A Cognitive Attachment Model of prolonged grief: Integrating attachments, memory, and identity

Maccallum, Fiona; Bryant, Richard A.

doi:10.1016/j.cpr.2013.05.001

Cited by 214Grief, Bereavement, and Mental HealthIdentity, Memory, and TherapyDeath, Funerary Practices, and Mourning

A Cognitive Attachment Model of prolonged grief: Integrating attachments, memory, and identity

Maccallum, Fiona, Bryant, Richard A.·2013·Clinical Psychology Review

DOI 10.1016/j.cpr.2013.05.001

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Abstract

Prolonged grief (PG), otherwise known as complicated grief, has attracted much attention in recent years as a potentially debilitating condition that affects approximately 10% of bereaved people. We propose a model of PG that integrates processes of attachment, self-identity, and autobiographical memory. The paper commences with a discussion of the PG construct and reviews current evidence regarding the distinctiveness of PG from other bereavement related-outcomes. We then review the evidence regarding the dysfunctional attachments, appraisals, and coping styles that people with PG display. Recent evidence pertaining to the patterns of autobiographical memory in PG is described in the context of the self-memory system. This system provides a unifying framework to understand the roles of personal memories, identity, attachments, and coping responses in PG. The proposed model places emphasis on how one's sense of identity influences yearning, memories of the deceased, appraisals, and coping strategies, to maintain a focus on the loss. The model is discussed in relation to existing models of PG. The potential for shaping treatment strategies to shift perceptions of the self is then outlined. Finally, we outline future directions to test propositions stemming from the model and enhance our understanding of the mechanisms underlying PG.

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PGD can be defined as an attachment-related disorder.
“PGD can, with its core symptoms of separation distress, be defined as an attachment related disorder (Maccallum and Bryant, 2013; WHO, 2022).”
From Group-based compassion-focused therapy for prolonged grief symptoms in adults – Results from a randomized controlled trial (2022) · cites this paper as Maccallum and Bryant, 2013
Maladaptive cognitive appraisals, including rumination, mediate longer-term prolonged grief symptomatology.
“Further, longitudinal studies indicate that maladaptive cognitive appraisals, including rumination, mediate longerterm prolonged grief symptomatology 88,116 .”
From Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder (2022) · cites this paper as [116]

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Continuing Bonds and Grief: A Prospective Analysis
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A Model of Mourning: Change in Schemas of Self and Other
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The role of cognitive variables in psychological functioning after the death of a first degree relative
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Unfulfilled goals interfere with tasks that require executive functions
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Whether to relinquish or maintain a bond with the deceased.
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The centrality of a loss and its role in emotional problems among bereaved people
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The role of negative interpretations of grief reactions in emotional problems after bereavement
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Impaired autobiographical memory in complicated grief
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Self-defining memories in complicated grief
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Long term consequences of suppression of intrusive anxious thoughts and repressive coping
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Does attachment avoidance help people cope with loss? the moderating effects of relationship quality
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Sleep in the wake of complicated grief symptoms: An exploratory study
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Cognitive behavioral variables mediate the associations of neuroticism and attachment insecurity with Prolonged Grief Disorder severity
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Impact of concurrent naturalistic pharmacotherapy on psychotherapy of complicated grief
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Prediction of Postnatal Affective Changes by Autobiographical Memories
Mackinger, H. F., Loschin, G., & Leibetseder, M. M. (2000) · European Psychologist · doi:10.1027//1016-9040.5.1.52 · Cited by 58 · see citing works
Attentional bias in complicated grief
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Remembering the Past and Envisioning the Future in Bereaved Adults With and Without Complicated Grief
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Prolonged Grief Disorder and Depression in Widows Due to the Rwandan Genocide
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Are normal and complicated grief different constructs? A confirmatory factor analytic test
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Differentiating Symptoms of Complicated Grief and Depression among Psychiatric Outpatients
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A Prospective Examination of Catastrophic Misinterpretations and Experiential Avoidance in Emotional Distress Following Loss
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Parental Control, Partner Dependency, and Complicated Grief Among Widowed Adults in the Community
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Attachment insecurities and identification of at-risk individuals following the death of a loved one
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Imagining the future in Complicated Grief
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Autobiographical memory specificity and symptoms of complicated grief, depression, and posttraumatic stress disorder following loss
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The Effects of Treatments for Depression on Perceived Failure in Self-Regulation
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The Role of Self-Concept Clarity in Prolonged Grief Disorder
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Do Shattered Worldviews Lead to Complicated Grief? Prospective and Longitudinal Analyses
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Self-worth mediates the effects of violent loss on PTSD symptoms.
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Adaptive and Maladaptive Dependency in Bereavement: Distinguishing Prolonged and Resolved Grief Trajectories
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Handbook of bereavement research and practice: advances in theory and intervention
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Development and Validation of an Instrument for the Assessment of Dependency Among Bereaved Persons
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Is Complicated Grief a Valid Construct?
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Autobiographical memory following cognitive behaviour therapy for complicated grief
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Facets of pejorative self-processing in complicated grief.
Golden, A.-M. J., & Dalgleish, T. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0027338 · Cited by 28 · see citing works
Follow-up outcome in short-term group therapy for complicated grief.
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Goal pursuit, goal self-concordance, and the accessibility of autobiographical knowledge
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Social problem solving in complicated grief
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Treating Prolonged Grief Disorder: A Randomized Clinical Trial
Bryant, R. A., Kenny, L., Joscelyne, A., Rawson, N., Maccallum, F., Cahill, C., Hopwood, S., Aderka, I., & Nickerson, A. (2014) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2014.1600 · Cited by 253 · see citing works
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Ecological Grief as a Response to Environmental Change: A Mental Health Risk or Functional Response?
Comtesse, H., Ertl, V., Hengst, S. M. C., Rosner, R., & Smid, G. E. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18020734 · Cited by 244 · see citing works
Network analysis of persistent complex bereavement disorder in conjugally bereaved adults.
Robinaugh, D. J., LeBlanc, N. J., Vuletich, H. A., & McNally, R. J. (2014) · Journal of Abnormal Psychology · doi:10.1037/abn0000002 · Cited by 219 · see citing works
Emerging experience with selected new categories in the <scp>ICD</scp>‐11: complex <scp>PTSD</scp>, prolonged grief disorder, gaming disorder, and compulsive sexual behaviour disorder
Reed, G. M., First, M. B., Billieux, J., Cloitre, M., Briken, P., Achab, S., Brewin, C. R., King, D. L., Kraus, S. W., & Bryant, R. A. (2022) · World Psychiatry · doi:10.1002/wps.20960 · Cited by 182 · see citing works
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Emotion Regulatory Strategies in Complicated Grief: A Systematic Review
Eisma, M. C., & Stroebe, M. S. (2021) · Behavior Therapy · doi:10.1016/j.beth.2020.04.004 · Cited by 152 · see citing works
A systematic review and meta-analysis of correlates of prolonged grief disorder in adults exposed to violent loss
Heeke, C., Kampisiou, C., Niemeyer, H., & Knaevelsrud, C. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1583524 · Cited by 143 · see citing works
Symptoms of prolonged grief, post-traumatic stress, and depression after loss in a Dutch community sample: A latent class analysis
Djelantik, A. A. A. M. J., Smid, G. E., Kleber, R. J., & Boelen, P. A. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.11.023 · Cited by 126 · see citing works
Disturbed grief: prolonged grief disorder and persistent complex bereavement disorder
Boelen, P., & Smid, G. (2017) · British medical journal · doi:10.1136/bmj.j2016 · Cited by 131 · see citing works
When a child dies: a systematic review of well-defined parent-focused bereavement interventions and their alignment with grief- and loss theories
Kochen, E. M., Jenken, F., Boelen, P. A., Deben, L. M. A., Fahner, J. C., van den Hoogen, A., Teunissen, S. C. C. M., Geleijns, K. P. W., & Kars, M. C. (2020) · BMC Palliative Care · doi:10.1186/s12904-020-0529-z · Cited by 123 · see citing works
Symptoms of persistent complex bereavement disorder, depression, and PTSD in a conjugally bereaved sample: a network analysis
Malgaroli, M., Maccallum, F., & Bonanno, G. A. (2018) · Psychological Medicine · doi:10.1017/s0033291718001769 · Cited by 116 · see citing works
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Symptomatology following loss and trauma: Latent class and network analyses of prolonged grief disorder, posttraumatic stress disorder, and depression in a treatment-seeking trauma-exposed sample
Djelantik, A. A. A. M. J., Robinaugh, D. J., Kleber, R. J., Smid, G. E., & Boelen, P. A. (2020) · Depression and Anxiety · doi:10.1002/da.22880 · Cited by 110 · see citing works
The impact of continuing bonds following bereavement: A systematic review
Hewson, H., Galbraith, N., Jones, C., & Heath, G. (2024) · Death Studies · doi:10.1080/07481187.2023.2223593 · Cited by 101 · see citing works
Cognitive–behavioral variables mediate the impact of violent loss on post-loss psychopathology.
Boelen, P. A., de Keijser, J., & Smid, G. E. (2014) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000018 · Cited by 101 · see citing works
Treatment for complicated grief: state of the science and ways forward
Doering, B., & Eisma, M. (2016) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000263 · Cited by 84 · see citing works
An open trial of meaning-centered grief therapy: rationale and preliminary evaluation
Lichtenthal, W. G., Catarozoli, C., Masterson, M., Slivjak, E., Schofield, E., Roberts, K. E., Neimeyer, R. A., Wiener, L., Prigerson, H. G., Kissane, D. W., et al. (2019) · Palliative and Supportive Care · doi:10.1017/s1478951518000925 · Cited by 88 · see citing works
Complicated grief after suicide bereavement and other causes of death
Tal, I., Mauro, C., Reynolds, C. F., Shear, M. K., Simon, N. M., Lebowitz, B. D., Skritskaya, N. A., Wang, Y., Qiu, X., Iglewicz, A., et al. (2016) · Death Studies · doi:10.1080/07481187.2016.1265028 · Cited by 86 · see citing works
Concurrent and prospective associations of intolerance of uncertainty with symptoms of prolonged grief, posttraumatic stress, and depression after bereavement
Boelen, P. A., Reijntjes, A., & Smid, G. E. (2016) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.03.004 · Cited by 76 · see citing works
Cognitive predictors of grief trajectories in the first months of loss: A latent growth mixture model.
Smith, K. V., & Ehlers, A. (2020) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000438 · Cited by 73 · see citing works
Networks of loss: Relationships among symptoms of prolonged grief following spousal and parental loss.
Maccallum, F., Malgaroli, M., & Bonanno, G. A. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000287 · Cited by 68 · see citing works
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Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): toward integrated treatment of symptoms related to traumatic loss
Smid, G., Kleber, R., de la Rie, S., Bos, J., Gersons, B., & Boelen, P. (2015) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v6.27324 · Cited by 62 · see citing works
Features of Prolonged Grief Symptoms in Chinese and Swiss Bereaved Parents
Xiu, D., Maercker, A., Woynar, S., Geirhofer, B., Yang, Y., & Jia, X. (2016) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0000000000000539 · Cited by 64 · see citing works
Negative-pressure wound therapy versus standard dressings for adults with an open lower limb fracture: the WOLLF RCT
Costa, M. L., Achten, J., Bruce, J., Davis, S., Hennings, S., Willett, K. M., Petrou, S., Jeffery, S., Griffin, D. R., Parker, B., et al. (2018) · Health Technology Assessment · doi:10.3310/hta22730 · Cited by 64 · see citing works
A Network Approach to Understanding Quality of Life Impairments in Prolonged Grief Disorder
Maccallum, F., & Bryant, R. A. (2019) · Journal of Traumatic Stress · doi:10.1002/jts.22383 · Cited by 64 · see citing works
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Feelings of loss in parents of children with infantile cerebral palsy
Fernández-Alcántara, M., García-Caro, M. P., Láynez-Rubio, C., Pérez‐Marfil, M. N., Martí‐García, C., Benítez‐Feliponi, Á., Berrocal-Castellano, M., & Cruz‐Quintana, F. (2014) · Disability and health journal · doi:10.1016/j.dhjo.2014.06.003 · Cited by 57 · see citing works
Prolonged grief disorder
Killikelly, C., Smith, K. V., Zhou, N., Prigerson, H. G., O'Connor, M., Kokou‐Kpolou, C. K., Boelen, P. A., & Maercker, A. R. A. (2025) · The Lancet · doi:10.1016/s0140-6736(25)00354-x · Cited by 62 · see citing works
Grief rumination mediates the association between self-compassion and psychopathology in relatives of missing persons
Lenferink, L., Eisma, M., de Keijser, J., & Boelen, P. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1378052 · Cited by 50 · see citing works
Prolonged grief and attachment security: A latent class analysis
Maccallum, F., & Bryant, R. A. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.07.038 · Cited by 55 · see citing works
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One or Multiple Complicated Grief(s)? The Role of Kinship on Grief Reactions
Fernández‐Alcántara, M., & Zech, E. (2017) · Clinical Psychological Science · doi:10.1177/2167702617707291 · Cited by 49 · see citing works
Anxious and depressive avoidance behavior in post-loss psychopathology: a longitudinal study
Boelen, P. A., & Eisma, M. C. (2015) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2015.1004054 · Cited by 54 · see citing works
Toward a Better Understanding of Psychological Symptoms in People Confronted With the Disappearance of a Loved One: A Systematic Review
Lenferink, L. I. M., de Keijser, J., Wessel, I., de Vries, D., & Boelen, P. A. (2017) · Trauma Violence & Abuse · doi:10.1177/1524838017699602 · Cited by 50 · see citing works
Grieving as a Form of Learning: Insights from Neuroscience Applied to Grief and Loss
O'Connor, M., & Seeley, S. H. (2021) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2021.08.019 · Cited by 38 · see citing works
An exploration of gender and prolonged grief symptoms using network analysis
Maccallum, F., Lundorff, M., Johannsen, M., Farver-Vestergaard, I., & O’Connor, M. (2021) · Psychological Medicine · doi:10.1017/s0033291721003391 · Cited by 45 · see citing works
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DSM-5-TR prolonged grief disorder and DSM-5 posttraumatic stress disorder are related, yet distinct: confirmatory factor analyses in traumatically bereaved people
Lenferink, L. I. M., van den Munckhof, M. J. A., de Keijser, J., & Boelen, P. A. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.2000131 · Cited by 42 · see citing works
Distinct neural mechanisms of emotional processing in prolonged grief disorder
Bryant, R. A., Andrew, E., & Korgaonkar, M. S. (2021) · Psychological Medicine · doi:10.1017/s0033291719003507 · Cited by 39 · see citing works
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Prolonged grief and posttraumatic stress disorder following the loss of a significant other: An investigation of cognitive and behavioural differences
Smith, K. V., & Ehlers, A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0248852 · Cited by 46 · see citing works
Prolonged Grief, Posttraumatic Stress, Anger, and Revenge Phenomena Following Homicidal Loss
Boelen, P. A., van Denderen, M. Y., & de Keijser, J. (2015) · Homicide Studies · doi:10.1177/1088767915580674 · Cited by 37 · see citing works
A framework of meaning attribution following loss
Smid, G. E. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1776563 · Cited by 37 · see citing works
Symptoms of prolonged grief and posttraumatic stress following loss: A latent class analysis
Maccallum, F., & Bryant, R. A. (2018) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867418768429 · Cited by 36 · see citing works
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It’s not who you lose, it’s who you are: Identity and symptom trajectory in prolonged grief
Harris, C. B., Brookman, R., & O’Connor, M. (2021) · Current Psychology · doi:10.1007/s12144-021-02343-w · Cited by 36 · see citing works
The push and pull of grief: Approach and avoidance in bereavement
Maccallum, F., Sawday, S., Rinck, M., & Bryant, R. A. (2015) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2015.02.010 · Cited by 34 · see citing works
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Preparedness for the death of an elderly family member: A possible protective factor for pre-loss grief in informal caregivers
Singer, J., & Papa, A. (2021) · Archives of Gerontology and Geriatrics · doi:10.1016/j.archger.2021.104353 · Cited by 32 · see citing works
The presence of your absence: A conditioning theory of grief
Boddez, Y. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.04.006 · Cited by 30 · see citing works
Change in avoidance and negative grief-related cognitions mediates treatment outcome in older adults with prolonged grief disorder
Lechner-Meichsner, F., Mauro, C., Skritskaya, N. A., & Shear, M. K. (2022) · Psychotherapy Research · doi:10.1080/10503307.2021.1909769 · Cited by 27 · see citing works
Identity confusion in complicated grief: A closer look.
Bellet, B. W., LeBlanc, N. J., Nizzi, M., Carter, M. L., van der Does, F. H. S., Peters, J., Robinaugh, D. J., & McNally, R. J. (2020) · Journal of Abnormal Psychology · doi:10.1037/abn0000520 · Cited by 27 · see citing works
Predictors of treatment response for cognitive behaviour therapy for prolonged grief disorder
Bryant, R. A., Kenny, L. M., Joscelyne, A., Rawson, N., Maccallum, F., Cahill, C. M., & Hopwood, S. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1556551 · Cited by 27 · see citing works
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Circulating levels of oxytocin may be elevated in complicated grief: a pilot study
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Authors: Maccallum, F., & Bryant, R. A.
Affiliations: UNSW Sydney (AU)
Corresponding author: Maccallum, Fiona
ORCID: Maccallum, Fiona
Bryant, Richard A.
Venue: Clinical Psychology Review
Publisher: Elsevier BV
Published: 2013-08
Volume: 33
Issue: 6
Pages: 713-727
ISSN: 0272-7358 (ISSN-L)
DOI: 10.1016/j.cpr.2013.05.001
OpenAlex: W1997669167
Cited by: 214
References: 137
Citations by year: 2026: 24 · 2025: 23 · 2024: 16 · 2023: 20 · 2022: 12 · 2021: 26 · 2020: 20 · 2019: 11 · 2018: 9 · 2017: 22 · 2016: 11 · 2015: 11 · 2014: 9
FWCI: 1.53
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Clinical Psychology Review (publishedVersion)
PubMed (publishedVersion)
Topics: Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
Social Sciences › Psychology › Developmental and Educational Psychology › Identity, Memory, and Therapy
Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
Keywords: prolonged grief disorder, complicated grief, bereavement, attachment, self-identity, autobiographical memory, coping strategies, longing, appraisal, grief therapy
MeSH terms: Adaptation, Psychological, Bereavement, Death, Grief, Humans, Memory, Models, Psychological, Object Attachment

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A Cognitive Attachment Model of prolonged grief: Integrating attachments, memory, and identity

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