Skip to main content
NCBI home page
SAGE - PMC COVID-19 Collection logoLink to SAGE - PMC COVID-19 Collection
. 2023 Jan 22:10541373221145536. doi: 10.1177/10541373221145536

Addressing Grief and Bereavement in Covid-19 Pandemic

Saachi Arora 1,✉, Sangeeta Bhatia 1
PMCID: PMC9880143

Abstract

Losses that took place during the covid 19 pandemic are recognised as “bad deaths”. They are characterized by physical discomfort, difficulty breathing, social isolation, psychological distress and ineffective care. The experience of grief has been even more challenging during the covid times as compared to the usual grief prior to the pandemic due to the lack of resources that assist in coping. Lack of social support, uncertainty about the future, lack of routine, and absence of mourning rituals deny the bereaved with the basic opportunity to grieve adaptively. Enhancing advance care planning may help dying patients to receive effective care. Virtual funeral services, extending support through telephonic conversations, online psychotherapy and encouraging continuing bonds with the deceased assist individuals who experience grief and bereavement. The current chapter focuses on expanding awareness about the nature of grief during the pandemic and understanding effective measures to mitigate complicated grief across various subgroups of the society who experienced grief as a result of the covid-19 pandemic.

Keywords: bereavement, coping, grief, online psychotherapy, mental health

Introduction

The corona virus has led to the experience of many unexpected human losses. The quality of grief has been affected with the limited availability of ritualistic or spiritual support. Anticipatory grief reactions are likely to occur during the covid 19 pandemic as most people experience worry about losing their loved ones to the virus and come in touch with their mortality (Wallace, Wladkowski, Gibson, & White, 2020).

The prevalence rates of prolonged grief disorder have risen drastically during the covid 19 pandemic (Stroebe & Schut, 2021). The intensity of acute grief in those bereaved by covid 19 losses is found to be much more in comparison to those who are bereaved by other causes of death (Eisma, Tamminga, Smid, & Boelen, 2021).

Grief is often characterised as intense yearning for the loss accompanying cognitive, emotional, physical, and behavioural manifestations. The process of mourning is an important protective factor against pathological grief (Nakajima, 2018).

Covid 19 has led to certain harsh consequences. As a result of the social distancing policies, final goodbyes were not possible to one's loved one. Those who come in contact with the deceased are expected to isolate themselves even though they are experiencing grief. Social networks have been highly affected during the pandemic leading to disenfranchised grief in most individuals. Disenfranchised grief is conceptualised as unexpressed grief in public, social, or cultural terms (Girolamo et al., 2020).

Covid related fatalities has been devastating for bereaved individuals as they have been experienced grief in multiple layers owing to social isolation, lack of practical and emotional support, anticipatory grief reactions and worries for other loved ones and oneself, uncertainty related to the future, lack of structure, and confinement to homes. Grief in covid 19 requires to address grief reactions with special considerations to meet the emotional needs of the bereaved (Carr, Boerner, & Moorman, 2020).

The objective of this chapter is to inform the public, clinicians, researches and bereaved individuals about the nature, consequences, and interventions involved in grief and bereavement resulting from Covid 19 pandemic.

Pathological Grief

The process of adapting to the loss of a loved one is difficult as it involves the experience of a variety of emotional reactions. Grief is a unique experience to each individual. It involves cognitive, behavioral, spiritual, and physical responses (Zhai & Du, 2020). Pathological grief is described in the DSM-5 as a persistent, complex bereavement disorder with 12 months duration and in the ICD–11 as prolonged grief disorder of a duration of 6 months. Clinicians may also consider the diagnosis of depression in those who present with characteristic symptoms 2 weeks after their bereavement.

The decision to provide an intervention depends upon the level of distress, impairment and the risk associated. The symptoms associated with pathological grief include social withdrawal, lack of purpose, and not accepting the loss. There are also ruminations, negative thinking, and questioning one's existence. These symptoms can be pervasive and cause distress with interference in socio-occupational functioning (Boelen & Smid, 2017).

Adaptive Grief

An essential element of grief therapy involves adaptive grieving. Adaptive grieving suggests that the bereaved individual integrates the death events gradually into his narrative while he seeks connection and attachment from the previously shared relationship with the bereaved. The integration of the loss is helpful in acknowledging the reality of the death, retaining the bittersweet emotions in regulated manner, revising the mental representation of the deceased, as well as redefining one's goals and roles (Kosminsky & Jordan, 2016).

Nature of Grief in the Covid 19 Pandemic

Pandemics are associated with multi-layered losses characterized by difficulties in readjustment and healing. Complicated grief is experienced by most individuals during pandemics which often involves feeling stuck in processing the loss, difficulty moving on and persistent yearning of the loss. These grief reactions were exacerbated during the covid 19 pandemics due to sudden death, untimely loss, lack of adequate care, and lack of contact with the deceased due to social isolation. The suddenness of these losses led to “bereavement overload” in most families (Kokou-Kpolou, Fernandez-Alcantara, & Cenat, 2020).

Family members in the covid 19 pandemic responded with guilt and remorse due to being unavailable for one's loved one during their last days. This led them to feel that they could not stand up to one's expectations and standards as a relative to the deceased. The grief may be exacerbated with the guilt of having survived the illness, unlike the deceased, resulting in “survivor guilt.”

Mourning and performing final rites is a cultural defence to adapt to the loss. The pandemic did not allow individuals to engage in mourning. Due to physical distancing, social isolation, travel and other restrictions imposed by the government, the grief reactions of the individuals were compounded to a great extent (Shear, 2012).

Deaths in the covid 19 context led to heightened psychological symptoms of depression, anger, anxiety due to the lack of opportunity to bid final goodbye to the deceased, especially when the final days of the deceased were spent in pain, isolation and the death was untimely as well as unexpected. In such cases, most deaths during the covid scenario came across as unjust. Loss of a loved one during the pandemic prevented individuals from constructing a meaningful narrative around the loss and resulted in unfinished business in most (Li et al., 2019). Bereaved individuals who felt that their loss is unjust often experience anger and cast blame in order to make sense of their loss (Neimeyer, 2000)

Lack of preparation, social isolation, uncertainty, apprehension of losing other loved ones, being treated without dignity, inability to bid final goodbye to the deceased, receipt of unwanted medical interventions or anxiety about one's own mortality led to poor quality grieving during the pandemic (Krikorian et al., 2020). Adaptive grieving can often be facilitated by physical comfort, presence of emotional, social, and spiritual support, being treated with respect, and bidding final goodbyes to the deceased (Gawande, 2014). Erosion of these support systems that assist in coping have made the grieving process in the pandemic even more challenging and overwhelming (Pauly, 2020).

Protective Factors in Addressing Grief and Bereavement in Covid 19

The factors that heal in the grieving process involve meaning making of the loss, ability to verbalize emotions, social acknowledgement of these feelings which address the psychosocial aspects of the loss. Lack of social support and living away from family worsen the process of grieving. Spirituality and religion, especially in the Indian context having found to be factor that foster faster acceptance (Tikka, Garg, & Dubey, 2020). Stigma could be a potential barrier to family members of the deceased patients of COVID-19 in disclosing their distress and participating in any rituals related to the death. This section highlights the specific intervention that help individuals in overcoming their grief.

Building Awareness. The pandemic was unfamiliar for most. Most individuals were misinformed and unaware. In this case, it is important to be aware, seek information from health care workers, and other reliable sources. The need for isolation, awareness of restrictions, understanding of the unexpected fatalities involved in covid 19, as well as risks involved would help individuals to be psychologically prepared for the losses which could then facilitate advance care planning, end of life conversations and adaptive care.

Communication. Physical distancing and social isolation did not allow individuals to meet each other leading to frustration. Therefore, online and virtual connections with loved ones through audio and video conversations could inculcate the feeling of being available for one's loved ones in their last days preventing guilt. A sense of belonging and social support is highly essential in facilitating adaptive grieving. The treatment choices, discussion about the will, and other end of life conversations can be facilitated through virtual conversations.

Meaning Reconstruction. Another essential element of grief therapy involves reconstructing one's meaning around the loss. Individuals construct healthier meanings of the loss when they discover a way to stay connected with the deceased despite the absence of their physical presence. Changing one's narrative around the loss by seeking continuity in one's identify and relationship shared with the deceased is significant. Sharing stories in the presence of responsive loved ones contribute to healing to a large extent (Neimeyer, 2006).

The challenge in integrating and comprehending the loss becomes intense when the loss is unpredictable, sudden, and violent. It often makes one question one's assumptions about the fair and predictable world (Schwartzberg & Janoff-Bulman, 1991).

Continuing Bonds.Klass, Silverman, and Nickman (2014) provides insights on the idea of continuing bonds with the deceased after the loss. The idea of grief moved from letting go of the deceased to maintaining the relationship with the deceased even after the loss. The expression of this evolving relationship with the grief can look like talking to their photos, relocating the deceased in heaven, or seeing them as reconnected with the family ancestors. Participating in rituals and visiting their grief are conscious ways of connecting with the deceased. Continuing bonds are symbolic ways to stay connected with the deceased that facilitates integration of the loss along with acceptance of the loss.

Processing of the loss. The quality of the therapeutic relationship is critical in helping clients make meaning of the loss. A respectful, collaborative, and a directive style facilitates all grief interventions. An open space for reflection, validation, and change is the primary need for most bereaved individuals and one of the major agendas in grief therapy. The power of the deceased individual's presence beyond their physical presence. An important ingredient in processing the loss of the loved one is discovering the deceased's presence and connecting with the loved one mentally, emotionally, and spiritually in absence of their physical essence (Currier, Neimeyer, & Berman, 2008).

A broad range of techniques are helpful in processing the loss and finding meaning in one's loss (Neimeyer, 2012). Some on these techniques are :-

Retelling the narrative of the Death. In this techniques, bereaved individuals review the story of the loss in slow motion in order to inculcate the sense of mastery and regulation over the loss than avoidance.

Chapter of our lives. This technique involves viewing the loss as a previous experience and associating the loss with new meanings

Virtual Dream Stories. Creative writing about the loss facilitates exploration of feelings and thoughts related to the loss. Self-awareness often leads to effective healing in the process of loss.

Directed Journaling. In this technique, individuals are directed to do diary work in order to make sense of the loss and find benefits around the loss.

Loss characterization. Encouraging the individuals to narrate the impact of loss on one's sense of self from the distanced perspective.

Rituals of transition. The rituals of transition involves ways in which the bereaved individual can validate one's life changes through symbolically connecting with the individual he has lost.

Primary Treatments for Grief and Bereavement

The loss of a loved one is considered as a primary loss which is accompanied with loss of companionship, changes in family roles, and guilt which are secondary losses. The covid-19 pandemic has made closures with the deceased harder for individuals. This could lead to frustration and disempowerment among many bereaved individuals. Grief is normal and natural reaction to loss; however, the progression of grief into complicated grief can be mitigated.

A few themes that have been found to be helpful in positive outcomes for bereaved individuals are advance care planning, honouring religious and cultural rituals, and optimums opportunities for mobilizing social networks (Mayland, Harding, Preston, & Payne, 2020)

Pharmacology. Pharmacotherapy is seen to be effective in the treatment of depression or Post Traumatic Stress Disorder that are considered to be the two most highly prevalent comorbid conditions in grief. Antidepressants such as citalopram have been effective in optimizing the effects of psychotherapy on co occurring depressive symptoms but not on pathological grief (Boelen & Smid, 2017).

Psychotherapy. Provision of counselling and telepsychiatry services could help individuals in sharing about their losses, processing the loss and receiving validation. Psychotherapy would also help reconstructing meaning around the loss, redefining life goals and purpose, and adapting to life.

Internet based therapy was the primary need during the covid 19 pandemic due to the strict quarantine restrictions. Litz et al. (2014) found internet treatments to be effective in cases of prolonged grief disorder and the effectiveness was seen in the duration of 1 year. These findings promised the management of bereavement during the pandemic. Expressive writing, cognitive changes, improved loss orientation and restoration coping were effective components and targets of grief therapy.

The first line of treatment for pathological grief experienced in the pandemic is cognitive behavioral therapy (CBT) tailored to the needs of the individual. CBT promotes adaptive grieving by replacing negative thoughts with realistic ones (Eisma, Boelen, & Lenferink, 2020). Due to social distancing policies during the pandemic, CBT delivered through the online platforms were tested to be highly effective for grieving individuals (Iglewicz, Shear, & Reynolds, 2020). Wagner, Knaevelsrud, and Maercker studied the effectiveness of online CBT which focuses on journaling, exposure exercise, altering maladaptive thoughts and restoration coping in order to adapt to the loss. CBT addresses the post traumatic reactions and grief related ruminations after the loss.

Complicated Grief Psychotherapy is one of the most effective and evidence based grief interventions in cases of prolonged grief. It facilitates progression of therapy through all the stages of mourning. It has been found to be more effective than interpersonal psychotherapy and antidepressants (Goveas & Shear, 2020).

Present centred therapy inculcating a sense of being in the here and now as well as developing a realistic sense of control has been found to be highly effective in grieving process (Shea et al., 2003).

Special Considerations to Address Grief and Bereavement in Covid 19 Pandemic among Family and Friends

The process of adaptive grief has been difficult during the corona virus. In order to make the process of grieving more effective, a dignified passing of the loved one is highly essential. A few measures to allow adaptive grieving are mentioned below.

Online Social Connectivity. Communication through digital platforms would be highly beneficial in the final moments of individuals. Connectivity with the deceased in their final days through online platforms can substitute for the physical distance and allow extension of social as well as emotional support. In order to make the grieving process more adaptive, healthcare workers can share digital photos of the deceased in order to allow a final goodbye to process the loss (Wang et al., 2020).

Virtual Memorial Services. Digital platforms used for the purpose of funeral and memorial services allow the opportunity to process and accept the loss (Iglewicz et al., 2020). Covid 19 happened in the times of technological advancements which fortunately allows individuals to attend and arrange virtual funerals. Virtual memorial services and performance of final rites may provide support for bereaved individuals. The use of these services provide involvement of loved ones who would have otherwise been devoid of the opportunities to offer their condolences due to travel restrictions, financial constraints, social isolation, and people who are at high risk for contracting the infection and developing complications (Muturi, Freeman, & Banner, 2020).

Cultural Emphasis. In the Indian context, the emphasis on faiths, religions and customs is considered highly essential. Being sensitive to one's cultural practices is considered as a major healing factor in the grieving process.

End of life Care. An effective communication which facilitates validation of grief responses and anticipatory grief reactions assists in adaptive grieving. Discussions which focus upon advance care planning (ACP), end of life care as well as addressing holistic and spiritual needs (Wang, Teo, Yee, & Chai, 2020). Many health and palliative care organizations like Respecting Choices (2020), Compassion in Choices (2020), and Center to Advance Palliative Care (2020) have created documents to assist with ACP and guides for effective end-of-life conversations.

After care and support. Appropriate aftercare and support are required for those who experienced bereavement during the covid 19 pandemic. The care involves addressing individual needs, concerns, validation and reassurance for their experiences. Staying connected with one's social networks has been found to be effective in the grieving process as it provides one with the social and emotional support (Etkind et al., 2020).

Online Psychotherapy. Provision of online psychotherapy and counselling services can be effective in gaining new perspective, finding new meanings to loss, adapting to new life goals, and making sense of the loss. Encouraging the bereaved person to recall, share and write positive memories of the deceased can result in upliftment and inspiration.

Addressing Grief in Specific Populations

Health Care Workers. Health care workers have been through tremendous amounts of psychological distress during the Covid 19 pandemic. They witnessed the loss of their patients, their colleagues, and their own loved ones. Vicarious trauma is relevant for all the health care workers who were exposed to the infections, sudden deaths, isolation, and grief. The experience of loss and burnout for health care workers need to be addressed through psychotherapeutic and psychopharmacological interventions. Provision of comfortable environments, opportunity to spend quality time with other professionals and virtually connecting with loved ones could mitigate the grief reactions in the frontline workers (Dhadphale, 2020).

Older Adults. As a result of lowered immunity in older adults, they are likely to experience losses from the disease. They are likely to experience the death of a loved one accompanied with losing a sense of companionship. Older adults found it challenging to not be able to find solace through social networks during the grieving period. Absence of family gatherings, religious rituals, and disengagement from normal routine led to frustration and loneliness at the most intense level in older adults. However, it was noticed that therapy for older adults was much more effective than younger adults because of their experience of life as well as wisdom acquired all throughout life. Strength based building in older adults led to improved resilience to overcome grief. Different interventions such as mindfulness, cognitive therapy and complicated grief therapy showed promising results for older adults in dealing with loneliness, anxiety, depression, and post traumatic reactions resulting from loss (Dinnen, Simiola, & Cook, 2015).

Young Children. Younger children take time to grasp the concept of death and dying. Due to lack of conceptualisation of these concepts, educating children about the same is a healthy practice to address their grief. Children may not have the ability to express themselves about the way they feel about the loss. Supportive counselling has proven to be one of the most effective therapies for children as it allows the space to address parent related problems, confinement to home, and facilitates effective communication (Boelen, Lenferink, & Spuij, 2021). Grief can be manifested through eating disorders, conduct issues, anxiety, and mood swings in children. Therefore, these issues would need special attention in order to address grief in children (Ludwig et al., 2018).

Future Trends and Conclusion

Covid 19 has drastically altered the ways in which individual grieve and adapt to the loss. The inability to meet the loved one for one last and embrace the, lack of opportunity to seek comfort from other mourners in funerals, worries, apprehensions, and uncertainty complicate the experience of one's grief. The models of support during the pandemic requires to make special considerations through virtual and digital platforms in order to make practical, social, spiritual, and emotional resources accessible for effective grieving. The chapter will focus on expanding the understanding of grief and awareness of effective tools and interventions which effectively address grief among bereaved individuals who have lost their loved ones in the covid 19 pandemic. The chapter will highlight and emphasize on interventions across various sub groups of society experiencing grief as a result of the pandemic.

Author Biographies

Saachi Arora is a Clinical Psychologist licensed through the Rehabilitation Council of India (CRR no. A75421) & PhD Scholar at University of Delhi. She has gained experience in working with a wide variety of population including children, adolescents, as well as adults. Her specialty lies in managing Mood Disorders, Anxiety Spectrum Disorders (Generalized Anxiety Disorder, Panic Attacks, Social Anxiety, OCD, Phobia), Psychosomatic Concerns, and Traumatic responses. She aims to provide a safe space for individuals who want to share their story in a non-judgmental, compassionate, and supportive environment allowing everyone the opportunity to feel empowered. Her inclination towards the psychodynamic approach is reflected in her practice as she implements various psychodynamic tools such as dream analysis, hypnotherapy, and graphology to understand the impact of the unconscious on the conscious mind & build self-awareness. She believes that the choice of a therapeutic approach differs depending on the individual needs & concerns. To serve a wide variety of clients, she has attained training and certifications in various therapeutic approaches such as Cognitive Behavioral Therapy, Rational Emotive Behavioral Therapy, Positive Psychology, Clinical Hypnotherapy, and Trauma Focused Interventions.

Sangeeta Bhatia is an associate professor in the Department of Psychology. She received her PhD in Psychology from Delhi University in 2000 and was a merit position holder in MPhil in Psychology from Panjab University, Chandigarh. She joined the Psychology Department at Gargi College in 1990, where she currently teaches several undergraduate courses. Her area of specialization is in the fields of developmental and health psychology. During 25 years of teaching, she has also undertaken numerous research projects, having successfully completed Major and Minor Projects funded by UGC. Her work has been published in both international and national journals. Of special note is her contribution of two chapters on Community Psychology in India in international handbooks edited by authors from the UK and USA. These books are widely used as references by universities across the world. She has been a member of national and international professional associations in the field of psychology, such as the National Academy of Psychology, India (NAOP) and American Psychological Association (APA). She has also presented papers at conferences in India and abroad. Having mentored undergraduate students for research beyond the curriculum, at present she is also supervising doctoral research work at the University of Delhi.

Footnotes

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article

Ethics Approval: The ethical approval was done by Dr. Sangeeta Bhatia, Associate Professor At University of Delhi.

References

  1. Boelen P. A., Lenferink L. I. M., Spuij M. (2021). CBT For prolonged grief in children and adolescents: A randomized clinical trial. American Journal of Psychiatry, 178(4), 294–304. 10.1176/appi.ajp.2020.20050548 [DOI] [PubMed] [Google Scholar]
  2. Boelen P. A., Smid G. E. (2017). Disturbed grief: prolonged grief disorder and persistent complex bereavement disorder. Bmj, 357, 357. 10.1136/bmj.j2016 [DOI] [PubMed] [Google Scholar]
  3. Carr D., Boerner K., Moorman S. (2020). Bereavement in the time of coronavirus: Unprecedented challenges demand novel interventions. Journal of Aging & Social Policy, 32(4-5), 425–431. 10.1080/08959420.2020.1764320 [DOI] [PubMed] [Google Scholar]
  4. Currier J. M., Neimeyer R. A., Berman J. S. (2008). The effectiveness of psychotherapeutic interventions for the bereaved: A comprehensive quantitative review. Psychological Bulletin, 134(5), 648–661. 10.1037/0033-2909.134.5.648 [DOI] [PubMed] [Google Scholar]
  5. Dhadphale M. (2020). The living will, cultural aspects of death, and mourning rituals. Annals of Indian Psychiatry, 2(1), 47. 10.4103/aip.aip_15_18 [DOI] [Google Scholar]
  6. Dinnen S., Simiola V., Cook J. M. (2015). Post-traumatic stress disorder in older adults: A systematic review of the psychotherapy treatment literature. Aging & Mental Health, 19(2), 144–150. 10.1080/13607863.2014.920299 [DOI] [PubMed] [Google Scholar]
  7. Eisma M. C., Boelen P. A., Lenferink L. (2020). Prolonged grief disorder following the coronavirus (COVID-19) pandemic. Psychiatry Research, 288(189), 113031. 10.1016/j.psychres.2020.113031 [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Eisma M. C., Tamminga A., Smid G. E., Boelen P. A. (2021). Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison. Journal of Affective Disorders, 214, 54–56. 10.1016/j.jad.2020.09.049 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Etkind S. N., Bone A. E., Lovell N., Cripps R. L., Harding R., Higginson I. J., Sleeman K. E. (2020). The role and response of palliative care and hospice services in epidemics and pandemics: A rapid review to inform practice during the COVID-19 pandemic. Journal of Pain and Symptom Management, 60(1), e31–e40. 10.1016/j.jpainsymman.2020.03.029 [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Gawande A. (2014). Being mortal: Medicine and what matters in the end. Metropolitan Books. [Google Scholar]
  11. Girolamo G., Cerveri G., Clerici M., Monzani E., Spinogatti F., Starace F., Tura G., Vita A. (2020). Mental health in the coronavirus disease 2019 emergency-the Italian response. JAMA psychiatry, 77(9), 974–976. 10.1001/jamapsychiatry.2020.1276 [DOI] [PubMed] [Google Scholar]
  12. Goveas J. S., Shear M. K. (2020). Grief and the COVID-19 pandemic in older adults. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 28(10), 1119–1125. 10.1016/j.jagp.2020.06.021 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Iglewicz A., Shear M. K., Reynolds C. F., Simon N., Lebowitz B., Zisook S. (2020). Complicated grief therapy for clinicians: An evidence-based protocol for mental health practice. Depression and Anxiety, 37(1), 90–98. 10.1002/da.22965 [DOI] [PubMed] [Google Scholar]
  14. Klass D., Silverman P. R., Nickman S. (2014). Continuing bonds: New understandings of grief. Taylor & Francis. [Google Scholar]
  15. Kokou-Kpolou C. K., Fernández-Alcántara M., Cénat J. M. (2020). Prolonged grief related to COVID-19 deaths: Do we have to fear a steep rise in traumatic and disenfranchised griefs? Psychological Trauma: Theory, Research, Practice, and Policy, 12(c), S94–S95. 10.1037/tra0000798 [DOI] [PubMed] [Google Scholar]
  16. Kosminsky P., Jordan J. (2016). Attachment informed grief therapy. Routledge. [Google Scholar]
  17. Krikorian A., Maldonado C., Pastrana T. (2020). Patient’s perspectives on the notion of a good death: A systematic review of the literature. Journal of Pain and Symptom Management, 59(1), 152–164. 10.1016/j.jpainsymman.2019.07.033 [DOI] [PubMed] [Google Scholar]
  18. Li J., Tendeiro J. N., Stroebe M. (2019). Guilt in bereavement: Its relationship with complicated grief and depression. International Journal of Psychology, 54(4), 454–461. 10.1002/ijop.12483 [DOI] [PubMed] [Google Scholar]
  19. Litz B. T., Schorr Y., Delaney E., Au T. M., Papa A., Fox A. B., Prigerson H. G. (2014). A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder. Behaviour Research and Therapy, 20(3), 23–34. 10.1016/j.brat.2014.07.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Ludwig L., Pasman J. A., Nicholson T., Aybek S., David A. S., Tuck S., Kanaan R. A., Roelofs K., Carson A., Stone J. (2018). Stressful life events and maltreatment in conversion (functional neurological) disorder: Systematic review and meta-analysis of case-control studies. The Lancet Psychiatry, 5(4), 307–320. 10.1016/S2215-0366(18)30051-8 [DOI] [PubMed] [Google Scholar]
  21. Mayland C. R., Harding A. J. E., Preston N., Payne S. (2020). Supporting adults bereaved through COVID-19: A rapid review of the impact of previous pandemics on grief and bereavement. Journal of Pain and Symptom Management, 60(2), e33–e39. 10.1016/j.jpainsymman.2020.05.012 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Muturi I., Freeman S., Banner D. (2020). Virtual funerals: A feasible and safer option during the COVID-19 pandemic. Journal of Geriatric Psychology, 68(11), 2472–2247. 10.1111/igs.16774 [DOI] [PubMed] [Google Scholar]
  23. Nakajima S. (2018). Complicated grief: Recent developments in diagnostic criteria and treatment. Philosophical Transactions of the Royal Society B: Biological Sciences, 373(1754), 20170273. 10.1098/rstb.2017.0273 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Neimeyer R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24(6), 541–558. 10.1080/07481180050121480 [DOI] [PubMed] [Google Scholar]
  25. Neimeyer R. A. (2006). Re-storying loss: Fostering growth in the posttraumatic narrative. Research and Practice, 8(Supp 6), 66–88. 10.1080/20008198.2019.1583524 [DOI] [Google Scholar]
  26. Neimeyer R. A. (ed.) (2012). Techniques in grief therapy: Creative practices for counseling the bereaved. Routledge. [Google Scholar]
  27. Pauly M. (2020). Virtual memorials and no hugs: The funeral industry prepares for coronavirus. Mother Jones. Retrieved April, 26, 2020.
  28. Schwartzberg S. S., Janoff-Bulman R. (1991). Grief and the search for meaning: Exploring the assumptive worlds of bereaved college students. Journal of Social and Clinical Psychology, 10(3), 270–288. 10.1521/jscp.1991.10.3.270 [DOI] [Google Scholar]
  29. Shea M. T., Bernardy N., Howard J., Key F., Lambert J. (2003). Present Centered Therapy Manual (PCT). Developed for use in Veterans Administration project CSP-494, dt. Version (2017) Nocon, A., & Rosner, R. Universität Eichstätt, unveröffentlichtes Arbeitsmaterial.
  30. Shear M. K. (2012). Grief and mourning gone awry: Pathway and course of complicated grief. Dialogues in Clinical Neuroscience, 14(2), 119–128. 10.31887/DCNS.2012.14.2/mshear [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Stroebe M., Schut H. (2021). Bereavement in times of COVID-19: A review and theoretical framework. OMEGA - Journal of Death and Dying, 82(3), 500–522. 10.1177/0030222820966928 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Tikka S. K., Garg S., Dubey M. (2020). How to effectively break bad news: The COVID-19 etiquettes. Indian Journal of Psychological Medicine, 42(5), 491–493. 10.1177/0253717620948208 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. 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. 10.1016/j.jpainsymman.2020.04.012 [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Wang S., Teo W., Yee C. W., Chai Y. W. (2020). Pursuing a good death in the time of COVID-19. Journal of Palliative Medicine, 23(6), 754–755. 10.1089/jpm.2020.0198 [DOI] [PubMed] [Google Scholar]
  35. Zhai Y., Du X. (2020). Loss and grief amidst COVID-19: A path to adaptation and resilience. Brain, Behavior, and Immunity, 87, 80–81. 10.1016/j.bbi.2020.04.053 [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Illness, Crises, and Loss are provided here courtesy of SAGE Publications

RESOURCES