held.press · the evidence

The evidence behind the cards

Checked at claim level, against the papers. Including what we got wrong.

24attributions verified
3found wrong, and fixed
260cards across five decks

Every card in a HELD deck names the idea underneath it, and many name the researcher it comes from. In July 2026 we checked every one of those attributions against the actual papers — not the name, the claim: does the sentence on the card match what that researcher actually found?

Three did not. They are listed below alongside the rest, because a research page that only showed the wins would be marketing. This is the working.

The rule we hold ourselves to: a card may always say less than its source. It may never say more.

What we got wrong, and fixed

A citation that pointed the wrong way

One card offered permission about what to do with a wedding ring and the photographs — keep them, box them, decide later. It cited Vamık Volkan on “linking objects.” In Volkan’s work a linking object is a marker of complicated mourning: an item invested with magical significance that extends grief indefinitely. The card said something close to the opposite of its own citation. The attribution has been struck.

A finding stated more strongly than the study

We cited a Cochrane review for the benefit of “attending meetings.” The review tested manualised twelve-step facilitation as a clinical intervention, for alcohol use disorder specifically — not attendance, and not all recovery. The citation was rewritten to say what the review actually tested.

An overstatement still being corrected

A pet-loss card calls pet bereavement disenfranchised grief’s “most common form.” The literature treats it as an example among many. The wording is being changed to “one of its most familiar forms” — which also means re-recording that card’s reading.

The verified record

Cochrane 2020 — AA / twelve-step facilitation

Kelly JF, Humphreys K, Ferri M (2020). Alcoholics Anonymous and other 12-step programs for alcohol use disorder. Cochrane Database of Systematic Reviews, Issue 3, CD012880.

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Pagano — helping others in AA

Pagano ME, Friend KB, Tonigan JS, Stout RL (2004). *Helping other alcoholics in Alcoholics Anonymous and drinking outcomes: findings from Project MATCH.

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Marlatt & Gordon — relapse taxonomy

Marlatt GA & Gordon JR — relapse taxonomy / cognitive-behavioural model of relapse prevention.

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Medication for opioid use disorder — first-line, mortality-reducing

*(was A-004, the highest-stakes claim in the deck — it is printed clinical guidance about mortality and a prescriber will check it)

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Exercise in substance use disorder

What it actually found: meta-analyses of exercise during SUD withdrawal — craving reduced across light/moderate/high intensity (SMD −0.71, 95% CI −0.90 to −0.52, no significant difference between intensities); depression during withdrawal reduced (SMD −0.40, 95% CI −0.52 to −0.27, 15 trials, n=1,029).

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Doka — disenfranchised grief

Doka KJ (1989). Grief "that persons experience when they incur a loss that is not or cannot be openly acknowledged, socially sanctioned or publicly mourned." Pet loss is a canonical example; pet bereavement research finds grief paralleling human loss while mourners report stigma and absent support.

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Stroebe & Schut — dual process model

Stroebe M & Schut H (1999), rationale and description (PubMed 10848151); "a decade on" (2010, PubMed 21058610). Bereaved people oscillate between loss-oriented and restoration-oriented coping; oscillation — including time off from grieving — is the adaptive process, and failure to oscillate flexibly is the risk marker.

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Tonkin — growing around grief

Tonkin L (1996). Growing around grief — another way of looking at grief and recovery. Bereavement Care 15(1). The grief does not shrink;

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Kaplan & Kaplan — attention restoration theory

Directed attention is finite and fatigues; natural settings evoke soft fascination, which restores it. Well-established construct.

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Urge surfing — Marlatt

Introduced by Marlatt (1980s), later formalised in Mindfulness-Based Relapse Prevention. Cravings are treated as waves with a beginning, middle and end; most urges peak and pass within roughly 30 minutes when ridden out. An 8-week MBRP programme reduced craving and improved stress management.

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Divorce corpus — the three load-bearing attributions

Slotter, Gardner & Finkel (2010), Who Am I Without You? The Influence of Romantic Breakup on the Self-Concept, PSPB. Breakup produces self-concept content change and reduced self-concept clarity, and reduced clarity uniquely predicts post-breakup emotional distress. Larson & Sbarra (2015) found improvements in self-concept clarity precede gains in wellbeing — the direction runs clarity → wellbeing, not the reverse. VERIFIED. This is a strong, specific, correctly-attributed finding and the divorce deck should lean on it harder than it does.

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Bonanno — bereavement trajectories

Bonanno GA — resilience model of grief (2004 onward); Galatzer-Levy, Huang & Bonanno (2018) reviewed 54 studies. Resilience is the modal response to loss and potential trauma. Outcomes resolve into a small set of prototypical trajectories — in one bereavement study: resilience 68.2%, chronic grief 13.2%, depressed-improved 11.2%, pre-existing chronic depression 7.4%. Bonanno's work is an explicit challenge to stage models.

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Gross — expressive suppression

Gross JJ. Suppression comes late in the emotion-generative process and inhibits the outward signs of emotion. Findings: suppression decreases behavioural expression but FAILS to decrease the experience of emotion, impairs memory, and increases physiological responding — in the suppressor AND in their social partners. Reappraisal, by contrast, reduces experience and expression with no memory cost.

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Fisher — romantic rejection

Fisher HE, Brown LL, Aron A, Strong G, Mashek D (2010), Reward, addiction and emotion regulation systems associated with rejection in love, J Neurophysiology (PubMed 20445032). fMRI of recently-rejected participants still "in love": images of the beloved activated the ventral tegmental area and regions associated with craving, reward and addiction — the authors link this to the obsessive behaviours that follow rejection.

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Eisenberger — social pain

Eisenberger NI, Lieberman MD, Williams KD (2003), Does rejection hurt? An fMRI study of social exclusion, Science. Foundational work on social rejection recruiting neural substrates overlapping physical pain.

Sbarra & Neff — self-compassion after divorce

Sbarra DA, Smith HL, Mehl MR (2012), When leaving your ex, love yourself: observational ratings of self-compassion predict the course of emotional recovery following marital separation. Psychological Science 23(3):261–269.

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Bowlby — separation distress

Bowlby & Robertson: separation response runs protest → despair → detachment; protest involves crying, searching, resistance to comfort, often worst at night and around sleep, with real physical distress. Attachment theory holds that separation arouses this at every age, not only in childhood.

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Doka & Martin — grieving styles

Intuitive (affective; processes by feeling and talking) vs instrumental (cognitive/behavioural; processes by doing and thinking).

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Rando — STUG

Rando TA, early 1990s: Subsequent Temporary Upsurges of Grief — intense, unexpected waves triggered long after the loss by a song, a scent, an image, an anniversary. Rando's own metaphor is oceanic: grief usually laps at the ankles, then a wave takes your feet out.

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Neimeyer — meaning reconstruction

Neimeyer RA — meaning reconstruction is the central process in grieving; mourners face twin needs to process the event story and to access the back story of the shared life, in a way that reaffirms attachment security. The strongest available framing for that card is the event-story/back-story pair, which it does not currently use.

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Bruce & Schultz — nonfinite loss

Bruce EJ & Schultz CL (2001), Nonfinite Loss and Grief: A Psychoeducational Approach. Nonfinite grief is mourning for what was never realised, rather than for something possessed and lost — a continuing rather than resolving presence.

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McEwen — allostatic load

McEwen BS & Stellar E (1993). The multi-systemic "wear and tear" the body sustains when stress responses are activated too often, too long, or never shut off — cumulative across metabolic, endocrine, cardiovascular, immune, GI and nervous systems.

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Pennebaker — expressive writing

What the literature actually shows — and it is not clean. Smyth's 1998 meta-analysis: d ≈ 0.47. Across 100+ studies since: d ≈ 0.16. At least one recent meta-analysis found no significant effect averaging over all outcome categories. Results are difficult to replicate and the necessary conditions are unclear. A 2025 grief-specific meta-analysis found writing reduces grief but with small effect sizes, moderated by more sessions and therapist feedback.

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Volkan — linking objects

Volkan VD, Linking Objects and Linking Phenomena: A Study of the Forms, Symptoms, Metapsychology, and Therapy of Complicated Mourning.

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Where the evidence is thin, we say so

Expressive writing is the clearest example. The early meta-analysis reported a moderate effect; across a hundred-plus studies since, the average has fallen to small, and at least one recent review found no significant effect overall. Our card invites writing. It does not promise that writing will help, because the evidence no longer supports that promise.

Four cards currently cite a body of literature rather than a specific finding. That is on our list to fix: a literature name reads like evidence while being impossible for you to check.

These cards are companionship, not therapy

Nothing here is treatment, and no card should change anyone’s care. Where a card touches something clinical — medication for opioid use disorder is first-line and reduces mortality; grief that stays very heavy for very long deserves a person, not a card — we put that on the card itself, not in a footnote.