Quiz — Chapter 34: Grief, Loss, and Life Transitions

Instructions

25 multiple-choice questions covering the core concepts of Chapter 34. Each question has one best answer. Check answers against the key at the end.

1. Which of the following best describes the chapter's central framing of grief?

a) A psychological disorder requiring professional treatment when it persists beyond 6 months b) A natural response to loss that should be processed as efficiently as possible to restore normal functioning c) A natural response to loss that is evidence of what mattered — not a problem to solve but a process to navigate d) A physiological state that normalizes spontaneously without requiring psychological attention

2. "Ambiguous loss" (Pauline Boss) describes which type of loss?

a) Loss whose cause is unclear or disputed, making meaning-making more difficult b) Loss where the person is still physically present but something essential has changed, producing "frozen grief" c) Loss that occurs gradually rather than suddenly, preventing the clear onset of grief d) Loss that is ambiguous in its significance — neither clearly grieved nor clearly resolved

3. Which of the following most accurately describes how Kübler-Ross originally intended her five-stage model?

a) A universal sequence through which all bereaved people progress in the order presented b) A descriptive vocabulary for experiences that can occur in grief, not a sequential prescription c) A model of dying patients' psychological states that was always intended to generalize to bereavement d) A clinical assessment tool for determining whether a patient's grief is proceeding normally

4. The Dual Process Model (Stroebe and Schut) proposes that healthy grief involves:

a) Progressive movement through stages of emotional processing, from acute pain to eventual acceptance b) Oscillation between loss orientation (confronting the grief) and restoration orientation (adapting to the changed life) c) Primary focus on restoration orientation, with loss orientation reserved for therapeutic contexts d) Complete processing of the loss before engaging with practical restoration tasks

5. Worden's "Task 4" of grief — finding an enduring connection while embarking on a new life — challenges which earlier assumption about healthy grieving?

a) That grief resolves in predictable stages b) That the bereaved should complete tasks in a specific sequence c) That healthy grieving requires "letting go" and withdrawing emotional investment from the deceased d) That physical presence is necessary for the continuing relationship to be maintained

6. The continuing bonds model (Klass, Silverman, and Nickman) proposes that:

a) Continuing to feel connected to the deceased is a sign of pathological grief that requires clinical intervention b) Maintaining an inner relationship with the deceased — through memory, values, and ongoing connection — is often adaptive c) Physical rituals of continuing connection (visiting graves, keeping belongings) are adaptive while internal conversations are pathological d) Continuing bonds are healthy in the short term but should be gradually reduced in the years following loss

7. Prolonged Grief Disorder (DSM-5-TR) is distinguished from normal acute grief primarily by:

a) The intensity of grief in the first month, which is higher in prolonged grief b) The presence of physical symptoms (sleep disruption, appetite change) that are absent in normal grief c) Grief that does not gradually integrate over time, remaining acutely impairing beyond 12 months after the loss d) The specific emotions present — prolonged grief involves anger rather than sadness

8. Risk factors for Prolonged Grief Disorder include:

a) High initial emotional expression in the acute phase, suggesting poor regulation b) Sudden or traumatic death, highly central relationship, prior trauma, and poor social support c) Previous experience with loss, which sensitizes the nervous system to subsequent losses d) Strong social support, which creates dependency on others that impairs independent processing

9. Research on grief support consistently finds that the most helpful factor is:

a) Providing the bereaved person with information about the stages of grief to normalize their experience b) Helping the bereaved find meaning in the loss as quickly as possible c) The quality of presence — being with the person without trying to fix, minimize, or end the grief d) Encouraging the bereaved to maintain normal functioning and routine to prevent secondary depression

10. Which of the following is described in the chapter as a common but unhelpful grief response?

a) Sitting with the bereaved person in silence b) Saying "at least they are no longer suffering" c) Mentioning the deceased by name d) Offering specific, concrete practical help

11. "Disenfranchised grief" (Kenneth Doka) refers to:

a) Grief so severe that the person cannot function in their social roles b) Grief for losses that are not socially recognized or acknowledged, leaving the person without normal support c) Grief that has been franchised to a therapist — processed professionally rather than communally d) Grief that is disproportionate to the significance of the loss, according to social norms

12. Post-traumatic growth (Tedeschi and Calhoun) is best understood as:

a) A universal outcome of trauma and loss, available to anyone who processes their grief correctly b) Evidence that the grief was not as severe as initially reported c) A distinct phenomenon from resilience: change beyond baseline, not return to baseline d) A phenomenon primarily documented in Western cultures and not cross-culturally replicable

13. The chapter states that post-traumatic growth is most likely when:

a) The person has strong religious or spiritual beliefs that provide immediate meaning b) The loss occurred in early adulthood, when worldviews are still forming c) The person has good social support, can tolerate ambiguity, and can approach the meaning of the loss d) Professional therapy is sought within 30 days of the traumatic event

14. William Bridges' concept of the "neutral zone" in life transitions describes:

a) The period immediately after a change when the person is functioning normally but has not yet emotionally processed the change b) The in-between period when the old structure is gone and the new one has not yet formed — disorienting but potentially creative c) The emotionally neutral stance required for productive transitions, achieved through detachment from outcome d) The transitional phase in which the person is neither grieving the old nor anticipating the new

15. Bridges distinguishes between "change" and "transition." This distinction is important because:

a) Changes are external events requiring logistical management; transitions are internal processes requiring psychological attention b) Changes are typically welcome; transitions are unwelcome and require therapeutic support c) Changes are reversible; transitions are permanent alterations to identity and functioning d) Changes require cognitive processing; transitions require emotional processing

16. The "broken heart syndrome" (takotsubo cardiomyopathy) is relevant to the psychology of grief because it:

a) Demonstrates that grief is primarily psychological rather than physiological b) Provides medical evidence that grief is real, not imaginary c) Documents that grief's physiological consequences are real — stress hormones in acute bereavement can produce cardiac effects d) Shows that grief is dangerous and requires medical monitoring for all bereaved individuals

17. Robert Neimeyer's meaning reconstruction model proposes that grief involves:

a) A natural decrement of meaning-seeking following loss, with meaning restored spontaneously over time b) The reconstruction of a meaning framework that can encompass the loss — developing a narrative in which the loss can be placed in a livable context c) Finding positive meaning in the loss as the primary indicator of healthy grief resolution d) Accepting that the loss has no meaning as the final resolution of the meaning-seeking process

18. The widowhood effect refers to:

a) The tendency for surviving spouses to develop depression within one year of bereavement b) The elevated mortality in the months following the death of a partner, documented across cultures c) The change in social identity from married to widowed, which produces social isolation d) The paradox in which surviving spouses often report improved functioning after the acute grief resolves

19. The chapter argues that PTG is NOT:

a) Real and well-documented across trauma populations b) A byproduct of genuine grief work rather than an alternative to it c) Compatible with ongoing suffering and distress d) Universal — every person who suffers major loss is guaranteed to grow from it

20. The continuing bonds research challenged which influential earlier framework?

a) Kübler-Ross's stage model — specifically the "acceptance" stage b) Freud's "decathecting" model — the idea that healthy grief requires withdrawing emotional investment from the deceased c) Worden's tasks model — specifically the task of adjusting to the changed world d) Bridges' transition model — specifically the concept of the neutral zone

21. Developmental losses — such as mid-life grief for potential futures that are no longer possible — are described in the chapter as:

a) Pathological if they produce more than mild sadness, since they involve no actual external loss b) Real losses that deserve the same attention as more recognized categories of loss c) Primarily cognitive rather than emotional, responsive to rational reappraisal rather than grief work d) Most significant for people who made poor choices earlier in life

22. Which of the following most accurately describes the clinical relationship between grief avoidance and Prolonged Grief Disorder?

a) Avoidance of grief-related content is protective against Prolonged Grief in the first 6 months but risks it thereafter b) Avoidance of grief processing is a primary maintaining factor in Prolonged Grief, as in CBT models of anxiety c) Prolonged Grief is caused by excessive grief expression rather than avoidance d) Avoidance has no documented relationship with Prolonged Grief; the risk factor is primarily genetic

23. The chapter's guidance on supporting someone in grief emphasizes which principle most strongly?

a) Provide information about grief stages to help the person understand their experience b) Encourage the person to maintain their social functioning to prevent secondary depression c) Help the person find meaning in the loss as soon as they are emotionally ready d) Be present without trying to fix or end the grief; follow the griever's lead about when to talk

24. A friend whose parent died four months ago says: "I still cry every day. Is something wrong with me?" Which response is most aligned with the chapter's framework?

a) "Yes, you might want to see a therapist — daily crying at four months suggests complicated grief" b) "Four months is early. Grief at this intensity is normal; give yourself more time without pressure to be 'over it'" c) "Try to reframe the loss positively — remember the good times and focus on what you still have" d) "The stage model suggests you should be in the depression stage by now, which is normal"

25. The chapter's most fundamental message about grief can be summarized as:

a) Grief should be professionally managed for optimal outcomes and timely resolution b) Grief is pathological when it persists beyond social norms; the goal is efficient processing c) Grief is the evidence of what mattered; it does not proceed on a schedule and cannot be resolved through suppression d) Grief is universal in its stages; individual differences reflect personality rather than the nature of the loss

Short-Answer Extensions

Choose two:

Extension 1: The continuing bonds model proposes that "letting go" is not the goal of healthy grief — transforming the relationship is. How does this reframing change what we consider "successful" grief resolution? What are the clinical implications for treatment of bereavement?

Extension 2: Disenfranchised grief — grief for losses that are not socially recognized — can be particularly difficult because the social support that helps with recognized losses is absent. Identify three types of disenfranchised grief and explain what would constitute appropriate acknowledgment for each.

Extension 3: The chapter distinguishes post-traumatic growth (PTG) from forced positive thinking, resilience, and the minimization of grief. Why might prematurely claiming PTG — saying "this made me stronger" before the grief has been processed — actually impede healthy grief resolution?

Answer Key