Intervention Approaches
There are various approaches to bereavement intervention (Harrop et al., 2020; Johannsen et al., 2019). For example, complicated grief therapy, cognitive-behavioral therapy, narrative therapy, exposure therapy in an individual setting; family-focused grief therapy in a family setting; bereavement supportive group, group CBT, art therapy, and music therapy in a group setting.
Drawing on both theoretical considerations and clinical experiences, our group has developed two distinct bereavement interventions: the ADAPTS Bereavement Intervention and the Dual Process Bereavement Group Intervention.
ADAPTS Bereavement Intervention
Instead of a manualized therapy that tries to fit one procedure for all, the ADAPTS model is a client-centered, need-based, semi-structured intervention model for bereaved individuals. Adopting a story-telling approach, a comprehensive ADAPTS assessment would be conducted first. It addresses the six dimensions of bereavement outcomes:
Bereavement-related Anomalous emotion,
Bereavement-related Dysfunctional cognition,
Bereavement-related Adjustment challenges,
Bereavement-related Physical responses,
Bereavement-related Traumatic responses,
and Separation Distress.
The intervention would then be individualized based on the comprehensive assessment.
Dual Process Bereavement Group Intervention
The Dual Process Bereavement Group Intervention (DPBGI) is an evidence-based and theory-driven intervention (Chow et al., 2018). It is based on the Dual Process Model (Stroebe & Schut,1999). In this model, loss-orientated coping focuses on dealing with the loss experience-related stressors, such as the painful emotions raised by the loss; restoration-orientated coping focuses on dealing with life challenges following the loss such as adjustment to new roles, identities, and relationships. An “oscillation”, meaning a dynamic back-and-forth movement between these two processes, is considered to benefit the bereavement adjustment. The DPBGI consists of 8 group sessions for bereaved persons, addressing both loss-oriented and restoration-oriented intervention, as well as the oscillation process. It has been proven to have a greater effect than traditional loss-oriented bereavement groups on bereavement outcomes including grief, depression, anxiety, and loneliness.
Lobb, E. A., Kristjanson, L. J., Aoun, S. M., Monterosso, L., Halkett, G. K. B., & Davies, A. (2010). Predictors of Complicated Grief: A Systematic Review of Empirical Studies. Death Studies, 34(8), 673-698. https://doi.org/10.1080/07481187.2010.496686
Lenferink, L. I. M., Eisma, M. C., Smid, G. E., de Keijser, J., & Boelen, P. A. (2022). Valid measurement of DSM-5 persistent complex bereavement disorder and DSM-5-TR and ICD-11 prolonged grief disorder: The Traumatic Grief Inventory-Self Report Plus (TGI-SR+). Comprehensive Psychiatry, 112, 152281.
https://doi.org/10.1016/j.comppsych.2021.152281
Prigerson, H. G., Maciejewski, P. K., Reynolds, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., Frank, E., Doman, J., & Miller, M. (1995). Inventory of complicated grief: A scale to measure maladaptive symptoms of loss. Psychiatry Research, 59(1), 65-79.
https://doi.org/10.1016/0165-1781(95)02757-2
Prigerson, H. G., Boelen, P. A., Xu, J., Smith, K. V., & Maciejewski, P. K. (2021). Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry, 20(1), 96-106. https://doi.org/10.1002/wps.20823
Stroebe, M. S., Folkman, S., Hansson, R. O., & Schut, H. (2006). The prediction of bereavement outcome: Development of an integrative risk factor framework. Social Science & Medicine, 63(9), 2440-2451. https://doi.org/10.1016/j.socscimed.2006.06.012
