Academic journal article European Journal of Psychotraumatology

Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): Toward Integrated Treatment of Symptoms Related to Traumatic Loss

Academic journal article European Journal of Psychotraumatology

Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): Toward Integrated Treatment of Symptoms Related to Traumatic Loss

Article excerpt

Responsible Editor: Ruth Lanius, Western University of Canada, Canada.

Copyright: © 2015 Geert E. Smid et al. This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

Received: 25 January 2015; Revised: 1 June 2015; Accepted: 2 June 2015; Published: 6 July 2015

Competing interests and funding: There is no conflict of interest in the present study for any of the authors.

*Correspondence to: Geert E. Smid, Foundation Centrum '45/Arq, Nienoord 5, NL-1112 XE Diemen, The Netherlands, Email:

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The loss of loved ones due to accidents, disaster, war, or criminal violence may bring about symptoms of persistent complex bereavement disorder (PCBD), such as persistent yearning/longing and distressing preoccupations regarding the traumatic nature of the death (APA, 2013). Traumatic loss refers to a situation where an individual is faced with the loss of one or several close family members or friends that occurred accidentally or in the context of war, homicide, suicide, or other situations of violence. Traumatic losses may be multiple and may include missing persons, also termed ambiguous loss (Boss, 2006). Traumatic grief refers to a clinical diagnosis of PCBD with comorbid (symptoms of) posttraumatic stress disorder (PTSD) and/or major depressive disorder (MDD) following confrontation with a traumatic loss. In patients who are referred for specialized treatment of complex psychological trauma symptoms, traumatic losses are common, especially in refugees (Nickerson et al., 2014). Contemporary PTSD treatments do not address grief specifically (Maercker & Znoj, 2010). Interventions designed for the treatment of PCBD mostly do not explicitly address comorbid disorders such as PTSD and/or MDD. However, in several studies, the efficacy of targeted treatment for PCBD has been demonstrated (Boelen, de Keijser, Van den Hout, & Van den Bout, 2007; Bryant, Kenny, & Joscelyne, 2014; Rosner, Pfoh, Kotoucìova, & Hagl, 2014; Shear, Frank, Houck, & Reynolds, 2005; Shear et al., 2014; Wagner, Knaevelsrud, & Maercker, 2006). Thus, there is a need to develop a treatment addressing both PCBD and PTSD/MDD, as a traumatic loss is a frequent cause of these disorders. We propose a cognitive stress model of traumatic grief that provides a rationale for the simultaneous treatment of symptoms of PCBD, PTSD, and MDD. Based on this model, we developed Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG) drawing from existing evidence-based interventions for PCBD and PTSD.

Diagnostic considerations

The proposed DSM-5 diagnosis of PCBD (APA, 2013) comprises core symptoms as well as additional symptoms that are divided into two groups named reactive distress to the death and social/identity disruption. Core symptoms of PCBD include (1) persistent intense yearning and longing for the deceased, often experienced as recurrent pangs of grief, (2) intense sorrow and emotional pain in response to the death, (3) preoccupation with thoughts of the deceased, and (4) preoccupation with the circumstances of the death. The latter may manifest itself as distressing, intrusive thoughts regarding the traumatic nature of the death, often in response to loss reminders, including the deceased's last moments, degree of suffering and mutilating injury, or the malicious or intentional nature of the death (APA, 2013). …

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