Academic journal article European Journal of Psychotraumatology

Narrative Reconstruction Therapy for Prolonged Grief Disorder-Rationale and Case Study

Academic journal article European Journal of Psychotraumatology

Narrative Reconstruction Therapy for Prolonged Grief Disorder-Rationale and Case Study

Article excerpt

The loss of a loved one is a common stressor in the life of a human being (Parkes & Prigerson, 2013). Approximately 10% of bereaved people suffer from debilitating grief reactions, such as a painful yearning for the deceased, separation anxiety, difficulties accepting the loss, and difficulties engaging in new activities after the loss (Maercker & Lalor, 2012). When the symptoms last for at least 6 months and cause significant impairment in social and occupational functioning the syndrome is considered a mental disorder (Prigerson, Vanderwerker, & Maciejewski, 2008; Wittouck, Van Autreve, De Jaegere, Portzky, & Van Heeringen, 2011). Herein, we refer to this disorder as Prolonged Grief Disorder (PGD), a term previously proposed by key researchers in the field (Prigerson et al., 2009) and now proposed for the upcoming International Classification of Diseases, 11th Revision (Maercker et al., 2013). PGD differs from normal expected reactions to loss (Boelen & Van Den Bout, 2008), bereavement-related depression and anxiety (Boelen, Van Den Bout, & De Keijser, 2003), and major depression, adjustment disorder and posttraumatic stress disorder (PTSD) (for review, see Shear et al., 2011).

Although PTSD differs from PGD (Boelen, Van De Schoot, Van den Hout, De Keijser, & Van den Bout, 2010), significant similarities between these disorders are also evident. PGD is characterized by persistent yearning, preoccupation with the deceased and intrusive images (Prigerson et al., 2009), similar to the PTSD intrusion cluster. "Avoidance of reminders of the reality of the loss" and "numbness" are consistent with avoidance symptoms in PTSD. Bitterness and anger, together with difficulties moving forward in life, parallel the negative alterations in cognitions and moods in the new D cluster in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (APA, 2013). The similarities between these two disorders have prompted the use of PTSD psychotherapy methods, primarily cognitive behavioral therapy (CBT) for PGD patients (Bryant et al., 2014; Shear et al., 2014; for review, see Rosner, 2015). These interventions have included cognitive behavioral techniques such as exposure and cognitive restructuring (Boelen, De Keijser, Van Den Hout, & Van Den Bout, 2007), integrative CBT (Rosner, Kotoucova, & Hagl, 2014), behavioral activation (Papa, Sewell, GarrisonDiehn, & Rummel, 2013), a combination of CBT with interpersonal elements (Shear, Frank, Houck, & Reynolds, 2005) and writing assignments based on Pennebaker's writing paradigm (Pennebaker, 1989; Wagner, Knaevelsrud, & Maercker, 2006). We may conclude that exposure to painful aspects of the loss is part of most CBT interventions for PGD, a conclusion that is supported by recent controlled studies (Bryant et al., 2014; Shear et al., 2014).

Based on a constructivist approach, Neimeyer presented a narrative-based treatment for PGD, involving meaning-reconstruction and an assimilation of the loss memory into one's personal narrative (Neimeyer, 2006, 2012; Neimeyer, Burke, Mackay, & van Dyke Stringer, 2010). This intervention incorporates journal writing (Lichtenthal & Neimeyer, 2012), retelling the story of the death (Neimeyer, 2012) and various other techniques based on the constructivist approach (Neimeyer et al., 2010). There is preliminary evidence that this technique is effective in reducing PGD symptoms (Gerrish, Steed, & Neimeyer, 2010; Gillies, Neimeyer, & Milman, 2014).

Based on the promising findings regarding exposurebased CBT and meaning-construction through narration, we suggest the implementation of Narrative Reconstruction (NR), an integrative treatment module originally developed for PTSD patients which incorporates exposure and narration, for the treatment of PGD. The adjustment of NR for PGD is described and demonstrated through a detailed evidence-based case report.

The rationale for the implementation of NR to treat PGD

NR is a time-limited (12-16 sessions) integrative intervention which has been shown to be effective in reducing both PTSD and depression symptoms (Peri, 2004; Peri & Gofman, 2014; Peri, Gofman, & Vidan, 2013). …

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