bereavement. Those who were widowed less than 500 days exhibited significantly more negative affect, less positive affect, and lower well-being that those widowed more than 500 days. Multiple regression analyses revealed that both loss and restoration variables were important throughout bereavement. Loss variables influenced negative affect and were especially critical during the early stages. Restoration variables significantly affected positive affect and had greater impact on the later bereaved. The results support a dual process model of bereavement, but also suggest that certain events, such as circumstances of death, are more important during early bereavement while reinvestment activities, such as dating, become relevant later. Some circumstances, such as a wife's suffering, have prolonged effects.
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This chapter considers how stress and coping theory, which was developed to examine how people appraise and cope with a wide variety of stressful encounters ranging from minor daily hassles to major life events, can be applied to the more specific case of understanding how people appraise and cope with bereavement. The 1st part of the chapter includes a brief description of stress and coping theory, its application in a longitudinal study of caregiving and bereavement, and some unexpected findings that motivated a revision of the model. The 2nd part of the chapter examines 3 conceptual and methodological issues that need to be addressed to adapt the revised coping model to the study of bereavement. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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A cognitive-behavioral conceptualization of complicated grief (CG) is introduced that offers a framework for the generation of hypotheses about mechanisms that underlie CG and that can be targeted in treatment. Three processes are seen as crucial in the development and maintenance of CG: (a) insufficient integration of the loss into the autobiographical knowledge base, (b) negative global beliefs and misinterpretations of grief reactions, and (c) anxious and depressive avoidance strategies. These processes are offered to account for the occurrence of CG symptoms, whereas the interaction among these processes is postulated to be critical to symptoms becoming marked and persistent. The model recognizes that background variables influence CG, but postulates that this influence is mediated by the model's three core processes.
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Bereavement is associated with increased risk of morbidity and mortality. How to protect the bereaved against extreme suffering and lasting health impairment remains a central research issue. It has been widely accepted that to adjust, the bereaved have to confront and express intense emotions accompanying their loss. It has further been assumed that others assist in this process, and that intervention programs are effective. To assess validity of these assumptions, this article reviews research on the impact of expressing and sharing emotions across four research domains (social support; emotional disclosure; experimentally induced emotional disclosure; and grief intervention). In none of these areas is there evidence that emotional disclosure facilitates adjustment to loss in normal bereavement. Implications of these findings are discussed.
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Researchers have deplored shortcomings in theoretically based models of coping with bereavement. Integration of cognitive stress with attachment theory is proposed to predict adjustment to bereavement, describe different forms of effective coping, and resolve ongoing debates about continuing versus relinquishing bonds. These 2 generic approaches are integrated within a bereavement-specific perspective, the dual-process model of coping (Stroebe & Schut, 1999). Accordingly, (a) different coping styles are adopted by, and are differentially efficacious for, bereaved people according to their style of attachment; (b) bereaved people's ways of continuing bonds differ according to their attachment style; and (c) grief complications are associated with insecure attachment styles. The authors conclude that it is better for some bereaved individuals to work toward retaining ties and for others to work toward loosening ties.