title: An attachment-based model of complicated grief including the role of avoidance.
abstract: BACKGROUND
  Complicated grief is a prolonged grief disorder with elements of a stress response syndrome. We have previously proposed a biobehavioral model showing the pathway to complicated grief. Avoidance is a component that can be difficult to assess and pivotal to treatment. Therefore we developed an avoidance questionnaire to characterize avoidance among patients with CG.
  
  
  METHODS
  We further explain our complicated grief model and provide results of a study of 128 participants in a treatment study of CG who completed a 15-item Grief-related Avoidance Questionnaire (GRAQ). RESULTS OF AVOIDANCE ASSESSMENT: Mean (SD) GRAQ score was 25. 0 +/- 12.5 with a range of 0-60. Cronbach's alpha was 0.87 and test re-test correlation was 0.88. Correlation analyses showed good convergent and discriminant validity. Avoidance of reminders of the loss contributed to functional impairment after controlling for other symptoms of complicated grief.
  
  
  CONCLUSIONS
  In this paper we extend our previously described attachment-based biobehavioral model of CG. We envision CG as a stress response syndrome that results from failure to integrate information about death of an attachment figure into an effectively functioning secure base schema and/or to effectively re-engage the exploratory system in a world without the deceased. Avoidance is a key element of the model.
authors.affiliation: Columbia University School of Social Work, 1255 Amsterdam Avenue, New York, NY 10027, USA. ks2394@columbia.edu
authors.forename: Katherine
authors.initials: K
authors.lastname: Shear
authors.forename: Timothy
authors.initials: T
authors.lastname: Monk
authors.forename: Patricia
authors.initials: P
authors.lastname: Houck
authors.forename: Nadine
authors.initials: N
authors.lastname: Melhem
authors.forename: Ellen
authors.initials: E
authors.lastname: Frank
authors.forename: Charles
authors.initials: C
authors.lastname: Reynolds
authors.forename: Russell
authors.initials: R
authors.lastname: Sillowash
mesh_terms: D000223:Adaptation, Psychological; D003627:Data Interpretation, Statistical; D006117:Grief; D006801:Humans; D001523:Mental Disorders / Q000209:etiology* / Q000523:psychology*; D008960:Models, Psychological; D009769:Object Attachment; D012919:Social Behavior; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D014947:Wounds and Injuries / Q000523:psychology