Psych active recall

Maslow’s Hierarchy of Needs

Types of losses
Physiological loss
⁃ amputation, loss of mobility, mastectomy, hysterectomy
Safety loss
⁃ domestic violence or abuse, child abuse, public abuse
Security loss and sense of belonging
⁃ loss of loved one, loss of feeling loved, birth, marriage, divorce,
illness, death
Loss of self esteem
⁃ job loss, death of loved one, retirement
Loss of self actualization
⁃ unable to fulfill goals or achievements due to crisis, feeling hopeless

Elisabeth Kübler-Ross Stages of Grieving

Denial
⁃ shock and disbelief
Anger
⁃ expressed towards God, friends, family, anyone, even HCP
Bargaining
⁃ requesting or asking God or fate to change or delay the loss, qny
request
Depression
⁃ becoming acutely aware of the loss, feeling sad and depressed
Acceptance
⁃ coming to terms with death and showing evidence

John Bowlby’s 4 phases of grieving (same concept with DABDA except no bargaining)
⁃ attachment behavior
⁃ Forming a bond = fall in love
⁃ Maintaining abond = loving
⁃ Disrupting a bond = divorce
⁃ Renewing a bond = resolve, renew
⁃ Source of security = maintaining a bond
⁃ Source of joy = renewing a bond

1. Experience numbness and denying of the loss

2. Emotionally yearning and protesting the permanent loss
3. Experiencing cognitive disorganization and difficulty functioning in
daily life
4. Reorganizing and reintegrating sense of self to pull life back together

George Engel’s 5 stages of grieving (SD REST RES REC)

1. Shock and disbelief - initial rxn - numb, followed by refusal to
acknowledge reality. This happens in order to protect self from overwhelming
stress.
2. Developing awareness - emotional release and beginning to acknowledge
the loss, sadness, anger, crying, frustration can be directed to anyone including
God, family and friends and HCP.
3. Restitution - participating in related activities of the loss such as
funeral, wake, ceremonies as a way to COPE and begin recovery.
4. Resolution of the loss - preoccupation of the lost person, becoming
OBSESSED to the point of imitating the lost person, may persist for a year and
more.
5. Recovery - preoccupation and obsession ends, able to go on with life

Mardi Horowitz’s 4 Stages of Grieving (OD WORK C)

1. Outcry - outwardly = crying, screaming, yelling, collapse while
suppressing = stoic, trying to compose self and emotional control.
2. Denial and Intrusion - going back and forth with denial and intrusion;
denial = becoming busy that they are unable to think about the loss while intrusion
= loss and all it represents suddenly becomes intense again.
3. Working through - finding new ways to manage life, not as overwhelming
and intense as it was.
4. Completion - feels “normal” again, but life feels different after the
loss. Memories come back but do not interfere with life, crying may happen on
anniversary but transient.

Rando’s GRIEVING TASKS (6 Rs)

ACTIVE PARTICIPATION > passive participation

1. Recognize - understand that it has happened

2. Reacting - feeling the feelings
3. Recollect and experience - memories are relived
4. Relinquish - accepting that there is no turning back
5. Readjust - adjusting
6. Reinvest - accepting change, forming new relationships

Worden’s 4 Task of Grieving

1. Accepting the reality of the loss - full acknowledgement can be too
painful to bear.
2. Working through the pain of grief - coping
3. Adjusting to environment that changed d/t the loss - roles changed.
4. Finding new ways to remember - lost person has a special place in the
mourner’s life, not forgotten or diminished.

Cognitive response to Grief

Questioning and trying to make sense of the loss

⁃ the goal of the search is to give meaning and purpose of the loss, as
to why the loss may have happened
⁃ Questioning can help accept the reality of why someone died

Attempting to keep the Lost one present

⁃ Helps in SOFTENING the reality of the loss
⁃ having an inner monologue as if the person is still present, such as
having a self talk. “Do you think I made a good choice, Mark?” is one of the
examples of trying to keep the lost one present.

Emotional response to Grief

⁃ (ASA) Anger, sadness, and anxiety are predominant emotional response to
loss
⁃ Hatred and revenge are common emotions for extreme death such as
suicide, murder, or war
⁃ Grieving person may interpret sounds, sights and smells associated with
the loss one as signs of hope for reunion—providing comfort

Spiritual response to Grief

⁃ deeply embedded personal beliefs and values that are central components
of spiritual response to grief
⁃ Angry and disillusioned with God
⁃ Anguish of abandonment, loss of hope, loss of meaning = deep spiritual
suffering
⁃ Finding explanations through religious and spiritual beliefs = positive
aspects of grieving
Behavioral response to Grief
⁃ Easiest to observe
⁃ Outcry = tearfully sobbing, crying uncontrollably, restlessness
⁃ Irritability and hostility toward others = Anger and Frustration
⁃ Keeping or discarding belonging of deceased
⁃ Seeking or avoiding places associated with the deceased
⁃ Drug and alcohol = maladaptive behavioral response
⁃ Suicide and homicide = extreme response if the mourner cannot accept

Physiological response to Grief

⁃ Sleep disturbances is the frequent and persistent problem for grieving
individuals
⁃ Insomnias, poor appetite, weight loss, lack of energy, headaches,
palpitations, indigestion
⁃ Changes in Immune and Endocrine system

Universal reactions to Loss

⁃ shock and disorientation, anger to bereaved or for the one responsible
for the death, attempting to continue the relationship with the deceased are common
responses to loss

Culture-specific rituals
Acculturation - altering cultural values or behaviors as a way to adapt to another
culture

Disenfranchised Grieving
⁃ Grief over a loss that is not or cannot be acknowledge publicly
⁃ As if they do not have the right to grieve, due to circumstances.

Why.
⁃ relationship that has no legitimacy (lover, health care workers with
close relationship to lost one)
⁃ Griever not recognized
⁃ Social stigma (same-sex relationship
⁃ Can be grieving over unborn child, abortion
⁃ Job loss
⁃ Separation
⁃ Divorce
⁃ Children leaving home

⁃ Death cafes are then established, it is an event, not a place, where

people come and talk openly about the process. Informal forum discussing about
death.

Complicated Grieving
⁃ Prolonged grieving, disproportionate grieving
⁃ Can lead to clinical depression
⁃ Common to bereaved with extreme loss = suicide, war, murder, military,
natural or manmade disasters, terrorist attacks

Risk for Complicated grieving

⁃ Low self esteem
⁃ Low trust or distrust
⁃ Previous psychiatric disorder
⁃ Previous suicide attempt
⁃ Insecure attachment
⁃ Neglectful family

Risk factors leading to vulnerability—to those already vulnerable

⁃ Death of loved one
⁃ Death of parent
⁃ Sudden death
⁃ Multiple deaths
⁃ Murder or suicide death

Manifestations
Physiological
⁃ Impaired immune system
⁃ Increased adrenocortical activity
⁃ Increased prolactin serum levels
⁃ Psychosomatic disorders
⁃ Increased heart mortality

Psychological
Maladaptive thoughts
⁃ rumination (cycle of negative thinking), catastrophizing, worrying
about doing the right thing, exclusion of problem solving, positive thoughts,
cognitive reaapraisal
Dysfunctional behaviors
⁃ either avoiding all the things that may remind them of the deceased, or
completely immersing oneself with the deceased’s belongings, daydreaming, and
exclusion of other coping strategies
Inadequate emotional regulation
⁃ focusing on negative emotions, not taking a break, ignoring regular
routine such as eating, sleeping and social contact.

3 Critical components of the Dimensions of Grieving

Adequate Perception regarding loss
• Encourage expression of emotions, as long as they do not harm
themselves or others. Never invalidate their feelings and let them feel. Grieving
is not a linear process, each person is unique and dynamic.
• Denial protects self from overwhelming stress that comes with
acknowledging the reality, it helps soften the effects.
• Adaptive denial - gradual acknowledgement of the reality of the loss
• Allow adaptive denial
• Start with BROAD OPENING
• OPEN ENDED questions
• Maintain active listening
• Attentive presence- maintaining eye contact, open body language
Adequate Support of loved ones
• Encourage or assist client to reach out to their support system by
helping them identify
Adequate Coping during the process
• Give client opportunity to compare and contrast previous coping
behaviors in the past
• Encourage client to examine patterns of coping behaviors, review
personal strengths and power
• Offer food without pressuring
• Volunteer activities
• Use reflection and focusing
• Establish rapport

Grieving clients need the support of someone they can trust with their emotions and
thoughts.

Evidence-based practice for Complicated Grieving

Core themes
1. Understanding and accepting grief
2. Managing painful emotions
3. Planning for meaningful future
4. Strengthening existing relationships
5. Telling the story of death
6. Learning to live with reminders
7. Establishing connection with memories of the deceased person