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Of course, negative findings are less likely to be published, but overall, these findings are quite consistent. In addition, particular subpopulations have been studied because of their compromised immune status. A number of studies have investigated HIV-positive individuals, and their experience of the death of a partner.
Through this expansion of immunological research, the theoretical perspective primarily posited that bereavement was an example of a nonspecific stressor compared with other stressors such as space shuttle touchdown, significant illness of a spouse, insomnia, and other stressors summed from life event checklists. Additional moderators and mediators have been considered in different studies eg, depressive disorder, active coping, finding meaning in the loss.
All of these studies hypothesize that bereavement is a form of life stress, which although very severe, operates through known stress-response systems. To state this differently, the investigators presume that the distress leads to increases in the figlit-or-flight response, and this leads to reduced cellular immune functioning. Regarding this general stress theory, some studies that investigated Cortisol and immune parameters simultaneously and have not found changes in Cortisol that could be linked to the immune decrements, 24 , 30 , 36 while others have found an association.
One theory is that bereavement stress leads to depression, and only depressed bereaved persons show immune decrements. Several studies 26 , 31 found no immune functioning or immune population differences between bereaved and nonbereaved, but did find that widows who were depressed had lower natural killer cell activity and lower responsivity to mitogen stimulation than widows who were not depressed. Nonetheless, none of the authors suggest that there is an immune response that is specific to bereavement stress, but rather that bereavement is one example of the general stress response.
None of these studies have used a diagnosis of CG to shed light on who has immune impairment and UFA dysregulation in response to a death event. Exclusionary criteria included diagnosis with major depressive disorder and antidepressant use. Controlling for body mass index, the CG group showed a significantly flatter slope than those with non-CG.
The initial neuroimaging study of bereavement used personalized stimuli to evoke grief. Participants each provided a photograph of their deceased loved one, which was matched with a photo of a stranger on characteristics such as gender, age, indoor vs outdoor setting, snapshot vs portrait type of photograph. Grief-related words were taken from an interview of the participants about the death event eg, collapse, funeral, loss and were matched with neutral words eg, announce, ceiling, list. These words were embedded into the photos to create composites.
These picture -word composites resulted in a 2 x 2 factorial design with two routes of eliciting grief. Behavioral results of the study included higher ratings of grief for the deceased with the grief word than the stranger, and electrodermal responses taken during scanning indicated that greater autonomic responsiveness to the pictures of the deceased as well. Regional neural activations that occurred in response to the pictures included, among other regions, the dorsal anterior cingulate cortex d ACQ and the insula.
These regions are activated together in a range of studies examining both physical pain 39 and social pain, such as grief and rejection. This region is involved in evaluating whether environmental stimuli are relevant to the self, particularly related to emotional memories. Two additional functional neuroimaging studies have investigated acute bereavement. The stimuli included unfamiliar babies with happy facial expressions and unfamiliar adults with happy and neutral facial expressions.
Kersting and colleagues 42 hypothesized that the regions involved in social pain would be activated, and supporting this hypothesis, increased activity in the dACC and periaqueductal gray was observed for happy baby faces in bereaved women vs controls. They also observed an increased activation in the PCC during the processing of happy baby faces in bereaved women vs controls. A second study focused on the neural correlates of the regulation of grief. Grief symptoms of intrusive thoughts and self-reported avoidance were negatively correlated with functional connectivity between the amygdala and emotion regulatory regions the rostral anterior cingulate cortex and the dorsolateral prefrontal cortex.
PCC was also activated in response to grief-related words. The importance of activation in the PCC has been clear since the first functional magnetic resonance imaging fMRI grief study. This area was activated both through word and photo grief cues. The additional two studies, with different types of grief-related stimuli, also had significant activation in this region. In other human and animal studies, this region is activated in autobiographical and emotional memory.
Dense projections extend to the parahippocampal gyrus, making the role of the PCC in emotional memory anatomically likely. PCC activation is important during learning, and a recent review theorized:. We predict that [PCC] activity will be more strongly modulated by new cues that predict environmental changes that require a cognitive set. Together, these observations indicate a healthy [PCC] is necessary for organizing flexible behavior in response to an ever-changing environment by mediating learning, memory, control, and reward systems to promote adaptive behavior. It is difficult to imagine a situation of greater personal relevance for an environmental change than learning to adapt to the death of a loved one.
To this point, although it is unclear what longitudinal changes in functional activation may occur across adaptation, it is reasonable to hypothesize that PCC activation would be greatest during the period when a person is most actively accommodating the reality of the loss. For most bereaved persons, this would be early in the bereavement process. In addition to the investigation of neural activation in general bereavement, one study has examined the neural response in those with CG.
The participants included 11 women with CG and 12 women with non-CG. Exclusion criteria included Axis I psychiatric disorders including current depression and medical disorders. Between groups, analyses revealed that CG participants showed greater activation compared with those with non-CG in a subcortical area of the brain, the nucleus accumbens, in response to reminders of the deceased. Research on both animals and humans clearly demonstrates that the nucleus accumbens is active during the processing of rewards.
To clarify, the conscious level of processing may or may not include the feeling of reward, even when an object is reinforced. In addition, correlational analyses were conducted between behavioral responses and activation in this region. The nucleus accumbens activation was positively correlated with self-reported yearning at an interview in the week prior to the scan. This result does not indicate that the nucleus accumbens activation is causal in distinguishing CG and non-CG ie, this region does not necessarily cause impaired adaptation during grief, as its higher level of activation may be a consequence of the symptoms of CG.
It also doesn't tell us if the region is related to individual differences, or whether its activation changes in intensity across adaptation.
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In other words, at least two possibilities exist: i those with CG would show distinctive activation in this region as an individual difference - perhaps even before the loss of a loved one; ii all individuals may show greater activation in this region early in adaptation to a loved one's death, and decreasing activation in this region as they adapt psychologically. In order to choose between these two explanations, future research must include multiple scans longitudinally, in order to observe change during adaptation. Finally, it is not possible to know from functional neuroimaging what neurons in the nucleus accumbens region are the sources of this increased activation.
For example, this brain region is rich in oxytocin, opioid, and dopamine receptors, and neurons that use one, two, or all three of these neurotransmitters may have been more active in those with CG than those with non-CG. Thus, future research using positron emission tomography PET , which quantifies the levels of these neurotransmitters in the central nervous system, would be a productive avenue of research in discriminating CG from non-CG.
For those with CG, reminders of the deceased activated neural reward activity, and this neural reinforcement may interfere with adapting to the loss in the present. Or, the nucleus accumbens activation may simply be a neurobiological indicator of where the bereaved is in the adaptation process. Because activation of this region is also seen in fMRI studies of adults viewing photos of their living romantic partners and their children, 47 it is reasonable to hypothesize that those with CG are responding subcortically to the cue because of the attachment relationship.
Why focus on the immunologic and neuroimaging biomarkers?
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One reason is precisely because these physiological variables may shed light on the similarities and differences between acute grief and CG. Along the same lines, studying the underlying aspects of the body's stress response to a death event may reveal distinctions between CG and post-traumatic stress disorder PTSD , or CG and major depressive disorder. Given that morbidity and mortality are necessarily physical events, some interaction is occurring between the individual's knowledge of the loss and their physical body, and although the mechanisms linking them are not well understood, the immune system is a likely suspect.
A third reason to focus on biomarkers is that understanding the mechanisms of CG may lead to improved treatment for this disorder. Although pharmacological treatment seems the obvious way to use biomarkers, psychological treatment that takes advantage of biomarkers is also possible. To draw on an example from another disorder, psychotherapy for PTSD has taken advantage of the discovery that when a patient's heart rate is high at the beginning of the first exposure treatment, therapy outcomes are better.
The study of the physiology and neurobiology of CG is only at the earliest beginning.
Self -regulation, at the psychological as well as physiological levels, may be important in coping with pangs of grief and in acceptance of the death of a loved one. The assimilation of the reality of the death occurs in the brain for the working model of attachment to be revised. Some physiological markers of CG will correlate with a separation distress response and others will correlate with a general stress response.
The physiological markers that correlate with a general stress response may occur with other stressful life events, but the physiological markers that correlate with the separation distress should be specific to the loss of an attachment figure. In addition, the physiological markers correlated specifically to the loss of an attachment figure may be pre-existing traits endemic to the individual or to the relationship , or these physiological markers may develop, or fail to recover, across time during the adaptation process.
If CG symptoms are mediated by attachment, 49 then understanding the neurobiology of attachment will no doubt assist in treating the CG response to bereavement. Observing and documenting the physiological response to bereavement, and how it shapes and is shaped by the psychological response, may help us to improve adaptation even in the face of one of life's most stressful events. It is highly unlikely that there is a one-to-one correspondence between any particular physiological or neurobiological marker and CG.
For one thing, physiological systems are part of a cascade and feed back information to each other, and therefore any single biomarker impacts a host of other biomarkers. As with biomarkers in most affective disorders, there are none that are ready to be used in a clinical setting to aid in diagnosis of CG yet. However, by measuring these markers, we may see what contributes to poor adaptation or what the physiological predictors of CG are. Using immunological and neuroimaging variables in bereavement research as one part of a multimethod approach will only increase our understanding of these phenomena.
National Center for Biotechnology Information , U. Journal List Dialogues Clin Neurosci v. Dialogues Clin Neurosci. Author information Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Complicated grief CG is a disorder marked by intense and persistent yearning for the deceased, in addition to other criteria. Keywords: complicated grief , bereavement , fMRI , immunity , widow , depression , inflammation.
Introduction Complicated grief CG is a disorder of significant impact 1 , as described in other articles in the current issue.
The Lingering of Loss
Bereavement models and theories Why investigate the immunological and neuroimaging biomarkers of CG? Physiological regulation We can add to the original attachment theory ie, that attachment confers capacity for psychological regulation that it also may confer physiological regulation. Turn a child into the hero of their own story—and nurture their imagination, confidence, and love of reading, for life.
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Worldwide Bestseller Lost My Name. Best for Birthdays Happy Birthday to You. Browse our books. In other studies, the reading achievement of both high- and low-income students was found to improve during the academic year, yet the overall achievement gap between the two groups remained high.
After examining 3, students over a twoyear period, Heyns found that the top quartile made rapid gains during the academic year and slower, albeit continued, growth over the summer months. The reading achievement of average students remained steady or fell slightly over the summers. The bottom quartile of students made comparatively slower gains in reading achievement during the academic year and then lost a significant portion of those gains over each summer.
Lower achieving students exhibited a sharper decline than higher achieving students. While working in a lower socioeconomic-status, urban school whose students were already performing, on average, significantly below expectations, we found declines over summer in word decoding among fourth graders and declines in both word decoding and reading fluency among sixth graders. At a time when the policy climate is intensely focused on raising the achievement levels of all students, summer reading loss seems to have its greatest impact on low-achieving students and at-risk students — those who can least afford to fall further behind.
Access to reading materials has been consistently identified as a vital element in enhancing the reading development of children. Children from lowincome households have a limited selection of books to read both within their homes and their communities McQuillan, Other barriers to reading at home include parents' lack of awareness of the benefits of reading to children and lack of confidence in reading, particularly in the case of adults who are themselves English-language learners or who possess a low literacy level.
In an effort to respond to the lack of access to reading materials and to the need for continued reading instruction, some school districts offer formal summer intervention programs or summer book lists with suggested or required titles. While these initiatives can be effective for some students, for others participation in them is not probable. Even if formal reading instruction cannot be part of all students' summer schedules, there are recommendations that teachers can make to help families support children's reading development when school is not in session.
Supporting reading development over the summer months can be done in ways that tap into children's own interests and imaginations. It is not enough, however, to simply tell parents that it is important to read to children. Parents, particularly lower socioeconomic-status parents, need to be offered concrete, specific programs and suggestions on how to participate in family literacy, and they need to be supported in their attempts to do so Edwards, Schools and teachers can do much to set the stage for children's continued engagement in literacy over the summer.
Schools can host workshops for parents in the weeks before the start of summer vacation in which teachers make the case for summer reading and share suggestions for keeping children engaged over the summer months. This would be a wonderful time to coordinate with the local public library on its summer reading program.
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Perhaps the library could arrange to sign up parents and children for library cards and the summer reading program at one of the school workshops. A required summer reading list of three to five proven favorites for which children will be accountable when school begins again may be appropriate for some schools. Teachers need to be sure that the books assigned are readily available at the local library. Perhaps the school library could remain open over the summer, on a limited basis, to facilitate student reading and access to materials.
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In a school of students, if each student read 30 minutes a day over the course of a day summer vacation, the total amount of reading done by the student body would be about a million minutes. The school parent — teacher association could arrange to run the program with students submitting weekly logs of the number of minutes read to the school. A team of parents would tally the minutes by student, grade level, and whole school. Outside, the school could display the cumulative total of minutes read. Reminders could be sent periodically to children and parents about the program.
The school year would then begin with a celebration of achieving the summer reading goal and with recognition given to individual students and grade levels that achieved or exceeded their goals. At the family level, the International Reading Association suggested that parents look for reading materials that relate to interests that a child enjoys, such as baseball, swimming, animals, or nature.
Families may need to be assured that useful reading materials come in many forms. In addition to books, children's magazines may link to a child's interest or hobby. While reasonable limits should be set for television viewing, television programs and age-appropriate movies that are based on books can serve as a catalyst for reading. Moreover, when watching television, parents should be advised to engage the captioning feature and reduce the volume so that students have access to and are encouraged to read the words on the television screen.
Every word that is read counts. Daily routines provide reading opportunities. Cooking, using the phone book, reading the television listing in a local newspaper, looking for information on the World Wide Web, reading directions for using a new gadget, or reading a brochure or article about a place to which the family may travel during the summer can all provide authentic reading experiences.
The value of modeling reading for children needs to be reiterated to families. All too often families unwittingly send the message to children that reading is a chore: something that must be finished before one can proceed to more active and enjoyable pursuits. Instead, it is important to remind families of the need to create a positive climate for reading so that children look forward to reading. Encourage parents or caregivers to show their children how family members use reading to extend their own interests and acquire information.
Let children see family members reading and talking together about what they have read. Books and other reading materials can be made available during transition times. Children can read on the way to a destination, at the park, at the beach, or while waiting for an appointment.
A local library can, of course, help to suggest reading materials. Encourage families to make regular visits to the library and allow children to explore different reading materials. Librarians can offer suggestions that might be a good match for a child's interests and reading level. Keep in mind that reading books that seem slightly below a child's reading level or books that have become "old favorites" can help a developing reader to build confidence and fluency.
Table 1 outlines additional suggestions that teachers can make to families of early readers and more advanced readers. There is little doubt that family participation in children's literacy experiences is valuable and needed, especially if attempting to increase children's literacy experiences over the summer months. Educators seek to establish an effective climate for family literacy programs and to elicit substantive family participation in those programs.
Family members can offer insights for understanding individual children as well as information to enhance specific units of study.
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Recognize that every member has something useful to contribute. A teacher's interpersonal skills, along with his or her perceived professional competence, affects parents' willingness to participate. Simple gestures that convey welcome and an appropriate level of concern can enhance teacher-parent rapport. Parent-teacher communication can and should take a variety of forms. Those forms can include face-to-face contact, phone calls those calls can convey positive messages as well express concern , classroom newsletters sent home on a consistent basis, as well as opportunities for parents to visit the classroom and learn firsthand about what is happening there.
Requesting and encouraging family participation needs to happen consistently over the course of the school year. The more opportunities families have to interact with one another, the more likely their participation in school programs is to increase. Families need concrete suggestions about how to support literacy development at home. The ideas presented in this article can serve as a starting point. When making suggestions to parents, teachers need to keep in mind that effective family literacy interactions should seek to promote the natural and enjoyable interactions between parents and children, not to make the home environment a structured extension of the classroom.
The vast majority of families want to provide a home environment that will allow younger members to thrive. Life circumstances often make this hope a difficult reality to accomplish. Be aware of circumstances that may make literacy participation challenging for some families. When possible, offer suggestions and resources that may aid families in overcoming these challenges. Summer reading loss is a documented reality for many students. It is often of greatest concern for those students who are already at risk — who typically have limited access to reading materials at home and parents or caregivers who may be reluctant to or unsure of how to help.
By raising parents' awareness of the importance of supporting their children's reading development during the summer months and by providing concrete guidelines on how to do so, teachers and students may be better able to start anew instead of starting from scratch when the next school year begins. Allington, R. What really matters for struggling readers: Designing research-based programs 2nd ed. The impact of summer loss on the reading achievement gap. Phi Delta Kappan, 85,