Bereavement group

Bereavement groups, or grief groups, are a type of support group that bereaved individuals may access to have a space to process through or receive social support around grief. Bereavement groups are typically one of the most common services offered to bereaved individuals, encompassing both formalized group therapy settings for reducing clinical levels of grief as well as support groups that offer support, information, and exchange between those who have experienced loss.
Bereavement groups started from models of peer support for widows in the 1960s. From the start, these groups were diverse in facilitation format and offered at organizations such as churches. Such groups gained popularity in subsequent decades, such that they now are typically led by a designated trained facilitator.
Social support is a key therapeutic element of bereavement groups. Groups can enhance social support that is received within groups among bereaved group members, as well as group members' perceptions of and ability to ask for and receive social support from their loved ones outside of group. These forms of social support might span emotional, logistical, and practical needs. Additionally, bereavement groups also facilitate meaning-making processes by allowing members to reconstruct narratives of themselves and their lives after loss.
There exist two main types of bereavement groups today: those that offer general forms of support and those that are based in a specific psychotherapy modality. General support groups are highly variable but may provide psychoeducation, coping strategies, and problem-solving for issues after loss. On the other hand, psychotherapy groups draw from evidence-based treatments that are delivered in a group format. Psychotherapy groups for loss include cognitive-behavioral, interpersonal, complicated grief treatment, and interpretative therapy groups.
Despite the widespread offering and use of bereavement support groups, limited scientific evidence supports their effectiveness. Analyses of several randomized control trials of bereavement groups have suggested that they yield only small improvements in psychological distress and no long-term improvements. More broadly speaking, there is a lack of empirical consensus for which clinical services are beneficial for bereaved individuals. Still, those experiencing grief have offered feedback on their perceived utility of bereavement groups, such as the greater accessibility of care, as well as criticisms that groups may add to their stress or be unequipped to address issues requiring individualized services for a mental health professional.

Origin of bereavement groups

Bereavement support groups originated from the widow-to-widow mutual support program in the late 1960s. Through this program, a widow aide would provide support and serve as a role model to a newly bereaved widow in facilitating the transition to widowhood. Under a preventative public health framework of early intervention before the development of deleterious impacts, the rationale for the program was based in previous findings that new widows struggled to ask for help but found another widow's experiences most helpful.
In the ensuing decades, support groups became increasingly popular as a frontline intervention offered by hospices, churches, and organizations providing bereavement support. National organizations such as Compassionate Friends and THEOS offered self-help groups that were entirely operated by bereaved members who shared facilitation and leadership responsibilities. On the other hand, mutual support groups typically had designated leaders such as a volunteer or mental health professional.
Despite the wide adoption of this service, scientific evidence for the effectiveness of bereavement groups was limited, leading to the National Institute of Mental Health's program announcement in 1985 calling for "Prevention Research on Mutual Support Approaches with Bereaved Populations". This call led to increased research yielding mixed findings in the 1980s on whether self-help bereavement groups significantly reduced adverse mental health outcomes across depression, anxiety, and medication usage, though group members frequently reported their perceived helpfulness of groups.
Bereavement groups have since become one of the most offered services for people who have lost a loved one. The current definition of bereavement groups now draws from the criteria for group interventions that groups must be led by a designated facilitator rather than a peer according to the self-help group model.

Therapeutic elements

Role of social support

has been identified as one of the most critical predictors of mental health outcomes among bereaved individuals. Accordingly, social support also presents a key mechanism through which grief support groups provide benefit to the bereaved. Reflections from participants of bereavement support groups indicate that the social quality of groups was a key draw for their participation.
Participation in grief support groups may facilitate increased social support in several ways: groups themselves may serve as a form of receiving social support, but perceptions of social support from family and friends may also increase subsequent to participation in groups. Group members have the opportunity to share their feelings after loss, as well as experience their loss reactions as normal. They also receive social support from other group members about difficult interactions with loved ones following loss. By bolstering bereaved individuals' capacity for coping with the stressors associated with bereavement, social support provides a stress-buffering effect that in turn predicts fewer depressive symptoms and post-traumatic stress disorder symptoms, improved physical health, and decreased medication use, among other outcomes.
Generally speaking, research categorizes four general forms of support. Informational support may consist of logistical advice and suggestions, while instrumental support consists of more actionable forms of service or material needs including food and transportation. Appraisal support is a type of peer-to-peer contact that allows someone to understand their circumstances in interacting with others who hold shared experiences. Lastly, emotional support includes expressions of care such as empathy and validation.
In the context of the support provided after loss, these distinctions in types of support cohere with the widely known dual-process model of coping for grief, which distinguishes between restoration-oriented and loss-oriented coping. Restoration-oriented coping is concerned with the substantial life and logistical changes that are outcomes of loss. Examples might include taking on the tasks the deceased had been previously responsible for, assuming new roles in a family, and handling arrangements for the deceased's funeral. Informational and instrumental forms of support typically fall under restoration-oriented needs. On the other hand, loss-oriented coping is the widely recognized form of coping, focused on emotionally processing aspects of the experience of loss itself. Such coping tends to the range of emotional reactions that the loss brings, which can be supported by appraisal and emotional forms of support. Bereavement groups contain content that addresses the support required for both types of coping, including addressing logistical demands that have interfered with grieving and expressing grief-related emotions.

Role of meaning-making

Meaning-making presents another mechanism that allows for adjustment to stressful life events, though there is some disagreement on whether it is essential for adjustment. Under a constructionist view, bereaved individuals must rebuild their narratives of themselves to meet a human need for having meaning to life experiences. After loss, people may focus on learning new models of the world based on the information that experiences of loss provide—ultimately forming a consistent narrative in the transitions that loss entails. This process may be especially strained after a loss by violent or sudden means, for which the bereaved's core beliefs about the world may be altered. Other grief researchers have postulated that the bereaved who do not engage in meaning-making processes may be better off, noting a lack of empirical evidence that meaning-making is universally supportive.
In the context of grief groups, participants have expressed that being present to others' experiences highlighted their own processes of healing. For example, those bereaved by suicide may develop meaning-making by making sense of the cause and reality of their loved one's death through group participation.

Types of bereavement groups

General support group

Many support groups utilize basic support group principles to facilitate engagement with grief and psychoeducation on aspects of grief. Groups provide support and problem solving to aid with a return to normalcy, with a focus on increasing self-esteem and coping strategies. These groups are broadly defined and have taken various forms, but they generally aim to facilitate immediate adjustments to the changes that come with losing a loved one. For example, one group integrated the arts through written expression, storytelling, and drama scripts to support bereaved individuals. Another group focused on providing psychoeducation to decrease distress and highlight growth following loss in the context of near-death experiences. Bereavement support groups specific to those with health-related losses, such as from breast cancer and AIDS, included content on identifying stressor load, utilizing social support networks, and selecting adaptive coping strategies.
In line with its origins in public health, the nature of general support groups can be preventative before the development of adverse mental outcomes, termed "postvention" by Edwin Shneidman in the context of bereavement after suicide. One such group intervention for parents grieving the loss of their child by violent means offered detailed skills including active confrontation of grief, making progress around closure, mutual respect for grieving styles, and implementing self-care. Another general bereavement group delivered by nurses for people bereaved by suicide reduced psychological distress and enhanced social adjustment in therapeutic group activities.