School of Psychology
Grief is a normal psychological and emotional process occurring in response to a significant loss, but a small proportion of people develop Prolonged Grief Disorder (PGD) – a proposed clinical syndrome characterised by debilitating persistent grief reactions post-death. Acceptance and Commitment Therapy (ACT) has demonstrated effectiveness in helping people cope with a range of life challenges. However, limited research has examined ACT mechanisms of therapeutic change in grief or psychological distress among individuals living with serious illness, or for those caring for a loved one with serious illness through to bereavement. The primary aims of this thesis were to investigate the ACT variables of acceptance and valued-living in adjustment at end of life amongst patients and in bereavement for carers. It also tests the feasibility of an ACT self-help intervention for carers of patients in palliative care.
A conceptual review was conducted and a model proposed to describe the potential roles that acceptance and valued-living play in adjustment to serious illness and bereavement.
Study 1 constituted a cross-sectional survey of 97 bereaved university students in order to explore the relationships between grief with acceptance and valued-living. Acceptance was a strong predictor of grief and valued-living predicted variance in grief above and beyond acceptance.
Study 2 then explored the relationships between pre-loss grief and acceptance among 73 patients in palliative care. It showed that acceptance was a strong predictor of pre-loss grief, and accounted for variance above and beyond anxiety and depression. For Study 3 a pilot randomised controlled trial tested the feasibility of an ACT self-help intervention for carers of patients in palliative care. Carers participated and completed measures of acceptance, valued-living, grief and psychological distress at baseline (N=55), 1-month following baseline (N=44) and 6-months following the death of their loved one (N=29). Results showed that the self-help intervention was overall feasible and acceptable to carers, and revealed promising trends primarily for improving acceptance and psychological distress.
Study 4 involved a cross-sectional survey of 46 clinical staff working in palliative care and examined the attitudinal and skills-based factors that might impact xvii on their capacity and willingness to act as referrers to a self-help intervention for grief. Results showed that attitudes toward PGD as a diagnosis and intervention for grief were associated with perceived acceptability of self-help intervention for carers, and thus warrant addressing in future implementation trials.
The results of this series of studies provide preliminary evidence that acceptance, and to some extent valued-living, are likely mechanisms of therapeutic change in psychological distress and grief for individuals at end of life or in bereavement. An ACT self-help intervention was also found to be a viable intervention option for carers but would require positive staff attitudes and structures for successful implementation. Overall, the results of this thesis point to the potential merit and need for further research into ACT-based interventions for individuals adjusting to serious illness or bereavement.
Davis, Esther L., Adjustment at end of life and in bereavement for patients and carers in palliative care: The role of acceptance and valued-living, thesis, School of Psychology, University of Wollongong, 2017. https://ro.uow.edu.au/theses1/197