Special Issue "New Psychological Perspectives on Death and Dying—between Normality and the COVID-19 Emergency"

A special issue of Behavioral Sciences (ISSN 2076-328X). This special issue belongs to the section "Social Psychology".

Deadline for manuscript submissions: 31 March 2022.

Special Issue Editor

Prof. Dr. Ines Testoni
E-Mail Website
Guest Editor
1. Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, 35122 Padova PD, Italy
2. Emili Sagol Creative Arts Therapies Research Center, University of Haifa, Haifa 3498838, Israel
Interests: death; dying; palliative care; psychological interventions; dignity in end-life; self-determination in end-life choices; support for dying people; support for caregivers; anxiety of death and its management; representations of death; Terror Management Theory; spirituality and religiosity; epistemology of ontological representations of life

Special Issue Information

Dear Colleagues,

In these days of trauma caused by COVID-19, the whole world is confronted with a renewed importance to be attributed to behaviors that protect health. The West is also confronted with the inability to represent death and dying, until now strongly removed from everyday real life. This unpreparedness has perhaps made the COVID-19 event even more traumatic in all more technologically advanced countries. For this reason, it is important from now on to systematically enhance research on the ways in which people die, more or less independently of the COVID-19 event, giving importance to all the expressions with which death manifests itself in the existential horizon of people and societies, investigating the best strategies to deal with it.

This Special Issue is divided into several sections, some are closely related to the ongoing COVID-19 emergency, others refer to the whole horizon of research, studies and reflections on the forms and modalities of dying, as well as the interventions that can help to manage death and the suffering it implies.

Section One - COVID-19: The trauma caused by the virus in people's lives, in the community, and in society: appropriate psychological reflections and interventions;

Second Section - Palliative Psychology: the model of palliative care, which is based on the support that psychology can offer the patient, family members, and the palliative care team, both within the hospice and in home care;

Third Section - Grief: an examination of all expressions of loss and grief and appropriate interventions to support mourners, resilience and risk factors, new expressions, and social factors influencing the experience of loss;

Fourth section - Death Education: social and psychological strategies for dealing with death anxiety.

Prof. Dr. Ines Testoni
Guest Editor

Manuscript Submission Information

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Keywords

  • psychological effects of COVID-19
  • palliative psychology
  • loss, grief, and mourning
  • death studies
  • spirituality
  • religiosity
  • Terror Management Theory
  • representation of death
  • death education
  • grief/mourning counselling or psychotherapy
  • social trauma
  • social health discrimination processes
  • social representations of death

Published Papers (14 papers)

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Research

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Article
Meaning-Making Coping Methods among Bereaved Parents: A Pilot Survey Study in Sweden
Behav. Sci. 2021, 11(10), 131; https://0-doi-org.brum.beds.ac.uk/10.3390/bs11100131 - 24 Sep 2021
Viewed by 532
Abstract
The death of a child may result in traumatizing forms of grief, and meaning-making coping with loss seems to be important in prevention of intense psychosocial problems among bereaved parents. The aim of this quantitative pilot study was to discover the divergent meaning-making [...] Read more.
The death of a child may result in traumatizing forms of grief, and meaning-making coping with loss seems to be important in prevention of intense psychosocial problems among bereaved parents. The aim of this quantitative pilot study was to discover the divergent meaning-making coping methods used by bereaved parents in Sweden. In doing so, 162 respondents were selected using a convenience sampling method, and they responded to the modified version of RCOPE. The study revealed that the strategies talking to others about their feelings, pondering the meaning of life alone, and being in nature for greater emotional affiliation, i.e., what we call secular existential coping methods, have been the most used meaning-making coping methods among Swedish mourning parents. While explaining the results, we considered the respondents’ cultural background and speculated about the potential influence of cultural teachings and elements in the selection of ways of coping with bereavement. Further, we compared the results obtained with those of the two other Swedish studies conducted among people coping with cancer and COVID-19 to further discuss the impact of culture on coping with illness, loss, grief, and crisis. The study supports the idea that culture plays an essential role in the choice of coping methods. Full article
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Article
Grief Iconography between Italians and Americans: A Comparative Study on How Mourning Is Visually Expressed on Social Media
Behav. Sci. 2021, 11(7), 104; https://0-doi-org.brum.beds.ac.uk/10.3390/bs11070104 - 20 Jul 2021
Viewed by 724
Abstract
As an innovative way to express grief, social media posts about the deceased have become fairly common. However, few studies have examined commonly posted grief photos. The purpose of the present study was to examine such pictures, as well as the motivations and [...] Read more.
As an innovative way to express grief, social media posts about the deceased have become fairly common. However, few studies have examined commonly posted grief photos. The purpose of the present study was to examine such pictures, as well as the motivations and reactions of those who posted them, among Italians and Americans. Surveys were sent to both Italian and US participants. The US group yielded 262 responses (mean age = 22 years; 81% female), and the Italian group yielded 51 (mean age = 32 years; 82% female). Several key issues emerged, such as the need for social media users to receive empathic support from other users, the desire to maintain continuing bonds, the wish to remember the deceased, and the desire to share beauty and symbolic pictures. The images were analyzed using content analysis. Both samples posted photos to remember, and to enhance their posts. A strong preference for pictures with a positive emotional connotation appeared, depicting the deceased in a conjoint appearance with the participant. The results suggest that the imagery used for the expression of grief in social media sites, an “iconography of grief”, is a popular means of expression for grievers across the two cultures. Full article
Article
From Fear to Hopelessness: The Buffering Effect of Patient-Centered Communication in a Sample of Oncological Patients during COVID-19
Behav. Sci. 2021, 11(6), 87; https://0-doi-org.brum.beds.ac.uk/10.3390/bs11060087 - 14 Jun 2021
Cited by 2 | Viewed by 901
Abstract
Background: COVID-19 represents a threat both for the physical and psychological health of oncological patients experiencing heightened distress levels to which the fear of the virus is also added. Moreover, fear of COVID-19 could lead oncological patients to experience feelings of hopelessness related [...] Read more.
Background: COVID-19 represents a threat both for the physical and psychological health of oncological patients experiencing heightened distress levels to which the fear of the virus is also added. Moreover, fear of COVID-19 could lead oncological patients to experience feelings of hopelessness related to their medical care. Patient-centered communication may act as a buffer against the aforementioned variables. This study aimed to test the role of doctor–patient communication in the relationship between fear of COVID-19 and hopelessness. Methods: During the COVID-19 pandemic, a sample of 90 oncological outpatients was recruited (40 males (44.4%) and 50 females (55.6%), mean age = 66.08 (SD = 12.12)). A structured interview was developed and used during the pandemic to measure the patients’ perceived (A) fear of COVID-19, and (B) feelings of hopelessness, and (C) physicians’ use of empathetic and (D) clear language during the consultation. A multiple mediation model was tested, and the effects between males and females were also compared. Results: Empathetic and clear doctor–patient communication buffered the adverse effect of the fear of COVID-19 on hopelessness through a full-mediation model. The effects did not differ between males and females in the overall model but its indirect effects. Discussions: Patient-centered communication using empathy and clear language can buffer the adverse effect of the fear of COVID-19 and protect oncological patients from hopelessness during the pandemic. These findings might help to improve clinical oncological practice. Full article
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Article
Journalistic Denial of Death during the Very First Traumatic Period of the Italian COVID-19 Pandemic
Behav. Sci. 2021, 11(3), 41; https://0-doi-org.brum.beds.ac.uk/10.3390/bs11030041 - 23 Mar 2021
Viewed by 1042
Abstract
Exactly one year ago, between February and March 2020, the COVID-19 infection went from an epidemic confined to China to a worldwide pandemic that was particularly lethal in Italy. This study examined the media accounts during that period by analysing the representation of [...] Read more.
Exactly one year ago, between February and March 2020, the COVID-19 infection went from an epidemic confined to China to a worldwide pandemic that was particularly lethal in Italy. This study examined the media accounts during that period by analysing the representation of death-related constructs in Corriere della Sera, the most widely read newspaper in Italy. A textual and thematic analysis of articles published between period A (epidemic: 23 January–22 February 2020) and period B (pandemic: 23 February–31 March 2020) was conducted using Nvivo-11. A total of 141 articles comprising 48,524 words were collected. The most utilised words and meanings linked to COVID-19 were computed. In the rank distribution, ‘China’ and ’virus’ were the terms most frequently used in both periods. The terms ‘death’ and ‘dead’ were completely absent in period A and appeared in the 535th position in period B. The term ‘dead’ was used primarily to indicate the number of deceased. From a Terror Management Theory perspective, it is possible that the minimal reference to death-related issues was a reflection of death denial and a manifestation of efforts to deny death to manage terror. These findings highlight the ambiguities and ambivalence surrounding any issue pertaining to death; on the one side, undue alarmism may provoke exaggerated reactions, such as moral panic, while on the other denial-based messages that minimise references to mortality may reduce safe behaviour during a pandemic. Full article
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Article
“Imagine You Have ALS”: Death Education to Prepare for Advance Treatment Directives
Behav. Sci. 2021, 11(1), 6; https://0-doi-org.brum.beds.ac.uk/10.3390/bs11010006 - 06 Jan 2021
Cited by 1 | Viewed by 1490
Abstract
The study presents the results of qualitative research carried out within a death education project dedicated to advance treatment directives (ATDs) in which it was proposed to participants to empathize with people who had received a diagnosis of Amyotrophic Lateral Sclerosis (ALS). The [...] Read more.
The study presents the results of qualitative research carried out within a death education project dedicated to advance treatment directives (ATDs) in which it was proposed to participants to empathize with people who had received a diagnosis of Amyotrophic Lateral Sclerosis (ALS). The study involved 104 people who discussed and reflected on issues related to the knowledge of having to die, palliative care and ATDs, investigating what choices they would have made if they had received such a diagnosis. Finally, they were asked to write a paper describing their impressions and hypothetical choices. Qualitative analysis has elucidated among fundamental themes. Four thematic areas emerged from the data analysis: (1) ATDs and the family; (2) the importance of reducing pain and suffering; (3) emotions and considerations regarding death, illness and spirituality; and (4) opinions on the DeEd course. It has emerged that some people are unfamiliar with palliative care or the right to self-determination and that addressing these issues helps manage the thought of the future with less terror. The experience of death education has therefore proven to be very positive in dealing with complex and often censored issues, allowing thinking about death in a less distressing way. Full article
Article
The Sense of Dignity at the End of Life: Reflections on Lifetime Values through the Family Photo Album
Behav. Sci. 2020, 10(11), 177; https://0-doi-org.brum.beds.ac.uk/10.3390/bs10110177 - 23 Nov 2020
Cited by 3 | Viewed by 767
Abstract
This study focuses on the dimensions of dignity, linking Chochinov’s Dignity Therapy to Schwartz’s Theory of Values. The use of family photo albums has enriched the application of dignity therapy. Seven terminal patients in home-based palliative care participated in the therapeutic intervention. To [...] Read more.
This study focuses on the dimensions of dignity, linking Chochinov’s Dignity Therapy to Schwartz’s Theory of Values. The use of family photo albums has enriched the application of dignity therapy. Seven terminal patients in home-based palliative care participated in the therapeutic intervention. To measure the effects of the intervention, we administered the Edmonton Symptom Assessment Scale and the Patient Dignity Inventory, then, at the end of the meetings, collected the opinions of participants, available nurses, and relatives who attended the sessions. The resulting generativity documents were then analyzed through thematic analysis, which revealed three main themes linked to both fundamental values and the dimensions of dignity: The relationship between continuity of self and myriad values in the context of family relationships; personal dignity as characterized by the values of personal success, hope, and wisdom; and hope and generativity. The fourth theme reflected the participants’ final judgements on the intervention, which were highly positive and greatly encouraged further use of photographs in similar therapeutic interventions. The assessment protocol highlighted a significant decrease in tiredness amongst the participants and a trend towards a significant decrease in drowsiness after the intervention. Full article
Article
A Challenge for Palliative Psychology: Freedom of Choice at the End of Life among the Attitudes of Physicians and Nurses
Behav. Sci. 2020, 10(10), 160; https://0-doi-org.brum.beds.ac.uk/10.3390/bs10100160 - 21 Oct 2020
Cited by 2 | Viewed by 1114
Abstract
This article considers a particular aspect of palliative psychology that is inherent to the needs in the area of attitudes concerning Advance Healthcare Directives (AHDs) among Italian physicians and nurses after the promulgation of Law No. 219/2017 on AHDs and informed consent in [...] Read more.
This article considers a particular aspect of palliative psychology that is inherent to the needs in the area of attitudes concerning Advance Healthcare Directives (AHDs) among Italian physicians and nurses after the promulgation of Law No. 219/2017 on AHDs and informed consent in 2018. The study utilized a mixed-method approach. The group of participants was composed of 102 healthcare professionals (63 females and 39 males). The quantitative part utilized the following scales: Attitudes toward Euthanasia, the Religious Orientation Scale, the Balanced Inventory of Desirable Responding, and the Testoni Death Representation Scale. The results were mostly in line with the current literature, especially concerning a positive correlation between religiosity and the participants’ rejection of the idea of euthanasia. However, the qualitative results showed both positive and negative attitudes towards AHDs, with four main thematic areas: “Positive aspects of the new law and of AHDs”, “Negative aspects of the new law and of AHDs”, “Changes that occurred in the professional context and critical incidents”, and “Attitudes towards euthanasia requests.” It emerged that there is not any polarization between Catholics or religious people and secularists: Their positions are substantially similar with respect to all aspects, including with regard to euthanasia. The general result is that the law is not sufficiently understood, and so a quarter of the participants associate AHDs with euthanasia. Discussions on the opportunity for palliative psychologists to help health professionals to better manage these issues through death education courses are presented. Full article
Article
Enhancing Existential Thinking through Death Education: A Qualitative Study among High School Students
Behav. Sci. 2020, 10(7), 113; https://0-doi-org.brum.beds.ac.uk/10.3390/bs10070113 - 07 Jul 2020
Cited by 6 | Viewed by 2186
Abstract
The censorship of death-related issues is widespread in contemporary Western culture because the boundary between death and life is substantially managed in medical areas. In the context of Italian educational initiatives, to remove this limitation, 215 high school students in Southern Italy were [...] Read more.
The censorship of death-related issues is widespread in contemporary Western culture because the boundary between death and life is substantially managed in medical areas. In the context of Italian educational initiatives, to remove this limitation, 215 high school students in Southern Italy were educated on death through conventional and informal lessons. The students answered a questionnaire with open questions to survey their emotional and reflective experiences. Their answers were qualitatively, thematically analysed to explore how the representation of death can follow a death education course, and if this experience can be managed without harmful effects. The students’ answers narrated how the course reduced their anxiety linked to these themes, on the one hand improving communication between peers by making it more authentic and empathic and, on the other, providing alternative perspectives on life. Indeed, the project offered an opportunity to discuss something strongly heartfelt but rarely faced, and the survey confirmed that the research objectives were fully achieved. Full article
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Article
The Endless Grief in Waiting: A Qualitative Study of the Relationship between Ambiguous Loss and Anticipatory Mourning amongst the Relatives of Missing Persons in Italy
Behav. Sci. 2020, 10(7), 110; https://0-doi-org.brum.beds.ac.uk/10.3390/bs10070110 - 06 Jul 2020
Cited by 6 | Viewed by 2333
Abstract
This article presents the results of a qualitative study aiming to consider the relationship between ambiguous loss and anticipatory mourning amongst relatives of missing people in Italy. Eight people participated in the research, narrating their experiences of losing a beloved person (one found [...] Read more.
This article presents the results of a qualitative study aiming to consider the relationship between ambiguous loss and anticipatory mourning amongst relatives of missing people in Italy. Eight people participated in the research, narrating their experiences of losing a beloved person (one found alive, three found dead, and four still missing). Findings suggest the presence of a particular form of ambiguous loss, characterised by traits typical of both prolonged and traumatic grief. These findings describe how families are faced with an emotional vortex related to a never-ending wait, and how the mourning is solved only when the missing person is found dead or alive. The discovery of a corpse is traumatic but it allows mourners to fully recognise their grief. When a person is found, it changes the relationship in a positive way. When neither of these events happen, mourners have two different kinds of reactions: they experience either a prolonged grief or a drive to solve their suffering by helping other people (post-traumatic growth). In this study, it is highlighted how a community can be useful or detrimental in this process, and the importance of psychological and social support to prevent significant clinical outcomes is stressed. Full article
Article
Loss of Close Relationships and Loss of Religious Belonging as Cumulative Ostracism: From Social Death to Social Resurrection
Behav. Sci. 2020, 10(6), 99; https://0-doi-org.brum.beds.ac.uk/10.3390/bs10060099 - 10 Jun 2020
Cited by 3 | Viewed by 1915
Abstract
Background: Ostracism is a negative experience that has been studied primarily in laboratory settings. This study extends current research by investigating ostracism in daily life, analyzing the transition from social death to social resurrection of Catholic partners who suffered ostracism both in the [...] Read more.
Background: Ostracism is a negative experience that has been studied primarily in laboratory settings. This study extends current research by investigating ostracism in daily life, analyzing the transition from social death to social resurrection of Catholic partners who suffered ostracism both in the couple (with the consequent divorce) and in the religious community they belong to (ban from religious practices). Therefore, we introduce the notion of ‘cumulative ostracism’. Method: Data are composed of the biographical narratives of n = 25 participants in a religious experience group in a period of 7 months. A narrative analysis was used within the framework of the temporal need–threat model. Results: Participants’ narratives are consistent with the temporal need–threat model. The ostracism experience, both in the couple and in the religious group, is characterized by the sequence: immediate stage, coping stage and resignation stage. Moreover, the cumulative ostracism suffered by the participants presents an analogy with the cumulative trauma that occurs in intra-family abuse. Social resurrection occurs through the encounter with a new religious group that allows ostracized people to experience a Catholic religious affiliation again. Conclusions: Our findings reflect the existing theory and add to the existing laboratory research by capturing ostracism-unique dynamics in real life. Full article
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Article
The Value of Dignity in Prison: A Qualitative Study with Life Convicts
Behav. Sci. 2020, 10(6), 95; https://doi.org/10.3390/bs10060095 - 28 May 2020
Cited by 3 | Viewed by 2133
Abstract
Background: This research is based on the perspective of dignity according to Chochinov; thus, the life imprisonment of detainees is assimilated to a severe disease. Methods: Ten male prisoners were interviewed trough Chochinov’s Dignity Therapy, and the results were analysed using thematic analysis. [...] Read more.
Background: This research is based on the perspective of dignity according to Chochinov; thus, the life imprisonment of detainees is assimilated to a severe disease. Methods: Ten male prisoners were interviewed trough Chochinov’s Dignity Therapy, and the results were analysed using thematic analysis. Results: Two areas of thematic prevalence emerged, namely, value of freedom, self-consciousness and education and their failure in jail, and life sentence as annihilation of life meaning and of the values of generativity and family. Conclusions: Life imprisonment has been described in its negativity by several respondents as a punishment worse than the death penalty. It has been compared to death itself, to a terminal illness, to torture and to a pain that grows over the years, with the awareness that despite the passing of time, you will not have the opportunity to return to your loved one and to a free life. In fact, prisoners live out their condition within a space in which any value that gives meaning to life risks being destroyed. Full article
Article
Lack of Truth-Telling in Palliative Care and Its Effects among Nurses and Nursing Students
Behav. Sci. 2020, 10(5), 88; https://0-doi-org.brum.beds.ac.uk/10.3390/bs10050088 - 11 May 2020
Cited by 5 | Viewed by 3124
Abstract
Unclear communication of inauspicious prognoses may disorientate both patients and their relatives, drastically jeopardizing the planning of palliative care. This paper considers the issue of truth-telling in the communicative problems of nurses and students of nursing with terminally ill patients. The fundamental objective [...] Read more.
Unclear communication of inauspicious prognoses may disorientate both patients and their relatives, drastically jeopardizing the planning of palliative care. This paper considers the issue of truth-telling in the communicative problems of nurses and students of nursing with terminally ill patients. The fundamental objective is the analysis of the difficulties related to the lack of truth-telling and how it might impact their professional and personal lives. A qualitative study was realized, involving 47 participants, both nurses (25) and nursing students (22), working in palliative care units or in associations of volunteers for the assistance of oncological patients. The exploration was focused on the way they relate to patients who are not aware of their real health conditions and their consequences. Particular attention was paid to their opinions concerning what could be done in order to manage such problematic situations in the near future. Full article
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Review

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Review
Psychopathological Impact and Resilient Scenarios in Inpatient with Schizophrenia Spectrum Disorders Related to Covid Physical Distancing Policies: A Systematic Review
Behav. Sci. 2021, 11(4), 49; https://0-doi-org.brum.beds.ac.uk/10.3390/bs11040049 - 13 Apr 2021
Viewed by 1183
Abstract
The COVID-19 epidemic posed great challenges to the healthcare community. To contain the epidemiological emergency, confinement measures were instituted, affecting the entire population. The lack of social contact, as well as the disruption of daily life, caused the exacerbation of anxiety and depressive [...] Read more.
The COVID-19 epidemic posed great challenges to the healthcare community. To contain the epidemiological emergency, confinement measures were instituted, affecting the entire population. The lack of social contact, as well as the disruption of daily life, caused the exacerbation of anxiety and depressive symptoms. The present review of the literature aims to investigate what the effects of the pandemic have been on patients with schizophrenia, hypothesizing, an exacerbation of psychotic symptomatology (positive, negative, disorganized symptoms). Between November 2020 and January 2021, 5353 articles were collected and analyzed from the databases of the ResearchGate, Pubmed, and Psycnet websites, subjected to PRISMA methodology. Of these, 11 were evaluated for eligibility, but only three were included in the study because they met all inclusion criteria. The research did not confirm the expected results, showing that any kind of worsening of schizophrenic symptomatology involved the study samples. However, interesting outcomes were highlighted, such as a significant increase in general well-being during the early period of the pandemic, especially by women, or an increase in CPR (C-reactive Protein) levels in the blood, signaling an inflammatory state. Although the systematic review refuted the initial hypothesis, this must be a starting point: the topic is recent and these findings leave ample room for further investigation, particularly in long-term longitudinal research. It is possible that the true response to this disruption of daily life that occurred only during the past year may manifest itself later in time. On the other hand, interesting outcomes have been brought to light that may provide further interesting research insights. Full article
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Review
Improving Dignity of Care in Community-Dwelling Elderly Patients with Cognitive Decline and Their Caregivers. The Role of Dignity Therapy
Behav. Sci. 2020, 10(12), 178; https://0-doi-org.brum.beds.ac.uk/10.3390/bs10120178 - 24 Nov 2020
Cited by 3 | Viewed by 1263
Abstract
Demographic changes have placed age-related mental health disorders at the forefront of public health challenges over the next three decades worldwide. Within the context of cognitive impairment and neurocognitive disorders among elderly people, the fragmentation of the self is associated with existential suffering, [...] Read more.
Demographic changes have placed age-related mental health disorders at the forefront of public health challenges over the next three decades worldwide. Within the context of cognitive impairment and neurocognitive disorders among elderly people, the fragmentation of the self is associated with existential suffering, loss of meaning and dignity for the patient, as well as with a significant burden for the caregiver. Psychosocial interventions are part of a person-centered approach to cognitive impairment (including early stage dementia and dementia). Dignity therapy (DT) is a therapeutic intervention that has been shown to be effective in reducing existential distress, mood, and anxiety symptoms and improving dignity in persons with cancer and other terminal conditions in palliative care settings. The aims of this paper were: (i) To briefly summarize key issues and challenges related to care in gerontology considering specifically frail elderly/elderly with cognitive decline and their caregivers; and (ii) to provide a narrative review of the recent knowledge and evidence on DT in the elderly population with cognitive impairment. We searched the electronic data base (CINAHL, SCOPUS, PSycInfo, and PubMed studies) for studies regarding the application of DT in the elderly. Additionally, given the caregiver’s role as a custodian of diachronic unity of the cared-for and the need to help caregivers to cope with their own existential distress and anticipatory grief, we also propose a DT-dyadic approach addressing the needs of the family as a whole. Full article
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