This document includes the articles and for the course ‘Loss and Psychotrauma’ (University of Utrecht).
Overview
Week 1
Lecture: Introduction to the course / general introduction on loss & Psychotrauma 2
Marjolein Missler & Mirjam van Zuiden
Article: Disturbed grief: PGD and PCBD (Boelen & Smid, 2017) 7
Article: The health consequences of bereavement (Stroebe, 2007) 10
Article: Treatment of PTSD: a state-of-art Review article section 1; 2; 5.1; 5.2; 6; 7(Burback et al., 2023) 13
Week 2
Lecture: Theoretical approaches to grief and grieving Maggie Stroebe 23
Article: Models of coping with bereavement (Stroebe, Schut & Boerner, 2017) 26
Week 3
Lecture: Child, family, loss and trauma Trudy Mooren 30
Article: A trauma-informed (...)virtual home visiting program for your children (Mogil et al., 2022) 33
Article: Cognitive behavioral treatments for children and adolescents (Yohannan, …& Volker, 2021) 35
Week 4
Lecture: Understanding the complexity of sexual abuse Iva Bicanic 37
Article: Development of multidisciplinary sexual assault centers (Covers, Karst & Bicanic, 2022) 38
Week 5
Lecture: Characteristics and effectiveness of grief interventions Henk Schut 40
Article: Psychological interventions for grief in adults (Johannsen et al., 2019) 43
Week 6
Lecture: Treatment of prolonged grief in adults and children Paul Boelen 45
Article: Prolonged grief disorder: Cognitive-behavioral theory and therapy (Boelen, Hout & Bout, 2013) 52
Article: Cognitive Therapy for prolonged grief in children (Spuij, Londen-Huiberts & Boelen) 54
Week 7
Lecture: Evidence-based psychological interventions for PTSD Sjef Berendsen 58
Article: Treatment of PTSD: A state-of-art Review article sections 3; 4; 5.4 (Burback et al., 2023) 62
Week 8
Lecture: A diversity perspective on trauma / cultural concepts of distress and migration related aspects 70
Jeroen Knipscheer & Franziska Lechner-Meichsner
Article: Prevalence of mental disorders in refugees and asylum seekers (Patanè et al., 2022) 73
Article: A network meta-analysis of psychosocial interventions for refugees (...) (Turrini et al., 2021) 74
Article: The assessment of grief in refugees in postconflict survivors (Killikelly, Bauer & Maercker, 2018) 75
1
, Week 1
Lecture: Introduction to the course / general introduction on loss & Psychotrauma
Marjolein Missler & Mirjam van Zuiden
Grief
Loss: separation from someone or something that you are attached to
→ separation distress (grief): pain, sadness, difficulties accepting
Psychotrauma: experiencing or witnessing an event that is traumatic (threaten to safety/control/health)
→ traumatic distress: anxiety, hypervigilance, sense of current threat (not believing its is in the past)
These subjects are different from each other, however they can overlap (for example: traumatic loss)
bereavement situation of having lost a loved one/relative
grief the emotional/psychological response to this loss
→ all responses occurring after being separated from an
attachment figure
→ individual process
mourning behavioral and social expressions of grief, which are shaped by
culture or society
unhealthy, disordered, complicated grief general term for stagnated grief
prolonged grief disorder term for formal classification of grieving disorder
Misconceptions about grief
● grieving is a process occuring in phases (and you need to go through all phases)
● the same reaction (anger/depression/sadness) are always part of the grieving process
● intense emotions in the initial period if mourning predict healthy adjustment, absence of reactions indicate
unhealthy/abnormal grief
● losing a child is always worse than losing a partner
● a grieving process ends after a certain period (1 or 2 year)
Grief it is associated with feelings (yearning, longing, loneliness, guilt), behavior (proximity seeking),
thoughts/cognitions (preoccupation with thoughts about deceased or moment of death, loss of concentration,
lowered self-esteem), perceptions (sensation of seeing the person, feeling that the separation is unreal) and physical
(sleep-related problems, stress, low energy)
Instead of going through phases, it is more about doing
tasks. Following the Grief Task Model, tasks include:
● accepting the reality of the loss
● allowing yourself to experience all the emotions
● adjusting to life without deceased
● relocating the deceased emotionally
● move on
Normal grief is switching between loss-orientated and
restoration-oriented. When there is no switching (so
2
,someone has just one orientation) or when someone goes outside the ‘normal’ intensity of the orientation, the grief
is considered disturbed.
Prolonged grief disorder
Prolonged Grief Disorder (PGD) is a
relative new diagnosis, described in both
ICD-11 as DSM-5-TR
Important differences:
● typological vs detailed description
of criteria
● number of symptoms and severity
specifications for diagnosis
● timing after loss when diagnosis
can be made
Determinants of grief:
● background of bereaved person
● characteristics of the death
(sudden, traumatic circumstances,
etc)
● characteristics of the deceased
(relationship, quality, etc)
● situation after the loss (support,
secondary losses, coping, etc)
Distinction between PGD and ‘healthy grief’
● degree of progress in grieving
○ PGD? no progress or worsening over time
● duration of grief
○ PGD? grief reaction persist (6 month ICD of 12 months DSM)
● degree of suffering
○ PDG? grief causes distress + impairs function
When you suspect PDG, you can do a stepped diagnostic assessment
1. self-report questionnaire to get indication of disturbed grief
● for example: traumatic grief inventory self report plus (TGI-SR+)
○ total score of >71 indicates clinically relevant PGD
2. clinical interview to make formal diagnosis
10% of people get PGD following natural loss, 49% following unnatural/violent losses
3
, risk factors for PGD: protective factors for PGD:
● being a woman ● the younger, the better
● stigmatizing (negative responses) ● high education
● personality (depression, anxiety, neuroticism) ● perceived support
● anxious attachment ● secure attachment
Other factors: death of children/partners or unnatural/violent death leads to more intense reaction
Psychotrauma
The definition of trauma depends on the
profession or time you asked for the
definition.
trauma general term for different kind of wounds
psychotrauma emotional response to a distressing event
psychotraumatology study of psychological trauma
→ specifically the disciplines involved with treating, preventing and researching
traumatic situations
Traumatic events can:
● happen to one individual or many at the same time (collective memory)
● be apparent or remain hidden to others
● be anticipated or unexpected
● happen at any age
● single time vs prolonged/repeated
All reactions to all potentially traumatic life events can be conceptualized in 4 principles:
● people always have to resolve a discrepancy between the event and pre-existing knowledge (can cause
intrusions)
● there are always specific implications (appraisal) about the event, making the event meaningful (causing
emotional response)
○ the events is a threat to one’s self-esteem → anxiety
○ the event causes loss or failure → sadness
● there are always many cues connected with the event, that very easily get connected with many other cues
(through classical conditioning + generalization)
● there is always a natural inclination to avoid cues eliciting intrusions, cognitions and emotions maintained
by operant conditioning
4
Overview
Week 1
Lecture: Introduction to the course / general introduction on loss & Psychotrauma 2
Marjolein Missler & Mirjam van Zuiden
Article: Disturbed grief: PGD and PCBD (Boelen & Smid, 2017) 7
Article: The health consequences of bereavement (Stroebe, 2007) 10
Article: Treatment of PTSD: a state-of-art Review article section 1; 2; 5.1; 5.2; 6; 7(Burback et al., 2023) 13
Week 2
Lecture: Theoretical approaches to grief and grieving Maggie Stroebe 23
Article: Models of coping with bereavement (Stroebe, Schut & Boerner, 2017) 26
Week 3
Lecture: Child, family, loss and trauma Trudy Mooren 30
Article: A trauma-informed (...)virtual home visiting program for your children (Mogil et al., 2022) 33
Article: Cognitive behavioral treatments for children and adolescents (Yohannan, …& Volker, 2021) 35
Week 4
Lecture: Understanding the complexity of sexual abuse Iva Bicanic 37
Article: Development of multidisciplinary sexual assault centers (Covers, Karst & Bicanic, 2022) 38
Week 5
Lecture: Characteristics and effectiveness of grief interventions Henk Schut 40
Article: Psychological interventions for grief in adults (Johannsen et al., 2019) 43
Week 6
Lecture: Treatment of prolonged grief in adults and children Paul Boelen 45
Article: Prolonged grief disorder: Cognitive-behavioral theory and therapy (Boelen, Hout & Bout, 2013) 52
Article: Cognitive Therapy for prolonged grief in children (Spuij, Londen-Huiberts & Boelen) 54
Week 7
Lecture: Evidence-based psychological interventions for PTSD Sjef Berendsen 58
Article: Treatment of PTSD: A state-of-art Review article sections 3; 4; 5.4 (Burback et al., 2023) 62
Week 8
Lecture: A diversity perspective on trauma / cultural concepts of distress and migration related aspects 70
Jeroen Knipscheer & Franziska Lechner-Meichsner
Article: Prevalence of mental disorders in refugees and asylum seekers (Patanè et al., 2022) 73
Article: A network meta-analysis of psychosocial interventions for refugees (...) (Turrini et al., 2021) 74
Article: The assessment of grief in refugees in postconflict survivors (Killikelly, Bauer & Maercker, 2018) 75
1
, Week 1
Lecture: Introduction to the course / general introduction on loss & Psychotrauma
Marjolein Missler & Mirjam van Zuiden
Grief
Loss: separation from someone or something that you are attached to
→ separation distress (grief): pain, sadness, difficulties accepting
Psychotrauma: experiencing or witnessing an event that is traumatic (threaten to safety/control/health)
→ traumatic distress: anxiety, hypervigilance, sense of current threat (not believing its is in the past)
These subjects are different from each other, however they can overlap (for example: traumatic loss)
bereavement situation of having lost a loved one/relative
grief the emotional/psychological response to this loss
→ all responses occurring after being separated from an
attachment figure
→ individual process
mourning behavioral and social expressions of grief, which are shaped by
culture or society
unhealthy, disordered, complicated grief general term for stagnated grief
prolonged grief disorder term for formal classification of grieving disorder
Misconceptions about grief
● grieving is a process occuring in phases (and you need to go through all phases)
● the same reaction (anger/depression/sadness) are always part of the grieving process
● intense emotions in the initial period if mourning predict healthy adjustment, absence of reactions indicate
unhealthy/abnormal grief
● losing a child is always worse than losing a partner
● a grieving process ends after a certain period (1 or 2 year)
Grief it is associated with feelings (yearning, longing, loneliness, guilt), behavior (proximity seeking),
thoughts/cognitions (preoccupation with thoughts about deceased or moment of death, loss of concentration,
lowered self-esteem), perceptions (sensation of seeing the person, feeling that the separation is unreal) and physical
(sleep-related problems, stress, low energy)
Instead of going through phases, it is more about doing
tasks. Following the Grief Task Model, tasks include:
● accepting the reality of the loss
● allowing yourself to experience all the emotions
● adjusting to life without deceased
● relocating the deceased emotionally
● move on
Normal grief is switching between loss-orientated and
restoration-oriented. When there is no switching (so
2
,someone has just one orientation) or when someone goes outside the ‘normal’ intensity of the orientation, the grief
is considered disturbed.
Prolonged grief disorder
Prolonged Grief Disorder (PGD) is a
relative new diagnosis, described in both
ICD-11 as DSM-5-TR
Important differences:
● typological vs detailed description
of criteria
● number of symptoms and severity
specifications for diagnosis
● timing after loss when diagnosis
can be made
Determinants of grief:
● background of bereaved person
● characteristics of the death
(sudden, traumatic circumstances,
etc)
● characteristics of the deceased
(relationship, quality, etc)
● situation after the loss (support,
secondary losses, coping, etc)
Distinction between PGD and ‘healthy grief’
● degree of progress in grieving
○ PGD? no progress or worsening over time
● duration of grief
○ PGD? grief reaction persist (6 month ICD of 12 months DSM)
● degree of suffering
○ PDG? grief causes distress + impairs function
When you suspect PDG, you can do a stepped diagnostic assessment
1. self-report questionnaire to get indication of disturbed grief
● for example: traumatic grief inventory self report plus (TGI-SR+)
○ total score of >71 indicates clinically relevant PGD
2. clinical interview to make formal diagnosis
10% of people get PGD following natural loss, 49% following unnatural/violent losses
3
, risk factors for PGD: protective factors for PGD:
● being a woman ● the younger, the better
● stigmatizing (negative responses) ● high education
● personality (depression, anxiety, neuroticism) ● perceived support
● anxious attachment ● secure attachment
Other factors: death of children/partners or unnatural/violent death leads to more intense reaction
Psychotrauma
The definition of trauma depends on the
profession or time you asked for the
definition.
trauma general term for different kind of wounds
psychotrauma emotional response to a distressing event
psychotraumatology study of psychological trauma
→ specifically the disciplines involved with treating, preventing and researching
traumatic situations
Traumatic events can:
● happen to one individual or many at the same time (collective memory)
● be apparent or remain hidden to others
● be anticipated or unexpected
● happen at any age
● single time vs prolonged/repeated
All reactions to all potentially traumatic life events can be conceptualized in 4 principles:
● people always have to resolve a discrepancy between the event and pre-existing knowledge (can cause
intrusions)
● there are always specific implications (appraisal) about the event, making the event meaningful (causing
emotional response)
○ the events is a threat to one’s self-esteem → anxiety
○ the event causes loss or failure → sadness
● there are always many cues connected with the event, that very easily get connected with many other cues
(through classical conditioning + generalization)
● there is always a natural inclination to avoid cues eliciting intrusions, cognitions and emotions maintained
by operant conditioning
4
