Facial Behavior During an Attachment Interview in Patients With Complicated Grief

Abstract

The present study investigated differences in various aspects of facial behavior among female patients with complicated grief (CG; n = 18) and healthy controls (n = 18) during the assessment of their attachment representation using the Adult Attachment Projective Picture System. All patients were classified with an unresolved attachment status. On a behavioral level, they demonstrated longer gazing behavior away from the interviewer and the picture stimuli, more speech pauses, less smiling toward the interviewer, and more crying, especially in response to stimuli portraying the theme of loss. Focusing on the in-depth analysis of death-related stimuli using the Facial Action Coding System, patients demonstrated less facial affective behavior, less disgust, and less smiling in response to these stimuli compared with the healthy controls. The impaired capacity of patients with CG responding in an affective appropriate manner regarding bereavement might be interpreted as a specific emotion dysregulation when their attachment and mourning system is activated.

Persistent Complex Bereavement Disorder Symptoms Predict Grief Interview Emotions

“…Specifically, PCBD symptoms were found to be positively correlated with both the frequency and intensity of sad expressions observed during the grief interviews as well as the self-report measures taken immediately after the interviews (reactivity period) and 5 minutes after the previous assessment (recovery period). These findings were not only consistent with our expectations and previous research (Bonanno & Keltner, 1997;Gander et al, 2018), but they also kept with the notion that sadness is one of the longest lasting and highly recognizable emotions tied to loss (Ekman, 2003). However, it is important to recognize that although the PCBD symptoms were uniquely predictive of all measures of sadness, except in the reactivity period, beyond depression, posttraumatic stress, and separation anxiety, incremental validity was not firmly established because of multicollinearity.…”

“…evaluating grief, as mourners struggling with loss often exhibit distinct emotional reactions when talking about a deceased loved one (Bonanno & Keltner, 1997;Bonanno et al, 1995;Ekman, 2003;Gander et al, 2018). During relatively brief observations of mourners during interviews about loss (i.e., less than 6 minutes), researchers noticed that mourners suffering from complicated grief symptoms frequently displayed negative emotional reactions, such as crying, and rarely showed any positive emotions, such as smiling (Bonanno & Keltner, 1997;Gander et al, 2018). This pattern of emotions is important because it reflects regulation difficulties that are characteristic of psychopathology (Gross & Thompson, 2007) and, more notably, complicated grief (Gupta & Bonanno, 2011).…”

“…We also measured these emotions using behavioral observations, since mourners fraught with grief tend to be affectively expressive when talking about loss (e.g., Bonanno & Keltner, 1997). Based on previous research (Bonanno & Keltner, 1997;Gander et al, 2018) and basic emotion theory (Ekman, 2003), we expected PCBD symptoms during and after the grief interviews to positively correlate with sadness and negatively correlate with happiness. For a stringent examination of validity, we further tested whether PCBD symptoms could predict these emotional outcomes beyond the influences of depression, posttraumatic stress, and separation anxiety as differential diagnostic constructs.…”

Emotion Regulatory Strategies in Complicated Grief: A Systematic Review

“…Secondary pre-post change analyses of RCTs also supported the importance of behavioral loss avoidance in the treatment of CG (e.g., Glickman et al, 2017). However, laboratory studies have yielded equivocal findings on avoidance of loss-related cues and CG, sometimes yielding positive associations (Gander et al, 2018;Yu et al, 2017), sometimes e i s m a & s t r o e b e null-results (Eisma, Rinck, et al, 2015), and sometimes negative associations (Maccallum et al, 2015). One explanation for these mixed findings is methodological: cues that people with CG avoid are often highly idiosyncratic, as they are interlinked with one's personal experiences (e.g., avoiding looking at pictures of the deceased from the holiday before the death).…”

“…Yu et al (2017) further showed that a group with high CG symptoms (vs. low CG symptom group) was slower to respond to deathrelated (vs. living-related) words in subliminal and supraliminal tasks, indicating that people with CG showed relative avoidance of death-related words. e m o t i o n r e g u l a t i o n i n c o m p l i c a t e d g r i e f Gander et al (2018) also showed that looking away from a cemetery picture during an interview was associated with CG. However, found no convincing evidence for a role of CG symptoms in attentional avoidance of loss-reality stimuli over and above grief rumination levels in an eye-tracking task.…”