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An attachment-based model of complicated grief including the role of avoidance

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Abstract

Introduction

Complicated grief is a prolonged grief disorder with elements of a stress response syndrome. We have previously proposed a biobehavioral model showing the pathway to complicated grief. Avoidance is a component that can be difficult to assess and pivotal to treatment. Therefore we developed an avoidance questionnaire to characterize avoidance among patients with CG.

Methods

We further explain our complicated grief model and provide results of a study of 128 participants in a treatment study of CG who completed a 15-item Grief-related Avoidance Questionnaire (GRAQ).

Results of Avoidance Assessment

Mean (SD) GRAQ score was 25. 0 ± 12.5 with a range of 0–60. Cronbach’s alpha was 0.87 and test re-test correlation was 0.88. Correlation analyses showed good convergent and discriminant validity. Avoidance of reminders of the loss contributed to functional impairment after controlling for other symptoms of complicated grief.

Discussion

In this paper we extend our previously described attachment-based biobehavioral model of CG. We envision CG as a stress response syndrome that results from failure to integrate information about death of an attachment figure into an effectively functioning secure base schema and/or to effectively re-engage the exploratory system in a world without the deceased. Avoidance is a key element of the model.

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Acknowledgments

This work was supported by grants from the National Institute of Mental Health: MH60783, AG020677, AG13396, P30MH30915, and P30MH52247.

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Authors and Affiliations

  1. Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY, 10027, USA

    Katherine Shear M.D.

  2. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Timothy Monk Ph.D., Patricia Houck M.Stat., Nadine Melhem Ph.D., Ellen Frank Ph.D., Charles Reynolds M.D. & Russell Sillowash

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  1. Katherine Shear M.D.
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  2. Timothy Monk Ph.D.
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  3. Patricia Houck M.Stat.
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  4. Nadine Melhem Ph.D.
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Correspondence to Katherine Shear M.D..

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Shear, K., Monk, T., Houck, P. et al. An attachment-based model of complicated grief including the role of avoidance. Eur Arch Psychiatry Clin Neurosc 257, 453–461 (2007). https://doi.org/10.1007/s00406-007-0745-z

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