GOOD GRIEF! A NEW WAY TO CONCEPTUALIZE, ASSESS, AND … · 2019-10-10 · conceptualizing,...

GOOD GRIEF! A NEW WAY TO CONCEPTUALIZE, ASSESS, AND TREAT

BEREAVED & TRAUMATICALLY BEREAVED CHILDREN & ADOLESCENTS

Christopher M. Layne, PhDDirector of Education in Evidence-Based Practice

UCLA/Duke University National Center for Child Traumatic Stress; & Research Psychologist,

Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles

1(C) Christopher M. Layne, Ph.D.

Author Disclosures• Dr. Layne is a co-author of Trauma and Grief Component Therapy: A

Modular Approach to Treating Traumatized and Bereaved Youth(Cambridge University Press, 2017) and the forthcoming Multidimensional Grief Therapy (Cambridge University Press, under contract).

• Dr. Layne is a co-author of the Persistent Complex Bereavement Disorder Checklist (Behavioral Health Innovations).

• Dr. Layne is on the Scientific Advisory Board of Behavioral Health Innovations.


Session DescriptionAssessing and treating bereaved youth can be especially challenging and rewarding at the same time, in that clinicians must acknowledge and accommodate both adaptive and maladaptive grief reactions in their assessment, case formulation, and treatment plan. Grief reactions can be influenced by many factors, including the age of the child, relationship to the deceased, circumstances of the death, time elapsed since the death, degree of parental facilitation of the youth’s grief reactions, and the youth’s coping strategies. Multidimensional grief theory is a useful framework for conceptualizing, assessing, and treating youths’ grief reactions. This includes the complex interplay that can arise between trauma and bereavement, and between posttraumatic stress reactions and grief reactions following traumatic bereavement (e.g., due to accident, drug overdose, suicide, homicide, or tragic medical illness). This workshop will focus on basic tenets of multidimensional grief theory and explore their implications for developmentally- and bereavement-informed assessment, case formulation, and treatment planning.


Breakout Session Learning Objectives

• Discuss why assessing grief reactions to bereavement is as clinically important as assessing posttraumatic stress reactions to trauma exposure, and the special challenges that assessing grief reactions pose (in that most bereaved youth grieve in adaptive ways).

• Discuss implications of multidimensional grief theory for identifying, conceptualizing, and treating cases of childhood bereavement, including traumatic bereavement.


First, a Painful Story from My Past:

“You’re making a mistake.”

-Nadejda Savjak, Ph.D.


Key Terms • Bereavement: The act of losing a loved one, close person through death • Traumatic bereavement: the act of losing a loved one under traumatic

circumstances (violent, tragic, may involve intense suffering, violation of social contract, volitional/intentional, disfigurement, wasting illness). • Mourning: Ritualized and often culturally-sanctioned ways of

recognizing, honoring, remembering the deceased and their life. • Public mourning rituals (memorial services, wakes, funerals, sitting shiva,

memorials & monuments, plaques) • Private mourning rituals (mementos, T-shirts, cars, tattoos, lighting a candle)

• Grief: Psychological, emotional, spiritual reactions to bereavement • Adaptive grief reactions • Maladaptive grief reactions • How do we differentiate between them?


Outline: 8 Key Points

1. Our Modern Epidemics2. Grief is Coming of Age: WHO (ICD-11) and APA (DSM 5.1) Proposed Diagnoses 3. Bereavement: A Potent Stressor Unlike Any Other 4. Grief: A Key Mediator between Bereavement and Adjustment5. Good Grief: Grief as a Diagnostic and Treatment Dilemma6. Multidimensional Grief Theory: Differentiating between Adaptive vs.

Maladaptive Grieving 7. Implications for Assessment and Treatment 8. Professional Self-Care


1. Our Modern Epidemics


Death (and Taxes) (Layne & Kaplow, in press)

• Bereavement under tragic and potentially traumatic circumstances, is a major mental health concern and public health emergency. • Suicide rate in 2017 was highest in over 50 years. Suicide has consistently

ranked among the 10 leading causes of death over the past decade. • Too many American lives are being lost, too often and too early, to

preventable causes, including drug overdose, suicide, motor vehicle accidents, and homicide (Redfield, 2018). • Self-harm 14th leading cause of death worldwide in 2016, is predicted to

rise to 11th leading cause of death worldwide by 2040 (Foreman et al., 2018).

• Overdose deaths have risen dramatically over the past 18 years. • National life expectancy has dropped for first time in 100 years.


Parental Bereavement (2012-2015)

Nationally-representative studies of bereaved adolescents show lifetime prevalence rates of parental death: • between 1.48% to 1.59% of adolescents report that their

biological mother, • 3.80% to 4.02% report that their biological father, are no longer

living (Harris & Udry, 2008; Kessler, 2011)• Childhood Bereavement Estimation Model (2018) predicts that

6.81% of children nationwide (more than 4.8 million) have or will have experienced the death of a parent or sibling by age 18.


Incidence and Prevalence Estimates of Sibling Bereavement Between 2012-2015• Annual incidence rate or children across the US bereaved by

death of a sibling is o 61,389 per year o 0.0832% (nearly 1%) of children and adolescents each year o 83.2 children per 100,000 in the general population

• Nearly 1.5% of all children nationwide will be bereaved by the death of a sibling by the age of 18.

(Hulsey et al., 2018)


Outcomes of Sibling Bereavement

• lower educational attainment (Fletcher et al., 2013)• increased depression, suicide attempts, and physician visits

(Bolton et al., 2016); • increased anxiety and illicit substance use (Rosenberg et al.,

2015); • increased mortality risk (Yu, Liew ,& Cnattingius, 2017)

Another child grief resource: Childhood Bereavement Estimation Model (CBEM): https://www.judishouse.org/cbem


https://www.judishouse.org/cbem

2. Grief is Coming of Age:

APA (DSM 5.1) and WHO (ICD-11)Proposed Diagnoses


How Do Young People Respond to the Loss of a Loved One?

(Kaplow, Layne, Pynoos, & Saltzman, 2019) • “Typical” grief reactions are hard to define

• Very few large studies of bereaved children… even fewer studies of bereaved children followed longitudinally over time…even fewer studies of bereaved youth living in underserved communities. • Grief reactions can be influenced by the child’s:

odevelopmental leveloprevious life experienceso relationship to deceasedo Family environment, mental health and parenting practices of surviving parento cultureo religious/spiritual beliefsoBroader social environment (extended family, neighbors, friends) o circumstances of the death of the loved one

14(C) Christopher M. Layne, Ph.D. & Julie B. Kaplow, PhD.

What Do “Normal” or Adaptive Grief Reactions Look Like?

• Can be very intense (yearning, sadness, anger or protest over the loss).

• Are often at least temporarily associated with decreased functioning, less energy, blunted mood, increased susceptibility to illness.

• Can fluctuate over time, often in response to loss reminders.

• Typically transition from pain to more pleasant reminiscing over time.

• Adjustment often takes longer if there are complicating factors (traumatic or tragic death, didn’t get to say goodbye, major secondary life changes, legal proceedings, disrupted caregiving routines).


Maladaptive Grief Reactions• More likely to occur under traumatic circumstances (what is “traumatic” to children is only

beginning to be seriously studied).

• The literature varyingly refers to maladaptive grief as“complicated grief”, “prolonged grief”, “pathological grief,” or “childhood traumatic grief,” although they differ in their makeup and core assumptions. Don’t assume these terms mean the same thing.

• The best available evidence suggests that approximately 10% of bereaved children fall within the clinical range of maladaptive grief reactions, although published studies have been conducted primarily with Caucasian middle-class samples.

• Typical grief reactions (pining, yearning, longing, sadness) are typically evoked by loss reminders (reminders of the continuing and future absence of the deceased).

• Youth bereaved by traumatic deaths can be troubled by both loss reminders and trauma reminders.

• Very little is known about specific symptoms, age-related manifestations, and course.


3. Bereavement: A Double—Barreled Challenge

(High Frequency, High Potency)


High Frequency, High Potency

Keyes et al. (2014) studied a large adult sample (N = 27,534). • Unexpected death of a loved one (accident, murder, suicide, heart attack,

terrorist attack) was the most common traumatic experience (~50%). • More respondents experienced first unexpected death between ages 15-

19 than any other age interval. • Most likely to rate unexpected death as their worst lifetime experience. • Dose-response relation between number of unexpected deaths and

number of lifetime psychiatric disorders: Increased incidence after unexpected death at nearly every point across the life course for posttraumatic stress disorder, major depressive episode, and panic disorder.


4. Grief: A Key Mediator between

Bereavement and Adjustment


Why Distinguish between Bereavement and Grief?

• Bereavement is a both a highly prevalent, and highly stressful, life adversity. • Bereavement per se is associated with significant risk for

impaired school functioning (Oosterhoff et al., 2018) and suicide risk (Hill et al., 2019).


Why Distinguish between Bereavement and Grief?

Studying, assessing, conceptualizing, treating bereavement without grief reactions.

is like Studying, assessing, conceptualizing, treating trauma without posttraumatic stress reactions.

Bereavement Adverse OutcomeGrief


Consequences of Untreated Maladaptive Grief(Kaplow, Angold, & Costello, 2008)

• Relationship problems

• Substance abuse

• Police involvement (criminal behavior)

• School drop-out

• Violence (revenge)

• Depression and suicidal thoughts/behaviors22(C) Christopher M. Layne, Ph.D. & Julie B. Kaplow, PhD.

5. Grief as a Diagnostic and Treatment Dilemma

(The Charlie Brown Problem)


Charlie Brown was right!

• There is such a thing as “good grief”.

• Adaptive grief is not studied nearly as much as “maladaptive”grief—a major shortcoming.

• However, “good grief” is the norm.

• The Shared Grief Project highlights important examples of “good grieving” (http://sharedgrief.org/).


http://sharedgrief.org/

Grief differs from:

• PTSD • Clinical Depression, • Schizophrenia, • Manic Depressive Disorder • Tic Disorder • etc.

• (Closest theoretical relative: Anxiety)


Why do we need a theory that can explicitly address both adaptive “good grief” and maladaptive grief reactions?

Isn’t grief…well, grief?


6. Multidimensional Grief Theory


Multidimensional Grief TheoryLayne & Pynoos (2008); Layne, Kaplow, & Pynoos (2011); Kaplow, Layne, et al. (2013)

Adaptive/Helpful Maladaptive/Not Helpful

Separation Distress

Existential / Identity Distress

Circumstance-Related Distress



Based on the assumptions that: • both maladjustment and positive adjustment can manifest within each

domain. • positive and negative adjustment processes can and frequently do co-

occur within a given domain. • each of the three grief domains encompasses both adaptive and

maladaptive responses to a central challenge specific to that domain. • The extent to which a given youth engages in specific grief responses—

both adaptive and maladaptive—within each domain, and across domains, makes up their individual grief profile.


Central Challenge of Separation Distress

“How can I continue to feel connected to the person who died, so that they remain an

important part of my life?”


Separation Distress


Central Challenge of Existential/Identity Distress

“Who am I as a person, and what is the purpose of my existence, now that this loved

one is physically absent from my life?”




Central Challenge of Circumstance-Related Distress

“How do I manage my distressing thoughts,beliefs, wishes, fantasies, emotions, and

impulses evoked by how this person died?”




Loss and Trauma RemindersLoss Reminders• Images, sounds, smells, people, situations that remind adolescent that the person is gone—

both now and in the future • Present and future oriented (birthdays, anniversaries, rites of passage) • (e.g., the person’s name, belongings, photos, places they used to be, friends, favorite chair,

favorite dish, times when I want their support, etc.) • Frequently evoke separation distress

Trauma Reminders• Sounds or images, sounds, smells, people, situations that remind adolescent of the way the

person died• (fireworks, movies about car accident, feelings themselves, etc.)• Frequently evoke circumstance-related distress, PTSD symptoms linked to manner of death

Layne, C. M., Warren, J. S., Saltzman, W. R., Fulton, J., Steinberg, A. M., & Pynoos, R. S. (2006). Contextual influences on post-traumatic adjustment: Retraumatization and the roles of distressing reminders, secondary adversities, and revictimization. In Schein, L. A., Spitz, H. I., Burlingame, G. M., & Muskin, P. R., (Eds.), Group Approaches for the Psychological Effects of Terrorist Disasters (pp. 235-286). New York: Haworth. 33(C) Christopher M. Layne, Ph.D.

• Intense negative emotions (e.g., guilt or shame over stigmatized deaths) inhibit reminiscing, support-seeking • Cognitive/behavioral avoidance (“I try not to think about him”). • Preoccupation with retaliatory fantasies, desires for revenge. • Intense preoccupation with fantasies about how the death could or

should have been prevented by altering preceding events. o “He wouldn’t have been to work that early if I hadn’t slept in and missed the bus” o “They should have done more to save him”o “I missed my friend’s last call before he killed himself. If only I’d taken that call” o “I should have been there for him.”

Source: Layne, C. M., Kaplow, J.B., Oosterhoff, B., Hill, R., & Pynoos, R.S. (2017). The interplay between posttraumatic stress and grief reactions in traumatically bereaved adolescents: When trauma, bereavement, and adolescence converge. Adolescent Psychiatry, 7, 220-239.


How Can Posttraumatic Stress Reactions Encroach Upon and Interfere With Adaptive Grieving?


• Interference by intrusive posttraumatic stress re-experiencing symptoms into efforts to remember and reminisceo “Every time I start missing my brother, I keep picturing the terrible look on my

mom’s face when she came out of his bedroom.”

• Interference with youths’ ability to make meaning of the death o “I want my brother’s death to mean something. But when I start warning kids

about drinking and driving, my mind goes back to the night we identified his body at the ER and I can’t talk about it at all.”

• Functional impairment that impedes efforts to carry on their legacyo “I’m never going to be able to graduate like Dad wanted because I can’t

concentrate and remember stuff from class.”



• Psychic numbing inhibits grieving and mourningo “I just feel numb–like I’m frozen inside. I haven’t even cried,” “I don’t have any

feelings at all.”

• Dissociation linked to the circumstances of the death o “I feel zoned out. It’s like it didn’t really happen.”

oDifferences in degree of exposure to death, relationship to deceased, coping style, maturity, symptom profiles, can create dyssynchronies in how family members and friends grieve and mourn. These can lead to poor communication, social withdrawal, estrangements, exacerbation of posttraumatic stress/maladaptive grief reactions.

o Interpersonal tensions can arise if such behavior is perceived by others as calloused, unfeeling, or lacking in love or loyalty towards the deceased (Kaplow, Layne, & Pynoos, 2014; Pynoos, 1992; Saltzman et al., 2017).




• Exposure to trauma reminders linked to the traumatic / tragic circumstances of the death can interfere with efforts to recover. o Anniversaries of the deatho Season of the year o Weather (rainy day) o People connected to the death o Places where it happened o 9/11: recover physical remains, grandfather’s ring o Forensic/judicial proceedings




Reciprocally, How Can Grief Reactions Interfere with Youths’ Capacity to Manage Posttraumatic Stress

Reactions? • Inability to accept the reality of the death (“I don’t want to talk about it. I still don’t

really believe he’s dead.” May avoid trauma narrative construction) • Shame, guilt, or stigma connected to the manner of death interferes with processing

its traumatic circumstances (“If I told you how he died, you would think less of me, or of him.”).

• Avoidance of loss reminders interferes with confronting reality and manner of death (“Anytime I hear my dad’s name, it hurts so much I leave the room”).

• Existential or identity crisis induces demoralization, nihilism (“nothing matters anymore”), erodes motivation to recover, including participation in treatment.

• Intense sorrow and loneliness, stress (financial strains, legal proceedings), and loss reminders (“I hate going home to an empty house”), compromise physical, mental health (“I just don’t have the energy to talk about it”) (McEwen, 2007).



Therapeutically Facilitating and Leveraging Good Grief




Separation Distress



Proc

eed Recede


Adaptive Grieving Exercise:

• Pair up with a partner or in a small group. Decide for yourselves—do the following stories represent a positive response to: o Challenges arising from the physical separation?o Existential/Identity-related challenges? o Challenges arising from the death circumstances?


Death, Grief, and SpiritualityAre Intimately Interconnected in

Bereaved Youth (and many Adults)


Poll: Another Exercise, or Focus on Assessment and Treatment?


(Optional) Adaptive Grieving Exercise

• Pair up with a partner or in a small group. • Share a brief story of someone you care about who has died, but whose

life continues to influence yours for good. • Describe their beneficial influence and how it enriches your life. • Then, use multidimensional grief theory to help you clarify the

psychological functions of helpful grieving (you can code more than one). oDoes it help you to feel closer to the person who died? oDoes it give you a deeper sense of purpose and meaning to your life? oDoes it strengthen your sense of personal identity and who you are? oDoes it help you deal constructively with the particular way they died?




Separation Distress




11. Implications for Assessment and Treatment


Why is Child Assessment So Complicated? Developmental, Social, Cultural, Societal Contexts• Developmental level of bereaved child • Relationship to the deceased • Circumstances of the death • Degree of exposure to the death • Time elapsed since the death • Health/well-being of surviving caregivers, capacity to carry out roles • Impact on family system • Subsequent exposure to trauma reminders• Subsequent exposure to loss reminders• Cultural context (belief systems, mourning rituals)


Layne, C. M., & Kaplow, J. B. (in press). Evidence-Based Assessment of Persistent Complex Bereavement Disorder, with Special Consideration to Adolescent Traumatic Bereavement. In E. A. Youngstrom, M. J. Prinstein, E. J. Mash, & R. A. Barkley (Eds). Assessment of Childhood Disorders, 5th Edition. New York: Guilford.

Valid Measures Are Being Developed

• Persistent Complex Bereavement Inventory (Lee, 2018) (validated on college students) • Persistent Complex Bereavement Disorder Checklist (Layne, Kaplow,

Pynoos, 2014) (validated for youth 9-18)


Effective Treatments Are Being Developed

• Shear et al. (2005) treated 83 women and 12 men aged 18 to 85 years. • Participants randomly assigned to receive interpersonal psychotherapy (n=

46) or complicated grief treatment (n= 49); both were administered in 16 sessions during an average interval of 19 weeks per participant.• Both treatments produced improvement in complicated grief. Response

rate greater for complicated grief treatment (51%) than interpersonal psychotherapy (28%; P =.02). Time to response was faster for complicated grief treatment (P =.02). Number needed to treat = 4.3.

Shear , K., Frank, E., Houck, P. R., & Reynolds, C. F. (2005). Treatment of complicated grief: a randomized controlled trial. JAMA, 293(21), 2601-8.


Effective Treatments Are Being Developed • Layne et al., (2008) 127 war-exposed secondary school students attending

10 schools in central Bosnia. • Randomly assigned to either an active-treatment comparison condition (tier

1), consisting of a classroom-based psychoeducation and skills intervention alone (n = 61) or a treatment condition composed of both the classroom-based intervention and a 17-session manual-based group therapy intervention (tier 2) (Trauma and Grief Component Therapy for Adolescents (n = 66). • Significant pre- to posttreatment and posttreatment to 4-month follow-up

reductions in PTSD and depression symptoms in both the treatment and comparison conditions. • Significant pre- to posttreatment reductions in maladaptive grief reactions

were found only in the treatment condition.

Layne, C. M., et al., (2008). JAACAP. 50(C) Christopher M. Layne, Ph.D.


• Grassetti et al. (2014) 33 adolescents from three middle schools completed a 17-week course of group-based TGCTA. • 61% of students reported reliable pre–post improvement in either PTSD

symptoms or maladaptive grief reactions. • Students whose narratives focused on loss both reported higher starting

levels and showed steeper rates of decline in grief reactions than students whose narratives focused on trauma. • In contrast, students whose narratives focused on trauma reported higher

starting levels of PTSD than students who narrated loss experiences. Loss-focused narratives, in particular, appear to be associated with greater decreases in MG reactions.


Hill, Oosterhoff, Layne, Rooney, Yudovich, Pynoos, & Kaplow (in press) open trial (N = 42) of Multidimensional Grief Therapy (in development): • After Phase I, analyses of grief reactions scored according to

multidimensional grief theory identified significant reductions and very large effect sizes in each of the three maladaptive grief domains. • Separation Distress, t(41) = 8.74, p < .001, Cohen’s d = 1.35; • Existential/identity distress, t(41) = 6.76, p < .001, d = 1.04; • Circumstance-related distress, t(41) =7.58, p < .001, d = 1.17.• Over 60% reliably improved on at least one grief subscale after the

first phase of treatment as gauged using the Reliable Change Index.


• Youth completing Phase II (n = 22) exhibited significant reductions from the end of Phase I, showing medium to large effect sizes (range = 0.57-0.90) for Separation Distress, Circumstance-Related Distress, PTSD symptoms, and depressive symptoms.• 38.9% showed reliable improvement in PTSD symptoms • Between 15.8% and 26.3% showed reliable improvement in maladaptive grief, • 16.7% exhibited reliable improvement in depressive symptoms. • 47.4% of youth showed reliable improvement in at least one outcome (which in

every case included at least one grief domain).


• Reliable deterioration in Phase II was rare: 0% showed reliable deterioration in PTSD symptoms and depressive symptoms; 1 (5.3%) showed reliable deterioration in Separation Distress, Existential/Identity Distress, and Circumstance-Related Distress. • These findings parallel those from post-war Bosnia (Layne et al., 2008). • Implications drawn from both studies (Hill et al., in press; Layne et al., 2008):

• The majority of youth who have been treated improve significantly on at least some of the key intervention targets.

• The worst outcome we observe in general is that some youth don’t significantly improve. Very few significantly worsen.


Trauma and Grief Component Therapy for Adolescents (TGCTA)

Saltzman, W. R., Layne, C. M., Pynoos, R. S., Olafson, E., Kaplow, J. B., & Boat, B. (2017). Trauma and Grief Component Therapy for Adolescents:

A Modular Approach to Treating Traumatized and Bereaved Youth.Cambridge University Press.


Trauma and Grief Component Therapy for Adolescents (TGCTA)

Module 1 -Group Cohesion -Psycho-Education -Coping Skills

Module 2 Trauma Processing

Module 3 Grief Processing

Module 4 Promoting Adaptive Developmental Progression

Designed to be:• Modularized• Assessment-driven (UCLA PTSD Reaction Index for DSM-5; Persistent Complex Bereavement Disorder

Checklist) • Can be tailored to particular needs, strengths, life circumstances of individuals or groups • Can be adapted for school, clinic, private practice, juvenile justice settings


Module III: Working Through Grief Experiences

• Designed to help bereaved adolescents reduce distressing grief reactions and cope in adaptive ways with the death of a loved one.

• Strength-based, non-pathologizing approach to grief • Balanced emphasis on:

o Regulating and reducing maladaptive grief reactions o Facilitating adaptive grief reactions o Helping youth to deal with adversities and life changes o Coping in adaptive ways with reminders


Module III: Working Through Grief Experiences

• Psychoeducation about grief• Connection between loss reminders and bereavement-related

thoughts, feelings and consequences• Exploration and sharing of intense negative emotions • Address ambivalent feelings about deceased• Renegotiate relationship with deceased from one of physical

presence to one of memory• How to speak about loss and recruit social support


Overview of Module III(Saltzman, Layne, Pynoos, Olafson, Kaplow, & Boat, 2017)

Session 1: Learning About Grief

Session 2: Understanding Connections Between Loss Reminders, Grief Reactions &

Consequences

Session 3: Dealing With Distress Over the Circumstances of Tragic Deaths

Session 4: Identifying Positive and Negative Traits

Session 5: Reminiscing Together

Session 6: Planning for Difficult Days (Relapse Prevention)


12. Self-Care


A Lesson from My Externship:

“Who are you going to talk to?”

“No--who are you going to talk to?”


Contact InformationChristopher M. Layne, Ph.D.

Director of Education in Evidence-Based Practice, UCLA/Duke University National Center for Child Traumatic Stress;

Research Psychologist, Department of Psychiatry and BiobehavioralSciences, University of California, Los Angeles

[email protected]


mailto:[email protected]

Bereavement Website Links

Childhood Bereavement Estimation ModelFamily Bereavement ProgramNational Alliance for Grieving ChildrenNY Life FoundationNational Child Traumatic Stress NetworkNational Child Traumatic Stress Network Learning CenterThe Trauma and Grief CenterTrauma and Grief Component TherapyThe Shared Grief Project


https://learn.nctsn.org/mod/url/view.php?id=12086








References Cox, J., Davies, D. R., Burlingame, G. M., Campbell, J. E., & Layne, C. M., & Katzenbach, R. J. (2007). Effectiveness of a Trauma/Grief-Focused Group Intervention: A Qualitative Study with War-Exposed Bosnian Adolescents. International Journal of Group Psychotherapy, 57, 319-345.

Hill, R., Oosterhoff, B., Layne, C. M., Rooney, E., Yudovich, S. Pynoos, R. S., & Kaplow, J. (in press). Multidimensional Grief Therapy: Pilot Open Trial of a Novel Intervention for Bereaved Children and Adolescents. Journal of Child and Family Studies.

Geronazzo-Alman, L., Fan, B., Duarte, C. S., Layne, C. M., Wicks, J., Guffanti, G., Musa, G. J., 7 Hoven, C. W. (2019). The Distinctiveness of Grief, Depression and Posttraumatic Stress: Lessons from Children After 9/11. Journal of the American Academy of Child & Adolescent Psychiatry (online pre-publication draft).

Grassetti, S. N., Williamson, A. A., Herres, J., Kobak, R., Layne, C. M., Kaplow, J. B., & Pynoos, R. S. (2018). Evaluating referral, screening, and assessment procedures for middle school trauma/grief-focused treatment groups. School Psychology Quarterly, 33(1), 10-20. http://dx.doi.org/10.1037/spq0000231

Herres, J., Williamson, A.A., Kobak, R., Layne, C. M., Kaplow, J. B., Saltzman, W. R., & Pynoos, R. S. (2017). Internalizing and externalizing symptoms moderate treatment response to school-based trauma and grief component therapy for adolescents. School Mental Health, 9, 184-193. doi.org/10.1007/s12310-016-9204-1.

Kaplow, J.B., Layne, C. M., Oosterhoff, B. Goldenthal, H., Howell, K.H., Wamser-Nanney, R., Burnside, A., Calhoun, K., Marbury, D., Johnson-Hughes, L., Kiesel, M., Staine, M.B., Mankin, M., Porter-Howard, L., & Pynoos, R.S. (2018). Validation of the Persistent Complex Bereavement Disorder (PCBD) Checklist: A developmentally-informed assessment tool for bereaved youth. Journal of Traumatic Stress, 31, 244–254.

Kaplow, J.B., Layne, C. M., Saltzman, W.R., Cozza, S.J., & Pynoos, R.S. (2013). Using multidimensional grief theory to explore effects of deployment, reintegration, and death on military youth and families. Clinical Child and Family Psychology Review, 16, 322–340.

Kaplow, J.B., Layne, C. M., & Pynoos, R.S. (2014, December). Parental grief facilitation: How parents can help their bereaved children during the holidays. Traumatic StressPoints, (http://sherwood-istss.informz.net/admin31/content/template.asp?sid=40989&brandid=4463&uid=1019024255&mi=4449102&mfqid=17980717&ptid=0&ps=40989)

Kaplow, J.B., & Layne, C. M. (2014). Sudden loss and psychiatric disorders across the life course: Towards a developmental lifespan theory of bereavement-related risk and resilience. American Journal of Psychiatry, 171, 807-810.

Kaplow, J.B., Layne, C. M., & Pynoos, R.S. (2014). Persistent Complex Bereavement Disorder as a call to action: Using a proposed DSM-5 diagnosis to advance the field of childhood grief. Traumatic StressPointsJanuary 2014 (http://sherwood-istss.informz.net/sherwood-istss/archives/archive_3773102.html)

Layne, C. M., & Hobfoll, S. E. (in press). Understanding Posttraumatic Adjustment Trajectories in School-Age Youth: Supporting Stress Resistance, Resilient Recovery, and Growth. In E. Rossen (Ed.), Supporting and Educating Traumatized Students: A Guide for School-Based Professionals (2nd ed.). New York: Oxford University Press.

Layne, C. M., Kaplow, J.B., Oosterhoff, B., Hill, R., & Pynoos, R.S. (2017). The interplay between posttraumatic stress and grief reactions in traumatically bereaved adolescents: When trauma, bereavement, and adolescence converge. Adolescent Psychiatry, 7, 220-239.

Layne, C. M., Kaplow, J. B., Oosterhoff, B., & Hill, R. (2019, June 3). Developmental Perspectives on Persistent Complex Bereavement Disorder: Proposals for Improvement. Invited presentation at the Workshop on Developing Criteria for a Disorder of Pathological Grieving. Hosted by the American Psychiatric Association, New York City.

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Layne, C. M., & Pynoos, R. S. (2008, July 31-August 1). Trauma and Grief Component Therapy for Adolescents: Circumstance-Related Distress, Existential Distress, and Developmental Impacts. 2-day training conducted at the University of Montana).

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https://www.ncbi.nlm.nih.gov/pubmed/3689093

GOOD GRIEF! A NEW WAY TO CONCEPTUALIZE, ASSESS, AND … · 2019-10-10 · conceptualizing,...

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