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Grieving as a form of learning

This review proposes an updated understanding of grief through the lens of neuroscience, suggesting that grieving can be viewed as a form of learning rather than merely a response to loss. It highlights the conflict between the semantic knowledge of an attachment figure's everlasting presence and the episodic memory of their death, which complicates the grieving process and can lead to prolonged grief disorder (PGD). The authors argue that understanding the neurobiological mechanisms behind attachment and grief can provide insights into how individuals adapt to loss and the potential for developing new coping strategies.

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0% found this document useful (0 votes)
29 views6 pages

Grieving as a form of learning

This review proposes an updated understanding of grief through the lens of neuroscience, suggesting that grieving can be viewed as a form of learning rather than merely a response to loss. It highlights the conflict between the semantic knowledge of an attachment figure's everlasting presence and the episodic memory of their death, which complicates the grieving process and can lead to prolonged grief disorder (PGD). The authors argue that understanding the neurobiological mechanisms behind attachment and grief can provide insights into how individuals adapt to loss and the potential for developing new coping strategies.

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Coca Briganti
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© © All Rights Reserved
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Review

Grieving as a form of learning: Insights from


neuroscience applied to grief and loss
Mary-Frances O’Connor1 and Saren H. Seeley2

Abstract to ongoing life goals and behaviors, rather than the


Recent grief research suggests that the influential cognitive subtraction of a functioning element of the self (the
stress theory should be updated with evidence from cognitive loved one, or the overlapping other) that has enabled
neuroscience. Combining human and animal neuroscience successful goals and behaviors. However, evidence from
with attachment theory, we propose that semantic knowledge both human and animal models of grief and loss suggests
of the everlasting nature of the attachment figure and episodic, that cognitive stress theory may be an incomplete un-
autobiographical memories of the death are in conflict, derstanding of the basic neurobiology of the stress
perhaps explaining the duration of grieving and generating response during separation [4,5]. Specifically, the
predictions about complications in prolonged grief disorder encoding of attachment during bonding creates a stress
(PGD). Our gone-but-also-everlasting model emphasizes that response during separation that is more unconscious and
grieving may be a form of learning, requiring time and experi- automatic than suggested by cognitive stress theory.
ential feedback. Difficulties before loss, such as spousal de-
pendency or pre-existing hippocampal volume, can prolong In daily life, our need for attachment figures poses a
learning and predict PGD. Complications such as avoidance, problem because social mammals are mobile, and we
rumination, and stress-induced hippocampal atrophy may also must find our loved ones again to fulfill this need.
develop after loss and create functional or structural mecha- Attachment relies on the prediction of the persistence
nisms predicting PGD. of the other, given that attachment is the tether
enabling social mammals to leave and return to their
Addresses mates and offspring multiple times a day. Locating
1
Department of Psychology, University of Arizona, Tucson, AZ, United
those we are bonded to is therefore a critical function of
States
2
Department of Psychiatry, Icahn School of Medicine at Mount Sinai, the brain, as evidenced by a devoted category of
New York, NY, United States partner-approach neurons, for example [6]. In prairie
voles, the partner-approach neuronal ensemble in the
Corresponding author: O’Connor, Mary-Frances (mfoconnor@email. nucleus accumbens increases in size after bond for-
arizona.edu)
mation, and differences in the size of approach en-
sembles between partner and novel voles predict
Current Opinion in Psychology 2022, 43:317–322 attachment bond strength.
This review comes from a themed issue on Separation, Social Isola-
tion, and Loss Bonding is like a gun being cocked, and separation pulls
Edited by Gery C. Karantzas and Jeffry A. Simpson
the trigger. At the time of bond formation, neural
encoding is created to trigger a physiological stress
For a complete overview see the Issue and the Editorial
response to separation. Epigenetic changes in the nu-
Available online 20 August 2021 cleus accumbens during mating in the prairie vole lead
https://doi.org/10.1016/j.copsyc.2021.08.019 to increased oxytocin receptors, and this epigenetic
2352-250X/© 2021 Elsevier Ltd. All rights reserved. change ensures the monogamous bond [7]. Once the
voles are pair-bonded, they are primed to make the
Keywords
precursor of animal cortisol if their mate goes missing, so
Grief, Bereavement, Prolonged grief disorder, Neuroscience, fMRI, it can quickly be released when they lose track of each
Nucleus accumbens. other, motivating the vole to seek out its partner to
reduce the resulting stress [8,9]. Although the separa-
tion stress response fulfills an adaptive function when
Since the 1980s, dominant approaches to bereavement reunion is possible, in bereavement, the physiological
research have derived from cognitive stress theory [1,2] stress continues without the input of the pair-bonded
and attachment theory [3]. cognitive stress theory sug- mate. This evidence is congruent with overlapping
gests that bereavement is a stressful life event because self-other representation in human neuroimaging [10]
the loss is appraised as exceeding one’s resources to and the increased cortisol we see in acute grief [11]. We
cope with major readjustments [1]. This view of hypothesize that the encoding that occurs during
bereavement focuses on the addition of a stressful event bonding includes the prediction that this particular

www.sciencedirect.com Current Opinion in Psychology 2022, 43:317–322


318 Separation, Social Isolation, and Loss

other will always be one’s partner, with the emphasis on safety and comfort [4,13]. Death of a loved one poses a
‘always’. Built into the encoded characteristics consti- unique and rare challenge because the stream of infor-
tutive of the mate are their everlasting nature, and mation from semantic knowledge (persistence of the
absence is just a temporary state, requiring proximity attachment figure’s existence) now conflicts with
seeking. In contrast to cognitive stress theory, we episodic knowledge of the death of the person
interpret this evidence to suggest the automaticity may (e.g. memory of the death event or funeral). We propose
mean the stress of bereavement is primary and outside the gone-but-also-everlasting theory to emphasize the
of awareness. Thus, rather than the appraisal, ‘I realize dissonance between those two sources of information.
the other part of me is missing, and so I feel terrible’, This new theory emphasizes that grieving can be
more likely the order is ‘I feel terribledoh, that must considered a form of learning, requiring time and feed-
mean that the other part of me is missing’. back in the form of real-world experience. The first
morning that a widowed husband wakes up alone after
We hypothesize that the neural architecture of the bond thousands of mornings of waking up next to his wife, the
supports the belief (or semantic knowledge) that the best prediction is not to assume that she has died. In
other persists, despite any sensory evidence to the fact, many experiences will be required to convince him
contrary. This belief serves a great evolutionary that he will never again wake up next to her again and
needdthose who persisted in their belief that the other enable him to predict that her absence means he must
existed remained in place to have a caregiver return with change his way of understanding himself, the world, and
food, for example, or sought out their partner to main- the future [14,15].
tain their sexual or co-parenting relationship and pass on
their genes. The typical rewarding experience of daily The importance of the conflict between these dual
reunion with a loved one after separation (liking) con- streams of information is that the conflict will interfere
firms the prediction made during their absence with learning (updating the model of the attachment
(wanting, yearning). Neurohormones instantiate the figure) and with making new predictions that reflect the
reaction to reunion, which elicits a reduction in cortisol, reality of the permanent absence of the attachment
and release of oxytocin and dopamine. The reason that figure (applying the model). Acutely, difficulty with
the emphasis on this semantic knowledge is important learning the new reality will lead to (a) emotional in-
and novel is because it determines how the brain makes tensity and lability, when the reality is confronted over
predictions about where the attachment figure is and and over, and (b) confusion, disbelief, magical thinking,
when a reunion will happen. These predictions deter- and counterfactuals (if only, what if), as the brain at-
mine how the bereaved will function and behave in the tempts to accommodate the two sources of information.
world after the rare but permanent separation of death. Furthermore, the experience of bereavement involves
multiple mechanisms that drive intrusive thoughts in
The human mind functions as a predicting, generative grief: emotional salience, inability to complete the
agent, which maintains relatively stable ‘models’ or seeking-reunion process, environments that stimulate
representations of both external and internal environ- cue-elicited retrieval, and dissonance between the
ments, constantly making predictions about the predicted/desired and actual experience [16].
environment and updating these models with new
stimuli and life events via a learning mechanism [12]. At Evidence for the new theory in
a neurobiological level, once a pair bond or caregiving neuroscience of grief
bond has been formed, the neural circuitry is reset At different levels of complexity, learning to make new
(e.g. through epigenetic changes) to include both predictions means (1) new automatic habits must be
members of the dyad as the functioning unit. Viewing learned [17], (2) the self must be updated to include
separation and loss as the subtraction (and then the absence of the person or a revision in predicting
absence) of a functioning aspect of the individual’s ‘self ’ their presence/availability, and (3) other bonds must be
is illuminated when considering subsequent prediction. developed/strengthened to meet ongoing attachment
How does awareness of loss change the expectations of needs (revising the attachment hierarchy [4]). Note
where the missing other is, and whether future pre- that each of these requires new neural connections in
dictions should be changed based on the absence? When the brain, a biomechanical process requiring time,
there can be no reward of reunion given the loved one’s feedback through experience, and a brain with struc-
death, prediction error is experienced until the updated tural integrity.
semantic knowledge can be learned.
Incorporating new knowledge into predictions goes
The gone-but-also-everlasting theory of beyond habit. At one level, it is a long time before a
grieving daughter stops picking up the phone to relay a funny
The brain’s model of the world must change in order for incident to her deceased mother. This behavior suggests
the person to fulfill their goals and achieve a state of an automaticity that must be relearned. In addition,

Current Opinion in Psychology 2022, 43:317–322 www.sciencedirect.com


Grieving as Learning: Insights from Neuroscience O’Connor and Seeley 319

however, changes in nucleus accumbens seen in animal the death, due to the emotional pain of grief [25,29],
and human functional magentic resonance imaging and complications develop in how the death information
(fMRI) research suggest that regions of the reward is brought to awareness [30]. These complications,
network (including caudate, orbitofrontal cortex, etc.) including avoidance and grief-related rumination, may
are important for predicting their presence and moti- lead to prolonged grieving or lack of learning over
vating us to seek/yearn for them [18e22]. time [31].

Evidence for the new theory in Spousal dependence predicts feelings that life is empty
neuroscience of prolonged grief disorder or meaningless, a sense of diminished identity, and dif-
By focusing on grieving as a form of learning, we can see ficulty imagining the future [32]. Dependence before
how complications in adaptation may occur. Laboratory- the loss may be a risk factor for PGD because of the
based behavioral tasks can show us where functional increased risk for preoccupying thoughts related to the
problems in learning (e.g. using reward feedback, deceased and a sense that one’s identity, meaning in life,
avoiding experience) may lead to prolonged grief disor- and plans for the future are lost without the deceased
der (PGD; [23]), and structural neuroimaging can help [33]. These findings are in keeping with Maccallum and
us see where problems in structural integrity of the brain Bryant’s [34] cognitive attachment model in which they
can lead to PGD (Figure 1). posit that a merged identity with the deceased will
enhance the accessibility of deceased-related memories
An excellent systematic review of the neurobiology of and reduce the ability to imagine the future. In addition,
disordered grief has conceptualized PGD as a disorder of a robust predictor of PGD severity is the extent to which
reward [24]. Reward is inherently a process by which the self-concept of the bereaved is dominated by the
learning develops, as one’s predictions about the world deceased [35].
are either rewarded or not, leading to accommodation
and consolidation of information and future predictions. Learning requires experience, and avoidance of things
Those who develop PGD may have (1) a pre-existing that remind the bereaved of the loved one’s death or
reward system that strongly supports the anxiety and absence will prevent accommodation of the information.
attention to the ‘everlasting’ aspect of attachment as a Only through learning does the integration of the loss
diathesis (dependency [25], attachment style [26], and experience enable the restoration of a meaningful life.
separation anxiety as predictors [27]). Attachment style Ironically, grief-related rumination may actually serve the
may also be a diathesis for brain function [28] and may same function as avoidance. Grief-related rumination
predict complications when layered with bereavement. focuses on the counterfactuals (what ifs and would have/
Another possibility is that (2) complications arise after could have/should have), all of which are virtual reality

Figure 1

Graphical depiction of the complications that may precede or result from the death of an attachment figure, using trajectories described in Refs. [40,47].

www.sciencedirect.com Current Opinion in Psychology 2022, 43:317–322


320 Separation, Social Isolation, and Loss

scenarios that end in the loved one not dying [36]. Grief- neural encoding of an attachment bond, and the
related rumination may maintain the ‘everlasting’ aspect required brain structure and function for that learning,
of the attachment relationship, enabling the bereaved to enables novel predictions that can be tested to further
avoid the painful evidence of ‘gone’ [37,38]. Of course, advance our understanding of grief and loss.
these counterfactual outcomes only create grief anew
each time that the reality of the loss resurfaces. CRediT author statement
Mary-Frances O’Connor: Conceptualization, Writing-
Structural neuroimaging shows us another reason why Original draft preparation. Saren H. Seeley: Writing-
learning may be disrupted in PGD. As with functional Original draft preparation, Writing- Reviewing
predictors of PGD, differences in brain structure could and Editing.
(1) precede the death as a diathesis or (2) follow from
the stress of the bereavement experience. A prospective Conflict of interest statement
study showed that a smaller hippocampus before the Nothing declared.
death predicted disordered grieving [39]. Most studies
are more equivocal as to whether structural differences Acknowledgements
precede or follow the loss. Importantly, all of this This project was supported by a grant from the National Institute of Aging
learning/grieving must be done while there is concurrent (R13 AG066368; PI: O’Connor). The authors would like to thank Jessica
AndrewseHanna and Matt Grilli for comments on an earlier draft of
excessive cortisol, blood pressure, and inflammation as a this manuscript.
physiological stress response to the death event [40].
Cortisol impacts brain structures such as the hippo- References
campus, regions needed for learning and memory. Papers of particular interest, published within the period of review,
Decreased hippocampal volume has been shown in have been highlighted as:
those who have lost a child, with and without post- * of special interest
traumatic stress disorder [41]. On the other hand,
recent work has shown increased bilateral amygdala 1. Folkman S, Lazarus R: Stress, appraisal, and coping. New York:
Springer Publishing Company; 1984.
volumes and in subsamples, larger nucleus accumbens
and caudate volumes after bereavement or relationship 2. Stroebe W, Stroebe MS: Bereavement and health. Cambridge
University Press; 1987, https://doi.org/10.1017/
break-up across the lifetime [42]. CBO9780511720376.
3. Bowlby J: The Bowlby-Ainsworth attachment theory. Behav.
Education is a predictor of poor bereavement outcomes, Brain Sci. 1979, 2:637–638, https://doi.org/10.1017/
including higher levels of PGD, and might reflect long- S0140525X00064955.
standing learning difficulties [43,44], although there 4. LeRoy AS, Knee CR, Derrick JL, Fagundes CP: Implications for
may be many reasons why education is predictive. reward processing in differential responses to loss: impacts
on attachment hierarchy reorganization. Pers. Soc. Psychol.
Behavioral studies also suggest that Stroop learning is Rev. 2019, 23:391–405, https://doi.org/10.1177/
affected in PGD [21], a neuropsychological test of 1088868319853895.
managing conflicting inputs. Another possible view is 5. Pohl TT, Young LJ, Bosch OJ: Lost connections: oxytocin and
that the death of a loved one is a notable inflection point the neural, physiological, and behavioral consequences of
disrupted relationships. Int. J. Psychophysiol. 2018, https://
in an ongoing trajectory of cognitive decline in older doi.org/10.1016/j.ijpsycho.2017.12.011.
adults, possibly hastening the trajectory, but not causal 6. Scribner JL, Vance EA, Protter DSW, Sheeran WM, Saslow E,
per se [45]. * Cameron RT, Klein EM, Jimenez JC, Kheirbek MA,
Donaldson ZR: A neuronal signature for monogamous
reunion. Proc. Natl. Acad. Sci. Unit. States Am. 2020, 117:
Almost all functional and structural neuroimaging 11076–11084, https://doi.org/10.1073/pnas.1917287117.
studies are about grief rather than grievingdthey This study in prairie voles identified striatal neurons activated by
partner approach, termed "partner approach cells", and demonstrated
sample a single time point, and learning/grieving is that number of partner approach cells increased with strength of the
inherently a trajectory of change over time. Thus, we do bond. Findings suggest that specific aspects of the pair-bond, such as
motivation to reunite, are encoded in specific neuronal ensembles in
not have functional neuroimaging evidence for many the nucleus accumbens.
pre-existing diatheses. Worst of all, not distinguishing
7. Wang H, Duclot F, Liu Y, Wang Z, Kabbaj M: Histone deacety-
acute and/or typical grief and prolonged grief within the lase inhibitors facilitate partner preference formation in
sample muddies the waters further. female prairie voles. Nat. Neurosci. 2013, 16:919–924, https://
doi.org/10.1038/nn.3420.

Most of the observations in this article are simply 8. Sadino JM, Donaldson ZR: Prairie voles as a model for un-
derstanding the genetic and epigenetic regulation of attach-
updated, empirical examples of existing attachment ment behaviors. ACS Chem. Neurosci. 2018, https://doi.org/
theory [46] and cognitive psychology research, but the 10.1021/acschemneuro.7b00475.
gone-but-also-everlasting theory incorporates new evi- 9. Bosch OJ, Nair HP, Ahern TH, Neumann ID, Young LJ: The CRF
dence from cognitive neuroscience and the neurosci- system mediates increased passive stress-coping behavior
following the loss of a bonded partner in a monogamous
ence of relationships and grief and loss. This emphasis rodent. Neuropsychopharmacology 2009, 34:1406–1415, https://
on grief or PGD as the consequence of updating the doi.org/10.1038/npp.2008.154.

Current Opinion in Psychology 2022, 43:317–322 www.sciencedirect.com


Grieving as Learning: Insights from Neuroscience O’Connor and Seeley 321

10. Courtney AL, Meyer ML: Self-other representation in the social 25. Robinaugh DJ, LeBlanc NJ, Vuletich HA, McNally RJ: Network
* brain reflects social connection. J. Neurosci. 2020, 40: analysis of persistent complex bereavement disorder in
5616–5627, https://doi.org/10.1523/JNEUROSCI.2826-19.2020. conjugally bereaved adults. J. Abnorm. Psychol. 2014, 123:
This study, while not bereavement-specific, demonstrates that social 510–522, https://doi.org/10.1037/abn0000002.
relationships are mapped in the medial prefrontal cortex according to
degree of closeness. Further, there was neural overlap between rep- 26. Stroebe M, Schut H, Stroebe W: Attachment in coping with
resentations of the self and of close others, supporting the idea that our bereavement: a theoretical integration. Rev. Gen. Psychol.
most intimate relationships are integrated into our sense of self. 2005, 9:48–66, https://doi.org/10.1037/1089-2680.9.1.48.

11. Buckley T, Bartrop R, McKinley S, Ward C, Bramwell M, Roche D, 27. Lobb EA, Kristjanson LJ, Aoun SM, Monterosso L, Halkett GKB,
Mihailidou AS, Morel-Kopp M-C, Spinaze M, Hocking B, Davies A: Predictors of complicated grief: a systematic review
Goldston K, Tennant C, Tofler G: Prospective study of early of empirical studies. Death Stud. 2010, 34:673–698, https://
bereavement on psychological and behavioural cardiac risk doi.org/10.1080/07481187.2010.496686.
factors. Intern Med. J. 2009, 39:370–378, https://doi.org/
28. Vrti
cka P, Vuilleumier P: Neuroscience of human social in-
10.1111/j.1445-5994.2008.01879.x.
teractions and adult attachment style. Front. Hum. Neurosci.
12. Critchley HD, Harrison NA: Visceral influences on brain and 2012, 6, https://doi.org/10.3389/fnhum.2012.00212.
behavior. Neuron 2013, 77:624–638, https://doi.org/10.1016/
29. Frumkin MR, Robinaugh DJ, LeBlanc NJ, Ahmad Z, Bui E,
j.neuron.2013.02.008.
Nock MK, Simon NM, McNally RJ: The pain of grief: exploring
13. Sbarra DA, Hazan C: Coregulation, dysregulation, self- the concept of psychological pain and its relation to
regulation: an integrative analysis and empirical agenda for complicated grief, depression, and risk for suicide in
understanding adult attachment, separation, loss, and re- bereaved adults. J. Clin. Psychol. 2021, 77:254–267, https://
covery. Pers. Soc. Psychol. Rev. 2008, 12:141–167, https:// doi.org/10.1002/jclp.23024.
doi.org/10.1177/1088868308315702.
30. Schneck N, Tu T, Haufe S, Bonanno GA, GalfaIvy H,
14. Pietromonaco P, Overall NC: Implications of social Isolation, * Ochsner KN, Mann JJ, Sajda P: Ongoing monitoring of mind-
separation and loss during the COVID-19 pandemic for cou- wandering in avoidant grief through cortico-basal-ganglia
ples’ relationships. Curr. Opin. Psychol. 2022, 43. interactions. Soc. Cognit. Affect Neurosci. 2019, 14:163–172,
https://doi.org/10.1093/scan/nsy114.
15. Karantzas G, Feeney J, Agnew C, Christensen A, Cutrona C, Prolonged grief often involves hypervigilance and avoidance of grief-
Doss B, Eckhardt C, Russell D, Simpson J: Dealing with loss in related cues. In this study, bereaved adults with an avoidant grieving
the face of disasters and crises: integrating interpersonal style reported more intrusive thoughts of the loss during a sustained
theories of couple adaptation and functioning. Curr. Opin. attention task – despite fMRI activation indicating attempts to monitor
Psychol. 2022, 43. internally-focused thought for reminders of the deceased via in-
teractions between a fronto-temporoparietal network (linked to
16. Visser RM, Anderson MC, Aron A, Banich M, Brady KT, deceased-related attention) and an orbitofrontal-basal ganglia network
Huys QJM, Monfils MH, Schiller D, Schlagenhauf F, Schooler J, (linked to mental representation of the deceased).
Robbins TW: Neuropsychological mechanisms of intrusive
thinking. In Intrusive thinking: from molecules to free will. Edited 31. van der Houwen K, Stroebe M, Schut H, Stroebe W, van den
by Kalivas P, Paulus M, Cambridge, MA: MIT Press; 2020. Bout J: Mediating processes in bereavement: the role of
rumination, threatening grief interpretations, and deliberate
17. Boddez Y: The presence of your absence: a conditioning grief avoidance. Soc. Sci. Med. 2010, 71:1669–1676, https://
theory of grief. Behav. Res. Ther. 2018, 106:18–27, https:// doi.org/10.1016/j.socscimed.2010.06.047.
doi.org/10.1016/j.brat.2018.04.006.
32. Robinaugh DJ, McNally RJ: Remembering the past and envi-
18. Bartels A, Zeki S: The neural basis of romantic love. Neuro- sioning the future in bereaved adults with and without
report 2000, 11:3829–3834, https://doi.org/10.1097/00001756- complicated grief. Clin. Psychol. Sci. 2013, https://doi.org/
200011270-00046. 10.1177/2167702613476027.
19. Gündel H, O’Connor M-F, Littrell L, Fort C, Lane RD: Functional 33. Maciejewski P, Falzarano F, She W, Lichtenthal W, Prigerson H:
neuroanatomy of grief: an FMRI study. Am. J. Psychiatr. 2003, A micro-sociological theory of adjustment to loss. Curr. Opin.
160:1946–1953, https://doi.org/10.1176/appi.ajp.160.11.1946. Psychol. 2022, 43.
20. O’Connor M-F, Wellisch DK, Stanton AL, Eisenberger NI, 34. Maccallum F, Bryant RA: A Cognitive Attachment Model of
Irwin MR, Lieberman MD: Craving love? Enduring grief acti- prolonged grief: integrating attachments, memory, and
vates brain’s reward center. Neuroimage 2008, 42:969–972, identity. Clin. Psychol. Rev. 2013, 33:713–727, https://doi.org/
https://doi.org/10.1016/j.neuroimage.2008.04.256. 10.1016/j.cpr.2013.05.001.
21. Arizmendi B, Kaszniak AW, O’Connor M-FF: Disrupted pre- 35. Bellet BW, LeBlanc NJ, Nizzi M, Carter ML, van der Does FHS,
frontal activity during emotion processing in complicated * Peters J, Robinaugh DJ, McNally RJ: Identity confusion in
grief: an fMRI investigation. Neuroimage 2016, 124:968–976, complicated grief: a closer look. J. Abnorm. Psychol. 2020,
https://doi.org/10.1016/j.neuroimage.2015.09.054. 129:397–407, https://doi.org/10.1037/abn0000520.
The feeling that part of one’s self died along with the deceased can be
22. Wittfoth-Schardt D, Gründing J, Wittfoth M, Lanfermann H,
especially acute in people with disordered grief. The authors identified
Heinrichs M, Domes G, Buchheim A, Gündel H, Waller C:
that complicated grief was associated with disrupted self-concept fluency
Oxytocin modulates neural reactivity to children’s faces as a
(or accessibility) and more impoverished description. They suggest that
function of social salience. Neuropsychopharmacology 2012,
identity disruption in grief may be most impairing when the death is
37:1799–1807, https://doi.org/10.1038/npp.2012.47.
perceived to eliminate entire domain(s) of a person’s self-concept.
23. Robinaugh D, Toner E, Djelantik A: The causal systems
36. Robinaugh DJ, Mauro C, Bui E, Stone L, Shah R, Wang Y,
approach to prolonged grief: recent developments and future
Skritskaya NA, Reynolds CF, Zisook S, O’Connor M-F, Shear K,
directions. Curr. Opin. Psychol. 2022, 43.
Simon NM: Yearning and its measurement in complicated
24. Kakarala SEE, Roberts KEE, Rogers M, Coats T, Falzarano F, grief. J. Loss Trauma 2016, 21:410–420, https://doi.org/10.1080/
* Gang J, Chilov M, Avery J, Maciejewski PKK, Lichtenthal WGG, 15325024.2015.1110447.
Prigerson HGG: The neurobiological reward system in
37. Eisma MC, Schut HAW, Stroebe MS, Van Den Bout J, Stroebe W,
Prolonged Grief Disorder (PGD): a systematic review.
Boelen PA: Is rumination after bereavement linked with loss
Psychiatr. Res Neuroimag. 2020, 303, https://doi.org/10.1016/
avoidance? Evidence from eye-tracking. PloS One 2014,
j.pscychresns.2020.111135.
https://doi.org/10.1371/journal.pone.0104980.
This summary of neurobiological evidence from studies of bereave-
ment and disordered grief in humans offers the most robust empirical 38. Eisma MC, Schut HAW, Stroebe MS, Voerman K, van den Bout J,
support to date for the involvement of abberant reward processing in Stroebe W, Boelen PA: Psychopathology symptoms, rumina-
prolonged grief. tion and autobiographical memory specificity: do

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322 Separation, Social Isolation, and Loss

associations hold after bereavement? Appl. Cogn. Psychol. behavioural correlates. Soc. Psychiatr. Psychiatr. Epidemiol.
2015, 29:478–484, https://doi.org/10.1002/acp.3120. 2019, https://doi.org/10.1007/s00127-019-01776-w.
39. Saavedra Pérez HC, Ikram MA, Direk N, Prigerson HG, Freak- 44. Boelen PA, Lenferink LIM, Smid GE: Further evaluation of the
Poli R, Verhaaren BFJ, Hofman A, Vernooij M, Tiemeier H: factor structure, prevalence, and concurrent validity of DSM-
Cognition, structural brain changes and complicated grief. A 5 criteria for Persistent Complex Bereavement Disorder and
population-based study. Psychol. Med. 2015, 45:1389–1399, ICD-11 criteria for Prolonged Grief Disorder. Psychiatr. Res.
https://doi.org/10.1017/S0033291714002499. 2019, 273:206–210, https://doi.org/10.1016/
j.psychres.2019.01.006.
40. O’Connor M-F: Grief: a brief history of research on how body,
mind, and brain adapt. Psychosom. Med. 2019, 81:731–738, 45. Saavedra Pérez HC, Ikram MA, Direk N, Tiemeier H: Prolonged
https://doi.org/10.1097/PSY.0000000000000717. grief and cognitive decline: a prospective population-based
study in middle-aged and older persons. Am. J. Geriatr.
41. Luo Y, Shan H, Liu Y, Wu L, Zhang X, Ma T, Zhu W, Yang Y, Psychiatr. 2018, 26:451–460, https://doi.org/10.1016/
Wang J, Cao Z: Decreased left hippocampal volumes in par- j.jagp.2017.12.003.
ents with or without posttraumatic stress disorder who lost
their only child in China. J Affect Disord. 2016, https://doi.org/ 46. Shear K, Shair H: Attachment, loss, and complicated grief.
10.1016/j.jad.2016.03.003. Dev. Psychobiol. 2005, 47:253–267, https://doi.org/10.1002/
dev.20091.
42. Acosta H, Jansen A, Kircher T: Larger bilateral amygdalar
volumes are associated with affective loss experiences. 47. Bonanno GA, Lehman DR, Tweed RG, Haring M, Wortman CB,
J. Neurosci. Res. 2021:1–17, https://doi.org/10.1002/jnr.24835. Sonnega J, Carr D, Nesse RM: Resilience to loss and chronic
grief: a prospective study from preloss to 18-months post-
43. Boelen PA, Lenferink LIM: Symptoms of prolonged grief, loss. J. Pers. Soc. Psychol. 2002, 83:1150–1164, https://doi.org/
posttraumatic stress, and depression in recently bereaved 10.1037//0022-3514.83.5.1150.
people: symptom profiles, predictive value, and cognitive

Current Opinion in Psychology 2022, 43:317–322 www.sciencedirect.com

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