Academic journal article European Journal of Psychotraumatology

Participant Experiences of Eye Movement Desensitisation and Reprocessing vs. Cognitive Behavioural Therapy for Grief: Similarities and Differences

Academic journal article European Journal of Psychotraumatology

Participant Experiences of Eye Movement Desensitisation and Reprocessing vs. Cognitive Behavioural Therapy for Grief: Similarities and Differences

Article excerpt

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Grief following the death of a loved one is an almost universal experience; however, for some the pain and anguish that follows such a loss does not subside and continues to impact functioning long after the death. There have been attempts to distinguish between normal grief and a collection of symptoms that would warrant a diagnostic label. The most current labels are Persistent Complex Bereavement Disorder (PCBD) as defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) and Prolonged Grief Disorder (PGD) which has been proposed for inclusion in the 11th revision of the International Classification of Diseases (ICD-11; Maciejewski, Maercker, Boelen, & Prigerson, 2016). These diagnostic classifications are met when the grief reaction is prolonged and accompanied by symptoms such as yearning for the deceased, preoccupation with the deceased or their death, and difficulty accepting the loss. Maciejewski et al. (2016) suggested that there are no substantive differences between PGD and PCBD and that each is associated with a prevalence rate of around 10%. Issues surrounding the controversy over a proposed diagnostic criteria for grief (either PGD or PCBD) are the potential for pathologizing what may be considered normal reactions to loss. Another issue is that a focus on a diagnosis such as PCBD may not capture all the psychological morbidity following the death of a loved one (Boelen, 2016).

The findings from meta-analyses of grief interventions imply that individuals who meet a diagnostic criteria of grief symptoms will benefit substantially from therapy, compared to bereaved individuals experiencing 'normal' grief (Wittouck, Van Autreve, De Jaegere, Portzky, & van Heeringen, 2011). Whereas in other reviews (Allumbaugh & Hoyt, 1999; Schut, Stroebe, van den Bout, & Terheggen, 2001), consistently larger effect sizes and positive outcomes have been reported where participants were self-referred or referred by a general practitioner, when compared to preventative or outreach approaches. These studies suggest that a self-perception of struggling with grief and active treatment seeking results in a benefit from therapy.

One treatment that has been shown to be effective in reducing symptoms associated with grief is cognitive behavioural therapy (CBT). It involves teaching participants skills to initially identify and then modify unhelpful thoughts and behaviours (Boelen, van den Hout, & van den Bout, 2006). CBT for grief is underpinned by the theory that problematic grief symptoms are maintained by negative cognitions and avoidant behaviours. CBT has been found to lead to larger and more rapid grief symptom reduction compared to interpersonal therapy (Shear, Frank, Houck, & Reynolds, 2005).

Another approach to treating grief is Eye Movement Desensitisation and Reprocessing (EMDR), which was designed to deal with traumatic memories (Shapiro, 1995). In this treatment, the therapist facilitates the client to access the critical components of their distressing memories while simultaneously engaging in another task, such as eye movements. This therapeutic process has been found to result in a reduction in Posttraumatic Stress Disorder (PTSD) symptoms, such as the frequency of intrusive symptoms (Chen et al., 2014), and a reduction in the vividness and emotional intensity of distressing memories (Lee & Cuijpers, 2013). While EMDR has been systematically studied as a therapy for PTSD, there is very little research on its effects on grief. In a non-randomized controlled study, Sprang (2001) found that an EMDR group required significantly fewer sessions compared to the control condition of 'guided mourning' to achieve the same symptom reduction. In another study, participants who reported distressing memories following the death of a loved one (Hornsveld et al., 2010) had greater decline in emotionality of a grief-related memory following a recall plus eye movements condition compared to recall-only or recall with music condition. …

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