Treatment Of Complicated Grief Research Articles

Pertinent Studies on Treatments for Prolonged Grief Disorder

Prolonged grief disorder (PGD) is a distinctive disorder and leads to severe impairments in people’s life. Treatments specific to PGD are urgently needed. However, there have not been enough studies on this topic and universally effective treatments have not been validated. As a result, the current paper aims to summarize some studies about pertinent treatments and list what may be their shortcomings, in order to give future direction for investigation on treatment for PGD. Results show that study of pharmacology for PGD may just start. There has not been effective medicine yet. Complicated grief treatment can be an effective way to treat PGD, but its response rate can be better, if future studies can confirm its real working factors and examine the treatment in a larger and more diverse sample group. Cognitive behavioral therapy (CBT) targeted at CG shows promising outcomes. However, its response rate should also be improved in the future. Meanwhile, as different CBT plans always have different intervention procedure, it may be hard to figure out what really works on PGD and helps to improve. Future study can try to confirm its true therapeutic factors. In all, there is much work need to be done in the future.

Prolonged grief disorder treatment: An approach to COVID-19 grief

Background. It has been estimated that COVID-19 grief will affect approximately sixteen million people worldwide, while the prevalence of prolonged grief disorder (PGD) could rise to 40%. Objective. To review treatments that can be administered to patients with PGD due to COVID-19. Method. PUBMED and Google Scholar were searched with the following keywords: prolonged grief disorder, complicated grief, grief and psychotherapy, and treatment of prolonged grief, complicated grief or persistent complex grief. Results. Fifty articles were reviewed on the efficacy of interpersonal therapy, rational emotional-behavioral therapy, supportive therapy, humanistic therapy, systemic family therapy, group therapy, writing therapy, Internet-based intervention, and a modality of cognitive behavioral therapy used with prolonged grief, metacognitive therapy, and acceptance and commitment therapy. Discussion and conclusion. There is no consensus on the psychotherapeutic treatment of choice for people with PGD due to the loss of a family member to COVID-19. Group therapy is effective in reducing the intensity of uncomplicated grief, cognitive-behavioral therapy is highly efficacious in reducing the severity of grief, metacognitive therapy specifically designed for PGD has a positive impact on depression, anxiety, stress, rumination, and quality of life while Acceptance and Commitment Therapy is helpful for restoring spirituality. Psychotherapy is most effective when combined with drug therapy. It is suggested that comparative studies be undertaken of psychotherapeutic techniques for managing patients with PGD associated with COVID-19 and the adaptation of these techniques to virtual settings.

Complicated Grief Following the Traumatic Loss of a Child: A Systematic Review.

Complicated grief is a disabling condition that occurs when the natural grief process is disturbed or prolonged. Research demonstrates that complicated grief is more prevalent following the sudden or violent loss of a child. Despite the high incidence of accidental death worldwide, little research has focused on parental grief trajectories following this form of traumatic loss. A systematic review was conducted to explore parental bereavement outcomes following accidental death. Studies were included if they specifically examined complicated grief in parents bereaved by the accidental death of their child. A total of 767 articles were identified and seven studies met the eligibility criteria for review. Poorer outcomes were identified in relation to the mode of death, relationship type, time post-loss, perceived support, perceived justice and comorbidities. Results of the current study may be used to inform the development of clinical practice guidelines for the treatment of complicated grief.

Hypnomeditative Reprocessing Therapy In The Treatment Of Complicated Grief

Hypnomeditative Reprocessing Therapy In The Treatment Of Complicated Grief

CAREGIVERS' EXPECTATIONS OF A MIND-BODY THERAPY FOR COMPLICATED GRIEF

Abstract Accelerated Resolution Therapy (ART) is a psychotherapy for the treatment of complicated grief, defined as unusually prolonged, functionally impairing grief. The purpose of this study was to qualitatively examine caregiver’s expectations of ART. The sample included 29 primarily female, older (67.4 + 7.1 years) former informal caregivers; a little over half (n=18) had been married to their care recipient. Thematic analysis resulted in three themes and six sub-themes arising: The role of knowledge in expectations (sub-themes uncertainty, prior knowledge); The role of personality in expectations (sub-themes openness, positive affect); and Expecting a process (sub-themes cognitive processes, affective processes) which described the interaction of person and process in shaping expectations of our intervention. An across theme analysis of the specificity of the participants’ expectations uncovered that knowledge and personality inform expectations of ART and that individuals who verbalize a process for recovery tend to be very specific in their expectations.

THE MANY VOICES OF CARE PARTNERS ACROSS THE CONTINUUM OF CARE

Abstract Caregiving and care-sharing is a dynamic, stressful, and physically demanding responsibility, often leading to adverse psychological and physical outcomes. Caregiving for chronic illness and disease involves increasing complexity and scope of responsibilities and expectations. Utilizing strengths-based approaches and a variety of qualitative methods, this symposium highlights the many voices of care partners across the continuum of care; pre-, during and post-caregiving. First, Latimer and colleagues will present a case study of an older adult with multiple chronic illnesses, offering insight into anticipating care needs and coping with daily stressors of multi-morbidity in late life. Second, Morgan and colleagues will present findings from interviews with care partners on supporting the inner strength of those recently diagnosed with mild cognitive impairment. Third, Fox and colleagues share results from a dyadic, multi-modal intervention for pain management. Care partners who both experience persistent pain discuss changes in their relationship as a result of participating in the intervention together. Fourth, Wladkowski discusses caregiver’s perspectives on live discharge and re-enrollment into hospice care. Her findings demonstrate how the anticipated “end” isn’t always the end for ADRD caregivers. Fifth, Buck and colleagues will share caregivers’ responses to a psychotherapy intervention for the treatment of complicated grief post-death of the care partner. Discussant Deborah Waldrop will contextualize these findings and offer suggestions for future research and interventions to enhance care partners’ well-being across the continuum of chronic illness and care.

Simultaneous Individual Complicated Grief Treatment With a Couple

Persistent complex bereavement/complicated grief occurs when, after a period of 12 months following a death, there remains an ongoing intense yearning and sorrow for the deceased, preoccupation with the death and its circumstances, difficulty accepting its reality, and disruption in personal identity. This case study illustrates the successful application of Complicated Grief Treatment (CGT), a manualized research-supported intervention, with a husband and wife each receiving individual therapy simultaneously with separate clinicians. The core of CGT involves graded completion of imaginal and situational revisiting (i.e., exposure) exercises. To target maladaptive rumination and counterfactual thinking more explicitly, strategies from a research-based treatment for trauma, Cognitive Processing Therapy, were also incorporated for one member of the couple. To our knowledge, CGT has not been examined with couples receiving individual therapy delivered simultaneously. As such, practitioners have little information about how to proceed with cases where multiple members of the same family are experiencing complicated grief. We will detail the treatment provided, outlining the course of care for each member of the couple, highlighting unique adjustments made to tailor implementation to each individual and to deliver the intervention simultaneously. Quantitative and qualitative data show the effects of treatment on symptoms of complicated grief, depression, and relationship satisfaction.

Acceptance and commitment therapy focused on repetitive negative thinking for complicated breakup grief: A randomized multiple-baseline evaluation

Romantic relationship breakups often cause important behavioral and emotional consequences that can lead to experiencing complicated grief. However, little empirical research has tested psychological interventions for this frequent problem. This preliminary study explored the efficacy of a three-session protocol of Acceptance and Commitment Therapy (ACT) focused on repetitive negative thinking (RNT) for the treatment of complicated breakup grief in three women. A nonconcurrent, across participant, randomized multiple-baseline design was conducted. The three participants showed very large decreases in breakup distress that surpassed the criteria for claiming clinically significant changes. Two participants showed clinically significant changes in emotional symptoms, and all of them attained significant changes in life satisfaction. All three participants showed clinically significant changes in repetitive negative thinking, experiential avoidance, cognitive fusion, and valued living. Effect sizes comparable across designs were very large and statistically significant for breakup distress (d = 7.11), emotional symptoms (d = 2.46), and life satisfaction (d = 1.25). In conclusion, RNT-focused ACT protocols might be efficacious in cases of complicated breakup grief.

The Neglected Role of Psychotherapy for Treatment-Resistant Depression.

The Neglected Role of Psychotherapy for Treatment-Resistant Depression.

On the Control of Psychological Networks.

The combination of network theory and network psychometric methods has opened up a variety of new ways to conceptualize and study psychological disorders. The idea of psychological disorders as dynamic systems has sparked interest in developing interventions based on results of network analytic tools. However, simply estimating a network model is not sufficient for determining which symptoms might be most effective to intervene upon, nor is it sufficient for determining the potential efficacy of any given intervention. In this paper, we attempt to remedy this gap by introducing fundamental concepts of control theory to both psychometricians and applied psychologists. We introduce two controllability statistics to the psychometric literature, average and modal controllability, to facilitate selecting the best set of intervention targets. Following this introduction, we show how intervention scientists can probe the effects of both theoretical and empirical interventions on networks derived from real data and demonstrate how simulations can account for intervention cost and the desire to reduce specific symptoms. Every step is based on rich clinical EMA data from a sample of subjects undergoing treatment for complicated grief, with a focus on the outcome suicidal ideation. All methods are implemented in an open-source R package netcontrol, and complete code for replicating the analyses in this manuscript are available online.

Prolonged Grief Disorder: Course, Diagnosis, Assessment, and Treatment.

Losing a loved one is one of life's greatest stressors. Although most bereaved individuals navigate through a period of intense acute grief that lessens with time, approximately 10% will develop a prolonged grief condition. This review provides an overview of the course of grief and describes risk factors for developing prolonged grief disorder. The evolution of the prolonged grief disorder diagnosis, including the latest criteria sets for ICD-11 and DSM-5, as well as common comorbid conditions and differential diagnosis are discussed. Clinically useful self-report and clinician-rated measures for assessing symptom constructs and overall prolonged grief disorder severity, evidence-based psychotherapies (such as complicated grief treatment), as well as evidence about pharmacologic approaches are presented. Finally, the authors discuss important future directions, including a potential increase in prolonged grief disorder cases due to the COVID-19 pandemic.

Posttraumatic Distress Symptoms and Their Response to Treatment in Adults With Prolonged Grief Disorder.

Posttraumatic stress disorder and prolonged grief disorder (PGD) arise following major life stressors and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of posttraumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD. A randomized controlled trial of 395 adults with PGD (defined as an Inventory of Complicated Grief score ≥ 30 plus confirmation on structured clinical interview) randomly assigned participants to either complicated grief treatment (CGT) with citalopram, CGT plus placebo, citalopram, or placebo between March 2010 and September 2014. This secondary analysis examined the presence of PTSS (per the Davidson Trauma Scale) at baseline and change in PTSS with treatment using longitudinal mixed-effects regression and examined the role of violent compared to nonviolent deaths (loss type). High levels of PTSS were present at baseline, regardless of loss type, and were associated with increased functional impairment (P < .001). CGT with placebo demonstrated efficacy for PTSS compared to placebo in both threshold (OR = 2.71; 95% CI, 1.13-6.52; P = .026) and continuous (P < .001; effect size d = 0.47) analyses, and analyses were suggestive of a greater effect for CGT plus citalopram compared to citalopram alone (threshold analysis: OR = 2.84; 95% CI, 1.20-6.70; P = .017; continuous analysis: P = .053; d = 0.25). In contrast, citalopram did not differ from placebo, and CGT plus citalopram did not differ from CGT plus placebo. Bereavement-related PTSS are common in bereaved adults with PGD in the context of both violent and nonviolent death and are associated with poorer functioning. CGT shows efficacy for PTSS, while the antidepressant citalopram does not. : ClinicalTrials.gov identifier: NCT01179568.

Change in avoidance and negative grief-related cognitions mediates treatment outcome in older adults with prolonged grief disorder

ABSTRACT Objective: The present study investigated the role of the two theoretically derived mediators in the treatment of Prolonged Grief Disorder (PGD). Mediators were changes in avoidance and maladaptive cognitions. An additional hypothesis tested whether these candidate mediators are specific to CBT-based Complicated Grief Treatment (CGT) compared to Interpersonal Therapy (IPT). Method: We performed secondary analyses with assessment completers (n = 131) from a randomized-controlled trial with older adults with PGD. Patients received 16 sessions of CGT or IPT. Outcomes were treatment response and reductions in grief symptoms and grief-related related impairment. Results: Reductions in avoidance between baseline and week 16 mediated reductions in grief symptoms and grief-related impairment. Reductions in maladaptive grief-related cognitions over the same period mediated treatment response, reductions in grief symptoms and grief-related impairment. There were no significant treatment-mediator interactions. We could not establish that mediators changed before the outcomes. Conclusion: Results are consistent with theoretical models of PGD, including the CGT treatment model. Despite different therapeutic procedures, we found no significant interaction effect, but CGT produced larger effects. Future research needs to establish a timeline of change through the use of multiple measurements of mediators and outcomes. Trial registration: ClinicalTrials.gov identifier: NCT01244295.

Challenges in Obtaining and Assessing Salivary Cortisol and α-Amylase in an Over 60 Population Undergoing Psychotherapeutic Treatment for Complicated Grief: Lessons Learned.

Biomarkers may serve as objective measures in complicated grief (CG) potentially capturing responses to stress reduction treatment. This paper reports challenges in obtaining and assessing salivary cortisol and α-amylase (sAA) for a recent randomized clinical trial. Within-session changes in salivary cortisol and sAA for 54 older adults with CG who received Accelerated Resolution Therapy were compared with perceived stress measured by Subjective Units of Distress Scale. Bivariate correlations and multiple regressions examined changes in biomarkers. Protocols, study logs, and audit reports identified challenges. Challenges included obtaining unstimulated passive drool salivary samples and their analyses. Our sample of older females on multiple medications may have resulted in a perfect storm of moderating and intervening variables which affected the stress response. This paper contributes to the discussion on designing clinical trials for older adults which must account for physiologic changes, multimorbidity, and polypharmacy common in this population and makes recommendations moving forward.

The Impact of Referral to Mental Health Services on Suicide Death Risk in Adolescent Suicide Survivors.

ObjectivesThis study aims to examine the effect of adolescent suicide survivors’ experience on suicide death risk, and the effect of referral to mental health services (hereafter referral) in this regard.MethodsThis study used the data of 878 suicide-deceased and suicide-attempted adolescents aged 8–19 years, managed by the Suicide and School Mental Health Institute from 2016 to 2018.ResultsRegression analysis for main effects showed that although suicide experience had no direct effect on suicide death, non-referral status was associated with a greater risk of death by suicide. While the “non-suicide survivor with non-referral” and “suicide survivor with non-referral” groups showed 1.87 [adjusted odds ratio=1.87, 95% confidence interval (CI)=1.21–2.89] and 4.59 (adjusted odds ratio= 4.59, 95% CI=2.02–10.42) times higher odds of suicide death, respectively, the “suicide survivor with referral” group showed no difference compared to the “non-suicide survivor with referral” group.ConclusionFrom these findings, there is a need to strengthen referral to mental health services and apply complicated grief treatment to improve the mental health of adolescent suicide survivors.

The pain of grief: Exploring the concept of psychological pain and its relation to complicated grief, depression, and risk for suicide in bereaved adults.

Emotional or psychological pain is a core symptom of complicated grief (CG), yet its correlates are largely unexamined among bereaved individuals. Bereaved adults (N = 135) completed self-reports regarding psychological pain, CG, depression, and suicidality. We assessed correlations among these variables and tested whether psychological pain was elevated among individuals with CG and individuals with current or past suicidal thoughts and behaviors. Using logistic regression, we also assessed psychological pain, depression, and CG symptom severity as predictors of suicide risk. Psychological pain was strongly associated with both CG and depression severity and was elevated among subjects reporting current or past suicidality. CG and depression were not statistically significant predictors of suicidal ideation after accounting for the effects of psychological pain. Psychological pain is strongly associated with bereavement-related psychopathology and warrants further investigation in studies examining the nature and treatment of CG.

Doświadczenie żałoby po samobójczej śmierci bliskiego – zagrożenia i metody wspierania pozostawionych

&lt;p class="Standard"&gt;Celem artykułu było wskazanie specyfiki przeżywania samobójczej śmierci bliskiego w rzeczywistości społecznej, która jest nieprzychylna doświadczaniu tej utraty. W tekście poruszono problem tabuizacji zjawiska samobójstwa oraz stygmatyzacji społecznej samobójców i ich rodzin. Przegląd doniesień z badań poświęconych poznaniu tego zagadnienia wsparto przytoczonymi świadectwami osób przeżywających żałobę po samobójczej śmierci bliskiego. Rozważono różnice przeżywania żałoby po śmierci samobójczej i po śmierci z przyczyn naturalnych. Przedmiotem refleksji są zwłaszcza te aspekty doświadczenia bliskich samobójców, które nie odpowiadają społecznie aprobowanym wzorcom doświadczania żałoby (m.in. brak aprobaty społecznej dla wyrażania emocji gniewu i doświadczenia ulgi w kontekście przeżywania śmierci bliskiego). Na podstawie analizy przedstawionych materiałów wskazano potencjalne zagrożenia, które mogą dotykać tej grupy żałobników. W tym celu omówiono badania poświęcone analizie ryzyka wystąpienia zaburzeń psychicznych pośród bliskich samobójców. W kontekście poczynionych w artykule obserwacji rozważono efektywność terapii &lt;em&gt;Complicated Grief Treatment&lt;/em&gt; dedykowanej pracy z tą grupą klientów.&lt;/p&gt;

Complicated Grief: Risk Factors, Protective Factors, and Interventions

Complicated grief (CG) poses significant physical, psychological, and economic risks to bereaved family caregivers. An integrative review of the literature published 2009−2018 on CG associated with caregiving was performed using PubMed, PsychINFO, and Web of Science. The search returned 1428 articles, of which 32 were included in the review. Sixteen studies described risk and protective factors and 16 described interventions for CG. Caregiver-related risk factors included fewer years of education, depression, anxiety, poor physical health, and maladaptive dependency and attachment traits. Additional risk factors included lower perceived social support, family conflict at end-of-life, and family having difficulty accepting death. Care recipient-related risk factors are younger age, fear of death, and place of death. Protective factors included hospice utilization in reducing fear of death, high pre-bereavement spiritualty, and satisfaction with palliative care. Complicated grief treatment was the most widely-studied intervention. Social Workers and other clinicians can use this information to identify family caregivers at increased risk for CG and refer or implement an early intervention to lessen its impact.

Treating Complicated Grief among Orphaned Children in Kenya: Effectiveness of Complicated Grief Therapy

Complicated Grief (CG) also referred to as complicated bereavement is a clinically significant condition even though there is limited evidence on its prevalence and treatment in Kenya and Africa in general. The main aim of this 2019 study was to test the efficacy of a modified Complicated Grief Therapy (CGT) in treating complicated grief (CG) among orphaned children. A total of 426 orphaned children aged 10 - 15 years were screened using the Brief Grief Questionnaire to sample those with elevated grief scores. Of the 263 who met the criteria, only 241 participants fully participated in the six months study with 123 and 118 participants in the treatment and the control groups respectively. The treatment group was subjected to a shortened version of the CGT (12 weeks) while no treatment was offered to the control group. The prevalence of grief among orphaned children was 66% and using the Inventory for Complicated Grief, to determine the clinical levels, a mean grief score of 31.6 (SD = 9.52) was recorded. The reduced version of CGT was effective in the reduction of complicated grief symptoms t(122) = -15.79, p at a weekly reduction of 1.29 points. In the case of the control group, the paired sample test showed a statistically insignificant reduction of CG score, t(117) = -0.712, p = 0.478. Conclusions: Reducing CGT sessions 12 sessions to make it shorter and less stringent and using it as group therapy in a school setup did not interfere with its effect on the treatment of complicated grief among orphaned children.

Changes in typical beliefs in response to complicated grief treatment.

Prolonged grief disorder (PGD) is a new diagnosis in the 11th edition of the International Classification of Diseases, estimated to affect 1 in 10 bereaved people and causing significant distress and impairment. Maladaptive thoughts play an important role in PGD. We have previously validated the typical beliefs questionnaire (TBQ), which contains five kinds of thinking commonly seen in PGD: protesting the death, negative thoughts about the world, needing the person, less grief is wrong, and grieving too much. The current paper examines the role of maladaptive cognition as measured by the TBQ in PGD and its change with treatment. Among participants in a multisite clinical trial including 394 adults, we examined (a) the relationship between maladaptive thoughts at baseline and treatment outcomes, (b) the relationship between maladaptive thoughts and suicidality at baseline and posttreatment, and (c) the effect of treatment with and without complicated grief therapy (CGT) on maladaptive thinking. TBQ scores were associated with treatment outcomes and were strongly related to suicidal thinking before and after treatment. TBQ scores showed significantly greater reduction in participants who received CGT with citalopram versus citalopram alone (adjusted mean standard error [SE] difference, -2.45 [0.85]; p = .004) and those who received CGT with placebo versus placebo alone (adjusted mean [SE] difference, -3.44 [0.90]; p < .001). Maladaptive thoughts, as measured by the TBQ, have clinical and research significance for PGD and its treatment.