Measuring Maladaptive Cognitions in Complicated Grief: Introducing the Typical Beliefs Questionnaire

Abstract

Objectives Maladaptive cognitions related to loss are thought to contribute to development of complicated grief and are crucial to address in treatment, but tools available to assess them are limited. This paper introduces the Typical Beliefs Questionnaire (TBQ), a 25-item self-report instrument to assess cognitions that interfere with adaptation to loss. Design Study participants completed an assessment battery during their initial evaluation and again after completing treatment at 20 weeks. Test-retest reliability was assessed on a subsample of the participants who did not show change in complicated grief severity after the first four weeks of treatment. To examine latent structure of the TBQ, an exploratory factor analysis (EFA) was performed. Setting Academic medical centers in Boston, New York, Pittsburgh and San Diego from 2010–2014. Participants 394 bereaved adults who met criteria for complicated grief. Measurements The TBQ along with assessments of complicated grief symptoms and related avoidance, depression symptoms, functional impairment, and perceived social support. Results The TBQ exhibited good internal consistency (α= .82) and test-retest reliability (n=105; ICC= .74). EFA indicated a five-factor structure: “Protesting the Death,” “Negative Thoughts About the World,” “Needing the Person,” “Less Grief is Wrong” and “Grieving Too Much.” The total score and all factors showed sensitivity to change with treatment. Conclusions This new tool allows a clinician to quickly and reliably ascertain presence of specific maladaptive cognitions related to complicated grief, and subsequently, to use the information to aid a diagnostic assessment, to structure the treatment, and to measure treatment outcomes.

Effectiveness of interventions for people bereaved through suicide: a systematic review of controlled studies of grief, psychosocial and suicide-related outcomes

“…APSA: Adolescent Problem Solving Appraisal [60]; BDI: Beck Depression Inventory [48]; BHS: Beck Hopelessness Scale [61]; BSI: Brief Symptom Inventory [50]; CDI: Children’s Depression Inventory [62]; CES-D: Center for Epidemiological Studies Depression Scale [49]; CG-CGI-I: Complicated Grief Clinical Global Impressions Scale – Improvement [63]; CPTSRI: Childhood Posttraumatic Stress Reaction Index [64]; C-SSRS-r: Columbia Suicide Severity Rating Scale – Revised [52]; GCQ: Grief Cognitions Questionnaire [46]; GEI: Grief Experience Inventory [47]; GEQ: Grief Experience Questionnaire [65]; GRAQ: Grief-Related Avoidance Questionnaire [66]; GRQ: Grief Recovery Questions [57]; IES: Impact of Event Scale [67]; ITG: Inventory of Traumatic Grief [68]; PSI: Paykel’s Suicidality Items [69]; RBQ: Risk Behavior Questionnaire [70]; RCMAS: Revised Children’s Manifest Anxiety Scale [71]; SAICA: Social Adjustment Inventory for Children and Adolescents [72]; SAS: Social Adjustment Scale [51]; SCAN 2.1: Schedules for Clinical Assessment in Neuropsychiatry [73]; SCI-CG: Structured Clinical Interview for Complicated Grief [74]; SES: Self Efficacy Scale [75]; SPP: Self-Perception Profile for Adolescents [76]; TBQ: Typical Beliefs Questionnaire [77]; TRGR2L: Traumatic Grief Evaluation of Response to Loss [45]; UCL: Utrecht Coping List [78]; WSAS: Work and Social Adjustment Scale [79]; YSR: Youth Self Report Child Behavior Checklist [80]…”

Attachment Style, Complicated Grief and Post-Traumatic Growth in Traumatic Loss: The Role of Intrusive and Deliberate Rumination

“…Multiple studies have investigated several other emotional regulation strategies related to the grief response. [51][52][53][54][55][56] Based on those previous studies, the mediation effect of other cognitive or emotional regulation processes that might affect the paths between different types of attachment insecurity and the grief response should be investigated in the future, especially for attachment avoidance.…”

Individual goal achievement in group psychotherapy: The roles of psychological mindedness and group process in interpretive and supportive therapy for complicated grief

“…Indeed, although we lack data regarding the specific dilemmas that patients worked on in their groups, we speculate that psychologically minded patients utilized the exploratory focus of interpretive therapy to tackle barriers to personal goals that stemmed from unconscious conflicts between their wishes or objectives and grief‐related affects—such as guilt and anger—or beliefs. Maladaptive cognitions are a key feature of complicated grief (Boelen et al, ), including beliefs about the death, predictions of danger, and beliefs that the lost person is needed or that recovery from grief will hurt the lost person (Skritskaya et al, ). These beliefs are theorized to contribute to emotional distress, in turn evoking avoidance strategies that ultimately impede adaptive behaviours (Boelen et al, ).…”