Innovative Therapy Helps Complicated Grief

A new type of psychotherapy created specifically to target symptoms of complicated grief appears to be more effective at helping patients recover after the death of a loved one.

Complicated grief occurs after the death of a loved one, and symptoms (which persist for more than six months after the death) include a sense of disbelief about the loved one's death, anger and bitterness over the death, yearning for the deceased person, and preoccupation with thoughts of the loved one, including distressing intrusive thoughts related to the death itself.

According to Katherine Shear, M.D., who is lead author of a study published in the June 1 Journal of the American Medical Association, complicated grief shares elements of major depression (sadness, guilt, and social withdrawal) and post-traumatic stress disorder (disbelief, intrusive images, and avoidance behaviors), but treatments typically used for these disorders don't work well for people with complicated grief.

In addition, since complicated grief isn't yet recognized as a disorder in the Diagnostic and Statistical Manual, many clinicians may misdiagnose patients who are experiencing traumatic grief with depression, Shear added. "Helping clinicians to identify complicated grief is crucial to successful treatment."

Shear and her colleagues developed complicated grief treatment (CGT), in which professional therapists guide clients to recall stories of their loved one's death while they tape-record the client's recollections. Periodically, the therapist asks clients to report their levels of distress. Therapists tried to reduce distress levels during each session by "promoting a sense of connection" to the loved one. Between sessions clients listened to their tapes.

These connections included imagined conversations with the deceased and a discussion of positive and negative memories about him or her. Therapists using CGT also asked clients to discuss what their plans and goals would be if their grief wasn't so intense.

All patients were independently rated before and after receiving CGT using the Clinical Global Improvement (CGI) scale. This scale measures clinical improvement from before therapy on a scale of 0 to 7. Shear found that 51 percent of those who received CGT reported "very much improvement" (CGI score of 1) or "much improvement" (CGI score of 2) after therapy, whereas just 28 percent of those receiving standard interpersonal psychotherapy did.

Researchers also found that 55 percent of the CGT group experienced a 20-point improvement on the CGI compared with 25 percent of the other group.

Shear also noted that "people who were on antidepressants" at the time of therapy "had the same mean CGI score as those who weren't on medications,"... "so the medications didn't seem to relieve symptoms of complicated grief".

Adapted from Psychiatric News July 15, 2005 Volume 40 Number 14 © 2005 American Psychiatric Association
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