From Grief to Personal Growth

Hogan, N. S., & Schmidt, L. A. (2002). Testing the grief to personal growth model using structural equation modeling. Death Studies, 25, 615-634. Nancy Hogan and Lee Schmidt from the University of Miami tested their Grief to Personal Growth theory using structural equation modeling. The Grief to Personal Growth theory is one approach to understanding how people grow as a result of loss. Their theory defines grief as involving despair and detachment as well as intense thoughts and images of loved ones. A turning point involves some experience of social support that eventually leads to personal growth. Structural equation modeling allows researchers to test a model by specifying the model prior to analysis and then assessing it empirically.

To facilitate structural equation modeling of the Grief to Personal Growth theory, the researchers operationalized and measured their key constructs: grief, intensity, avoidance, social support, and personal growth. The various grief and personal growth variables were measured by the Hogan Grief Reaction Checklist subscales; intensity and avoidance were measured by the Impact of Event scale; and social support was measured by the Inventory of Social Support. The sample consisted of 167 residents who completed a survey packet made available to them because of their involvement in a national organ/tissue donor foundation. Respondents were primarily female (77%) and married (78%), with an average age of 49. Seventy-five percent of respondents had lost a son.

Most deaths were due to accidents (65%), though suicide (15%), homicide (9%), and illness (7%) were also reported. About half (55%) of respondents reported some involvement with a support group. The model that best fit the data shows Å"grief leading to intensity, intensity leading to avoidance, avoidance leading to social support, and social support leading to personal growth (p. 627). In other words, a common reaction to the reality of loss is uninvited and intrusive thoughts and images. These are often followed by efforts to avoid reminders of the loss. Avoidance eventually leads a person to seek social support or it prompts others to offer social support. In this model discussion the loss plays a role in personal growth.

The researchers note that the Grief to Personal Growth theory seems consistent with commonly held assumptions about grief, including what grief is (despair characterized by Å"shattered hopes and detachment or isolation from others). One conventional piece of wisdom that was not supported by the Grief to Personal Growth theory is the belief that grief is best addressed by Å"grief work or the resolving of grief and return to Å"normal. The findings are certainly suggestive. However, as the researchers note, the sample size is rather small for structural equation modeling. Also, the experience of parental loss to an accident (the most frequently reported loss) may be different than grief experienced by spouses or others going through anticipatory grief or other experiences of loss. In any case, Christian counselors can appreciate this model as one of perhaps several that help us sort through the best approaches to meet the needs of the bereaved.

Resilience to Chronic Grief

Bonanno, G., Wortman, C. B., Lehman, D. R., Tweed, R. G., Haring, M., Sonnega, J., Carr, D., & Nesse, R. M. (2002). Resilience to loss and chronic grief: A prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology, 83, 1150-1164. George Bonanno and his colleagues reported on a study of 205 persons who were assessed prior to the loss of their spouse and at 6 and 18 months following the loss. The sample was obtained from a larger prospective study of a probability sample of 1532 married couples. The researchers considered several bereavement patterns: common grief, chronic grief, chronic depression, improvement during bereavement, and resilience. About 90% of the sample fell into these five categories, with resilience being the most common (46%) and the others in descending order: common grief (17%), chronic grief (16%), depressed-improved (10%), and chronic depression (8%).

Prior to the loss there were no differences among those who fell into the common grief, chronic grief, and resilient patterns, and these participants scored lower on measures of depression than those who fell into the chronic depression and depression- improved categories. At six months post-bereavement, the resilient group had the lowest levels of depression, followed by the depression-improved, common grief, chronic grief, and the chronic-depressed groups. At 18- month follow-up, the resilient and depressed-improved groups showed no statistically significant differences. Those who fell into the chronic grief category experienced greater preloss dependency than those in the other groups. Also, those who were resilient tended to report greater acceptance of the reality of death and were more likely to believe in a just world as compared to those in the other groups. Christian counselors can join the researchers in acknowledging that for those who are resilient there may be a point of diminishing returns in providing intervention, and that some interventions may not help and Å"might produce some harm by causing them to focus on issues they had already dealt with or by undermining their natural coping strategiesÂ� (p. 1161).

More research needs to be done on resilience, but these findings suggest that preloss worldview assumptions may play an important role in coping with loss. Christian counselors will want to know whether Christian worldview assumptions are associated with adaptive coping responses, though worldview alone will not be the sole determinant of how one responds to loss. Christian Counseling Today 2003 Vol. 11 No. 2 75 Spiegel, D. (2002). Change in emotion- regulation strategy for women with metastatic breast cancer following supportive-expressive group therapy. Journal of Consulting and Clinical Psychology, 70, 916-925. Janine Giese-Davis and her colleagues at the Stanford University School of Medicine and the Stanford Hospital and Clinics reported on their test of several ways women in supportive-expressive group therapy for metastatic breast cancer regulate their emotions (suppression, restraint, repression, and emotional self-efficacy). One hundred twenty-three women with metastatic breast cancer and two women with recurrent breast cancer participated in the study (from an original 155 women who initially agreed to participate but had to drop out of the study for a variety of reasons). At oneyear follow-up, the researchers found that reports of suppression of negative emotions decreased while restraint of hostile behavior increased in comparison to the control group. Online therapy can be helpful to get rid of such problems.

The therapy and control groups did not differ significantly on either repression or emotional self-efficacy, so there was no evidence that emotion-focused group therapy helped these participants reduce repression of negative affect or experience an increase in emotional self-efficacy. But the findings suggest that emotion-focused group therapy can help women with metastatic breast cancer be more expressive without becoming more aggressive, inconsiderate, or hostile toward others. As noted by the researchers, future research can help to determine whether affect regulation can be improved among those suffering from non- life-threatening illnesses and what specific group processes facilitate changes in affect regulation as were present in this study. In any case, Christian counselors can appreciate the potential value of emotion-focused support groups in helping women who are facing life-threatening illness and are in need of learning ways to manage a range of emotions in response to their life circumstances.