Magazine article Clinical Psychiatry News

Complicated Grief Treatment May Beat Psychotherapy

Magazine article Clinical Psychiatry News

Complicated Grief Treatment May Beat Psychotherapy

Article excerpt


SAN FRANCISCO -- The effectiveness of complicated grief treatment rests, to a significant extent, on its capacity to reduce the grieving patient's level of avoidance of reminders of the loss, Kim Glickman, PhD, said at the annual conference of the Anxiety and Depression Association of America.

Her psychotherapeutic mechanism-of-action study identified two other mediators of improvement in response to complicated grief treatment (CGT): guilt related to the death and negative thoughts about the future. Patients who had significant reductions in levels of those variables during CGT were much more likely to ultimately be treatment responders.

The clinical implication of these findings is that psychotherapists should focus on reducing grief complications, such as avoidance behaviors and maladaptive thoughts, including blaming oneself or others for how the person died and seeing a hopeless future, according to Dr. Glickman of the City University of New York.

Complicated grief affects about 7% of bereaved individuals. It is characterized by prolonged emotional pain, intense sorrow, preoccupation with thoughts of the loved one, and persistent yearning. It is typically resistant to antidepressant therapy. In the DSM-5, it is called "persistent complex bereavement disorder" and is described in a chapter on provisional conditions for further study. Since it doesn't have the status of a formal diagnostic entity, insurers typically will not pay for the treatment of complicated grief reactions.

CGT has been shown to be effective in three randomized clinical trials. It is a manualized 16-session therapy that can be considered a form of cognitive-behavioral therapy with added elements of interpersonal psychotherapy and motivational interviewing. …

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