View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Drexel Libraries E-Repository and Archives Coping with Bereavement through the use of Optimistic Emotional Disclosure A Thesis Submitted to the Faculty of Drexel University by Kelly Lynn Gilrain in partial fulfillment of the requirements for the degree of Doctor of Philosophy March 2004 ii Dedication This work is dedicated to those in my life who have pushed me to be more than I thought I could and supported me when the road was bumpy. To my mother - who told me at a very young age that I could be anything that I wanted to be. My father - who has the amazing ability to keep me calm and return my focus during times of stress. Bill - who reminds me to always enjoy the little things in life. Susan – who embodies the free spirit of drive and dedication. My sister - who consistently demonstrates more motivation and determination than anyone I know. My brother - who is an inspiration as he sets his goals and attains them all brilliantly. ….And In Loving Memory of Danny iii Acknowledgements I would like to thank Dr. Jacqueline Kloss for all of her time and effort dedicated to the review of this work. Through her challenging questioning, she has not only encouraged the structure of this material but my own conceptions of psychological theory and its place within the field of bereavement and emotional disclosure. Additionally, I would like to thank all members of my committee – Doug Porpora, James Herbert, John Colomosca, and Jason Young for their time and appraisal of this material; all of their input has made my research stronger. Furthermore, I extend a thank you to my colleagues Danielle Arigo, Susan Smith, Shakesha Anderson Clark, and Katherine Tweedy, as they have all provided insight into the framework and methodology of my research as well. iv Table of Contents List of Tables ...............................................................................................................................viii Abstract.......................................................................................................................................viiii 1. Review of the Literature............................................................................................................1 1.1 MODELS OF BEREAVEMENT...................................................................................................5 1.1.1 Psychoanalytic and Griefwork Model...........................................................................................6 1.1.2 Attachment Model.........................................................................................................................7 1.1.3 Psychosocial Model ......................................................................................................................8 1.1.4 Stage Model ................................................................................................................................10 1.1.5 Cognitive Behavioral Models .....................................................................................................11 1.1.6 Evaluation of Grief Theories ......................................................................................................15 1.2 VARIETIES OF GRIEF – NORMAL VS. COMPLICATED ...........................................................18 1.3.CONCEPTUALIZATION OF GRIEF ..........................................................................................24 1.3.1 Bereavement and Depression .....................................................................................................25 1.3.2 Bereavement and Anxiety............................................................................................................27 1.4 THE POSITIVE VALUE OF MOURNING..................................................................................30 1.5 COPING.................................................................................................................................31 1.5.1 Working Through the Loss, Making Meaning.............................................................................31 1.5.2 Humor.........................................................................................................................................35 1.5.3 The Advantage of Avoidance ......................................................................................................38 1.5.4 Problems associated with Avoidance and Inhibition ..................................................................46 1.6 TRADITIONAL APPROACHES FOR BEREAVEMENT ...............................................................49 1.6.1 Psychopharmacology..................................................................................................................50 1.6.2 Psychotherapy.............................................................................................................................52 1.6.3 Efficacy of Known Treatments....................................................................................................57 1.7 EMOTIONAL DISCLOSURE THROUGH WRITING ...................................................................60 v 1.7.1 Bereavement and Writing ...........................................................................................................65 1.8 POSITIVE PSYCHOLOGY .......................................................................................................71 1.8.1 Positive Emotions .......................................................................................................................76 1.8.1.1 History of Emotion.............................................................................................................................. 76 1.8.1.2 Broaden and Build Theory .................................................................................................................. 77 1.8.1.3 Undoing Hypothesis............................................................................................................................ 79 1.8.2 Evoking Positive Emotion through Emotional Disclosure..........................................................83 1.9 HYPOTHESES........................................................................................................................85 1.9.1 Outcome Measures .....................................................................................................................85 1.9.2 Process Measures .......................................................................................................................85 1.9.3 Statistical Plan............................................................................................................................85 1.9.4 Manipulation Check....................................................................................................................86 2. Method ......................................................................................................................................87 2.1 PARTICIPANTS......................................................................................................................87 2.2 DESIGN AND PROCEDURE ...................................................................................................87 2.3 MEASURES ...........................................................................................................................88 2.4 WRITING INSTRUCTIONS......................................................................................................91 3. Results.......................................................................................................................................95 3.1 BASELINE DATA...................................................................................................................95 3.2 MANIPULATION CHECK .......................................................................................................96 3.3 OUTCOME DATA ..................................................................................................................98 3.4 PROCESS MEASURES..........................................................................................................100 3.5 SESSION FOLLOW-UP MEASURES ......................................................................................100 3.6 POST-HOC ANALYSIS..........................................................................................................102 4. Discussion ...............................................................................................................................104 4.1 ACTIVE COPING .................................................................................................................104 4.2 EVALUATION OF RESULTS ON NEGATIVE AND POSITIVE SCALES.....................................106 vi 4.3 COPING -ACCEPTANCE ......................................................................................................107 4.4 NEGATIVE AFFECT OVER TIME..........................................................................................108 4.5 POST-HOC ANALYSES.........................................................................................................109 4.6 WRITING STYLE OF THE BEREAVED ..................................................................................110 4.7 LIMITATIONS AND POPULATION PARAMETERS .................................................................111 4.8 FUTURE DIRECTIONS .........................................................................................................112