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 Therapy Targeting Complicated Grief Improves Outcomes Over Standard Depression Counseling, Study Finds

Using therapy to target the complicated grief of widows has proven nearly twice as effective as using therapy to treat widowed women for depression, new clinical trials have found.
Mental health professionals have long understood that those who bury their loved ones are sometimes stricken by grief that consumes them for months and even years. Officially known as “persistent complex bereavement disorder,” complicated grief hits the elderly—particularly elderly women—the hardest, a new study says.
The disorder’s victims are often crippled physically, intellectually, and emotionally and are at risk from declining health and early death or suicide. Nearly 9 percent of women who lose a loved one are hit by complicated grief.
In what may be the first-of-its-kind study, a team of Columbia University and Brookdale Center for Healthy Aging researchers have tested a tailor-made therapy regime—based on methods used to treat shell shock rather than depression—and found its results to be near-miraculous.
Women in the complicated therapy regimes saw their symptoms improve nearly twice as fast as those treated classically for depression, and more women in the complicated group got healthier than women in the depression group, researchers say in the latest issue of JAMA Psychiatry.
“Complicated grief is an under-recognized public health problem that likely affects millions of people in the United States, many of them elderly,” corresponding author and Columbia University Professor M. Katherine Shear says. “Given a growing elderly population, increased rates of bereavement with age, and the distress and impairment associated with [complicated grief], effective treatment should have important public health outcomes.”
In the five-year study, women were recruited from around the New York City area, and 151 were enrolled in one of two therapy regimes. The traditional therapy route had the therapists trying to help the patients review and identify their moods, Shear says.
“Therapists helped patients to see how bereavement and other interpersonal events can affect emotions and mood,” Shear says. “They discussed the patient’s relationship with the deceased, encouraged a realistic assessment of the positive and negative aspects of this relationship, reviewed the circumstances of the death, and worked to help the patient develop or enhance satisfying relationships and activities in the present.”
Those treated for complicated grief followed a different course, though, Shear says. The goals there were to help resolve “grief complications” but also to help the patients through “natural mourning.” Each session featured “loss-focused and restoration-focused components,” Shear says. The sessions followed four courses.
“In phase 1, therapists reviewed the patient’s history and bereavement experience, introduced a grief-monitoring diary, explained [complicated grief], began work on aspirational goals, and held a conjoint session with a significant other,” Shear says. Phase 2 included exposure-based procedures, “work with memories and pictures, and a continued focus on personal goals,” she says.
The third course was “a midcourse review” of what therapist and patient had worked on so far, Shear says, while “phase 4 included an ‘imaginal’ conversation with the deceased, completion and consolidation of treatment aims, and attention to treatment termination.”
The women in both therapy courses improved, but those who were treated for complicated grief did better, and quicker, Shear says.
“Complicated grief treatment produced clinically and statistically significantly greater response rates … than a proven, efficacious treatment for depression,” Shear writes. “Results strongly support the need for physicians and other health care providers to distinguish [complicated grief] from depression.”
Bill Myers is Provider’s senior editor. Email him at Follow him on Twitter, @ProviderMyers.
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