Examining Cognitive Impairments in Bereaved Adults With and Without Complicated Grief
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Robinaugh, Donald John. 2015. Examining Cognitive Impairments in Bereaved Adults With and Without Complicated Grief. Doctoral dissertation, Harvard University, Graduate School of Arts & Sciences.Abstract
Grief is a syndrome of cognitions, emotions, and behaviors that commonly arise together following the death of a loved one. It includes intense pangs of emotional pain, yearning for the deceased, emotional numbness, subjective difficulty imagining the future without the deceased, and preoccupation with thoughts related to the death and the deceased. In the initial months following loss, the majority of bereaved adults will experience some or even many elements of this syndrome. For most, the frequency and severity of these elements diminishes over time. However, for some, grief persists for years after the loss; a condition known as complicated grief (CG). These distinct grief trajectories raise a critically important question for grief research: why does grief persist in some individuals, but not others?In this dissertation, I aimed to take an initial step toward answering this question. I first review recent advances in our understanding of the nature of CG and discuss the implications of these advances for research examining the etiology of CG. Most notably, I review how vulnerability factors that render bereaved adults susceptible to experiencing specific elements of the CG syndrome may contribute to the development or maintenance of CG. I then present three studies in which I examined cognitive impairments that may act as vulnerability factors for the core cognitive elements of CG and, thereby, may contribute to the broader CG syndrome.
In Paper 1, I examined the ability to resist distracter information and the ability to resist proactive interference; two types of cognitive inhibition that, if impaired, may render bereaved adults vulnerable to experiencing intrusive grief-related cognitions and, thus, the broader CG syndrome. Contrary to my hypotheses, I found no evidence that bereaved adults with CG exhibit deficits in either type of cognitive inhibition for either emotional or non-emotional information relative to a bereaved comparison group without CG. In Paper 2, I examined another type of cognitive control: the ability to shift between mental representations. Contrary to my hypotheses, bereaved adults with CG did not exhibit deficits in cognitive set shifting for either emotional or non-emotional information. In Paper 3, I examined the ability to engage in episodic simulation of novel future events. Consistent with my hypotheses, bereaved adults with CG produced event simulations with fewer episodic details, less perceptual richness, less emotion/thought content, and less episodic richness than did the bereaved comparison group.
Together, these studies provide a small step toward identifying cognitive vulnerabilities that may contribute to the development or maintenance of CG. Papers 1 and 2 suggest that general deficits in cognitive control are unlikely to feature prominently in the etiology of CG. Accordingly, in future studies, it will be important for researchers to examine alternative factors that may contribute to the preoccupying grief-related cognitions observed in CG, including cognitive control for more specific types of information than were assessed in this study (e.g., attachment- or grief-related information) and higher-order cognitive variables such as perceived explicability of the loss. Paper 3 providers further evidence that prospection is impaired in bereaved adults with CG and identifies impaired constructive episodic simulation of novel future events as a potential cognitive vulnerability that may contribute to the etiology of the broader CG syndrome.
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