Prolonged Grief: An Investigation in the Frame of Separation Individuation Processes and Emotion Regulation Difficulties

Yıl 2021, Cilt: 8 Sayı: 2, 221 - 240, 28.06.2021

Gizem Cesur Soysal

https://doi.org/10.31682/ayna.716004

Öz

The main aim of this study was to investigate separation-individuation pathologies due to early childhood experiences and difficulties of emotion regulation as predictors of the prolonged grief symptoms. The sample of the study consisted of 212 participants who experienced loss: 123 female (%58) and 89 male (%42). The mean age of the sample was 26.26 (Sd = 7.55). Demographic Information Form, The Inventory of Complicated Grief (ICG), Separation-Individuation Inventory (SII), and Difficulties in Emotion Regulation-Short Form (DERS-16) were used. The results of the correlation analysis showed that prolonged grief symptoms were positively associated with difficulties of emotion regulation and separation-individuation subscales. Besides, hierarchical regression analysis indicated that relationship problems and differentiation subscales of separation-individuation, and clarity dimension of emotion regulation difficulties were significant predictors of prolonged grief symptoms. The model’s explained variance was .30. Obtained results highlighted the importance of separation-individuation and emotion regulation processes in prolonged grief. This study examined prolonged grief from the perspective of Mahler’s (1974) separation-individuation theory and emotion regulation difficulties. Therefore, the results have unique contribution to the literature. Finally, the results pointed out to the importance of clinical interventions targeting separation-individuation and emotion regulation processes due to early life experiences in understanding prolonged grief symptoms.

Anahtar Kelimeler

Prolonged grief, complicated grief, separation-individuation, emotion regulation difficulties

Uzamış Yas: Ayrılma-Bireyleşme Süreçleri ve Duygu Düzenleme Güçlüğü Temelinde Bir İnceleme

Öz

Çalışmanın amacı, erken çocukluk dönemine dayanan ayrılma-bireyleşme süreçlerindeki problemlerin ve duygu düzenleme güçlüklerinin uzamış yas belirtilerini ne ölçüde yordadığının belirlenmesidir. Çalışmanın örneklemi 123 (%58) kadın, 89 (%42) erkek olmak üzere yaş ortalaması 26.26 (S = 7.55) olan 212 kayıp yaşamış katılımcıdan oluşmaktadır. Veri toplama amacıyla, Kişisel Bilgi Formu, Karmaşık Yas Envanteri (KYE), Ayrılma-Bireyleşme Envanteri (ABE) ve Duygu Düzenleme Güçlüğü Ölçeği-Kısa Form (DDGÖ-16) kullanılmıştır. Korelasyon analizi sonucunda uzamış yas belirtilerinin ayrılma bireyleşme envanteri ve duygu düzenleme güçlüğü ölçeği arasında pozitif yönde ilişkiler olduğu görülmüştür. Araştırmanın temel amacı doğrultusunda yürütülen hiyerarşik regresyon analizi sonucuna göre ise uzamış yas belirtilerini ayrılma-bireyleşme farklılaşma ve ilişki problemleri ile duygu düzenleme güçlüğü açıklık alt boyutunun pozitif yönde yordadığı görülmüştür. Son modelde açıklanan toplam varyans %30 olmuştur. Bulgular uzamış yasta ayrılma-bireyleşme ve duygu düzenleme süreçlerinin önemini ortaya koyan ampirik veriler sunmaktadır. Aynı zamanda mevcut çalışma ile M. Mahler’in (1974) ayrılma bireyleşme kuramı ve duygu düzenleme güçlükleri temelinde uzamış yas belirtilerini inceleyerek özgün bulgulara ulaşıldığı düşünülmektedir. Elde edilen sonuçlar uzamış yas belirtilerinde erken dönem yaşantılardan temel alan ayrışma, bireyleşme, ilişki süreçleri, duygu düzenleme süreçlere yapılacak klinik müdahalelerin önemine de işaret etmektedir.

Anahtar Kelimeler

Uzamış yas, Karmaşık Yas, Ayrılma Bireyleşme, Duygu düzenleme güçlüğü

Kaynakça

• Aldao, A., Nolen-Hoeksema, S. ve Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2), 217-237. doi: 10.1016/j.cpr.2009.11.004
• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5. basım). Arlington, VA: American Psychiatric Publishing.
• Ayaz, T. (2011). The contributory roles of attachment styles, coping and affect regulation strategies on bereavement. (Yayımlanmamış yüksek lisans tezi). Orta Doğu Teknik Üniversitesi Sosyal Bilimler Enstitüsü, Ankara.
• Berenbaum, H., Bredemeier, K., Thompson, R. J. ve Boden, M. T. (2012). Worry, anhedonic depression, and emotional styles. Cognitive Therapy and Research, 36, 72-80. doi: 10.1007/s10608-010-9329-8
• Bion, W. R. (1962). Learning From Experience. London, England: William Heinemann Medical Books.
• Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E., Sahlin, H., Lundh, L. G., Bjärehed, J., DiLillo, D., i Messman-Moore, T., Gumpert, C.H. ve Gratz, K. L. (2016). Development and validation of a brief version of the difficulties in emotion regulation scale: the DERS-16. Journal of Psychopathology and Behavioral Assessment, 38(2), 284-296. doi: 10.1007/s10862-015-9514-x
• Boelen, P. A., Lenferink, L. I. ve Smid, G. E. (2019). Further evaluation of the factor structure, prevalence, and concurrent validity of DSM-5 criteria for Persistent Complex Bereavement Disorder and ICD-11 criteria for Prolonged Grief Disorder. Psychiatry Research, 3, 206-210. doi: 10.1016/j.psychres.2019.01.006
• Bonanno, G. A. ve Burton, C. L. (2013). Regulatory flexibility: An individual differences perspective on coping and emotion regulation. Perspectives on Psychological Science, 8(6), 591-612. doi:10.1177/1745691613504116
• Bonanno, G. A., Wortman, C. B., Lehman, D. R., Tweed, R. G., Haring, M., Sonnega, J.,Carr, D. ve Nesse, R. M. (2002). Resilience to loss and prolonged grief: A prospective study from preloss to 18-months postloss. Journal of Personality and Social Psychology, 83(5), 1150–1164. doi: 10.1037/0022-3514.83.5.1150
• Bowlby, J. (1980). Attachment and Loss, Vol. 3. Loss, Sadness and Depression. New York: Basic Books. Castro, S. I. ve Rocha, J. C. (2013). The moderating effects of previous losses and emotional clarity on bereavement outcome. Journal of Loss and Trauma, 18(3), 248-259. doi: 10.1080/15325024.2012.687327
• Cesur, G. (2017). Karmaşık yas: Bilişsel - Davranışçı Model çerçevesinde bir inceleme. (Yayımlanmamış doktora tezi). Ankara Üniversitesi Sosyal Bilimler Enstitüsü, Ankara.
• Christenson, R. M. ve Wilson, W. P. (1985). Assessing pathology in the separation-individuation process by an inventory: A preliminary report. Journal of Nervous and Mental Disease, 173(9), 561-565. doi:10.1097/00005053-198509000-00007.
• Dauber, R. B. (1980). An investigation of guilt, loss and the separation-individuation process in depression. Yayımlanmamış doktora tezi. Loyola University of Chicago, USA.
• Diminich, E. D. ve Bonanno, G. A. (2014). Faces, feelings, words: divergence across channels of emotional responding in complicated grief. Journal of Abnormal Psychology, 123 (2), 350-361. doi: 10.1037/a0036398.
• Edward, J., Ruskin, N. ve Turrini, P. (1992). Separation/Individuation: Theory and Application (Vol. 2). New York: Brunner/ Mazel.
• Erdem Atak, İ., Beyazıt, U., Subay, N., Sarı, B., Kokucu, G., ve Ünverdi, H. (2012, 25-28 Nisan). Karmaşık Yas Envanteri (revize edilmiş formu)’nin Türkçe’ye çevirisi: Geçerlik ve güvenirlik çalışması. [Poster sunumu] 17. Ulusal Psikoloji Kongresi, Boğaziçi Üniversitesi, Türkiye. http://www.psikon2012.org/
• Fernández-Alcántara, M., Cruz-Quintana, F., Pérez-Marfil, M. N., Catena-Martínez, A., Pérez-García, M. ve Turnbull, O. H. (2016). Assessment of emotional experience and emotional recognition in complicated grief. Frontiers in Psychology, 7, Article 126. doi: 10.3389/fpsyg.2016.00126
• Freud, S. (1961). The Ego and the Id. (J. Strachey, Çev.). İçinde J. Strachey (Ed.), The Standard Edition of The Complete Psychological Works of Sigmund Freud, Volume 19 (ss. 3- 66). London: Hogarth Press. (1923)
• Freud, S. (1957). Mourning and Melancholia. (J. Strachey, Çev.). İçinde J. Strachey (Ed.), The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume 14 (ss. 243-258). London: Hogarth Press. (1917)
• Gesi, C., Carmassi, C., Shear, K. M., Schwartz, T., Ghesquiere, A., Khaler, J. ve Dell'Osso, L. (2017). Adult separation anxiety disorder in complicated grief: an exploratory study on frequency and correlates. Comprehensive Psychiatry, 72, 6-12. doi: 10.1016/j.comppsych.2016.09.002
• Göral-Alkan, F. S. (2010). The Second separation-individuation process of the Turkish young adults: The relationships between the perceived maternal parenting attitudes, second separation individuation, expanding self and experiences in the romantic relations. (Yayınlanmamış yüksek lisans tezi). Boğaziçi Üniversitesi Sosyal Bilimler Enstitüsü, İstanbul.
• Göral-Alkan, F. S. (2010). Coupling through projective ıdentification: bridging role of projective ıdentification in the associations among early parenting experience, personality constructs and couple relationship. (Yayınlanmamış doktora tezi). Orta Doğu Teknik Üniversitesi Sosyal Bilimler Enstitüsü, Ankara
• Gratz, K. L. ve Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41-54. doi: 10.1023/B:JOBA.0000007455.08539.94
• Grotevant, H. D. ve Cooper, C. R. (1986). Individuation in family relationships: A perspective on individual differences in the development of identity and role-taking skill in adolescence. Human Development, 29(2), 82-100. doi: 10.1159/000273025
• Gupta, S. ve Bonanno, G. A. (2011). Complicated grief and deficits in emotional expressive flexibility. Journal of Abnormal Psychology, 120(3), 635-643. doi: 10.1037/a0023541
• Johnson, N. J., Backlund, E., Sorlie, P. D. ve Loveless, C. A. (2000). Marital status and mortality: The national longitudinal mortality study. Annals of Epidemiology, 10(4), 224–238. doi: 10.1016/S1047-2797(99)00052-6
• Jordan, A. H. ve Litz, B. T. (2014). Prolonged grief disorder: Diagnostic, assessment, and treatment considerations. Professional Psychology: Research and Practice, 45(3), 180-187. doi: 10.1037/a0036836
• Kernberg, O. F. (1980). Internal World and External Reality. Object Relations Theory Applied. New York/London:Aronson.
• Kins, E., Beyers, W. ve Soenens, B. (2013). When the separation-individuation process goes awry: Distinguishing between dysfunctional dependence and dysfunctional independence. International Journal of Behavioral Development, 37(1), 1-12. doi: 10.1177/0165025412454027
• Klein, M. (1940). Mourning and its relation to manic-depressive states. International Journal of Psycho-Analysis, 21, ss. 125-153.
• Klein, M. (1946). Notes on some schizoid mechanisms. International Journal of Psycho-Analysis, 27, ss. 99-110.
• Klein, M. (1975). Developments in Psychoanalysis. London: Hogarth Press.
• Klingspon, K. L., Holland, J. M., Neimeyer, R. A. ve Lichtenthal, W. G. (2015). Unfinished business in bereavement. Death Studies, 39(7), 387-398. doi: 10.1080/07481187.2015.1029143
• Lachmann, F. M. ve Stolorow, R. D. (1980). The developmental significance of affective states: Implications for psychoanalytic treatment. Annual of Psychoanalysis, 8, 215-229.
• Lundorff, M., Holmgren, H., Zachariae, R., Farver-Vestergaard, I. ve O’Connor, M. (2017). Prevalence of prolonged grief disorder in adult bereavement: A systematic review and meta-analysis. Journal of Affective Disorders, 212, 138-149. doi: 10.1016/j.jad.2017.01.030
• Mahler, M. S. (1972). Rapprochement subphase of the separation-individuation process. The Psychoanalytic Quarterly, 41(4), 487-506.
• Mahler, M. S. (1974). On the first three subphases of the separation-individuation process. Psychoanalysis and Science, 3, 295-306.
• Mahler, M. S., Pine, F. ve Bergman, A. (1975). The Psychological Birth of the Human Infant. Symbiosis and Individuation. New York: Basic Books.
• Masur, C. (2001). Can women mourn their mothers? İçinde, Three Faces of Mourning: Melancholia, Manic Defense, and Moving on. (ss. 35-45). Northvale, N.J.: Jason Aronson.
• Mennin, D. S., Holaway, R. M., Fresco, D. M., Moore, M. T. ve Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38(3), 284–302. doi: 10.1016/j.beth.2006.09.001
• Parkes, C. M. (2002). Grief: Lessons from the past, visions for the future. Death Studies, 26, 367-385. doi: 10.1080/07481180290087366
• Parkes, C. M. & Weiss, R. S. (1983). Recovery from Bereavement. New York: Basic Books.
• Paivio, S. C. ve Laurent, C. (2001). Empathy and emotion regulation: Reprocessing memories of childhood abuse. Journal of Clinical Psychology, 57(2), 213-226. doi: 10.1002/10974679(200102)57:2<213::AID-JCLP7>3.0.CO;2-B
• Pine, F. (1979). On the Pathology of the Separation Individuation Process as Manifested in Later Clinical Work: An Attempt at Delineation. International Journal of Psycho-Analysis, 60, 225-242.
• Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., Beverley Raphael, B., Marwit, S. J., Wortman, C., Neimeyer, R. A., Bonanno, G., Block, S. D., Kissane, D., Boelen, P., Maercker, A., Litz, B. T., Johnson, J. G., First, M. B., ve Maciejewski, P. K. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine, 6(8), 1-12. http:// dx.doi.org/10.1371/journal.pmed. 1000121
• Prigerson, H. G., Maciejewski, P. K., Reynolds III, C. F., Bierhals, A. J., Newsom, J. T., Fasiczka, A., Frank, E., Doman, J. Ve Miller, M. (1995). Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Research, 59(1-2), 65-79. doi: 10.1016/0165-1781(95)02757-2
• Rar-Tur, L. ve Levy-Shiff, R. (2000). Coping with losses and past trauma in old age: The separation-individuation perspective. Journal of Personal & Interpersonal Loss, 5(2-3), 263-281. doi: 10.1080/10811440008409756
• Shear, M. K. (2012). Grief and mourning gone awry: pathway and course of complicated grief. Dialogues Clin Neurosci, 14(2), 119-128.
• Shear, M. K., Simon, N., Wall, M., Zisook, S., Neimeyer, R., Duan, N., Reynolds, C., Lebowitz, B., Sung, S., Ghesquiere, A., Gorscak, B., Clayton, P., Ito, M., Nakajima, S., Konishi, T., Melhem, N., Meert, K., Schiff, M., O'Connor, M.F. ... Keshaviah, A. (2011). Complicated grief and related bereavement issues for DSM-5. Depression and Anxiety, 28(2), 103-117. doi: 10.1002/da.20780
• Stroebe, W. ve Stroebe, M. S. (1987). Bereavement and Health: The Psychological and Physical Consequences of Partner Loss. Cambridge: Cambridge University Press.
• Thompson, R. A. ve Meyer, S. (2007). The socialization of emotion regulation in the family. İçinde J. Gross (Ed.), Handbook of Emotion Regulation (ss. 249-268). Nueva York: The Guilford Press.
• Vine, V. ve Aldao, A. (2014). Impaired emotional clarity and psychopathology: A transdiagnostic deficit with symptom-specific pathways through emotion regulation. Journal of Social and Clinical Psychology, 33(4), 319-342. https://doi.org/10.1521/jscp.2014.33.4.319
• Volkan, V. (1970). Typical findings in pathological grief. The Psychiatric Quarterly, 44(1-4), 231-250.
• WHO. (2018). ICD-11 international classification of diseases for mortality and morbidity statistics (11th revision). Retrieved from https://icd.who.int/ct11_2018/ icd11_mms/en/release#/
• Yiğit, İ. ve Guzey Yiğit, M. (2017). Psychometric properties of Turkish version of Difficulties in Emotion Regulation Scale-Brief Form (DERS-16). Current Psychology, 38(6), 1503-1511. doi: 10.1007/s12144-017-9712-7