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Lightscape at Chicago Botanic Garden. Certainly there is value in the mere evidence of these biomarkers, but in addition, the physiological components or correlates of CG may help us to understand how CG arises, predict who it may affect, and provide suggestions for how to treat it. However, these latter reasons are best served when there is a clear theory behind the study of the biomarkers. Theory points us in the direction for study, and the results of the studies inform and refine our theories. The following section reviews cognitive stress theory, attachment theory, and the biopsychosocial model of CG.
Cognitive stress theory suggests that the death of a loved one is stressful because it is a disruptive event requiring a great deal of adjustment. This is one definition of stress: the perceived demands of the situation tax or exceed the individual's perceived coping resources. Attachment theory states that the bonds between parent and child, and romantic partners, is a product of behavioral conditioning whereby an association is developed between the attachment figure and: i a reduction in distress; and ii the generation of pleasure.
For bereavement, attachment theory has specific predictions. Bereavement includes a gradual extinction of this conditioning, in which the regulatory benefits conferred by mental representations of the attachment figure diminish slowly over time. Bowlby 4 described the end point of successful mourning as a psychological reorganization of one's thoughts and feelings about a deceased attachment figure for review, see ref 5. In a very elegant study comparing cognitive stress theory and attachment theory, Stroebe and colleagues 2 examined a prospective dataset of older adults.
At the baseline, both members of the couple were alive. At the second time point, one of the spouses had died. They hypothesized that attachment theory would predict that pre-bereavement marital quality would only affect yearning for the loved one who died, but not other more general grief reactions. Alternatively, cognitive stress theory would predict that support from family and friends, though unlikely to reduce yearning, might ameliorate general grief symptoms and depression.
The results demonstrated that yearning was the only grief symptom associated with marital quality and was not associated with social support, consistent with predictions from attachment theory.
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Thus, although supportive others reduce depression and other general symptoms, they can not alleviate the loss of an attachment figure. We can add to the original attachment theory ie, that attachment confers capacity for psychological regulation that it also may confer physiological regulation.
Repeated social contact with a particular person results in a conditioned response whereby the attachment figure is reliably associated with a state of psychological security and physiological calm.
For example, warmth and milk are two very different aspects of the loss. Fie inferred that human bereavement also included the loss of physiological regulators, rather than only psychological stress. Sbarra and Hazan 5 theorized that the response to separation or bereavement in fact has two unrelated though usually co-occurring physiological components. First, there is a general stress response termed organized by Sbarra and Hazan.
Second, there is an attachment-specific stress response termed disorganized by Sbarra and Hazan driven by the loss of the rewarding aspects of attachment. Bereavement research has demonstrated increases in catecholamines and Cortisol in the early stages of bereavement. In addition to the general stress response, there is an attachment-specific stress response driven by the loss of the rewarding aspects of attachment.
The physiological systems responsible for this attachmentspecific stress response include the dopamine system, 6 the opioid system, 15 , 16 and the oxytocin system. Dopamine is one of the neurotransmitters that is fundamental in conditioning, in associating the experience of reward with specific objects. Dopamine is important in pursuing rewards, and opioids are important in the enjoyment of those rewards.
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Oxytocin is a neurohormone important in birthing and nursing in all mammals, but in humans it has also been linked to suppression of anxiety during psychosocial stress and to the enhancement of trust. However, in order to explain why some individuals develop CG in response to the death of a loved one and others adjust resiliently, we must move beyond models and theories designed for bereavement generally. A biopsychosocial model of CG posits first that the symptoms of acute grief result from a temporary failure of biobehavioral regulatory functions resulting from the mental representation of the deceased person, much like what has been described above.
This allows an effective attachment system to function again, and there is a reduction of overwhelming and intense sadness. Although acute grief is usually followed by resilient adjustment, 23 Shear and Shair 22 suggest that adjustment to the death may become complicated by maladaptive attitudes and behaviors and perhaps new evidence will be discovered that includes physiological constraints of the neurobiological attachment system.
Creating a neurobiological model of CG faces a problem with the lack of evidence on a basic point. Does CG represent merely a person with acute grief whose process of adaptation has been interrupted, or does CG represent a wholly other process from noncomplicated bereavement adjustment? For example, CG may stem from a pre-existing individual difference, which is already present at the time of the death of the attachment figure. However, it may require the removal of the attachment figure for this pre-existing condition to be revealed in behavior.
The effect of bereavement on the immune system has been empirically documented since the s. Bartrop and colleagues 24 measured T-cell and B-cell functioning in widows at 2 weeks and 8 weeks following the death, and in controls.
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T-cell functioning was significantly reduced compared with controls, and was reduced at the second time point compared with the first. B cells showed no changes. These early results were theorized to occur because of the general stress response to such a distressing life event as opposed to a grief-specific response. Research on multiple aspects of immune functioning during bereavement continued through the s, 25 , 26 the s 27 - 31 and the s.
Of course, negative findings are less likely to be published, but overall, these findings are quite consistent. In addition, particular subpopulations have been studied because of their compromised immune status. A number of studies have investigated HIV-positive individuals, and their experience of the death of a partner. Through this expansion of immunological research, the theoretical perspective primarily posited that bereavement was an example of a nonspecific stressor compared with other stressors such as space shuttle touchdown, significant illness of a spouse, insomnia, and other stressors summed from life event checklists.
Additional moderators and mediators have been considered in different studies eg, depressive disorder, active coping, finding meaning in the loss. All of these studies hypothesize that bereavement is a form of life stress, which although very severe, operates through known stress-response systems. To state this differently, the investigators presume that the distress leads to increases in the figlit-or-flight response, and this leads to reduced cellular immune functioning.
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Regarding this general stress theory, some studies that investigated Cortisol and immune parameters simultaneously and have not found changes in Cortisol that could be linked to the immune decrements, 24 , 30 , 36 while others have found an association.
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