Who were the investigators and what was the aim of the study? Bonanno and colleagues (2005) noted that grief following the loss of a loved one often tends to be denied. However, research evidence related to positive benefits of resolving grief is largely lacking. Thus, whether unresolved grief is "bad" remains an open issue. Likewise, cross-cultural evidence is also lacking.

How did the investigators measure the topic of interest? Collaborative meetings between U. S. and Chinese researchers resulted in a 13-item grief processing scale and a 7-item
grief avoidance scale, with both English and Mandarin Chinese versions. Self-reported symptoms of psychological and physical health were also collected.

Who were the participants in the study? Adults under age 66 who had experienced the loss of either a spouse or child approximately 4 months prior to the start of data collection were asked to participate through solicitation letters. Participants were from either the metropolitan areas of Washington, D. C., or Nanjing, Jiangsu province, in China.

What was the design of the study? Two sets of measures
were collected at approximately 4 months and 18 months after the loss.

Were there ethical concerns in the study? Because participation was voluntary, there were no ethical concerns.

What were the results?

Consistent with the grief work as rumination view, scores on the two grief measures were uncorrelated. Overall, women tended to show more grief processing than men, and grief processing decreased over time. As you can see in Figure 13.6, Chinese participants reported more grief processing and grief avoidance than U. S. participants at the first time of

measurement, but differences disappeared by the second measurement for grief processing.

What did the investigators conclude? Based on converging results from the United States and China, the researchers
concluded that the data supported the grief work as rumination view. The results support the notion that excessive processing of grief may actually increase a bereaved person’s stress and
feelings of discomfort rather than being helpful. These findings contradict the idea that people should be encouraged to work through their grief and that doing so will always be helpful.

lost relationship over time; and (4) the role of coping and emotion-regulation processes that cover all cop­ing strategies used to deal with grief (Bonanno & Kaltman, 1999). The four component model relies heavily on emotion theory, has much in common with the transactional model of stress, and has some empirical support. According to the four compo­nent model, dealing with grief is a complex process that can only be understood as a complex outcome that unfolds over time.

There are several important implications of this integrative approach. One of the most important is that helping a grieving person involves helping them make meaning from the loss (Wong, 2008). Second, this model implies that encouraging people to express their grief may actually not be helpful. An alternative view, called the grief work as rumination hypothesis, not only rejects the necessity of grief processing for recovery from loss but views extensive grief processing as a form of rumination that may actually increase distress (Bonanno, Papa, & O’Neill, 2001). Although it may seem that people who think obsessively about their loss, or ruminate about it, are confronting the loss, rumination is actually considered a way to avoid it because the person is not dealing with his or her real feelings and moving on (Stroebe et al., 2007).

One prospective study has shown, for instance, that bereaved individuals who were not depressed prior to their spouse’s death but then evidenced chronically elevated depression through the first year and a half of bereavement (i. e., a chronic grief pat­tern) had also tended to report more frequently thinking about and talking about their recent loss at the 6-month point in bereavement (Bonanno, Wortman, & Neese, 2004). Thus, some bereaved individuals engage in minimal grief processing,
whereas others are predisposed toward more exten­sive grief processing. Furthermore, the individuals who engage in minimal grief processing will show a relatively favorable grief outcome, whereas those who are predisposed toward more extensive grief process­ing will tend toward ruminative preoccupation and, consequently, toward a more prolonged grief course (Bonanno et al., 2001; Nolen-Hoeksema, 2001).

As noted earlier, the grief work as rumination hypothesis also views grief avoidance as an inde­pendent but maladaptive form of coping with loss (Stroebe et al., 2007). In contrast to the traditional perspective, which equates the absence of grief processing with grief avoidance, the grief work as rumination framework assumes that resilient individuals are able to minimize processing of a loss through relatively automated processes, such as distraction or shifting attention toward more posi­tive emotional experiences (Bonanno et al., 1995). The grief work as rumination framework argues that the deliberate avoidance or suppression of grief represents a less effective form of coping (Wegner & Gold, 1995) that tends to exacerbate rather than minimize the experience of grief (Bonanno et al., 1995; Nolen-Hoeksema, 1998).

The How Do We Know? feature explores grief work regarding the loss of a spouse and the loss of a child in two cultures, the United States and China. As you read it, pay special attention to the question of whether encouraging people to express and deal with their grief is necessarily a good idea.

The Dual Process Model. The dual process model (DPM) of coping with bereavement integrates exist­ing ideas (M. Stroebe & Schut, 2001). As shown in Figure 13.7, the DPM defines two broad types of

Dying and Bereavement 519

Figure 13.7 The dual process model of coping with bereavement shows the relation between dealing with the stresses of the loss itself (loss-oriented) and moving on with one’s life (restoration-oriented).

Source: M. Stroebe & Schut (2001).

stressors. Loss-oriented stressors are those having to do with the loss itself, such as the grief work that needs to be done. Restoration-oriented stressors are those relating to adapting to the survivor’s new life situation, such as building new relationships and finding new activities. The DPM proposes that dealing with these stressors is a dynamic process, as indicated by the lines connecting them in the figure. This is a distinguishing feature of DPM. It shows how bereaved people cycle back and forth between dealing mostly with grief and trying to move on with life. At times the emphasis will be on grief, and at other times on moving forward.

The DPM captures well the process that bereaved people themselves report—at times they are nearly overcome with grief, while at other times they handle life well. The DPM also helps us understand how, over time, people come to a balance between the long-term effects of bereavement and the need to live life. Understanding how people handle grief requires understanding of the various contexts in which people live and interact with others (Sandler, Wolchik, & Ayers, 2008).