Behaviour Change

PROPAGANDA FOR CHANGE is a project created by the students of Behaviour Change (ps359) and Professor Thomas Hills @thomhills at the Psychology Department of the University of Warwick. This work was supported by funding from Warwick's Institute for Advanced Teaching and Learning.

Thursday, May 3, 2018

Bereavement Support at Warwick

by Marie Hill, Gabby Mack & Victor Fajemirokun 

The Issue - Non-existent Support for Bereavement
For our project we decided to increase the support available for students who have experienced bereavement. Around one quarter to one third of university students are within the first year of grieving a death (Balk, 1997; Balk, Walker, & Baker, 2010). University is considered by grief researchers to not be a helpful environment for coping with bereavement due to academic pressure, lack of peer support, separation from family members, and the students’ expectation of having fun while in college or university (Balk, 1997, 2001; Matthews & Servaty-Seib, 2007). Bereavement impacts many areas of students’ lives, including academic performance, social interaction, and the likelihood of graduation (Balk, 2011). Unfortunately universities often don't provide training for Student Services staff on student grief and bereavement (Balk, 2001). There is also a lack of emphasis on bereavement support in campus counselling centres and there are very few bereavement support groups on university campuses (Balk, 2011).
Many students within the first year of bereavement are at risk of dropping out (Fajgenbaum et al., 2012). They are also more likely to experience a significant decline in academic success, as the physical and cognitive impacts of grief affect their ability to sleep, concentrate, and recall subject matter for their courses (Balk, 1997, 2011; Matthews & Servaty-Seib, 2007; Monk, Germain, & Reynolds, 2008). Also, depressive symptoms and lack of motivation caused by grief impact the bereaved individual’s ability to maintain strong grades (Balk 2011; Matthews & Servaty Seib, 2007). Bereaved students often turn to drinking alcohol as a coping mechanism, which can lead to frequent binge-drinking, risky sexual behaviour and drug use as a means to relieve grief symptoms (Balk, 2011).

Bereavement is therefore an important issue that can lead to poor coping mechanisms and depression. It is still a massively taboo subject that many people feel uncomfortable talking about at University. The lack of attention received on campus is likely the result of the griever and friends not knowing what to say or how to respond (Volpe, 2016). This is why we believed that it is an issue that needs behaviour to change for. Whilst depression and grief may appear to be similar, researchers have noted significant differences between the two (Shear, 2015; Balk, 2011). It is therefore important that they are treated differently, tailored to the specific circumstances and experiences. As it affects students so drastically, Balk (2011) argues that universities should be doing more to provide support for bereaved students.

We Aimed to Change Behaviour in Three Ways:
1) Get students to be more open to talking about this issue.
2) Change the Student Union's behaviour in getting them to start providing support for bereavement.
3) Change the behaviours of the bereaved, in aiming for them to have better coping mechanisms for dealing with bereavement as opposed to bottling it up and dealing with it in unhealthy behaviours such as drinking alcohol, drugs, social withdrawal, etc.

What We Did
1) We spoke to Amanda Woodfield, the Welfare Advisor in the SU's Student Support services. She has a background working with the bereaved and she gave us advice about how to start the support groups.

2) We contacted the SU and booked a room to host the first support group meeting in week 1 of term 3.

3) We designed a poster that included a) statistics on bereavement and the 5 stages of grief model b) self-help tips for the bereaved c) tips on how to care for a friend who is bereaved d) details about the first support group meeting.

4) We posted this poster onto the Facebook freshers’ pages and we printed out many posters and stuck them around campus in places including the library and the psychology department.

5) We created a Facebook Page for Bereavement Support at Warwick.

6) We contacted Sam Parr, the SU’s Campaign Co-ordinator and Ellen Holmes, the Welfare Officer. Sam and Ellen promoted the group by sharing the poster on their SU Facebook pages.

7) We planned for the first Bereavement Support Group Meeting. We researched coping tips to share with our attendees.

8) We ran the first group session on Thursday 26th April in a meeting room in the SUHQ. 8 people who were bereaved attended and most brought a buddy with them meaning that 15 people in total attended. At the session experiences and coping behaviours were shared from those who had found helpful methods of coping.

9) At the end of the session we asked what they would like the university to do in terms of support. They responded with to run group sessions like this one. It was also requested for lecturers to put clear trigger warnings in advance of lecturers that contained sensitive topics such as graphic suicide descriptions in mind of those who are bereaved by suicide.

10) We contacted Liam Jackson, the SU's Education Officer, about changing lecturers' behaviour by posting trigger warnings prior to sensitive lecture topics. We have asked that he emails the lecturers outlining the importance and asks them to put trigger warnings. We are currently waiting for his update on this.

11) We organised the next support meeting for Week 3.

Persuasion Techniques
1.Just Asking
We used several persuasion techniques to create support for the bereaved at Warwick. The first of which was that we just asked for it to exist!

We went to Amanda and asked to start up a bereavement support group. We asked the SU to hire a room and we then asked people to attend. As Flynn and Lake (2008) found, we drastically underestimate other people’s compliance with our direct requests for help. In these studies, people underestimated by as much as 50% the likelihood that other would agree to a direct request to help! This was asking for favours of filling out a 5-10 minute questionnaire, borrowing a cell phone and asking for donations. In our project the SU were very willing to help out.

The fundamental basis of staging the bereavement group was to bring affected individuals together to discuss their feelings openly. There is a perceived stigma surrounding discussing grief or being open with feelings of grief. Research has shown however that group therapy can be incredibly beneficial to mourners, an example being the research of Burke, Neimeyer & McDevitt-Murphy (2010) which found that level of social support was a predictor of coping with grief in bereaved African-American family members. Prior research from Neimeyer indicates that the social support group must embrace the grieving process of victims therefore highlighting the importance of discussion regarding feelings of grief. Neimeyer goes on to explain that group therapy has positive impacts on the bereaved for the reason that there is relatability amongst the patients. This enables therapists and patients to achieve better results from the treatment from discovering shared experiences with other people.

Osterweis, Solomon and Green (1984) describe this group therapy as a mutual support approach which provides patients with interactions which are based on reciprocity. This can lead to shared ideas for coping strategies as well as highly specialized opinions from therapists. Interestingly the paper also sights the positive impacts which come as a result of participants in therapy being able to help others. It is explained that this can give grieving patients an enhanced feeling of self-worth and a feeling of being part of achieving a common goal. 

Research illustrating the value of our therapy also comes from Winter (1990) which found that insight oriented group therapy was more impactful for individuals that reported more psychological symptoms of grief while cognitive or behavioural techniques would be more useful for those displaying symptomatology related to grief. The research highlights the value of the group therapy provided in the project because the participants who attended the session highlighted the psychological issues related to their grief. The participants attending our group sessions would be similar in having gone through similar experiences but also that they are university students.

3.Theory of Planned Behaviour
The behaviour change we aimed to produce in bereaved students can be explained by the Theory of Planned Behaviour model (Ajzen).

Subjective Norm - Taboo (Balk, 2011)
Firstly we aimed to change the subjective norm surrounding grief, which was to not talk about it. We addressed it directly in the poster and suggested that friends allow their bereaved friends to talk about it. By aiming to break the taboo, we hope those experiencing bereavement can also be more open about what they are going through. We also stated that the session attendees could bring a buddy along with them, so that the friend of the bereaved could learn behaviours to help their friend.

We tried to change the bereaved students' attitude towards the behaviour instead of bottling it up. By knowing that there is a place to that they can go to to talk about what they're going through, they can plan to cope in that behaviour instead.

Perceived Behavioural Control
We aimed to change both the students' perceived behavioural control and the friends of those who are bereaved. We aimed to give them the control in taking their bereavement into their own hands and choosing to attend the meeting. We also highlighted ways that individuals could help their bereaved friends.
...Which lead to changed intentions and changed behaviour
The combination of changing the attitude towards open expression to a more positive one, changing the norm of the social taboo and increasing their perceived behavioural control, this leads to the intention of making an active effort to cope with their bereavement which leads to the behaviour of attending the group session and learning healthier coping mechanisms.
An example of when the Theory of Planned Behaviour was used is for predicting alcohol consumption. In predicting alcohol consumption Intentions and perceived behavioural control explained between 12% and 50% of the variability in behavior. (Conner et al, 1999).

4.Elaboration Likelihood Model 
We used the elaboration likelihood model (ELM) to decide what route to take when producing our poster. The ELM was created by Petty & Cacioppo (1986) whereby there are two routes to persuasion; central and peripheral. The central route is often taken when we are motivated and able to pay attention whereas the peripheral route is taken when we do not pay attention to the persuasive argument but are instead influenced by surface characteristics such as pretty pictures.

We decided to choose the central route to persuasion because we want to affect long term attitude change. Petty & Cacioppo (1986) found from a study on college students that when the central route to persuasion was taken, it resulted in long term attitude change compared to the peripheral route to persuasion.

Under the central route, persuasion will result from a person’s careful consideration of the information presented. We therefore used research based statistics from such as the prevalence of bereavement on campus, self-help tips for those suffering from grief from the NHS and the empirically supported 5 stages of grief model by Kübler-Ross (1969). We also researched how to best carry out a group bereavement session. This helped to stop people shying away from the topic and got 15 people to make an overt change in how they deal with bereavement and how the individuals can help their friends.

The more personal relevance the message of our poster has, the more likely individuals are to use the central route. Petty and Cacioppo (1986) found that when college students were going to be directly affected by changes at their college they were more likely to the central route to persuasion, whereas when they were not they used the peripheral route to persuasion. As our target population are those directly affected by bereavement or have had a friend affected by it, we made sure the information on our posters were personally relevant to them. We demonstrated this through the use of statistics about bereavement prevalence on campus, self-help tips, tips for friends and a group session for those who want to talk.

5.Principle of association
The principle of association is a behaviourist technique whereby innocent association with good or bad things influences how people feel about things, and thus their behaviour towards it. McCall & Belmont (1996) found that by having a MasterCard credit card insignia on a tip tray when patrons received their bill after a meal, they gave significantly larger tips than those without the credit card insignia present. The mere presence of the insignia changed behaviour! We used this principle when designing our poster. Doves and a growing lotus flower were used as they have positive associations with peace and self-enlightenment. Doves association with peace comes from religion; specifically, Christianity combined doves with an olive branch from Greek thought (Donfried & Richardson, 1998). It is also often used in politics to symbolise peace and pacifism. This will encourage a change of behaviour towards how they deal with their grief by encouraging peace of mind. It will also help promote peace towards others who are suffering from the effects of bereavement. The support group will be made to feel more appealing as it will be associated with a calm tranquil place. Subsequently, people are more likely to act on something they associate with being positive.

Overall, we have found that bereavement is an issue that individuals feel better about when it is not left unspoken as the more negative and prolonged outcomes often occur when grief is hidden (Sklar & Hartley, 1990). The support groups allow individuals to start talking about their grief as a healthy behaviour to cope with their grief. 
Through the use of behaviour change techniques, we asked for the SU to allow us to put these support groups on and they keenly granted our request. In changing attitudes towards bereavement, increasing their perceived control and changing the social norms towards bereavement, we have brought about a change in behaviour of the bereaved through the theory of planned behaviour. The poster used the techniques of association with positive things with the dove, olive branch and the growing flower, to increase the likelihood that there would be a high turnout. The technique of similarity meant that bereaved individuals were more likely to turn up in knowing that they would be similar to other individuals who had also experienced bereavement whilst at university. Our poster and Facebook posts also addressed readers through the central route of persuasion and used direct personal relevance, which has been shown to be highly effective at persuading individuals to change their behaviour (Petty and Cacioppo,1986). Using these behaviour change techniques, the support group had a successful turnout of 15 individuals and the attendees were keen for further bereavement support group sessions to be run.

Balk, D. E. (1997). Death, bereavement and college students: A descriptive analysis. Mortality, 2, 207-219.

Balk, D. E. (2001). College student bereavement, Scholarship, and the university: A call for university engagement. Death Studies, 25, 67-84.

Balk, D. E. (2011). Helping the bereaved college student. New York: Springer

Balk, D. E., Walker, A. C., & Baker, A. (2010). Prevalence and severity of college student bereavement examined in a randomly selected sample. Death Studies, 34, 459-468.

Bonanno, G. A., & Kaltman S. (2001) The varieties of the grief experience. Clinical Psychology Review, 21, 705-434.

Burke, L. A., Neimeyer, R. A., McDevitt-Murphy, M. E., Ippolito, M. R., & Roberts, J. M. (2011). Faith in the wake of homicide: Religious coping and bereavement distress in an African American sample. International Journal for the Psychology of Religion, 21, 289-307

Conner, M., Warren, R., Close, S., & Sparks, P. (2006). Alcohol Consumption and the Theory of Planned Behaviour: An Examination of the Cognitive Mediation of Past Behaviorid. Journal of Applied Social Psychology, 29, 1676-1704.

Donfried, K. P., & Richardson, P. (Eds.). (1998). Judaism and Christianity in first-century Rome. Wm. B. Eerdmans Publishing.

Fajgenbaum, D., Chesson, B., & Lanzi, R. G. (2012). Building a network of grief support on college campuses: A national grassroots initiative. Journal of College Student Psychotherapy, 26, 99-120.

Floerchinger, D. S. (1991). Bereavement in late adolescence. Journal of Adolescent Research, 6, 146–156.

Flynn, F. J., & Lake, V. K. B. (2008). If you need help, just ask: Underestimating compliance with direct requests for help. Retrieved from

Hardison, H. G., Neimeyer, R. A., & Lichstein, K. L. (2005). Insomnia and complicated grief symptoms in bereaved college students. Behavioral Sleep Medicine, 32, 99–111.

Kübler-Ross, E. (1969). On Death and Dying. London: Routledge.

LaGrand, L. E. (1986). Coping with separation and loss as a young adult: Theoretical and practical realities. Springfield, IL: Charles C. Thomas.

Mathews, L. L., & Servaty-Seib, H. L. (2007). Hardiness and grief in a sample of bereaved college students. Death Studies, 31, 183-204.

Monk, T., Germain, A., & Reynolds, C. (2008). Sleep disturbance in bereavement. Psychiatric Annals, 38, 671-675.

NHS Bereavement Self-Help Leaflet (n.d). Retrieved from:

Osterweis, M., Solomon, F., & Green, M. (1984). Bereavement: Reactions, consequences, and care. Washington, D.C.: National Academy Press.

Shear, M. K. (2015). Complicated grief. The New England Journal of Medicine, 372, 153-160.

Sklar, F., & Hartley, S. F. (1990). Close friends as survivors: Bereavement patterns in a “hidden” population. OMEGA-Journal of Death and Dying, 21, 103-112.

Winter, D. (1990). Therapeutic alternatives for psychological disorder. In G. Neimeyer & R. Neimeyer (Eds.), Advances in Personal Construct Psychology. JAI Press.

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