Abstract
Acquired brain injury (ABI) affects millions yearly potentially altering the emotional, behavioral, and physical characteristics of the person. Consequently, it can result in the person before the ABI being markedly different from the person after. Family members of individuals with ABI often report feeling grief but there is limited support to help them. This study aimed to pilot a four-week grief writing intervention based on the continuing bonds intervention “Hello Again,” for family members after ABI. The purpose was to determine the experience of writing the letters and the perceived benefit. Recruitment was through volunteer sampling, and three participants took part in the study. An interpretative phenomenological analysis (IPA) was used to determine the meanings of the writing task for the participants. The writing task was perceived to be beneficial, with four subordinate themes emerging: Acknowledging grief, Finding space to mourn, Creating an integrated narrative, and Writing being difficult but necessary. This study contributes novelly to the field both in research and practice. It is the first study to apply a continuing bonds perspective and implement a continuing bonds intervention for family members of individuals with ABI.
Introduction
Acquired brain injury (ABI) is an umbrella term used to describe any brain injury post-birth (Goldman et al., 2022). ABI can result from damage caused by illnesses, stroke, or reduced blood flow to the brain, or from Traumatic Brain Injuries (TBI) caused by blunt force or penetrative means, such as falls, road traffic collisions, or assaults (Goldman et al., 2022). In the UK, around 1.3 million people are living with disabilities from these injuries (Maas et al., 2017). In 2019–2020, there was an increase of 12% in hospital admissions related to ABI since 2005–2006 in the UK (Headway, 2019).
A wide variety of changes can occur following ABI, including physical, behavioral, emotional, and cognitive. Physical changes include motor and speech difficulties, fatigue, and headaches (Kelly et al., 2019; Lennon et al., 2018). Behavioral and emotional changes include increased aggression (Vutakuri, 2023), anxiety, and depression (Stubberud et al., 2020; Shiho et al., 2022). A range of cognitive impairments can occur including difficulties with memory, attention, speed of processing, and executive impairments involved with problem solving, initiation, and decision-making (Uddin, 2021). As a result, there can be a marked difference between the pre-morbid characteristics of the person and how they present post-injury, which can be challenging for the family and friends of individuals with ABI (Sansonetti et al., 2023). Close family may be required to help support their loved one as an informal caregiver following injury, which can be overwhelming and lonely, with limited support available to deal with the behavioral and emotional changes that may have occurred (Oyesanya, 2017).
There is a myriad of research reporting the experiences of family following ABI that notes the process of grief and loss individuals can experience (Collings, 2007; Gamgee et al., 2023; Townshend & Norman, 2018; Whiffin et al., 2021). This grief is often referred to as ambiguous loss, meaning the loss of a person who is still physically present (Boss, 1999). Due to the ambiguity, it can be difficult for others to recognize this grief; a process known as disenfranchized grief (Doka, 1989). Corr (1999) described three situations that result in disenfranchised grief; when the relationship between the griever and the deceased is not recognized, when the death or the loss is not recognized, or when the grievers’ ability to grieve is not recognized. As a result, grievers can feel minimized in their loss; they may experience feelings of guilt and shame surrounding the loss and may not talk to others about their grief (Doka, 1989). In non-disenfranchised grieving, social support usually provides a safe place to explore the emotions surrounding grief, such as anger, denial, exploration of meaning, loneliness, and depression. However, in disenfranchised cases, the feelings can be suppressed, intensifying emotions rather than alleviating them. It can also prolong the grieving process, potentially leading to pathologized grief, such as prolonged grief disorder (Turner & Stauffer, 2023). It is, therefore, imperative that there are interventions and support to enfranchise grief experiences.
When considering appropriate interventions, it is important to acknowledge that the griever is grieving a person who is still physically alive and may need ongoing care from the griever. Therefore, there needs to be an integration of who the loved one was before and who they are now. Secondly, as ABI results from a sudden, often traumatic, event, the ambiguous loss archetypes are different to those applied to dementia grief where the losses are compounded rather than sudden (Gilmour & Steffen, 2025). In sudden death, there is no opportunity to say goodbye to the person, which can result in unfinished business and possible unresolved conflict, which, if not appropriately dealt with, can lead to prolonged grief disorder (Clements et al., 2004). This is reflected in the experiences of ABI grief, with family members reporting that there is no space for closure (Kratz et al., 2015; Townshend & Norman, 2018).
While interventions for ambiguous loss have been used following ABI (e.g., Kreutzer et al. 2016), there is limited evidence for their effectiveness. Applying the continuing bonds paradigm of grief may be beneficial as a framework for ABI ambiguous loss interventions. These approaches work on the premise that grief is not about breaking the bond with the deceased but about maintaining and adapting the bond moving forwards (Klass et al.,1996, 2014). The focus of continuing bond interventions is on reconstructing and continuing the bond with the deceased, bringing the deceased into the therapy, and continuing the griever's dialogue with them (Neimeyer, 2023; Root & Exline, 2013). This may translate well to ABI grief because we can view the loss of the person before the ABI as not entirely gone but living on in the memories of their loved one as well as in the physical person that remains.
One potential continuing bonds intervention is the “Hello Again” intervention (Neimeyer, 2012; White & Denborough, 1998) which focuses on maintaining a continuing bond with the deceased and utilizes a meaning-reconstruction perspective on grief (Neimeyer, 2019). Meaning reconstructions may benefit families after ABI as the approach is often used to address any unresolved conflict or unfinished business, which following an ABI may be particularly beneficial due to the sudden nature of the injury. Furthermore, the emotion-focused nature of the task may help clarify the grief processing (Neimeyer, 2012).
Therefore, the current study aimed to 1) ascertain the perceived helpfulness of the Hello Again intervention for family and friends of those with ABI and 2) gain insight into the grieving process of the family of those with ABI.
Methodology
Design
The study employed a qualitative design using semi-structured interviews intended to illicit information from participants about their experiences of the letter writing tasks. Data were analyzed using interpretive phenomenological analysis (IPA; Smith, 2019). IPA was chosen because of the philosophical underpinnings of phenomenology. Phenomenology is a way of understanding experience. It posits that meaning and value should be placed on individual lived experience (Smith, 2019). This research is concerned with understanding the lived experience of ambiguous loss in families after a loved one has experienced an ABI (Boss, 1999; ThØgersen & Glintborg, 2021). Grief is a subjective and idiographic experience; therefore, we employed an analytic technique that was also subjective and idiographic.
Participants
Participants in the study had to be willing to participate in letter-writing tasks in English, be a close family member or friend of someone with ABI and be willing to be asked questions about the person with the ABI. The individual with the ABI had to be a minimum of two years post-injury at the time of the study. The emotional demands of the task were considered too great to include those still in the early stages of adjusting to life post-injury. This is in keeping with the guidance of Neimeyer (2012) who stated that the therapeutic timing of this intervention was of utmost importance. The client must be emotionally ready to consider continuing the bond and have the emotional capacity to process the thoughts and feelings that may arise. Finally, any participant with a complex or potentially abusive relationship with their loved one with the brain injury were not eligible to take part in the study as it has been highlighted that this technique may not be beneficial for those in such relationships (Neimeyer, 2012).
Recruitment occurred by posting recruitment flyers on social media and in support groups using a snowball sampling technique. Three people were recruited to the study. All were mothers of children with ABI, two had TBIs, and one with an arteriovenous malformation. The proximity since the initial injury was between 2 and 14 years. All participants were between the ages of 40 and 55. All children were in the age bracket of 14–18 years at the time of data collection.
The study followed standard ethical guidelines as laid down by the British Psychological Association (2021) and followed the guidance laid out by Neimeyer (2012) in how to administer the continuing bonds intervention safely. Ethical approval was sought and obtained from the University of Plymouth, reference number EGAN2023SoPUoP.
Data Collection
Once participants expressed interest in the study, they were first emailed the information sheet, and then when content to proceed, they were sent the consent form. Once signed and returned an initial online meeting using the video conferencing package Zoom (Zoom Video Communications, 2024) was arranged. In meeting one, which took no longer than half an hour, participants were given the opportunity to address any questions about the study and were then taken through the eligibility criteria. Participants were advised that the continuing bonds intervention was being delivered outside of a therapeutic setting and were advised to have a close significant other available to speak to after each stage of the study. It was also reiterated that the task could be emotional, that they should ensure they were confident about participating, and that they were reminded about their right to withdraw. After determining their suitability and happiness with participating, the researcher set the first task. Participants were asked to write to their family member before they experienced their ABI, known as a ‘Hello Again’ letter. They were asked to write from the heart and were told that they had two weeks to complete the task. They were given writing prompts adapted from Neimeyer (2012) and a resources sheet that included grounding and breathing techniques. A further online meeting was scheduled for two weeks later.
Meeting two was a recorded, approximately forty-five-minute, semi-structured interview designed to illicit information about the experience of writing the first Hello Again letter. Interview questions were based on Neimeyer (2012) including questions such as what insights did you gain? How do you feel about the relationship now? After the interview, the recording was stopped, and participants were asked if they would like to continue to the final stage of the study. For those who did not wish to continue, a debrief was given verbally and sent electronically. For those who consented, they were asked to write a second letter written from the perspective of their loved one prior to their ABI in response to their initial letter, the second Hello Again letter. They were given a further two weeks to complete this task.
The final meeting was a recorded, approximately 45-minute, semi-structured interview designed to determine the experience of writing the response letter and the overall experience of writing both letters. After the interview, the participant was debriefed verbally and sent a sheet electronically. Transcripts of all interviews were transcribed using Otter.Ai and then manually checked for accuracy by the first author including non-verbal markers and pauses so that there could be selective attention to meanings. Transcription followed the Jefferson Transcript conventions (Jefferson, 2004). All identifiable information was removed at transcription.
Data Analysis
The data were gathered from the letters and the interview transcripts. IPA was used to analyze the data. IPA provides two levels of interpretation as it is a double hermeneutic approach, which serves this research well as the researcher becomes an integral part of the task and the reflections upon it. The researcher also provides a level of interpretation to create an understanding of new experiences.
Data analysis followed the process of IPA outlined by Willig (2008, 2013). In the first stage, transcripts and letters were read and re-read highlighting initial statements of significance in open coding. Major and minor themes were then identified and then cluster of themes developed and were labeled and organized to capture their essence. These themes were used to produce a summary table with quotations for each theme. Those with limited support from quotations were abandoned. A cohesive narrative was generated based on the summary table (Willig, 2008, 2013).
The first author conducted the analysis with support and checking from the second author. The first author kept a reflective diary throughout the process of data collection and analysis to appropriately consider the positionality of the researcher. The first author has limited experience within the population of brain injury but has experience conducting this intervention with family members of those with dementia and adapted the protocol for family members of those with ABI, with help of the second author. It should also be noted that the second author, as well as being an experienced academic in the field of ABI, is also a family member of someone with a TBI.
Analysis
Four subordinate themes were identified: Acknowledging grief, Finding space to mourn, Creating an integrated narrative, and Writing as difficult but necessary. Pseudonyms have been used for any names in this analysis.
Theme 1: Acknowledging Grief
The experience of writing the letters allowed Jane, Emma and Jo to recognize that a loss had occurred. They spoke about how they were subconsciously aware of the loss, but it had only been adequately recognized once sitting down to write the letter. Not being able to grieve their losses resulted in them feeling lonely, guilty, and confused. Being able to acknowledge their grief allowed them to come to more acceptance. Jane's daughter received a TBI 14 years ago when she was two years old. She spoke about how the first letter was an epiphany for her in recognizing that she was grieving and had experienced loss.
But the one thing that kept coming up, and I kept coming back to, is the word loss (voice breaking). I'm emotional just talking talking about it. It wasn't a word that had ever come up before. (Jane, I1)
Jane talks about discovering the word “loss”; she had never considered that she had experienced loss because her daughter did not physically die. For the first time, Jane recognized that she was grieving her daughter. Not having her grief recognized was a lonely experience for Jane:
No one can understand the fear, the guilt. I don't want them to. It's mine to shoulder, but it's also buried somehow yet carried along with us, weighing so heavy in everything we do. (Jane, L1)
Jo, whose son experienced a TBI two years previous, at the age of 12, also reflected on how the task made her realize the difficulty of being alone and not recognized with her grief.
Yeah, and I think it was the first time I was really aware about how difficult it is to talk to other people about it…just whenever I tried to talk about feeling sad about having lost a version of [name], people were like, oh, but you're so lucky because he's still here. (Jo, I1)
Jo provides insight into why it is lonely to grieve a version of her son. She discusses how when she tried to broach the subject with others, there was a lack of understanding, which resulted in her grief being diminished because she was supposed to feel “lucky” that her son survived. Emma, whose son had an ABI ten years ago at the age of eight expressed similar experiences:
We were constantly told how lucky we were that he did survive…But we didn't feel like that, because he went through years and years of having open brain surgery and like, you know, really horrific things that most adults couldn't do or would let alone an eight year old boy. (Emma, I1)
In her letter, Jo talks about her son as two versions, version 1.0 pre-TBI and version 2.0 post-TBI, and how they are different but “is not allowed” to admit that. Being able to admit that was significant for Jo as she talks about how writing the first letter gave her “permission” to mourn and come to a place of accepting the differences.
Everyone is so grateful for [name] 2.0. I am grateful for 2.0, but he isn't you. I don't think he will ever be you, and I miss you. It's hard to talk about that without seeming selfish and ungrateful (Jo, L1).
There is a real difference in the before and after. I think you try and convince yourself that it's not. That's it's the same person. But I think kind of having permission.. to. Mourn. (1.0) who he was. Will help me - to kind of really accept. the new[name]. (Jo, I1)
Theme 2: Finding Space to Mourn
Participants talked of the barriers that caring demands and constant fighting for the rights and needs of their children places on processing grief when the focus of daily life is on survival. Writing the letters allowed Emma, Jo, and Jane to find space to mourn their losses, which enabled them to clarify their feelings. In the first letter that Jo writes to her son:
I'll never know that man you would have become, who you would be. And there's no space to mourn you. (Jo, L1)
Here, Jo refers to the grief of a future lost but unable to have that space to grieve. One of the reasons that there is “just no time to look back at it” is because, with a brain injury, the primary focus is on the person surviving and this disrupts the ability to reflect on the losses.
You know, first, it's just making sure that they survive as painlessly as possible. And then it's just, you know, working and getting them out of hospital and then getting them what they need at school and you know all of those things you're just on a permanent kind of mission fighting some kind of battle with somebody but you don't really have time to reflect back. (Jo, I1)
It doesn't stop, but literally doesn't even after all these years, and it's really hard, really hard to keep it together when you've got this ((showing letter 1)) this like weighing down on you all the time, not knowing it's there. (Jane, I1)
giving myself a bit of time to think about it and reflect on it… It was nice to have a bit of time and space to think about. Him. (Jo, I2)
Theme 3: Creating an Integrated Narrative
The two letters created meanings for each participant in different ways. One of the similarities between them was how the letters allowed them to take a step back and view the whole story. The first task asked them to revisit memories from before the brain injury. Revisiting these memories can be challenging because they remind them of what was lost. Jane writes in her first letter: The photos of that time in your life are actually painful to look at, they feel unreal. Like that happy time, with so many hopes and dreams, didn't actually happen, that it was all just something I so wanted to experience but never actually did. A cruel taste of how life should be. (Jane, L1)
Jane highlighted how the brain injury took over her whole life and other life experiences were overshadowed. However, writing the letter allowed her to integrate the brain injury into her whole life story. She commented on how the letter writing, specifically the second letter, allowed her to take a more “objective” viewpoint, which helped her understand the brain injury story and her role in it. In her first letter to her daughter, she expresses:
I so desperately just want to be your mum again (3.0). Not your carer. Your physiotherapist, your nurse, your psychologist, I just want to be your mum. (Jane, L1)
I think the first one was useful for helping me to see or to remember what I've lost, and the second one was more helpful for helping me see what's still there. (Jo, I2)
Taking a step back and creating an integrated narrative of the illness and grief stories allowed Jane to acknowledge how other life experiences affected her coping with the TBI and to clarify her identity as a mum. Jo and Emma were able to acknowledge their losses but also start to understand the similarities between their sons before the brain injury and after.
Theme 4: Writing was Difficult but Necessary
The writing tasks required the participants to be brave, honest, and resilient. When writing the first letter, the participants approached the task differently. Emma felt that she had to write the letter “immediately after we spoke” because she knew what she wanted to write. Jane, however, found “it really, really difficult to start.” The task seemed daunting for Jane as “there was just so much in my head, that I just didn't seem to be able to bring to um bring into any sort of cohesion at all” (Jane, I1).
However, when she started writing, she was able to bring some cohesion into her thoughts, but it required resilience to get started. Similarly, Jo spoke about the difficulty of starting, however, when she started, she experienced a sense of flow early on. When asked about writing the first letter to her son, Jo talked about how difficult but necessary it was.
Sad. and difficult. (0.3) but it feels necessary as well ((said quietly)) to remember who he was. (Jo, I1)
I think doing it too soon might not be as beneficial. But then I don't know. Because I don't know how much festers away and perhaps dealing with it earlier on is better? I don't know. I don't know if - it's been helpful this time anyway. (Jane, I2)
Jo highlighted how writing a letter that will not be sent allowed her to be completely honest with the recipient. Moreover, because there was a recipient in mind, she felt that there was a direction to the writing which aided honesty and clarity. Jane also agreed that writing a letter was more beneficial than just writing. I think writing a letter to somebody, even if you're not going to send it…I think there is something about that process about not just putting things in writing…it helps you think about the situation, whatever it might be, from both of your perspectives. And if it's not a letter that's ever being sent, then you don't need to worry about hurting someone's feelings or being tactful or diplomatic…you can be completely honest… I think it's a good way of -exploring how you feel about things and finding some clarity in it. (Jo, I1)
I suppose the letter…gives it some structure, it gives it some way of collating it into something that is is meaningful, I think. If it had been just writing…it might have got a little bit lost along the way. I think it makes it quite personal, doesn't it, making it into a letter? (Jane, I2)
Jane highlighted the psychological risk of addressing her unresolved issues. The second letter, even though it was more challenging than the first, allowed her to “not get caught up in my side of things,” which gave her perspective on her feelings. Jo also related to how the first letter highlighted emotions and feelings, but the second letter provided space to explore the other side of her feelings.
I think the first letter was really important…but I think if it just been left at that first one again, there would have been an awful lot of just sort of hanging stuff. The second letter has brought it together. (Jane, I2)
Interestingly, Emma struggled with writing the second letter, instead choosing to write what she knew he was thinking at the time of the brain injury. However, the process of thinking about the letter was still beneficial. Emma discusses how thinking about the writing enabled her to approach her son and discuss her feelings.
And I said, I don't know why, but I just feel guilty. And he said, “you don't need to feel guilty”. He said, “it's just one of those things, it's just one of those things that happens”. And I think because of having to do that letter to him, I felt able to just drop that into a conversation when we were doing something else. And I think that's the most conversation we've had about it for a very long time, because normally it's like, I don't wanna talk about it. (Emma, I2)
Discussion
This study identified the themes of acknowledging grief, finding space to mourn, creating an integrated narrative, and writing being difficult but necessary within the interviews following the Hello Again letter writing task. This research, to the best of our knowledge, is the first study to apply a continuing bonds grief counseling technique to the family members of those with brain injury. The results suggest that addressing grief with a writing intervention is beneficial for the family members of those with brain injury because it helps them start to enfranchise their grief and clarify their feelings.
It is already well established that ABI grief is disenfranchised (Kratz et al., 2015; Lond & Williamson, 2020; ThØgersen & Glintborg, 2021), highlighting the importance of the first theme of acknowledging grief where participants discussed the fundamental changes in their loved one before and after the brain injury, and how this ambiguous sense of loss for family members is ignored (ThØgersen & Glintborg, 2021). The data in this study demonstrate the potential damage of perpetuating the societal narrative of family members being “lucky” that their loved one survived brain injury and how this can contribute to feelings of guilt, shame, and loneliness (Whiffin et al., 2021). The first letter allowed the participants to start to break through this disenfranchised grief and identify their feelings as a grief response. Within the theme “acknowledging grief” multiple experiences of disenfranchisement were demonstrated including societal disenfranchisement through feeling misunderstood and, therefore, not being able to grieve within their support systems (ThØgersen & Glintborg, 2021), and self-disenfranchisement (Cesur-Soysal & Arı, 2022) where participants did not allow themselves to grieve (Cesur-Soysal & Arı, 2022). Jo spoke of trying to convince herself that her son was the same. However, during the task, she was able to break through some of the barriers of self-disenfranchisement and start her grieving process.
When applying this intervention practically, self-disfranchisement should be considered; some family members may not be aware that they have experienced loss, making the task potentially more complex with the need to consider the potential emotional consequences. Further research is also needed to understand the relationship between self-disfranchised grief resulting from societal disenfranchisement and the stigmatization of potential loss in families after ABI (Kratz et al., 2015; Lond & Williamson, 2020).
The continuing bonds task allowed participants to take the time to slow down and reflect on their experiences. The theme of “finding space to mourn” demonstrates how the ongoing burden of care placed on family members to support their loved one post-injury can contribute to this lack of space to mourn their losses. To conceptualize this, it may be worth considering the Dual Process model of coping with bereavement (Stroebe & Schut, 1999, 2010). The Dual process model argues that there are two adjustment pathways following bereavement: loss-orientated coping which focuses on the loss and dealing with the emotions behind the loss and restoration-orientated coping which focuses on surviving and dealing with the problem-focused aspects of the loss (such as dealing with a funeral or wills). The authors posit that in healthy grieving, there is an oscillation between the two, and focusing on one and not the other can lead to a repression of emotional response (Stroebe & Schut, 1999, 2010). Because there is a focus on survival, participants are forced to stay on the restoration-focused coping pathway and have no time to deal with the loss-orientated elements. As a result, the emotional aspects of their grief become repressed and ignored. It is possible that the expressive nature of the Hello Again writing task allowed them to reorientate to loss-orientated coping and start to process their grief emotions. This is an area for future study.
This research is a novel approach to applying the continuing bonds theory to family members after ABI. Continuing bonds identify the importance of a continuation of the bond with the deceased (Klass et al., 2014). However, in this context, revisiting pre-injury memories of a loved one can be distressing as evidenced in the theme “creating an integrated narrative.” This reflects a debate within continuing bonds research about whether continuing the bond is beneficial because for some it can be distressing (Hewson et al., 2023). The theme of “writing being difficult but necessary” highlighted how the first letter was potentially distressing because it involved allowing repressed emotions to come to the surface; however, the second letter allowed for resolution and completeness. Participants reported that the second task's perspective-taking nature allowed them to be more objective with their feelings. This needs further investigation in a larger study.
The theme of “creating an integrated narrative” also demonstrates that continuing the bond, albeit challenging, may help to develop meaning reconstruction through integrating the previous self with the present self and clarifying losses and identities. This finding aligns with the benefits of the Hello Again task on dealing with unfinished business (Neimeyer, 2012). This research also supports the use of the Hello Again task to address unfinished business concerning ambiguous loss (Gilmour & Steffen, 2025).
Limitations
The task was completed with family members who had loved ones between two- and fourteen-years post-injury. This task may be beneficial for individuals at different time points, but the sample here did not allow this to be investigated. An additional limitation was the inclusion of only mothers in this sample. The study would benefit from being conducted with those with different relational dynamics to explore how this impacts their engagement with the intervention.
Recommendations for Practice
This small pilot study provides limited evidence for the benefit of using the Hello Again writing task with family members of those with an ABI. It was identified, qualitatively, that the experience of writing the task was beneficial for acknowledging grief and finding space to mourn, and that the writing task was difficult but necessary. The emotional preparedness of participants must be considered when applying this grief intervention with family members after ABI. Participants spoke about how completing the task earlier may not have benefited them because of the demands of caring or other personal circumstances surrounding the brain injury. This is in line with the ethical considerations put forward by Neimeyer (2012) who stated the importance of timing the task correctly for each person.
Further investigation is also needed to understand whether it is the nature of the Hello Again writing task that was beneficial or simply the process of reflecting upon loss. Some participants said that writing letters was beneficial, as suggested by previous literature (Larsen, 2022). However, the second task, which involved taking someone else's perspective, proved difficult for some participants as they struggled with writing a physical letter but did find the reflective process easy to engage with. Therefore, it is difficult to conclude whether the writing tasks were most beneficial or if it was having someone validate their grief and give them time to explore feelings. More research into other grief interventions within this population would clarify this.
Conclusion
This small study provides some limited, qualitative evidence for the benefit of using the Hello Again writing task with family members of those with an ABI. Family members found the experience of the writing task beneficial for acknowledging grief and finding space to mourn. They also found the writing task was difficult but necessary. These themes provide further support that the experience of family members of those with an ABI is a type of disenfranchised grief. The experiences of these mothers demonstrate how this grief is continually ignored leaving them feeling guilty and alone. The Hello Again task gave them permission, space, and time to mourn their losses, allowing them to voice what was unsaid and address unfinished business. This research highlights how vital it is for family members to receive grief support and has underscored the urgent need for more research and support interventions to understand and address the grief process following ABI.
Footnotes
Acknowledgments
We would like to thank the participants for giving up their valuable time to take part in this important research. We acknowledge how hard it is to tell such stories of grief and trauma. We would also like to thank all organizations who supported recruitment.
Author Contributions
The first author designed the study with support from the second author. The first author conducted all interviews and interventions. The first author also conducted primary data analysis. Validation of the analysis and second reviewing was undertaken by the second author. Both authors contributed to the writing of the submission.
Data Availability
Data will be made available by contacting the first author only due to the need to protect anonymity.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Ethical Approval and Informed Consent
Ethical approval was obtained through university ethics committee. All ethics principles of the British Psychological Society were followed. All participants gave written informed consent to take part in the research and for anonymized data to be used in publication.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
