Bereavement: A D.I.S.C. Analysis
Dillenburger, Karola, Keenan, Mickey, Behavior and Social Issues
Theories of bereavement abound. The endeavour to understand this complex process has moved from intra-psychic explanations and stage theories to cognitive rationalizations and, most recently, process orientated explorations of bereavement. What has been missing in most of the literature to date is a detailed analysis of the context within which bereavement behaviours occur. This paper outlines a contingency analysis that includes consideration for the context of Death itself, Individual factors of the bereaved, Social factors, and influences of Cultural norms and systems (D.I.S.C.). The paper concludes by proposing that a comprehensive D.I.S.C. analysis might lead to whole person evidence-based practice in helping those who are experiencing bereavement.
KEYWORDS: bereavement, behavior analysis, trauma, death
It is a myth to think death is just for the old. Death is there from the very beginning. (Herman Feifel, in Cassingham, 2004).
Human reaction to bereavement and loss is widely discussed in the psychological literature. Generally speaking it is thought that, "The death of someone close is, for many, the most devastating experience in life. Most people find ways of adjusting to their loss; for others it may be too difficult without additional support."(Strang, 2001). Holmes and Rahe (1967) rated death of a spouse as the most stressful life event people experience. Commonly, a range of theories is employed in an effort to understand and explain the human experience of bereavement, loss, and separation. In this paper, the evolution of theories of bereavement is very briefly described and critically assessed in the context of newly emerging data from long-term studies of traumatic bereavement. Then a contingency analysis of the context and process of bereavement is offered based on recent thinking in behaviour analytic research. Finally, implications for working with the bereaved are explored.
EVOLVING THEORIES OF BEREAVEMENT
For the past decade or so, the controversy has grown about the utility of existing theories related to grief and mourning (Fulton, 2003). Before having a look at what the science of behaviour analysis can offer to the topic, a brief overview of the evolution of theories of bereavement to date is outlined. Given the amount of writing in the field such a brief visit obviously cannot cover all the ground. Therefore, some general trends are outlined. The writers and thinkers to whom we refer to are by no means exhaustive of the available literature. They are to be viewed merely as representative of main trends in the evolution of theories of bereavement.
In Western scientific literature Freud's (1963) ideas of an inevitable grieving process or "grief work" that serves to end emotional and internal attachments to a love object, and the necessarily detrimental effects of not going through the natural path of grieving, have had a massive and extremely long lasting influence on thinking in the area (Worden, 1991). For centuries bereavement and grieving was understood in terms of stages that the bereaved has to go through in order to adjust to the loss (Stroebe, 2002). Although in the main these stages were considered not to be static, often they were described as following a relatively uniform sequence of shock, denial, depression, anger, regaining equilibrium or homeostasis, and recovery or resolution. Intriguingly, there was no agreement on the number of stages that the bereaved person had to go through. For example, Rubin (1977) and Tatelbaum (1981) stated that there are three stages, while Conroy (1977) and Bowlby (1980) described four; Kuebler-Ross (1969) and Littlewood (1986) outlined five stages, and Calhoun, Selby, and King (1976) used six categories, while Lipinski (1980) depicted seven stages of grief (cf. Dillenburger, 1992).
In the early 1990's professionals who worked with the bereaved became increasingly dissatisfied with the restrictive nature of stage theories and fresh approaches were called for (Greally, 1993; Stroebe & Stroebe, 1991). As a result, new ideas emerged. A popular example was the concept of a Grief Wheel (Goodall, Drage, & Bell, 2003) that suggested there are no clear-cut dividing lines between each phase/stage of the grieving process but that each phase merges into the next with some movement backwards and forwards. While the suggestion of more permeable boundaries (Minuchin, 1974) between stages was viewed as an advance, this new model still adhered to the traditional ideas of stages of grieving. However, increasingly researchers suggested that, "stage theories of adjustment are of little value" (Boohan, McGuiness & Trew, 1993, p. 37), and criticised stage theories as based on assumptions that have their origin in Western philosophy, as culturally insensitive (Spates, 2002), and as generally oblivious to contextual and learning processes (Baer, 1970; 1973).
Since then, serious attempts were made to rectify these problems and the idea gained predominance, that, "[i]n bereavement obviously some changes are linked to the loss itself (primary changes). Others, however, are more controllable and can actually be influenced (secondary changes)" (Dillenburger, 1992, p. 114). The Dual Process Model (DPM) (Stroebe & Schut, 1999) evolved as a dominant concept of coping. DPM was concerned broadly with two processes in bereavement: loss and restoration. Stroebe and Schut (1999) suggested that a loss orientation primarily represented emotional and mental coping with the loss, and restoration orientation referred to dealing with practicalities, coping with changes in everyday life, and taking on new roles. They acknowledged that both orientations contained emotional and problem-oriented elements and suggested that the oscillation between these two orientations was to be considered a necessary process for successful coping with bereavement. This categorisation of bereavement experiences was less prescriptive than stage theories and more sensitive to cultural and gender differences (Buchebner-Ferstl, 2003).
Most recently, a plethora of new concepts and much more integrative frameworks emerged with the aim of guiding future research. Cognitive psychologists, for example Malkinson and Ellis (2000), contended that bereavement presents the individual with new information that must be cognitively processed, assimilated, or accommodated. In their view cognitions are "central and essential to the normal process of grief, and must, therefore, be experienced and overtly expressed" (p. 176). Others went further and challenged the whole idea of grief work. For example, Wortman and Silver (1989) challenged the widely held assumption that working through grief was necessary for resolution. In their research people who did not show distress after the loss of a loved one did not necessarily experience subsequent difficulties.
Another concept that has recently been challenged is the assumption that detachment from the deceased is the desired outcome of grieving. Fraley and Shaver (1999) suggested that continuing bonds can and do exist. Walter (1996; 1998) has argued for some time that the purpose of grief is not severing the bonds with the deceased but rather the construction of long-lasting, durable biographies in which the memory of the deceased is integrated into the life of the bereaved. He suggests that the process through which this is achieved is based on conversations with those who knew the deceased.
In fact, the whole idea of bereavement being a semi-pathological process has been challenged. Evolutionary psychologists, for example Archer (1999), argued that grief is a natural reaction to the loss of a relationship and acknowledged the importance of ethology to aide understanding of human reactions to loss. They cautioned reductionistic concepts of grief and pointed out that many of the generalised theories of grief were based on idiosyncrasies of Western, in many cases Anglo-American, society, again petitioning cross-cultural considerations. The importance of the bereaved person's overall social context also has become increasingly recognised. For example, Bonanno and Kaltman (1999) utilising fundamental components from cognitive stress theory, socialfunctional accounts of emotion, attachment theory, and trauma theory suggested an account that includes an interaction between context, representations of the lost relationship, meaning, and coping and emotion-regulation processes.
This brief historical overview of the most pertinent trends in the evolution of theory in bereavement is by no means complete. More comprehensive reviews are available elsewhere (e.g., Genevro, 2003; Klass, Silverman, & Nickman, 1996; Neimeyer, 2001; Irish, Lundquist, & Nelson, 1993; Stroebe, Hansson, Stroebe, & Schut, 2001). The purpose of this paper is not to offer a comprehensive review of existing bereavement literature, but to show that the science of behaviour analysis can make significant and useful contributions to modern day understanding of bereavement.
EVOLVING KNOWLEDGE IN BEHAVIOUR ANALYSIS
At the same time as bereavement theories evolved, the science of behaviour analysis developed during the past century. The history of behaviour analysis is well documented (see for example, Lutzker & Whitaker, 2005; Roediger, 2004; Skinner, 1983). While at first much of the work was lab-based using simple organisms to explore simple behavioural processes, soon applied workers were keen to get involved (Baer, Wolf, & Risley, 1969; 1987). Before long, more complex behaviours such as relationships, creativity, intimacy, language, love and fear were explored with human subjects (Chance, 1999; Cordova & Scott, 2001; Skinner, 1989). Despite the fact that behavior analysis has moved well beyond the early methodological behaviourism of Watson, embracing radical behaviourism of Skinnerian behaviour analysis (Skinner, 1953; 1971), behavior analysis is still criticized wrongly as being unable to explain complex behaviours.
Today, behaviour analysis (represented by organisations such as the Association for Behavior Analysis and Division 25 of the American Psychological Association) is a thriving science with conceptual, experimental, and applied foci. Yet, in the early days, the issue of bereavement received only scant attention (Ashkanazi, 1977; Ramsey, 1977). In the 1990's this changed when a small number of behaviour analysts began to explore the potential of applying behaviour analytic knowledge to the phenomenon of bereavement and grief in more depth (Calkin, 1990; Dillenburger & Keenan, 1994). However, it was not until the late 1990s and early 2000's before others joined (Dillenburger & Keenan, 2001; Follette, Ruzek, & Abueg, 1998; Fraley, 1998; Rakos, 1998; Spates, 2002; Sulzer-Azaroff, 1999). To date, behaviour analytic literature of bereavement is still relatively scant and the remainder of this paper is devoted to expanding on contributions that behaviour analysis can make to the understanding of bereavement. Many of the behaviour analytic ideas outlined below are familiar to behaviour analysts, especially clinical behaviour analysts (Thyer, 1999) though their application to bereavement is not widely appreciated or publicised.
Before going into more detail, it is important to note that in behaviour analysis the term behaviour is used inclusively for covert (e.g., emotional and cognitive) and overt behaviours. "At the most basic level they [emotions and cognitions] are things people do. People 'do' think, they 'do' feel. Consequently, it may be useful to analyse feelings and thoughts by considering them together with other things people do. The usual term for things people do is human behaviour" (O'Hagan & Dillenburger, 1995, p. 156). Appropriately then, human behaviour is considered to be "anything that people do, including what they say and what they think and feel" (Reese, 1978, p. 2). This is an important point because all too often critics who have not kept up-to-date with developments in the science claim that behaviour analysts are not interested in the inner world of the individual, to the extent that behaviour analysis still is compared to blackbox psychology (Driscoll, 2000). Nothing could be further from the truth. Behaviour analysts are acutely interested in inner behaviours (Calkin, 1990; Keenan & Dillenburger, 2004; Skinner, 1989), however, explanations for behaviour that are placed inside the behaving person are exposed as hypothetical or fictional because, strictly speaking, they are based on circular reasoning and mentalism (Baum, 1994).
In this context, behaviour analysis exposes a significant problem with theories in the existing bereavement literature, which is the fact that even the most recent bereavement theories involve category mistakes (Ryle, 1949) in their search for explanations (Figure 1). Ryle offered an example of a category mistake. A visitor to Cambridge is shown lecture theatres, libraries, student canteens, and faculty offices and then asks to see the University. Similarly, a category mistake occurs if someone meets the mother, sister, uncle, granny, and then asks to meet the family, or when the meteorologist forecasts rain, storm, sunshine, and weather (Keenan, 2003). University, family, and weather do not belong in the same category as individual buildings, family members, or weather conditions. In fact, the former are summary labels (Grant & Evans, 1994) that encapsulate the latter. Holth (2001) warns, "many psychologists simply ignore the problem of category mistakes by treating both behavior and mental 'events' concurrently as dependent variables or explananda and both historical and mental 'events' concurrently as causes, with no embarrassment whatsoever" (p. 210).
In the bereavement literature then, terms such as shock, denial, distress, realisation, resolution, homeostasis, bond, growth, equilibrium, grief, etc., are summary labels for various behaviours that are observed after the death of a loved one. The summary label "grief," for example, includes behaviours such as crying, feeling sad, worrying, having present thoughts of the person, having a memory of a shared event, having feelings towards the person, behaving angrily (Calkin, 2001). Consequently, it is a category mistake, to look for shock, denial, distress, realisation, resolution, homeostasis, bond, growth, equilibrium, grief, etc., when we see a person being sad, searching, crying, or talking about the dead in a certain way, because the earlier terms already function as summary labels for these behaviours. In other words, because they already function correctly as descriptive terms they cannot be used again as explanatory terms. What's more, their descriptive function is derived from behaviour that is observed either by others or by the person living the experience. Thus, both the outer and inner worlds of the person are described by these terms. More detailed discussions of problems with reification, mentalism, and category mistakes can be found elsewhere (Baum, 1994; Grant & Evans, 1994; Keenan & Dillenburger, 2000).
Behaviour analysis offers an alternative approach to understanding bereavement, loss, and grief that avoids mentalism, and exposes the logical fallacy of post hoc ergo propter hoc inherent in most existing bereavement theories. Behaviour analysis is based on contingency analysis of processes "by which the behavior of every creature on earth adjusts according to the cumulative effect of moment to moment interactions with its environment" (Vargas, 2001, p. v). For behaviour analysts, behaviour (private and/or public) is a natural function of contingencies. While unusual or difficult contingencies may lead to unusual or difficult behaviours, all behaviour is natural, given the contingencies defining the context. In a contingency analysis, bereavement behaviours are understood holistically as the interaction of an individual organism with his/her environment within a cultural context (De Mey, 2003; Dillenburger & Keenan, 2001). In other words, the understanding of bereavement behaviours is based on a comprehensive contextual analysis of the contingencies of which the behaviour of the bereaved is a function (Dillenburger & Keenan, 1994/2001).
As with most processes, there usually is no distinct boundary demarcating where one behaviour ends and the next begins. Figure 2 illustrates the view of behaviour as a continuous stream (illustrated here as a film strip) in which the observation of a specific behaviour is considered a snapshot of one segment of the overall behavioural stream (Keenan, 1997a, 1997b; Keenan & Dillenburger, 2000). In the image the snapshot observation of behaviour is placed under the microscope to illustrate that it is possible to look precisely at the minutiae of behaviour without loosing the focus of its overall composition in context. This conceptualisation of behaviour is the basis of the analysis of bereavement behaviours proposed in the remainder of this paper.
Functional relations and operants
At a very basic level the search for explanations involves a search for functional relations between dependent and independent variables. This is a dynamic systems perspective (Novak, 1996) that relates changes in behaviour to the context in which they occur. More specifically, the analysis of functional relations between behaviour and environmental context is based on the examination of contingencies of reinforcement and punishment that are functionally related to the behavior (Sturmey, 1996). Functional relations can differ along at least two parameters. First, topographically similar behaviours can be a function of dissimilar contingencies. For example, crying can be a function of positive reinforcement contingencies (such as social attention) or of negative reinforcement contingencies (such as those involved in escape or avoidance). Second, topographically different behaviours can be a function of similar contingencies (e.g., strong silence and crying may both result from loss of a loved one) (Dillenburger, 2000). The term operant is used to summarize the latter category of behaviours (Lee, 1981); for example, the operant "eating" includes a range of different eating behaviours that are all a function of similar reinforcers (i.e., taste of food, satiety) (Johnson & Pennypacker, 1993).
Identifying pertinent operants in bereavement is complicated, due to the complexity of behaviours involved. Some time ago, we made a start by referring to "pasting" and "futuring" (Keenan, 1997a, 1997b), two categories of behaviours (private and public) that although common in everyday life, seem to occur more frequently in bereavement (Dillenburger & Keenan, 2001). These terms stem from the observation that much of the suffering in bereavement comes from problems with living in the here and now. "Guilt and anxiety are children of the past and future. To the extent that a person dwells upon the should-have-been or might-be of life at the expense of living life in the reality of the present, he suffers" (Brandon, 1990, p. 63).
When applied to the bereavement process, pasting includes operants that are a function of contingencies related to the past when the deceased was alive, such as talking about the deceased, thinking about him, remembering, crying, as well as other more public behaviours such as setting a place for him at the table, keeping his room unchanged, or visiting the grave. Futuring includes opérants that are a function of contingencies that are related to the future without the deceased, such as talking about future activities, planning a trip, making new friendships, reorganising the house, or buying new furniture. This is not to be confused with loss and restoration orientations described by Stroebe and Schut (1999). Here we are talking about more than general summary labels. We are talking about detailed contingency analyses of which bereavement behaviours are a function.
Both pasting and futuring depend on at least four different contingency contexts, including those related to (1) the Death itself, such as circumstances of the death and the way the death message is communicated, (2) Individual contexts, such as age, individual learning histories including the relationship with the deceased, and previous experience with bereavement, (3) Social circumstances, such as support from family and friends, and (4) Cultural and political backdrop, such as prevailing cultural rites and changing political norms (D.I.S.C. analysis). Figure 3 illustrates this D.I.S.C. analysis. It encapsulates Skinner's (1989) point when he noted that the word experience originally meant, "something a person had 'gone through' (from the Latin expiriri)" (p. 13). The illustration refers to the network of contingencies that a person is exposed to over a period of time. When a person travels through this context he/she changes. These changes become integral parts of what it means to be that person. To be a person, then, can be seen as the evolution of a dynamic process comprising physical and behavioural changes (Lee, 1988; Smith, 1985). The nature and extent of these changes is dependent on the interplay between "the dynamic limitations inherent in the adaptiveness of the [human] biological system and the dynamic limitations [in organism-environment interactions that are] imposed across time by the structure of the prevailing contingencies" (Keenan & Toal, 1991, p. 113). This mercurial-like quality of being a person is nicely captured by the idea of a behavioural stream that continually changes (Figure 2), and is changed by, its physical and social embankment/environment (Keenan, 1997'a, 1997b; Schoenfeld & Farmer, 1970)
The circumstances of the death are widely believed to have an impact on bereavement outcome (Mollica, 2000; Stroebe & Stroebe, 1987). For example, Dillenburger (1992) assessed psychological health of widows who had lost their husband in violent circumstances in Northern Ireland and found that traumatic death was associated with much higher levels of psychological disturbance than other kinds of deaths. In fact, 67.2% of widows who had experienced traumatic loss were in need of psychological help, while Cox (1987) reported that 37% of widows who had not experienced traumatic bereavement were considered in need of further help. In the general population these figures range between 26% (Cairns & Wilson, 1984) and 22.8% (Barker, McClean, McKenna, Reid, Strain, Thompson, Williamson, & Wright, 1988). In fact, a high level of psychological disturbance in the Northern Irish widows was maintained over a 30-year period (Dillenburger & Keenan, 2003). Of course psychological measures of health usually rely on verbal self-reports and as such cannot deliver reliable behavioural data (Guerin, 2001), but for the time being such measures are the only ones available.
In behaviour analytic terms, the event of traumatic death is considered amenable to an analysis involving respondent conditioning (Fraley, 2001). Through the experience of the death of a loved one, unconditioned aversive stimuli (e.g., the sound of a bomb explosion) are paired with neutral stimuli (e.g., a certain street corner) that come to function as conditioned aversive stimuli (e.g., widow avoids street corner where the event happened). Spates (2002) wrote that, "a trauma episode can successfully receive the force of conditioning after a single trial. This means that a single automobile crash, a single rape, a single episode of interpersonal violence or a single earthquake episode is sufficient to achieve conditioning of neutral stimuli. The stimuli associated with these events come, on future occasions, to evoke responses on a generalization gradient with the full traumatic stress reaction" (p. 14).
Principles of respondent conditioning are widely used in trauma treatment and therapy (Blake & Sonnenberg, 1998). Spates (2002) was confident that, "standard behavior therapy, utilizing exposure-based techniques, typically achieves rapid extinction of the controlling relations between identifiable environmental cues and fear/trauma reactions. The data are clear on this point whether the fear-target comprises phobic avoidance, panic, or other anxiety disorder" (p. 15). Spates based his confidence on a phenomenon called respondent extinction that offers a potential explanation for the Northern Irish data. Respondent extinction occurs when the conditioned stimulus is presented repeatedly over time without pairing it with the unconditioned stimulus until finally the conditioned response no longer occurs (Morganstern, 1973). In Northern Ireland prior to the ceasefires in 1994, over 30 years of intense community violence, the so-called Troubles, had lead to a wide range of stimuli being conditioned to induce fear, anxiety, and bereavement responses. While some of these stimuli were no longer present after the ceasefires in 1994, many of them still remain today and therefore prevent respondent extinction. For example, a mural on the wall depicting triumphant images of the Troubles, so-called "peace lines" in the neighbourhood (walls around ghetto areas to keep communities apart), or bags left unattended in a train station may continue to bring about waves of anxiety in a widow whose husband had been killed in these contexts.
The way in which the death message is communicated to the bereaved is thought to have a profound effect on bereavement behaviours (Kirschner, 1977). For example, Kuebler-Ross (1969) talks extensively about the importance of leave-taking for bereavement outcome, in other words, about the importance of being there when the loved one dies. Widows who were present when their husband was killed in traumatic circumstances scored somewhat lower on measures of psychological health, such as the General Health Questionnaire (GHQ-30; Goldberg, 1978) than those who were told by a third party (GHQ-30 mean score 7.2 vs. 10.9), although both exceeded by far the normative threshold for psychological disturbance of GHQ-30 mean score of 5.0. Interestingly, the difference diminished 10-30 years after bereavement (GHQ-30 mean score 9.6 vs. 8.2) (Dillenburger & Keenan, 2002). As such, while the way death was communicated seemed to have an impact on bereavement outcome for some time, this difference declined in the very long term.
While to date mainly intra-psychic explanations have been suggested for this kind of phenomenon, in behavioural terms this observation is explained by B.F. Skinner (1989) who recognised some time ago that "[t]hose who have been directly exposed to contingencies behave more subtly and effectively than those who have merely been told, taught, or advised to behave or who follow rules. There is a difference because rules never fully describe the contingencies they were designed to replace. There is also a difference in the states of the body felt" (p. 44).
The death of a loved one has two further interwoven impacts: a reinforcer establishing effect that changes the reinforcing effectiveness of a stimulus and an evocative effect that modifies the current frequency of all responses that have been reinforced by that stimulus. Michael (2000) used the term establishing operation (EO) for events that function in this way. Rakos (2001) explained, "the loss of the loved one and the conditions under which the loss occurred, (a) introduce the 'motivations' that make some environmental stimuli function as reinforcers, and (b) are associated with a change in the frequency of those behaviors that are likely to acquire or avoid those reinforcers" (p. 176). Sulzer-Azaroff s (1999) personal annotations illustrate this point; "the experience of losing my husband must have functioned as an establishing operation, changing the value of some of those presumed reinforcing activities. While some persisted, gardening and music dropped out entirely" (p. 59).
In regard to the Northern Irish data it seems logical to consider the actual experience of being present when their husbands were killed as an establishing operation that changed the effectiveness of reinforcers, inhibited the frequency of grief responses, and increased avoidance responses. This appeared to foster the widows' coping in the shortterm. However, long-term data indicate that this effect diminished over time.
Individual past experiences and present context influence the way in which each bereaved person responds to the death of a loved one. For example, Dillenburger and Keenan (2003) found that younger widows (<50 years of age) seem to suffer greater psychological ill health than older widows (>50 years of age), regardless of length of bereavement (GHQ-30 mean score 11.3 vs. 8.0). Rather than interpreting these differences as biological or intra-personal phenomena, Guerin (1994) suggested that with regard to age, gender, ethnicity, or marital status, etc., contingencies of reinforcement are similar for similar groups of people. Similar behaviour of widows in certain age groups then is understood as a function of similar contingencies of reinforcement and punishment; for example, younger widows are more likely to have non-widowed friends, young children, work commitments, while older widows are more likely to have had previous experience with death and bereavement, grown-up children, and widowed friends who support them socially.The relationship of the bereaved to the deceased prior to his or her death is widely thought to influence bereavement outcome (Rubin, Malkinson, & Witztum, 2003). This is a difficult area to measure because any assessment of quality of relationship relies on retrospective reports. However, there can be no doubt that the history between the bereaved and the deceased influences bereavement outcome. As in any relationship, before his death the deceased (e.g., the husband) was a source of much reinforcement for all kinds of behaviours of the bereaved (e.g., his wife). With his death, this source of reinforcement is no longer available.
A well-known behavioural process called operant extinction (Cooper, Heron, & Heward, 1987) takes place when previously reinforcing stimuli are no longer available. The behaviour that was previously reinforced by these stimuli extinguishes. The extinction process follows a well-researched pattern (Sulzer-Azaroff & Mayer, 1991). Initially, an extinction burst is experienced, that is, an intensification of previously reinforced behaviours occurs. With regard to the widow who lost her husband, the extinction burst may include a range of behaviours that are related to the deceased, such as talking about him, thinking and dreaming about him, even visualising him, and setting his place at the dinner table. This is followed by gradual reduction of these behaviours. At some later point, spontaneous recovery of previously reinforced behaviours is part of the extinction process. For the widow this may mean that just when she was beginning to feel a little better, very intense bereavement reactions recur, for example around anniversaries or at Christmas. Furthermore, extinction induced aggression is frequently observed as part of the extinction process. This might explain aggressive feelings, such as anger, guilt, or blame and outbursts of aggressive behaviours following the death of a loved one, such as revenge seeking or self-injurious behaviour (Dillenburger & Keenan, 2001). For example, during the wake the focus is on the deceased and the bereaved in the company of others "re-lives" many of the behaviours previously associated with the deceased during a relatively short time period without reinforcement of these behaviours. It is entirely possible that the contingencies that are in place during the wake set the occasion for the extinction burst. The feeling of "closure" after the wake and the funeral signals that the bereaved is now going to experience new contingencies that will lead to new "coping" behaviours.
Individual differences such as the age, previous life experience, and the relationship to the deceased have an important impact on bereavement outcome (Moynahan, 2001). However, they cannot be viewed without consideration of social contexts.
A supportive environment helps in the coping process as evidenced in a multitude of support networks and help-lines (Stroebe & Stroebe, 1983). Widows in Northern Ireland who had frequent social contact expressed much better psychological health when compared with widows who had infrequent and irregular social contact (GHQ-30 score 1.0 vs. 14.0). Furthermore, widows who had considered re-marriage scored lower on the GHQ-30 than those who had not considered this possibility (GHQ-30 score 5.2 vs. 10.6; Dillenburger & Keenan, 2002). For bereaved people who are well supported socially, Joseph and Linley (2004) emphasised the potential for positive change or adversarial growth following trauma, for example, the bereaved may do things they would not have done prior to the loss, such as go on foreign travel, write poetry, or take up a new hobby, or they may experience an intense feeling of being alive.
A number of behaviour analytic principles are operating here. In conjunction with the behavioural processes described earlier, a shaping process (Grant & Evans, 1994) is operating in which new adaptive behaviours of the bereaved are selected and reinforced in changed social contexts. Prior to his death the deceased not only approved of and encouraged (i.e., reinforced) behaviours of the bereaved, he also disapproved of or "punished" certain behaviours. After his death others may actively reinforce these behaviours. "It is not unheard of that a bereaved person 'finds a new lease of life' after the death of a loved one. This does not mean that she does not miss the deceased or would not prefer him to be alive, but in time, behaviours that were not reinforced [or were punished] by the deceased emerge, are reinforced by others, and flourish" (Dillenburger & Keenan, 2001, p. 15).
Rosales-Ruiz and Baer (1996) described transitions like this as developmental cusps. "A cusp is an interaction, or complex of interactions, that enables access to new reinforcers, new contingencies and new communities of reinforcement contingenciesand thus to new behaviours, and to new cusps, not all of which need to be seen by all of us as positive or desirable" (p. 156). The core of this "process of re-learning" (Parkes, 2003) for the bereaved is the development of new behavioural repertoires in conjunction with the extinction of old behavioural patterns. This process is functionally similar to a fading procedure (Martin & Pear, 1992).
Findings regarding the positive long-term effect of frequent social contact (Joseph, Linley, & Harris, 2005) corroborate the suggestion that it allows the bereaved to find alternative sources of reinforcement that function to strengthen existing and develop new survival skills and coping behaviours. Sulzer-Azaroff (1999), describing her response to the death of her first husband, wrote: "Basic behavioral principles allowed me to understand the grieving process. The anger and depression the children and I felt were a normal response to the extraordinary punishment and extinction conditions in effect. I also knew it would be temporary, which helped a great deal. I realized that recognizing and availing myself of alternative reinforcing choices would hasten the recovery process" (p. 57-58). Without a doubt, the social contingency context in which the bereaved find themselves before, during, and after the loss plays an important part in the bereavement process and ultimately determines the "social meaning of death" (Michalowski, 1976).
Increasingly, the cultural context in which the bereavement is experienced is viewed as influential in the process of recovery (Irish, Lundquist, & Nelson, 1993). For example, in Northern Ireland the cultural context changed dramatically during the past 30 years. Prior to the ceasefires in 1994, the Troubles in Northern Ireland had cost over 3,500 lives. Sectarian murders were a near daily occurrence reported repeatedly in television news and newspapers. There was very limited support for those who lost loved ones (in 1985 after extensive searches only 8 support groups could be located in the whole Province). A typical response to the study of traumatic death in Northern Ireland during that time looked like this: "I was very pleased to receive your letter. As sometimes I think nobody cares" (Dillenburger, 1992, p. 53). Findings that widows had not recovered from violent bereavement even 10 years after their husband's death were all but ignored by academics and practitioners (Cairns & Darby, 1998).
The context for widows in Northern Ireland changed dramatically after the ceasefires in 1994 and the ensuing Peace Process, when awareness of victim/survivor issues intensified dramatically. In fact, recognition of victims' issues was enshrined in the Good Friday Agreement and consequently in the Victims' Strategy of the Office of the First Minister and Deputy First Minister (OFMDFM). New victims units were established. Research data related to the Troubles, the deaths, and bereavement services became widely available (CAIN, 2004). Yet, there seems to have been no progression in recovery from traumatic death in Northern Ireland. Average GHQ-30 scores remained much the same after the ceasefires than they had been before (GHQ-30 score 8.7 vs. 9.8) (Dillenburger & Keenan, 2003). What happened?
Stroebe, Stroebe, Zech, and van der Bout (2002) are critical regarding the effectiveness of counseling and narrative that is widespread within the bereavement services and suggest that disclosure of emotions does not necessarily facilitate recovery from bereavement. Gilligan (2004) asked if it is possible that people in Northern Ireland could be traumatised by peace. Is it possible that inadvertently this high level of interest in victims' issues in Northern Ireland hinders the extinction process necessary for appropriate coping? Is it possible that the increased attention on the suffering of victims reinforces bereavement behaviours instead of reinforcing coping behaviours as intended (Bloomfield, 1998)? Some of the comments from widows in Northern Ireland seem to imply this possibility; "plenty of money but no husband"; "Everybody is getting loads of money" (Dillenburger & Keenan, 2002). Influx of money and attention on victims' issues are phenomena that occur after mass trauma in most cultures. It is possible that bereavement behaviours are reinforced by culture or society in the sense that lack of such behaviours is considered lack of caring for the deceased. Each culture has established bereavement rites that are functionally related to cultural norms in society (Irish, Lundquist, & Nelson, 1993).
In behaviour analysis, cultural contexts are important for a comprehensive analysis (Lamal, 1991). Moynahan (2001) drew attention to the significance of events that occur distant from the behaviour of the individual. The technical term for such events is setting events (SE). Setting events provide the general context in which behaviour is observed. Glenn (1988) described metacontingencies as providing important and relevant setting events in general. For the bereaved in Northern Ireland setting events such as the Good Friday agreement and metacontingencies that are associated with bereavement services mean that they are embedded in cultural, political, and philosophical contexts on national, international, and global levels that impact on their bereavement behaviours.
In this paper we used the knowledge base established in the scientific analysis of behaviour as the basis for an interpretation of existing findings on bereavement. Current theories of bereavement are based on observations of behaviour of those who have lost a loved one. They describe the responses to the contingencies these people are exposed to in some considerable detail. These observations have shown that bereavement responses are a natural way to respond to traumatic and other loss contingencies and this conclusion has been helpful to people who felt very vulnerable at times of loss.
However, current bereavement theories place the explanation for these bereavement behaviours inside the grieving person. This practice brings with it numerous interpretive problems including category mistakes and mentalism and it draws attention away from functional relations between various categories of behaviour and the contingencies in which these behaviours are observed. In psychology as a whole, this practice has lead to the development of increasing numbers of psychological theories existing side by side in many areas of study. Vasta (1992) pointed out that such practice is one of the clearest manifestations of a science in its infancy. It runs counter to the scientific demand that mature theories should be parsimonious (Schlinger, 1995).
A potential of the D.I.S.C. analysis described in this paper is that, if used appropriately-for example, to discover risk and protective factors in bereavement, we could be identifying real contingencies that need changing, rather than looking for hypothetical constructs. Given that risk factors usually lie with the individual, the family, or community, are present before the problem arises, and are associated with an increased probability of a specific problem, the D.I.S.C. is a useful model. The same is true for the identification of protective factors. They too are located with the individual, the family, or community, can be biological or psychosocial, and influence a person's reaction to otherwise risky events (Dowdney, 2000; Rutter, 1990). Behaviour analysis of bereavement points towards a highly sophisticated analysis of these factors, an analysis of exactly those contingencies that are responsible for the occurrence of bereavement behaviours. This knowledge is invaluable for the understanding of the behavioural processes of bereavement and the design of treatment, when necessary, and should form the basis of future research.
Despite this obvious advantage, contributions of behaviour analysis to knowledge regarding complex behaviours such as bereavement have not been appreciated in existing literature (Geis, Whittlesey, McDonald, Smith, & Pfefferbaum, 1998). Reasons for this are complex and have been discussed in detail elsewhere (Harzem, 2001; Morris, 1985). What we have shown here is that the natural science perspective of behaviour analysis is a conceptual framework that offers a fresh approach to our understanding of bereavement. In considering the person to be the focal point of a number of influences it expands upon a point made by Skinner (1974): "A person is not an originating agent; he is a locus, a point at which many genetic and environmental conditions come together in a joint effect" (p. 168).
Archer, J. (1999). The nature of grief: The evolution and psychology of reactions to loss. New York: Routledge.
Ashkenazi, Z. (1977). The application of principles of operant conditioning to war widows and their children. In C. D. Spiegelberger, I. G. Sarason, & N. A. Milgram (Eds.). Stress and anxiety (pp. 255-259). Washington DC: Hemisphere.
Baer, D. M. (1970). An age-irrelevant concept of development. Merrill-Palmer Quarterly of Behavior and Development, 16, 238-245.
Baer, D. M. (1973). The control of the developmental process: Why wait? In J.R. Nesselroade, & H.W. Reese. (Eds.), Lifespan developmental psychology (p. 185-193). New York: Academic Press.
Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1, 91-97.
Baer, D. M., Wolf, M. M., & Risley, T. R. (1987). Some still current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20, 313-327.
Barker, M. E., McClean, S. L, McKenna, P. S., Reid, N. G., Strain, J. J., Thompson, K. A., Williamson, A. P., & Wright, M. E. (1988). Diet, lifestyle and health in Northern Ireland. Coleraine, N.Ireland: University of Ulster.
Baum, W. (1994). Understanding behaviorism: Science, behavior and culture. New York, NY: HarperCollins College Publishers.
Blake, D. D., & Sonnenberg, R. T. (1998). Outcome research on behavioural and cognitive-behavioral treatments of trauma survivors. In V. M. Follette, J. I. Ruzek, & F. R. Abueg. Cognitive-behavioral therapies for trauma (pp. 15-47). New York: Guilford Press.
Bloomfield, Sir K. (1998). We will remember them. Report of the Northern Ireland Victims Commissioner. Belfast: The Stationary Office Northern Ireland.
Bonanno, G. A., & Kaltman, S. (1999). Toward an integrative perspective on bereavement. Psychological Bulletin, 125, 760-776.
Boohan, M., McGuinness, C., & Trew, K. (1993). Individual differences in adaption to widowhood. The Psychological Society of Ireland, 24th Annual Conference, Sligo, Ireland. The Irish Psychologist, 4, 37.
Bowlby, J. (1980). Attachment and loss. London: The Hogarth Press.
Brandon, D. (1990). Zen in the art of helping. London: Arkana.
Buchebner-Ferstl, S. (2003). Gender-specific differences in coping with bereavement. Retrieved from the Web 11/11/03. http://www.oif.ac.at/aktuell/buchebner-ferstl_en.pdf.
Conflict Archive on the Internet (CAIN; 2004). Retrieved from the Web 03/02/2004. http://cain.ulst.ac.uk/.
Calkin, A. (1990). Changes in behavior as the result of the death of a relative. Journal of Precision Teaching, 7, 74-78.
Calkin, A. (2001). Response to Bereavement: A behavioural process. European Journal of Behaviour Analysis, 2, 139-142.
Cairns, E., & Darby, J. (1998). The conflict in Northern Ireland: Causes, consequences, and controls. American Psychologist, 53, 754-760.
Cairns, E., & Wilson, R. (1984). The impact of political violence on mild psychiatric morbidity in Northern-Ireland. British Journal of Psychiatry, 145, 631-635.
Cassingham, R. (2004). This is True; Herman Feifel. Retrieved from the Web 11/11/04. http://www.honoraryunsubscribe.com/herman_feifel.html.
Calhoun, L. G., Selby, J. W. & King H. E. (1976). Dealing with crisis. New Jersey: Prentice-Hall Inc.
Chance, P. (1999). Cognition, creativity, and behavior. The Behavior Analyst, 22, 161-163.
Conroy R. C. (1977). Widows and widowhood. New York State Journal of Medicine, 77, 357-370.
Cooper, J. O., Heron, T. E. & Heward, W. L. (1987). Applied behavior analysis. London, Toronto: Merrill Publishing Company.
Cordova, J. V., & Scott, R. L. (2001). Intimacy: A behavioral interpretation. The Behavior Analyst, 24, 75-86.
Cox, B. D. (1987). The health and lifestyle survey. Cambridge: Health Promotion Research Trust.
De Mey, H. R. A. (2003). Two psychologies. Cognitive versus contingency-oriented. Theory and Psychology, 13, 695-709.
Dillenburger, K. (1992). Violent bereavement: Widows in Northern Ireland. Avebury: Ashgate Publishing Ltd.
Dillenburger, K. (2000). Functional assessment and analysis. In M. Davies. Encyclopaedia of Social Work. Oxford: Blackwell Publishers.
Dillenburger, K., & Keenan, M. (1994/2001). Bereavement: A behavioural process. European Journal of Behaviour Analysis, 2, 129-138. (First published in Irish Journal of Psychology, 15, 524-539.)
Dillenburger, K., & Keenan, M. (2001). Islands of pain in a sea of change: Behaviour analysis and bereavement. European Journal of Behaviour Analysis, 2, 187-207.
Dillenburger, K., & Keenan, M. (2002). Some suggestions for a behaviour analysis of bereavement and loss. Behaviour Analysis in Ireland, 25 years Anniversary Conference, Maynooth, Ireland, (May, 5).
Dillenburger, K., & Keenan, M. (2003) A functional analysis of bereavement and loss. Annual Convention of Association for Behavior Analysis. San Francisco (May, 23-27).
Dowdney, L. (2000). Annotation: Childhood bereavement following parental death. Journal of Child Psychology and Psychiatry, 41, 819-830.
Driscoll, M. P. (2000). Psychology of learning for instruction (2nd ed.). Needham Heights, MA: Allyn & Bacon.
Follette, V. M., Ruzek, J. I., & Abueg, F. R. (1998). Cognitive-behavioral therapies for trauma. New York: Guilford.
Freud, S. (1963). Mourning and melancholia. In J. Strachey (Ed.), The standard edition of the complete works of S. Freud, Vol 14, p. 243. London: Hogarth Press.
Fraley, L. E. (1998). Behaviorological thanatology: Foundations and implications. The Behavior Analyst, 21, 13-26.
Fraley, L. E. (2001). Behaviorological principles for the analysis of bereavement. European Journal of Behaviour Analysis, 2, 143-153.
Fraley, R. C., & Shaver, P. (1999) Loss and bereavement: Attachment theory and recent controversies concerning 'grief work' and the nature of detachment. In J. Cassidy & P. Shaver (Eds.), Handbook of attachment theory and research (pp 735-759). New York: Guilford Press.
Fulton, R. (2003). Anticipatory mourning: A critique of the concept. Mortality, 8, 342-351.
Genevro, J. L. (2003). Report on bereavement and grief research. Washington, DC: Centre for Advancement of Health.
Geis, H. K., Whittlesey, S. W., McDonald, N. B., Smith, K. L., & Pfefferbaum, B. (1998). Bereavement and loss in childhood. Stress in Children, 7, 73-84.
Gilligan, C. (2004.) Traumatized by peace? The social construction of conflict-related trauma in Northern Ireland. Paper presented at Departmental Research Seminar, Department of Geography and Sociology, University of Strathclyde, (27 October).
Glenn, S. S. (1988). Contingencies and metacontingencies: Toward a synthesis of behavior analysis and cultural materialism. The Behavior Analyst, 11, 161-179.
Goodall, A., Drage, T., & Bell, G. (2003). The Grief Wheel. Making sense of the "symptoms" of grief. Retrieved from the Web 11/11/03. http://www.kuringgai.net/the_grief_wheel.htm.
Goldberg, D. P. (1978). Manual of the General Health Questionnaire. Oxford: NFER Publishing Company.
Grant, L., & Evans, A. (1994). Principles of behavior analysis. New York: HarperCollins College Publishers.
Greally, H. (1993). Bereavement research: Emerging trends. The Psychological Society of Ireland, 24th Annual Conference, Sligo, Ireland. The Irish Psychologist, 4, 29.
Guerin, B. (1994). Analysing social behavior. Reno: Context Press.
Guerin, B. (2001). Explanations of bereavement, grief, and trauma: The misuse of both mental and foundational terms. European Journal of Behaviour Analysis, 2, 154-161.
Harzem, P. (2001). The intellectual dismissal of John B. Watson: Notes on a dark cloud in the history of the psychological sciences. Behavioral Development Bulletin, 1, 15-16.
Holmes, T. & Rahe, R. (1967). Holmes-Rahe life changes scale. Journal of Psychosomatic Research, 77, 213-218.
Holth, P. (2001). The persistence of category mistakes in psychology. Behavior and Philosophy, 29, 203-219.
Irish, D. P., Lundquist, K. F., & Nelson, V. J. (1993). Ethnic variations in dying, death and grief. Washington, DC: Taylor & Francis.
Johnston, J. M., & Pennypacker, H. S. (1993). Readings for strategies and tactics of behavioural research (2nd Ed). Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers.
Joseph, S., & Linley, P. A. (2004). Adversarial growth and positive change following trauma: Theory, research, and practice. Ricerche di Psicologia, 27, 177-190.
Joseph, S., Linley, P. A., & Harris, G. (2005). Understanding positive change following trauma and adversity: Structural clarification. Journal of Loss and Trauma, 10, 83-96.
Keenan, M. (1997a). Teaching about private events in the classroom. Behavior and Social Issues, 6, 75-84.
Keenan, M. (1997b). 'W'-ing: Teaching exercises for radical behaviourists. In K. Dillenburger, M. F. O'Reilly, & M. Keenan (Eds.), Advances in Behaviour Analysis (pp. 46-81). Dublin: University College Dublin Press.
Keenan, M. (2003). Autism in N. Ireland: The tragedy and the shame. Public meeting, Stormont Buildings, Northern Ireland: Belfast (Sept. 30).
Keenan, M., & Dillenburger, K. (2000). Behaviour analysis: A primer. [Computer software]. New York: Insight Media.
Keenan, M., & Dillenburger, K. (2004). Why I'm not a cognitive psychologist: A tribute to B. F. Skinner. [Computer software]. New York: Insight Media.
Keenan, M., & Toal, L. (1991). Periodic reinforcement and second-order schedules. The Psychological Record, 41, 87-115.
Kirschner, E. (1982). Data on bereavement and rehabilitation of war widows. Series in Clinical & Community Psychology: Stress & Anxiety, 8, 219-224.
Klass, D., Silverman, P. R., & Nickman, S. (1996). Continuing bonds. Washington, DC: Taylor and Francis.
Kuebler-Ross, E. (1969). On death and dying. New York: Macmillan.
Lamal, P. A. (Ed.) (1991). Behavior analysis of societies and cultural practices. New York: Hemisphere.
Lee, V. L. (1981). The operant as a class of responses. Scandinavian Journal of Psychology, 22, 215-221.
Lee, V. L. (1988). Beyond behaviorism. Hillsdale, NJ: Lawrence Erlbaum.
Lipinski, B. (1980). Separation anxiety and object loss. In B. Schoenberg (Ed.), Bereavement counselling. London: Greenwood Press.
Littlewood, J. L. (1986). The social context of bereavement. British Sociological Association, Loughborough.
Lutzker, J. R., & Whitaker, D. J. (2005). The expanding role of behavior analysis and support. Current status and future directions. Behavior Modification, 29, 575-594.
Malkinson, R. (2001). Cognitive-behavioral therapy of grief: A review and application. Research on Social Work Practice, 11, 671-698.
Malkinson, R., & Ellis, A. (2000). The application of Rational-Emotive Behavior Therapy (REBT) in traumatic and nontraumatic loss. In R. Malkinson, S. Rubin, & E. Witztum (Eds.), Traumatic and nontraumatic bereavement: Clinical theory and applications (pp. 173-195). Madison, CT: Psychosocial Press.
Martin, G., & Pear, J. (1992). Behaviour modification. What it is and how to do it (5th ed). Upper Saddle River, New Jersey, Prentice Hall.
Michael, J. (2000). Implications and refinements of the establishing operation concept. Journal of Applied Behavior Analysis, 33, 401-410.
Michalowski, R. J. (1976). The social meaning of violent death. Omega, 7, 83-93.
Minuchin, S. (1974). Families and family therapy. London: Tavistock Publications.
Mollica, R. F. (2000). Waging a new kind of war: Invisible wounds. New Scientist, June, 36-39.
Morganstern, K. P. (1973). Implosive therapy and flooding procedures: A critical review. Psychological Bulletin, 79, 318-334.
Morris, E. K. (1985). Public information, dissemination, and behavior analysis. The Behavior Analyst, 5, 95-110.
Moynahan, L. (2001). Relatio ergo sum - a spontaneous commentary upon Dillenburger and Keenan. European Journal of Behaviour Analysis, 2, 162-174.
Neimeyer, R. A. (Ed.). (2001). Meaning reconstruction and the experience of loss. Washington, DC: APA Books.
Novak, G. (1996). Developmental psychology: Dynamical systems and behavior analysis. Reno: Context Press.
O'Hagan, K., & Dillenburger, K. (1995). The abuse of women within childcare work. Buckingham: Open University Press.
Parkes, C. M. (2003). Bereavement. Retrieved from the Web 11/11/2003. http://www.tandf.co.uk/journals/archive/bereave.pdf
Parkes, C. M., & Weiss, R. S. (1983). Recovery from bereavement. Basic Books, New York.
Rakos, R. F. (1998). Dying slowly with compassion and dignity-A commentary. The Behavior Analyst, 27, 27-31.
Rakos, R. F. (2001). Bereavement: Preliminary behavior analytic hypotheses. European Journal of Behaviour Analysis, 2, 175-182.
Ramsay, R. W. (1977). Behavioral approaches to bereavement. Behavioral Research and Therapy, 15, 131-135.
Raphael, B. (1984). The anatomy of bereavement. London: Hutchinson & Co.Ltd.
Reese, E. P. (1978). Human operant behavior: Analysis and application (2nd Ed.). Iowa: WM. C. Brown Company Publishers.
Roediger, R. (2004). What happened to behaviorism. American Psychological Society, 17, Presidential Column.
Rosales-Ruiz, J., & Baer, D. M. (1996). A behavior-analytic view of development. In S. W. Bijou & E. Ribes (Eds.), New directions in behavior development (pp. 155-180). Reno, NV: Context Press.
Rubin, S. (1982). Persisting effects of loss: A model of mourning. Series in Clinical & Community Psychology: Stress & Anxiety, 8, 275-282.
Rubin, S., Malkinson, R. & Witztum, E. (2003). Trauma and bereavement: Conceptual and clinical issues revolving around relationships. Death Studies, 27, 667-690.
Rutter, M. (1990). Psychosocial resilience and protective mechanisms. In J. Rolf, A. S. Masten, D. Cicchetti, K. H. Neuchterlein, & S. Weintraub (Eds.), Risk and protective factors in the development of psychopathology (pp. 181-214). New York: Cambridge University Press.
Ryle, G. (1949). The concept of mind. Chicago: The University of Chicago Press,
Schlinger, H. Jr. (1995). A behavior analytic view of child development. New York: Plenum Publishing Corporation.
Schoenfeld, W. N., & Farmer, J. (1970). Reinforcement schedules and the 'behavior stream.' In W. N. Schoenfeld (Ed.), The theory of reinforcement schedules (pp. 215-245. New York: Appleton.
Skinner, B. F. (1953). Science and human behavior. New York: Macmillan Free Press.
Skinner, B. F. (1971/2002). Beyond freedom and dignity. Indianapolis, IN: Hackett Publishing Company.
Skinner, B. F. (1974). About behaviorism. New York: Knopf.
Skinner, B. F. (1983). A matter of consequences: Part three of an autobiography. New York: University Press.
Skinner, B. F. (1989). The origins of cognitive thought. In B.F. Skinner, Recent issues in behavior analysis (pp. 13-25). Columbus, Ohio: Merill Publishing Company.
Skinner, B. F. (1989). Recent issues in the analysis of behavior. Columbus, OH: Merrill Publishing Company
Smith, N. W. (1985). Heredity and environment revisited. The Psychological Record, 35, 173-176.
Spates, C.R. (2002). Posttraumatic stress disorder: A behavior analytic interpretation of the disorder and its treatment. Annual Convention of The Japan Association for Behavior Analysis (August 25).
Strang, G. (2001). London Bereavement Network. Annual Report 2000/2001. Retrieved from the Web 10/04/2003. http://www.bereavement.org.uk/
Stroebe, M. (2002). Paving the way: From early attachment theory to contemporary bereavement research. Mortality, 7, 127-138.
Stroebe, M., Hansson, R. O., Stroebe, W., & Schut, H. (2001). Handbook of bereavement research: Consequences, coping and care. Washington, DC.: APA Books.
Stroebe, M., & Stroebe, W. (1983). Social support and the alleviation of loss. Tubingen: Reports from the Psychological Institute, Nr. 14.
Stroebe, W., & Stroebe, M. S. (1987). Bereavement and health. Cambridge: University Press.
Stroebe, M., & Stroebe, W. ( 1991 ). Does "grief work" work? Journal of Consulting and Clinical Psychology, 59, 479-482.
Stroebe, M., Stroebe, W., Zech, E., & van der Bout, J. (2002). Does disclosure of emotions facilitate recovery from bereavement? Evidence from two prospective studies. Journal of Consulting and Clinical Psychology, 70, 169-178.
Stroebe, M. & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23, 197-224.
Sturmey, P. (1996). Functional analysis in clinical psychology. Chichester: John Wiley & Sons.
Sulzer-Azaroff, B. (1999). Meeting life's challenges-strategies and stories. A view from the far side. Behavior and Social Issues, 9, 55-60.
Sulzer-Azaroff, B. & Mayer, G. R. (1991). Behavior analysis for lasting change. Fort Worth, TX: Holt, Rinehart and Winston.
Tatelbaum, J. (1981). The courage to grieve. Trowbridge: Redwood Burn Ltd.
Thyer, B. A. (1999). Clinical behavior analysis and clinical social work: A mutually reinforcing relationship. The Behavior Analyst, 22, 17-29.
Vargas, J. (2001). Foreword. In W.T. O'Donohue, & K.F. Ferguson. The psychology of B.F. Skinner (pp.v-vii). Thousand Oaks, CS.: Sage Publications, Inc.
Vasta, R. (Ed). (1992). Six theories of child development: Revised formulations and current issues. London: Jessica Kingsley Publishers Ltd.
Walter, T. (1996). A new model of grief: Bereavement and biography. Mortality, 1, 7-25.
Walter, T. (1998). A sociology of grief. Mortality. 3, 83-87.
Worden, J. W. (1991). Grief counseling and grief therapy. New York: Springer.
Wortman, C. B., & Silver, R. C. (1989). The myths of coping with loss. Journal of Consulting and Clinical Psychology, 57, 349-357.
Queen's University of Belfast
University of Ulster at Coleraine
1 Requests for reprints should be addressed to Dr. K. Dillenburger, School of Sociology, Social Policy, and Social Work, The Queen's University of Belfast, 7 Lennoxvale, Belfast BT9 5BY, N. Ireland (e-mail: firstname.lastname@example.org) or Dr. M. Keenan, School of Psychology, University of Ulster at Coleraine, Cromore Road, Coleraine BT52 1SA, N. Ireland (e-mail M.Keenan@ulster.ac.uk).…
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication information: Article title: Bereavement: A D.I.S.C. Analysis. Contributors: Dillenburger, Karola - Author, Keenan, Mickey - Author. Journal title: Behavior and Social Issues. Volume: 14. Issue: 2 Publication date: Fall 2005. Page number: 92+. © Walden Fellowship, Inc. Fall 2008. Provided by ProQuest LLC. All Rights Reserved.
This material is protected by copyright and, with the exception of fair use, may not be further copied, distributed or transmitted in any form or by any means.