Gr ief and Resilience: Implications for Bereaved College Students by Lindsay Cather ine Willeford, B.A. Repor t Presented to the Faculty of the Graduate School of The University of Texas at Austin in Partial Fulfillment of the Requirements for the Degree of Master of Education The University of Texas at Austin May 2009 The Repor t committee for Lindsay Cather ine Willeford Cer tifies that this is the approved version of: Gr ief and Resilience: Implications for Bereaved College Students APPROVED BY SUPERVISING COMMITTEE: Alissa Sherry Dave Drum iii Gr ief and Resilience: Implications for Bereaved College Students by Lindsay Catherine Willeford, M.Ed. The University of Texas at Austin, 2009 SUPERVISOR: Alissa Sherry The current paper reviews the recent literature on grief and resilience. Specific limitations are noted, namely the lack of attention in the grief literature given to traditional-age college students. The personality characteristics and coping strategies associated with resilient grievers are discussed, followed by a review of the issues and barriers specific to grieving college students. Finally, this paper provides suggestions for how universities and college counselors can promote resilience in grieving students in order to allow for better adjustment during bereavement. iv Table of Contents Introduction ...............................................................................................................1 CHAPTER 1: Grief and Resilience ………………………....................................5 Resilience as Distinct from Recovery ………………………….....................6 Prevalence of Resilience …………………………………………………….8 CHAPTER 2: Characteristics of Resilient Grievers ………………………….....10 Hardiness and Meaning Making .....................................................................10 Religion and Spirituality ...……………………………………………….…12 Optimism and Positive Emotion ………………………………………….....13 Pragmatic Coping ….…………………………………………………….......14 Important Considerations ................................................................................16 CHAPTER 3: Bereaved College Students .............................................................18 Critical Developmental Tasks ………………………………………………18 Barriers and Specific Considerations for Grieving Students .........................19 Ambiguous Loss …………………………………………………………….21 CHAPTER 4: Promoting Resilience in Bereaved College Students ...................23 Suggestions for Universities and College Counselors ………………………23 Suggestions for Future Research …..………………………………………..27 Conclusion .................................................................................................................29 References .................................................................................................................30 Vita .............................................................................................................................38 1 Introduction The death of a loved one and subsequent grief reactions is an inevitable part of the human experience. In 2004, there were 2,397,615 deaths in the United States alone (National Vital Statistics Report, 2007). While grief is a common and universal experience, the way it is perceived will differ both across cultures and individuals (Archer, 1999). Therefore it is imperative that researchers develop a clear understanding of the process of grief in order to address each individual’s unique bereavement experience. Fortunately, the past 20 years have seen a significant increase in research directed toward understanding the process of grief. Investigators are continuing to broaden their conceptualizations of grief and its effects on mental health (Neimeyer, 2004). More specifically, new theories continue to be developed and tested in order to inform clinicians working with bereaved individuals. While there are differences, most theories are shaped around the basic assumption that an individual’s response to loss will lead to either chronic suffering or gradual recovery. Theorists also assume that the absence of overt distress or grief symptoms will result in delayed grief reactions or will become pathological in nature (Bonanno, Moskowitz, Papa, & Folkman, 2005). Bonanno et al. (2005) argues however, that the apparent absence of distress or grief symptoms following loss may be the function of an inherent resilience in the face of adversity as opposed to a reflection of denial or pathology. Interestingly, the concept of resilience as a separate course in the process of grief than that of recovery has gained significant attention in recent years (Bonanno, 2004; Mancini & Bonanno, 2006). 2 Resilience, as it pertains to loss and grief, can be defined as an individual’s ability to maintain relatively low levels of psychological disruption in response to a single traumatic event, such as the death of a close friend or family member (Bonanno, 2004). Initial empirical support for the theory of resilience was first provided in a study performed by Bonanno, Keltner, Holen, and Horowitz (1995). This investigation prompted further testing in the area of resilience and grief. More recent studies provide support for the notion that resilience is a common reaction to grief, distinct from other recovery perspectives (Bonanno, Wortman, & Nesse, 2004; Bonanno et al., 2005; Bonanno et al., 2002). In addition, researchers are now investigating coping strategies and personality characteristics in resilient individuals to better understand factors promoting resilience (Bonanno, 2004). For example, Bonanno (2004) suggests that there are multiple pathways to resiliency, including hardiness, self- enhancement, repressive coping, and positive emotion and laughter. Although empirical evidence is limited, the concept of meaning making as a coping strategy can be linked with the personality trait of hardiness and has received a considerable amount of attention in the literature (Currier, Holland & Neimeyer, 2006; Davis & Nolen-Hoeksema, 2001; Davis, Wortman, Lehman & Silver, 2000; Michael & Snyder, 2005; Neimeyer, Baldwin & Gillies, 2006). Importantly, one limitation of the resilience research is that the majority of empirical evidence is based on older adult samples. Therefore generalizability of the findings to younger adult populations is limited. Events such as the Virginia Tech shootings in April 2007 call attention to a younger population whose unique needs should 3 be considered. Although it may seem that bereavement would not be developmentally anticipated in younger adults, research supports its prevalence. For example, Balk (2001) found that 22-30% of college undergraduates are within their first year of grieving the loss of a close friend or family member. Additionally, the Scientific Advisory Committee of the Grief Research Project identified seven “priority areas” for future research in the field of bereavement and grief in the United States. One of these seven areas included a better understanding of the grief experience across the entire lifespan, considering especially the developmental variables that might influence the grief process (Center for the Advancement of Health, 2003). This is particularly relevant for college students who are facing their own unique set of transitions and developmental tasks. For example, building and maintaining intimate relationships, learning to be autonomous, and finding a clear sense of direction and purpose (Balk, 2001). Successful completion of these tasks may be delayed or disrupted by the experience of grief (Balk, 2001; Matthews & Servaty-Seib, 2007; Balk & Vesta, 1998). Another important consideration is what Arnett (2000) called the “emerging adulthood.” He proposed this term to describe a new developmental period extending from the late teens through the mid-twenties. He stated that many young people no longer identify as adolescents, but do not feel settled into the permanent role of young adult either. This stage is marked by a period of constant change and exploration. Recognition of the emerging adulthood and understanding the developmental tasks facing college students are important considerations. Therefore the study of resilience among 4 bereaved college students, as distinct from adult resilience, should be thoroughly examined. In summary, the purpose of this report is to provide a review of the current literature on resilience as it pertains to grief and bereavement. Particular attention will be paid to the personality characteristics that are associated with resilient individuals. An integration of the resilience literature with that of bereaved college students will then be considered. A discussion highlighting the importance of fostering resilience in these young individuals will follow, with specific implications for universities and college counselors. Finally, implications for future research in the area of resilience among bereaved college students will be discussed. 5 CHAPTER 1 Grief and Resilience Grief can be defined as the emotional perturbation that a bereaved individual experiences as the result of loss (Neimeyer, 2004; Zhang, El-Jawahri, & Prigerson, 2006). Some bereaved persons may experience chronic stress or prolonged sadness. Others may suffer acute reactions immediately following the loss with a gradual return to some level of normalcy. Yet others may experience relatively short-lived disruptions to everyday functioning with a surprisingly rapid recovery (Mancini & Bonanno, 2006). These differences in response to grief are explained in the literature across varying theoretical perspectives (Neimeyer, 2004). The grief work perspective, based on Freudian psychoanalytic theory, has dominated the grief literature throughout the past century (Stroebe, 2001). This perspective contends that “grief is an active process involving the struggle to give up the emotional and internal attachment to a love-object” (Archer, 1999, p.16). In order to meet grief resolution, the bereaved individual must actively bring the reality of their loss into conscious awareness (Stroebe, 2001). A lack of empirical evidence supporting the efficacy of the grief work perspective and emerging new theories in the field have shifted the focus of grief related research. Investigators are now concerned with developing a more general understanding of the basic psychological processes involved in the grief experience (Bonanno, 2001). Importantly, there has been a shift in the underlying premise that grief is a pathological experience (Bonanno, 2001). In fact, in a recent review of the literature, 6 Bonanno and Kaltman (2001) found evidence to support the notion that the majority of bereaved individuals experience non-pathological, or normal, patterns of grief. Moreover, the generally accepted notion that “absent grief” is maladaptive in nature (Middleton, Moylan, Raphael, Burnett, & Marinek, 1993) has been challenged throughout the last decade (Bonanno et al., 2005; Bonanno et al, 2002; Ott, Lueger, Kelber & Prigerson, 2007). For example, Bonanno et al. (2002) reported on 2 studies that provide significant support for the prevalence of a resilient response to grief and that this pattern is a genuinely healthy reaction to loss. Resilience as Distinct from Recovery Bonanno et al. (1995) examined the relationship between emotional avoidance and subsequent grief reactions. This study tested the assumption that emotional avoidance will lead to either prolonged grief, delayed grief, or delayed somatic symptoms. Interestingly, the investigators found a pattern of low distress, or resilience, in a group of conjugally (i.e., the loss of a spouse) bereaved individuals. That is, those who appeared to be avoiding the distressing grief emotions were able to carry out everyday activities with little to no obvious disruption in normal functioning. In contrast, the subjects exhibiting a more traditional recovery pattern after loss showed greater disruptions in everyday activities as well as moderate levels of grief symptoms. This study provided the first empirical evidence that some bereaved individuals may possess an innate resilience to grief, separate from the traditional recovery process. Within the past decade the grief literature has accepted the concept of resilience as commonplace, separating grief reactions into three main groups: common grievers, 7 chronic grievers, and resilient grievers (Bonanno & Kaltman, 2001; Bonanno et al., 2002; Ott et al., 2007). Common grievers (Bonanno et al., 2002) generally experience a period of heightened distress and depressive symptoms, lasting 6 to 7 months post-loss. This period is usually accompanied by varying degrees of disruption to normal functioning. However, unlike chronic grievers who experience this same distress and disruption for prolonged periods of time, common grievers gradually return to normal levels of functioning in a more or less adaptive manner (Zhang et al., 2006). It is argued that these individuals do not necessarily benefit from grief counseling interventions (Jordan & Neimeyer, 2003; Neimeyer, 2000; Ott et al., 2007). Clearly, more research is needed to test the efficacy of such interventions with common grievers. Chronic grievers on the other hand, experience prolonged distress and disruption even into their second year of bereavement. The symptoms associated with chronic grief resemble those seen in individuals with depression or post-traumatic stress disorder (Bonanno & Kaltman, 2001). The literature often refers to chronic grief as complicated grief, pathological grief, abnormal grief, or atypical grief (Zhang et al., 2006). Until recently, the majority of the grief literature has focused on the psychological nature of these individuals. Apparently, resilient grievers differ from both common and chronic grievers in that they experience little to no distress, grief symptoms, or disruption in normal everyday activities (Bonanno, 2004). It should be noted however that resilient grievers will in fact experience at least minimal grief symptoms immediately following the death (Bonanno et al., 2004; Ott et al., 2007). For example, Bonanno et al. (2004) examined 8 patterns of resilience and maladjustment among a sample of widows. They found that among those identified as resilient grievers, more than half reported having experienced at least some amount distress and grief-related emotions immediately following the loss. While the empirical evidence does show that resilient grievers experience at least some grief symptoms, Mancini and Bonanno (2006) stated that the key difference between resilience and recovery (as seen in common and chronic grievers) is the way in which the bereaved individuals manage their experiences. The authors contend that resilient individuals are capable of coping with their grief in a way that does not interfere with their ability to maintain normal levels of functioning. In contrast, the common and chronic grievers must struggle through a process of recovery in order to regain previous levels of functioning (Bonanno et al., 1995). Prevalence of Resilience In a review of the literature on grief reactions, Bonanno and Kaltman (2001) found that generally 50-85% of bereaved individuals across studies experienced normal, or common, grief reactions within their first year of loss. In other words, by the end of the first year of bereavement these individuals returned to levels of functioning consistent with pre-bereavement levels. Within this group, an estimated amount of individuals (15- 50%) experienced even minimal grief, or resilience, within the first months of loss, meaning that they experienced little to no grief symptoms and no disruption in everyday functioning. Bonanno and Kaltman (2001) found that across studies, only a minimal percentage (15%) of bereaved individuals experienced chronic grief reactions. 9 Recently, Ott et al. (2007) found that in a sample of 141 bereaved adults, 49% were common grievers, 34% were resilient grievers, and 17% were chronic grievers. While this study determined the common grief reaction to be the most prevalent, Bonanno has repeatedly found the resilient reaction to occur more frequently than other grief reactions (Bonanno et al., 2002; Bonanno et al., 2004; Bonanno et al., 2005). One such study found that almost half (45.9%) of a sample of 205 conjugally bereaved adults exhibited resilience after the loss of a spouse. This group showed low levels of depression at each wave of assessments, which took place on average 3 years prior to the death, and 6 and 18 months post-loss. They also exhibited very few grief symptoms during bereavement. What is important to note is that regardless of whether or not resilience is the most frequently occurring reaction to grief, it is in fact a common reaction. 10 CHAPTER 2 Characteristics of Resilient Grievers Most resilient grievers tend to be generally healthy people (Mancini & Bonanno, 2006). These individuals usually exhibit positive emotions such as smiling and laughter (Bonanno, 2004), view life situations with optimism, and have the propensity to face challenges with a positive attitude (Cooper, Feder, Southwick, & Charney, 2007). Resilience is also associated with certain personality traits and coping styles (Mancini & Bonanno, 2006). For example, Bonanno (2004) suggested that there are multiple pathways that lead to resilience. These factors include the personality characteristic of hardiness, trait self-enhancement, and repressive coping. These traits and relevant research are briefly reviewed below. Hardiness and Meaning Making Kobasa, Maddi, and Kahn (1982) provided evidence in support of the notion that the personality characteristic of hardiness works as a force of resistance to buffer against stressful life events. Hardiness can be understood along the following three dimensions: “being committed to finding meaningful purpose in life, the belief that one can influence one’s surroundings and the outcome of events, and the belief that one can learn and grow from both positive and negative life experiences” (Bonanno, 2004, p. 25). Campbell, Swank, and Vincent (1991) studied the role of personality in the resolution of grief. More specifically, they sought to examine the relationship between hardiness and varying levels of grief intensity, while controlling for variables such as the 11 subjects’ mental health, age, and time since the death. In a sample of 70 widows, they found lower levels of grief intensity to be associated with high scores on a measure of hardiness. Thus, they suggested that hardiness is an accurate predictor of adjustment during bereavement. They also noted no difference in the course of grief resolution when the death was expected versus unexpected. More recently, Matthews and Servaty-Seib (2007) extended these findings. They found that hardiness was related to lower levels of grief symptoms in a sample of 78 bereaved college students. Hardy individuals are more likely to use active coping techniques such as flexible adaption (Cooper et al., 2007; Mancini & Bonanno, 2006). Mancini and Bonanno (2006) refer to flexible adaption as the ability to adjust to challenging experiences in a more or less adaptive manner. One such technique, meaning making, has received considerable attention in the grief literature (Currier et al., 2006; Davis & Nolen-Hoeksema, 2001; Davis et al., 2000; Michael & Snyder, 2005; Neimeyer et al., 2006). The concept of meaning making as a coping strategy can be understood as two distinct processes: making sense of the loss and finding benefit from the experience (Davis, Nolen- Hoeksema, & Larson, 1998; Michael & Snyder, 2005). It should be noted that meaning making can serve both adaptive and maladaptive functions as a coping strategy for bereaved individuals. It appears that when a bereaved individual searches for meaning from the experience of loss but is unsuccessful, he is more likely to suffer intense grief reactions (Davis et al., 1998). In fact, investigators have found that those individuals who search for meaning but are unable to find it, actually suffer more than had they not searched (Davis et al., 2000). On the other hand, 12 those who search for meaning and are able to either make sense of the loss or find some sort of benefit, tend to show better psychological adjustment during bereavement (Neimeyer, 2006; Nolen-Hoeksema, 2000). It tends to be resilient individuals who possess the capacity to find positive meaning in the face of adversity (Cooper et al., 2007). Religion and Spirituality Religion and spirituality also play a role in the process of developing meaning from a traumatic event and is linked to better adjustment following loss (Davis et al., 1998; McIntosh, Silver, & Wortman, 1993; Park, 2005). Cooper et al. (2007) claimed that religious faith, and more broadly spirituality, increases one’s ability to find positive meaning from stressful events and is characteristic of resilient individuals. One study by McIntosh et al. (1993) assessed the relationship between 2 aspects of religion (religious participation and importance of religion) and 3 coping variables (finding meaning, perceived social support, and cognitive processing) among a sample of bereaved parents. Evidence was provided in support of the link between religious participation and the bereaved individuals’ ability to find meaning from the loss. Extending these findings, Davis et al. (1998) suggested that commitment to a religious or spiritual belief system was positively correlated with bereaved individuals’ ability to make sense of their loss. In this same study, the ability to make sense of the loss was associated with lower levels of distress within the first 6 months of bereavement. Interestingly, Park (2005) investigated the relationship between religion, meaning making, and adjustment during bereavement and found that while religiousness was 13 positively correlated with long-term adjustment during bereavement, it was inversely correlated with adjustment immediately following the death. She suggested that religiousness is a contributing factor to how a person views the world and that the death of a loved one may cause the bereaved to reappraise this view, resulting in initial distress. However, over time this same religiousness contributes to their ability to find meaning from the loss and readjust their worldview, resulting in higher levels of adjustment over time. Optimism and Positive Emotion Optimism and the use of positive emotions are also related to resilient individuals (Cooper et al., 2007). As previously mentioned, individuals that are able to find meaning in their loss tend to exhibit fewer grief symptoms, often resulting in a resilient reaction toward the distressing effects of grief. The ability to find something positive from one’s experience of loss is also associated with dispositional optimism (Davis et al., 1998; Nolen-Hoeksema, 2000). Davis et al. (1998) found that dispositional optimism predicted benefit-finding in a sample of 205 bereaved individuals. Within this same sample, those subjects finding benefit from their loss also reported lower levels of distress. In another study, Boelen and Van Den Bout (2002) investigated the relationship between positive thinking and psychiatric symptomatology after the loss of a loved one. The investigators correlated scores on measures of positive thinking and optimism with measures of grief, depression, and anxiety in a sample of 326 bereaved adults. Their results indicated an inverse relationship, meaning that higher levels of positive thinking 14 and optimism were associated with lower levels of grief symptoms, depression, and anxiety. Humor (Cooper et al., 2007) and the use of positive emotions (Bonanno, 2004) are also suggested predictors of resilience. Fredrickson (2001) stated that positive emotions such as joy, contentment, pride, interest, and love are all markers of healthy adjustment and optimal well-being. She proposed that these types of emotions may actually broaden individuals’ “thought-action repertoire,” allowing for the use of a broader spectrum of personal resources. It is predicted then that the use of positive emotions might actually help build psychological resilience (Fredrickson 2001; Tugade & Fredrickson, 2004). Tugade and Fredrickson (2004) studied the relationship between positive emotion and psychological resilience. They found that positive emotions were associated with resilient individuals’ ability to psychologically overcome the distressing effects of a negative arousal experience. In another study, Ong, Bergeman, and Bisconti (2004) found that positive emotions were related to lower levels of stress and depression in a sample of conjugally bereaved individuals. Additionally their findings suggested a possible link between humor coping and the promotion of emotional resilience. Pragmatic Coping Pragmatic coping refers to coping strategies that are generally considered to be negative or maladaptive under normal circumstances. However, when coping with a traumatic event such as the loss of a loved one, pragmatic coping has been associated with higher levels of resilience and adjustment (Mancini & Bonanno, 2006). Repressive 15 coping and self-enhancement are two such strategies discussed in the literature on resilience and grief. Repressive coping is an emotion-focused strategy that involves avoiding unpleasant thoughts or feelings (Bonanno, 2004). While repressive coping is generally thought to be maladaptive, resulting in long-term health problems (Bonanno & Singer, 1990), bereavement studies have suggested that when facing extreme adversity or trauma, repressive coping may serve an adaptive function (Coifman, Bonanno, Ray, & Gross, 2007). Coifman et al. (2007) investigated the impact of repressive coping on the grief experience in a sample of recently bereaved individuals. They found that those using repressive coping strategies experienced fewer health problems, exhibited lower symptoms of psychopathology, and were rated as better adjusted than those not using repressive coping. The authors are careful to note however that repressive coping might not serve an adaptive function in the context of all stressful life events and that more research is needed to fully understand the adaptive functions of repressive coping. Bonanno (2004) suggested that the use of self-enhancing biases might serve as a buffer against the distressing effects of grief, linking trait self-enhancement with resiliency. Trait self-enhancement refers to the tendency to view oneself in an overly, and perhaps unrealistically, positive manner (Bonanno, Rennicke, & Dekel, 2005). While self-enhancers may face certain disadvantages such as negative impressions among peers and higher scores on measures of narcissism (Paulhus, 1998), there is evidence in support of Bonanno’s (2004) suggested link between self-enhancement and resilience. 16 Bonanno et al. (2005) investigated outcomes of resiliency among a sample of survivors from the September 11th attacks on the World Trade Center. They found that trait self-enhancement was more common among those individuals exhibiting resilient reactions. These individuals were rated as better adjusted, providing evidence in support of the adaptive function of trait self-enhancement. Important Considerations While this review has expanded our understanding of resilience as it pertains to grief, there are important limitations that should be considered. The current available research does not provide sufficient evidence in support of the existence of delayed grief (Bonanno et al., 2002), which was previously assumed to exist. It is important to note however that the majority of these studies only follow subjects through 2 years of bereavement. Therefore it may be possible that some bereaved individuals do in fact experience delayed grief in their third or fourth year of bereavement. However one study did follow a sample of 39 conjugally bereaved individuals through their fifth year of loss and found no evidence of delayed grief reactions, suggesting that this is not the case (Bonanno & Field, 2001). More longitudinal research is needed to better understand the long-term effects of grief past 2 and 3 years post loss. Another important consideration is the limited focus on cultural differences. This is particularly relevant when considering how one’s religion and worldview might shape the way meaning is assigned to certain life events. Park (2005) noted that most research in the area of religion is limited to Christianity. It is necessary to understand the cultural 17 context of each bereaved individual in order to understand the meaning of death within a given society and to interpret different grief reactions among individuals. Finally, much of the grief literature focuses on older adult populations. While recent years have seen an increase in the attempt to understand the grief process within younger populations such as traditional-age college students (Balk, 1997; Balk et al., 1998; Balk & Vesta, 1998; Mathews & Servaty-Seib, 2007), little attention is placed on the role of resilience in this unique population. Bonanno et al. (2005) suggested that resilience in the face of grief may be less common among younger adults given that death is developmentally unexpected at such a young age. More research is needed to fully understand the role of resilience in regard to traditional-age college students. Given what the research suggests about the personality characteristics and coping techniques of resilient grievers, there are important implications for the role of college counselors in promoting and fostering these resilient traits within their students. The remainder of this report will focus on the specific barriers and issues facing grieving college students. Suggestions will be made on how universities and college counselors can foster resilience in their grieving students. 18 CHAPTER 3 Bereaved College Students To describe traditional-age college students (ages 18-25) dealing with the loss of a loved one, LaGrand (1985) used the term “the forgotten grievers.” College students may be particularly vulnerable to the effects of grief due to maturity level (Toth, Stockton, & Browne, 2000) and the university environment, which is not a particularly supportive setting for grieving students (Balk, 1997). These students may have difficulty concentrating on school, being away from family, and dealing with feelings of isolation (Floerchinger, 1991). They are also in a unique position considering the developmental tasks facing this young population (Chickering & Reisser, 1993; Erikson, 1959). Critical Developmental Tasks During this time, students are faced with new experiences and increased pressures that work toward shaping their identities. Experiencing loss and grief at this time in a young person’s life will inevitably increase already existing anxieties (LaGrand, 1981). This increased trauma and anxiety may have detrimental effects on the developmental tasks unique to this age (Balk, 2001). These tasks include the ability to develop intimate relationships, as understood through Erikson’s (1959) psychosocial developmental stage Intimacy versus Isolation. College students are also working toward developing autonomy and finding a meaningful purpose in life (Chickering & Reisser, 1993). Erikson (1959) claimed that this stage in a young person’s life is important for the development of secure and intimate relationships. He contended that increased anxiety or 19 trauma during this time period may result in the inability to form intimate relationships, often times leaving the individual with feelings of isolation. The distressing effects of grief may present a problem for grieving students attempting to navigate this developmental stage (Balk, 2001; Balk et al., 1998). For example, some students may seek isolation by throwing themselves into schoolwork or other activities in order to avoid social contact, while other students may seek unhealthy forms of intimacy through sexual promiscuity (Floerchinger, 1991). As previously noted, college is also an important time for students’ identity development especially in regard to building autonomy and finding meaningful purpose in life (Chickering & Reisser, 1993). Students are in the process of leaving their families, both physically and emotionally, while at the same time attempting to develop an autonomous identity. It can be particularly difficult for a student to deal with the distressing effects of grief while negotiating their individuality (Janowaik, Mei-Tal, & Drapkin, 1995). Moreover, a traumatic event such as the death of a loved one may force the student to question previously held beliefs and worldviews, making it more difficult to find meaning or purpose in their experience (Davis et al., 2000; Schwartzberg & Janoff-Bulman, 1991). Barriers and Specific Considerations for Grieving Students For many bereaved college students, it is often their first time to face the reality of death and to feel emotions of such great intensity (LaGrand, 1985; Toth et al., 2000). They become acutely aware of their mortality and begin to understand that death can come at any age (Floerchinger, 1991). For these young grievers, the availability of a close 20 friend or confidant with whom they can share their emotions and grief experiences becomes crucial for successful adaptation (LaGrand, 1981). Unfortunately, among the most pressing issues facing bereaved college students are the feelings of isolation and loneliness (Balk, Tyson-Rawson, & Colletti-Wetzel, 1993; Floerchinger, 1991). Peers of bereaved college students often times do not know how to talk about death, the subject matter leaving them frightened or uncomfortable (Balk, 1997; Floerchinger, 1991). In an effort to avoid this discomfort they simply avoid the situation altogether, inadvertently leaving their grieving peers unsupported and in a state of isolation (Balk, 2001; Balk et al., 1993; LaGrand, 1985). Sometimes well- meaning peers may have unrealistic expectations of the grieving process (Balk, 1997), further isolating their bereaved friends by assuming that after 6 months they should be able to move on (LaGrand, 1985). Others may have a general understanding of the grief process but do not necessarily have the appropriate skills to apply their knowledge when offering support to a grieving friend (Balk & Vesta, 1998; Toth et al., 2000). The lack of peer support among students makes the college campus an isolating environment for young grievers (Balk, 1997). One important issue associated with the increased isolation felt by many bereaved college students is depression (LaGrand, 1985). More importantly, if students suffering from depression fail to find an appropriate support network within the college community, suicide may become a viable alternative to suffering alone (Floerchinger, 1991). Prigerson et al. (1999) found that depression following the loss of a close friend was correlated with suicidal ideation in a sample of 76 young adults (mean age of 23). 21 More recently, Stroebe, Stroebe, and Abakoumkin (2005) reported correlations between bereavement and suicidal ideation and suicidal behaviors. Floerchinger (1991) stressed that college counselors need to accurately assess their grieving students’ coping strategies and available support networks in order to monitor those students who may be at risk of depression or suicide. Another important barrier facing bereaved college students involves various of academic pressures (Toth et al., 2000). Servaty-Seib and Hamilton (2006) found a drop in both academic performance and retention among a sample of 227 students who had experienced a loss from death. Also of importance are the many physical reactions associated with grief, such as sleep disturbance (Hardison, Neimeyer, & Lichstein 2005), anxiety and panic (Toth et al., 2000), crying spells, headaches, exhaustion, and digestive disturbances (LaGrand, 1985). There are a variety of ways students choose to cope with both the physical and emotional effects of grief; some productive and others counterproductive (LaGrand, 1985). Some of the more frequently cited productive coping strategies used by grieving students are talking about the loss, writing and drawing, crying, and exercising (LaGrand, 1981). Unfortunately there are also a number of counterproductive means of coping such as alcohol and drug use, and promiscuity (Floerchinger, 1991). These coping strategies are dangerous and may serve as a barrier to proper adjustment during bereavement. Ambiguous Loss The concept of ambiguous loss is also important to note because grief resulting in losses other than death can cause very similar reactions (LaGrand, 1981/1985). Toth et 22 al. (2000) defined loss, specifically with regard to college students, as more than just the experience of losing a loved one to death. They claimed that loss and the subsequent grief experience also includes the loss of a loved one as a result of divorce, physical separation, or the ending of a significant relationship. In an analysis of loss experiences within a sample of 1,139 college students, LaGrand (1981) also found events such as obtaining a failing grade, loss of a strongly held ideal, or loss of a body function to be among some of the other significant losses impacting the lives of college students. According to LaGrand (1981) the significance of a loss can only be interpreted by the individual who is actually experiencing the loss. That is, the experience of loss is subjective in nature and what may be significant to some students, such as the death of a pet or a failing grade, will be insignificant to others. What is important to remember is that these events will have a serious impact on the lives of some students depending on the personal meaning assigned by the individual (LaGrand, 1981). It is important to understand the process of grief as it relates to losses other than death so as to not assume that only certain events, such as the death of a loved one, constitute a major loss in the lives of college students (LaGrand, 1981). Students may not allow themselves time to grieve ambiguous losses because the associated emotions are rarely validated. Increasing our understanding of the process of grief among college students will allow college counselors to help their students cope with a wide variety of losses. 23 CHAPTER 4 Promoting Resilience in Bereaved College Students In recent years the grief literature has acknowledged the need for a better understanding of the grief process among college students. The incidence and prevalence of grief and loss on college campuses has gone largely unrecognized (Balk, 2001). Therefore universities need to raise awareness of not only the prevalence of grief, but also the serious impact of death in the lives of these students. It is encouraging that the grief literature is beginning to focus on this unique population, however little attention has been given to the specific construct of resilience among these young grievers. Researchers and clinicians could benefit from a clear understanding of resilience in regard to the developmental tasks that college students face in order to foster and promote resiliency within this population. This chapter will focus on suggestions for how universities and college counselors can promote resilience among their students, specifically in terms of raising awareness about the commonality of loss, strategies for fostering resilience, attending to the process of meaning making, and increasing peer to peer interactions. This chapter will conclude with implications for further research in the field of grief and resilience. Suggestions for Universities and College Counselors As with any counseling relationship, the college counselor needs to provide a safe environment and serve as an empathic listener. This is particularly important when it comes to validating the intensity of the students’ personal grief experience (Knox, 2007) 24 and providing the opportunity for the student to begin making sense of their loss (Toth et al., 2000). As previously discussed, making sense of the loss is associated with the coping strategy of meaning making. Meaning making serves an adaptive function when a grieving individual is able to actually make sense of, or find benefit from their experience (Neimeyer, 2006; Nolen-Hoeksema, 2000). Resilient grievers are better equipped, perhaps by means of a hardy personality, to make sense of their loss and find some element of purpose or benefit from the experience (Cooper et al., 2007). College students are facing the developmental task of finding meaning and purpose in life; characteristics that are associated with a hardy personality (Chickering & Reisser, 1993). Since these students are still developing their identities around this construct, perhaps they are more amenable to change. In other words, college counselors can work with grieving students to foster resilience through promoting characteristics associated with a hardy personality. While researchers have conflicting views as to whether or not hardiness can be taught (Matthews & Servaty-Seib, 2007), the use of meaning making interventions will equip grieving students with the appropriate skills to facilitate their search for meaning. Perhaps this will in turn increase their capacity to develop hardy personality traits. In order to assist students in their search for meaning, college counselors can help them become self-aware and introspective. Neimeyer (2006) suggested techniques such as reflective journaling and re-telling the life story of the deceased to help bereaved individuals reconstruct meaning after a loss. College counselors can encourage bereaved students to keep a journal in order to track their loss and to mediate how the student’s life 25 has changed in light of their experience. Providing students with a safe environment to re-tell the life story of their loved one will allow them to contemplate how the loss fits into their own self-narrative. This will provide grieving students the opportunity to integrate the loss into their own life story in a meaningful way (Neimeyer, 2006). Another important aspect of resilience is the use of positive emotion and optimism. Cooper et al. (2007) suggested that the use of psychotherapeutic interventions aimed at affective regulation and approaches derived from positive psychology may be particularly useful for the promotion of resilience in the face of adversity. College counselors should become familiar with such techniques and encourage their students to express positive emotions such as smiling and laughter. Mancini and Bonanno (2006) noted that some bereaved students may feel that they are not supposed to seek enjoyment or partake in pleasurable experiences following the death of a loved one. College counselors need to help students understand the benefits associated with positive emotions and encourage grieving students to participate in pleasurable activities at a level with which the student feels comfortable. Another consideration for college counselors when working with grieving students is the use of pragmatic coping strategies to help promote a resilient reaction to grief. These strategies should be used with caution however, given the possible negative consequences associated with these techniques (Bonanno & Singer, 1990; Paulus, 1999). As previously mentioned, bereavement studies have suggested that repressive coping serves an adaptive function when facing extreme adversity or trauma (Coifman et al., 2007). More research is needed to fully understand the adaptive function of repressive 26 coping; therefore college counselors should take extra care when determining with whom to use this technique. The use of self-enhancement strategies is another form of pragmatic coping that might be useful for fostering resilience among grieving college students. College counselors can promote the use of self-enhancing biases by using strategies that increase self-esteem and encouraging an optimistic view of the individual’s own life. Again, the possible negative consequences within the individual’s social context should be considered before deciding to implement such strategies. An important issue to consider is that many grieving students will not seek individual help or support from a counselor (Toth et al., 2000). Those that do, often times present for counseling with symptoms such as loss of motivation, sleep disturbances, or problems with concentration. These symptoms often times are misattributed to general stress and therefore the topic of grief may never be addressed (Janowaik, et al., 1995). Finally, another important consideration is the efficacy of individual grief counseling interventions. Neimeyer (2000) and Jordan and Neimeyer (2003) conducted comprehensive reviews of the bereavement intervention literature. They concluded that evidence in support of the effectiveness of grief counseling interventions is weaker than expected and that more research is needed in order to understand for whom these interventions might be beneficial. Therefore, college and university may benefit from working toward promoting resilience in order to make the campus a safe and encouraging environment for those students not seeking support from college counselors. While this is likely to be a highly 27 involved task, steps should be taken to begin the process by raising awareness on college campuses and calling for increased university engagement (Balk, 2001). Balk (2001) proposed that college campuses should begin by coordinating bereavement research and services through the use of a university-based bereavement center. He suggested that an effective bereavement center should train and provide death education for non-bereaved students to offer support to peers, implement structured interventions, raise overall consciousness and awareness on campus, and conduct research related to bereavement and grief among various populations. Universities should also set up grief support groups for bereaved students. Such groups would provide a safe environment to share stories, feelings, and experiences with individuals that are dealing with similar types of loss (Knox, 2007). Perhaps resilience can be fostered through such groups by way of increasing self-esteem and allowing for a supportive and understanding setting in which they can navigate through their experience and attempt to make meaning from their loss. Suggestions for Future Research As previously mentioned, one of the major limitations in the research on grief and resilience is that few studies have taken cultural factors into consideration. Future research should focus on understanding how different cultures and different worldviews might impact an individual’s capacity for resilience. For example, the personality characteristics associated with hardiness require, in general, the belief that an individual has some level of control over the impact of certain life events. However, not every culture carries a worldview that supports this belief and researchers need to investigate how resilience functions in bereaved individuals from various cultural and ethnic 28 backgrounds. More information is also needed to better understand whether or not resilience can be learned. If so, investigators need to study the mechanisms by which resilience is developed in order to inform clinicians working with bereaved clients. Finally, researchers need to continue to focus on the process of grief among traditional- age college students. This topic is continuing to gain momentum in the bereavement literature but more empirical evidence is needed to fully understand the specific nature of the grief experience in this unique population. 29 Conclusion The above review indicates that resilience is in fact a common reaction to grief, distinct from other recovery perspectives. Investigators have shifted their attention toward understanding the specific characteristics associated with resilient grievers in order to inform clinicians working with grieving clients. There also exits a population of grievers that have been largely forgotten, traditional-age college students. 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Journal of Personality and Social Psychology, 86(2), 320-333. Zhang, B., El-Jawahri, A., & Prigerson, H. G. (2006). Update on bereavement research: Evidence-based guidelines for the diagnosis and treatment of complicated bereavement. Journal of Palliative Medicine, 9(5), 1188-1203. 38 VITA Lindsay Catherine Willeford was born in Houston, Texas on November 17, 1982, the daughter of Cad Simpson Willeford and Byron Lee Willeford. After completing her work at Lamar High School, Houston, Texas, in 2001, she entered Loyola University New Orleans in New Orleans, Louisiana. During her junior year, Lindsay studied abroad in Madrid, Spain, at St. Louis University’s Madrid Campus. In May 2005, she received the degree of Bachelor of Arts from Loyola University New Orleans, with a major in both Psychology and Spanish. During the following years she was employed as a research assistant at the University of Houston and a Rehabilitation Clinician at the Mental Health Mental Retardation Authority of Harris County. In September 2007, she entered the Graduate School at the University of Texas at Austin. Permanent Address: 1503 Milford Houston, TX 77006 This report was typed by the author.