Counseling after traumatic loss: Effects on self-compassion, post-traumatic growth, and depression among among Mourners in Isfahan city

Document Type : Original Article

Authors

• Zahra Asgari ¹
• Azam Naghavi ²
• Mohammad Reza Abedi ³

¹ PhD in Counseling, Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran

² Associate professor, Department of Counseling, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran

³ Professor, Department of Counseling Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran

10.22067/tpccp.2024.84737.1576

Abstract

Introduction: One of the challenges related to traumatic losses is the issue of mourning after them, because their survivors experience the symptoms of bereavement more intensely and for a longer period. The phenomenon of grief is an internal experience and like other events, it requires a process to go through so that the survivors can return to the normal flow of life afterwards.

Objectives: This study aimed to investigate the effectiveness of a counselling package for traumatic loss in emergencies on self-compassion, post-traumatic growth, and depression in bereaved individuals.

Methods: This was an experimental study with pre-test, post-test, follow-up with control group. The population consisted of all bereaved men and women aged 19 to 40 who experienced traumatic loss in Isfahan in 2022. Thirty participants were selected using convenient sampling and randomly assigned into experimental and control groups. The counselling package was implemented only for people in the experimental group in six stages and with the number of 6 to 10 face-to-face sessions of up to 90 minutes. Data was collected using self-compassion questionnaires, post-traumatic growth, and Beck depression questionnaires. Data was analyzed using repeated measures ANOVA with SPSS 22 software.

Results: The results showed a significant difference in self-compassion, post-traumatic growth, and depression scores between the experimental and control groups at post-test (P<0.05), which remained after one month of follow-up.

Discussion and conclusion: The traumatic loss-counseling package can be effective in increasing self-compassion and post-traumatic growth while reducing depression in bereaved individuals during emergencies. This package can be used to facilitate the mourning process for people experiencing traumatic loss.

Keywords

• traumatic loss counseling
• grief
• self-compassion
• post-traumatic growth
• depression

Main Subjects

• Clinical psychology

---

References

Alonso-Llácer, L., Barreto Martín, P., Ramos-Campos, M., Mesa Gresa, P., Lacomba Trejo, L., & Pérez Marín, M. A. (2020). Mindfulness and grief: The maded program mindfulness for the acceptance of pain and emotions in grief. Psicooncologia, 17(1), 105-116. https://doi.org/10.5209/psic.68244

Asgari, Z., Naghavi, A., & Abedi, M. R. (2022). Grief interventions: A qualitative review of systematic reviews. Journal of Loss and Trauma, 1-17. https://doi.org/10.1080/15325024.2022.2102304

Augustat, O. (2023). Finding meaning after prolonged trauma: Is the construct of post-traumatic growth relevant for survivors with elevated symptoms of complex posttraumatic stress disorder? North Texas Journal of Undergraduate Research, 3(1). https://doi.org/10.12794/journals.ntjur.v3i1.238

Azadi, Z. (2011). Comparing the effectiveness of rational-emotive-behavior therapy and solution-focused therapy for divorcing couples on reducing their marital problems and maladjustment Ferdowsi University of Mashhad].

Azim Oghlui Oskooi, P. B., farahbakhsh, k., & moradi, o. (2021). Effective fields the experience of mourning after the death of a family member: A phenomenological study. Counseling Culture and Psycotherapy, 12(45), 117-160. https://doi.org/10.22054/qccpc.2020.48664.2275

Beck, A. T. (1972). Measuring depression: The depression inventory. Recent advances in the psychobiology of the depressive illnesses, 299-302.

Benjet, C., Lépine, J.-P., Piazza, M., Shahly, V., Shalev, A., & Stein, D. J. (2018). Cross-national prevalence, distributions, and clusters of trauma exposure. Trauma and posttraumatic stress disorder: Global perspectives from the WHO World Mental Health surveys, 43-71. https://doi.org/10.1017/9781107445130.004

Bosco, C., Tattoli, L., Di Vella, G., Ventura, F., Verde, A., & Rocca, G. (2021). The mourning process and “living with the dead”: Two case reports and a review of the literature. Journal of Forensic Sciences, 66(1), 407-412. https://doi.org/10.1111/1556-4029.14565

Breen, L. J., Greene, D., Rees, C. S., Black, A., Cawthorne, M., & Egan, S. J. (2023). A co-designed systematic review and meta-analysis of the efficacy of grief interventions for anxiety and depression in young people. Journal of Affective Disorders. https://doi.org/10.1016/j.jad.2023.05.032

Calhoun, L. G., & Tedeschi, R. G. (2014). The foundations of posttraumatic growth: An expanded framework. In Handbook of posttraumatic growth (pp. 3-23). Routledge.

Christ, G. H., Kane, D., & Horsley, H. (2021). Grief after terrorism: Toward a family-focused intervention. In Grief and bereavement in contemporary society (pp. 203-221). Routledge.

Coles, R. (2021). The madness of grief: A memoir of love and loss. Weidenfeld & Nicolson.

Currier, J. M., Holland, J. M., & Neimeyer, R. A. (2006). Sense-making, grief, and the experience of violent loss: Toward a mediational model. Death studies, 30(5), 403-428. https://doi.org/10.1080/07481180600614351 (In Persian)

Djelantik, A. M. J., Robinaugh, D. J., Kleber, R. J., Smid, G. E., & Boelen, P. A. (2020). Symptomatology following loss and trauma: Latent class and network analyses of prolonged grief disorder, posttraumatic stress disorder, and depression in a treatment‐seeking trauma‐exposed sample. Depression and Anxiety, 37(1), 26-34. https://doi.org/10.1002/da.22880

Faust, J. S., & Del Rio, C. (2020). Assessment of deaths from covid-19 and from seasonal influenza. JAMA internal medicine, 180(8), 1045-1046. https://doi.org/10.1001/jamainternmed.2020.2306

Frumkin, M. R., Robinaugh, D. J., LeBlanc, N. J., Ahmad, Z., Bui, E., Nock, M. K., Simon, N. M., & McNally, R. J. (2021). The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults. Journal of clinical psychology, 77(1), 254-267. https://doi.org/10.1002/jclp.23024

Goveas, J. S., & Shear, M. K. (2020). Grief and the covid-19 pandemic in older adults. The American Journal of Geriatric Psychiatry, 28(10), 1119-1125. https://doi.org/10.1016/j.jagp.2020.06.021

Harris, D. (2021). Compassion-focused grief therapy. British Journal of Guidance & Counselling, 49(6), 780-790. https://doi.org/10.1080/03069885.2021.1960948

Huggins, C., & Hinkson, G. (2022). Signs of traumatic grief, lack of justice, magnitude of loss, and signs of resilience following the homicidal loss of their adult child among caribbean black mothers. OMEGA-Journal of death and dying, 84(3), 914-934. https://doi.org/10.1177/0030222820921013

Jerome, H., Smith, K. V., Shaw, E. J., Szydlowski, S., Barker, C., Pistrang, N., & Thompson, E. H. (2018). Effectiveness of a cancer bereavement therapeutic group. Journal of Loss and Trauma, 23(7), 574-587. https://doi.org/10.1080/15325024.2018.1518772

Johannsen, M., Damholdt, M., Zachariae, R., Lundorff, M., Farver-Vestergaard, I., & O'Connor, M. (2019). Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials. Journal of Affective Disorders, 253, 69-86. https://doi.org/10.1016/j.jad.2019.04.065

Johnson, S. K., & Armour, M. P. (2016). Finding strength, comfort, and purpose in spirituality after homicide. Psychology of Religion and Spirituality, 8(4), 277. https://doi.org/10.1037/rel0000090

Jordan, T. R., Wotring, A. J., McAfee, C. A., Polavarapu, M., Cegelka, D., Wagner-Greene, V. R., & Hamdan, Z. (2022). The covid-19 pandemic has changed dying and grief: Will there be a surge of complicated grief? Death studies, 46(1), 84-90. https://doi.org/10.1080/07481187.2021.1929571

Kessler, R. C., Aguilar-Gaxiola, S., Alonso, J., Benjet, C., Bromet, E. J., Cardoso, G., Degenhardt, L., de Girolamo, G., Dinolova, R. V., & Ferry, F. (2017). Trauma and ptsd in the who world mental health surveys. European journal of psychotraumatology, 8(sup5), 1353383. https://doi.org/10.1080/20008198.2017.1353383

Khursheed, M., & Shahnawaz, M. G. (2020). Trauma and post-traumatic growth: Spirituality and self-compassion as mediators among parents who lost their young children in a protracted conflict. Journal of religion and health, 59, 2623-2637. https://doi.org/10.1007/s10943-020-00980-2

Komischke-Konnerup, K. B., Zachariae, R., Johannsen, M., Nielsen, L. D., & O'Connor, M. (2021). Co-occurrence of prolonged grief symptoms and symptoms of depression, anxiety, and posttraumatic stress in bereaved adults: A systematic review and meta-analysis. Journal of Affective Disorders Reports, 4, 100140. https://doi.org/10.1016/j.jadr.2021.100140

Kozu, S., & Gibson, A. (2021). Psychological effects of natural disaster: Traumatic events and losses at different disaster stages. The Intersection of Trauma and Disaster Behavioral Health, 85-101. https://doi.org/10.1007/978-3-030-51525-6_6

Kristiansen, C. B., Kjær, J. N., Hjorth, P., Andersen, K., & Prina, A. M. (2019). Prevalence of common mental disorders in widowhood: A systematic review and meta-analysis. Journal of Affective Disorders, 245, 1016-1023. https://doi.org/10.1016/j.jad.2018.11.088

Laranjeira, C., Moura, D., Salci, M. A., Carreira, L., Covre, E., Jaques, A., Cuman, R. N., Marcon, S., & Querido, A. (2022). A scoping review of interventions for family bereavement care during the covid-19 pandemic. Behavioral Sciences, 12(5), 155. https://doi.org/10.3390/bs12050155

Lightfoot, S. L., & Oliver, J. (1985). The beck inventory: Psychometric properties in university students. Journal of Personality Assessment, 49(4), 434-436. https://doi.org/10.1207/s15327752jpa4904_12

Montague, K. T., Christensen, K., & Furr, S. (2020). Counselor preparation in crisis, trauma, grief, and neurocounseling. Journal of Counselor Preparation and Supervision, 13(4), 1. https://repository.wcsu.edu/jcps/vol13/iss4/1?utm_source=repository.wcsu.edu%2Fjcps%2Fvol13%2Fiss4%2F1&utm_medium=PDF&utm_campaign=PDFCoverPages

Mosher, P. J. (2018). Everywhere and nowhere: Grief in child and adolescent psychiatry and pediatric clinical populations. Child and Adolescent Psychiatric Clinics, 27(1), 109-124. https://doi.org/10.1016/j.chc.2017.08.009

Parkes, C. M., & Prigerson, H. G. (2013). Bereavement: Studies of grief in adult life. Routledge.

Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the self‐compassion scale. Clinical Psychology & Psychotherapy, 18(3), 250-255. https://doi.org/10.1002/cpp.702

Rahmani, N., & Mansouri, A. (2020). The effectiveness of mindfulness–based cognitive therapy on the rumination and posttraumatic growth in bereaved women. Clinical Psychology and Personality, 17(1), 23-32. https://doi.org/10.22070/cpap.2020.2880 (In Persian)

Rajabi, G. R. (2005). Psychometric properties of beck depression inventory short form items (bdi-13). https://jip.stb.iau.ir/article_512442.html?lang=en (In Persian)

Rheingold, A. A., Baddeley, J. L., Williams, J. L., Brown, C., Wallace, M. M., Correa, F., & Rynearson, E. K. (2015). Restorative retelling for violent death: An investigation of treatment effectiveness, influencing factors, and durability. Journal of Loss and Trauma, 20(6), 541-555. https://doi.org/10.1080/15325024.2014.957602

Roepke, A. M., Tsukayama, E., Forgeard, M., Blackie, L., & Jayawickreme, E. (2018). Randomized controlled trial of secondstory, an intervention targeting posttraumatic growth, with bereaved adults. Journal of consulting and clinical psychology, 86(6), 518. https://psycnet.apa.org/doi/10.1037/ccp0000307

Seyed Mahmoudi, S., Rahimi, K., & Mohammadi, J. (2012). Psychometric properties of post-traumatic growth questionnaire (ptgi). Psychological methods and models, 12(3), 93-108. https://jpmm.marvdasht.iau.ir/article_294.html?lang=en (In Persian)

Shahbazi, M., Rajabi, G., Maghami, E., & Jelodari, A. (2015). Confirmatory factor analysis of the persian version of the self-compassion rating scale-revised. Psychological methods and models, 6(19), 31-46. https://jpmm.marvdasht.iau.ir/article_849_3bbe0bb15fda37601e8a2f09c6da5cb7.pdf (In Persian)

Shear, M. K., Ghesquiere, A., & Glickman, K. (2013). Bereavement and complicated grief. Current psychiatry reports, 15, 1-7. https://doi.org/10.1007/s11920-013-0406-z

Siqveland, J., Hafstad, G. S., & Tedeschi, R. G. (2012). Posttraumatic growth in parents after a natural disaster. Journal of Loss and Trauma, 17(6), 536-544. https://doi.org/10.1080/15325024.2012.678778

Sperandio, K. R., Gutierrez, D., Kirk, M., Lopez, J., & Nathaniel Mason, W. (2022). Post-traumatic growth after the drug-related death of a loved one: Understanding the influence of self-compassion and hope. The Family Journal, 30(3), 390-400. https://doi.org/10.1177/10664807211052479

Tal, I., Mauro, C., Reynolds III, C. F., Shear, M. K., Simon, N., Lebowitz, B., Skritskaya, N., Wang, Y., Qiu, X., & Iglewicz, A. (2017). Complicated grief after suicide bereavement and other causes of death. Death studies, 41(5), 267-275. https://doi.org/10.1080/07481187.2016.1265028

Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of traumatic stress, 9, 455-471. https://doi.org/10.1007/BF02103658

Tedeschi, R. G., & Moore, B. A. (2021). Posttraumatic growth as an integrative therapeutic philosophy. Journal of Psychotherapy Integration, 31(2), 180. https://doi.org/10.1037/int0000250

Tur, C., Campos, D., Herrero, R., Mor, S., López-Montoyo, A., Castilla, D., & Quero, S. (2021). Protocol: Internet-delivered cognitive-behavioral therapy (icbt) for adults with prolonged grief disorder (pgd): A study protocol for a randomized feasibility trial. BMJ open, 11(7). https://doi.org/10.1136/bmjopen-2020-046477

Vara, H., & Thimm, J. C. (2020). Associations between self-compassion and complicated grief symptoms in bereaved individuals: An exploratory study. Nordic Psychology, 72(3), 235-247. https://doi.org/10.1080/19012276.2019.1684347

Wallace, C. L., Wladkowski, S. P., Gibson, A., & White, P. (2020). Grief during the covid-19 pandemic: Considerations for palliative care providers. Journal of pain and symptom management, 60(1), e70-e76. https://doi.org/10.1016/j.jpainsymman.2020.04.012

Winders, S. J., Murphy, O., Looney, K., & O'Reilly, G. (2020). Self‐compassion, trauma, and posttraumatic stress disorder: A systematic review. Clinical Psychology & Psychotherapy, 27(3), 300-329. https://doi.org/10.1002/cpp.2429

Wong, C. Yeung. Ncy (2017). Self-compassion and posttraumatic growth: Cognitive processes as mediators. In: Mindfulness.

Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health practitioner. springer publishing Company.