The complicated grief following the death of a loved one, that lasts for 6 months or longer, can be relieved more effectively with interpersonal therapy combined with a focus on treating the loss than with interpersonal psychotherapy alone. Symptoms of complicated grief are not the same as those of major depression or posttraumatic stress disorder (PTSD). Complicated grief has specific symptoms, which include a sense of disbelief, anger and bitterness about the death, episodic pangs of painful emotion and very prominent longing for the person that died, with recurrent images of the death itself and avoidance behaviour. These symptoms can persist for years. The predominant emotion is sadness, rather than the fear and anxiety that usually accompany PTSD. Researchers from the University of Pittsburgh School of Medicine in Pennsylvania devised a novel approach for treating complicated grief that combines aspects of interpersonal psychotherapy and cognitive-behavioural therapy techniques. Patients were encouraged to retell the story of the death using a procedure called revisiting. They are also instructed to carry on an imagined conversation with the deceased. During the treatment sessions the patient is also helped to identify personal life goals and to develop plans to meet those goals. For their study, the researchers assigned 49 subjects to complicated grief treatment and 46 others to interpersonal psychotherapy for an average of 16 sessions. Among the 35 subjects assigned to complicated grief treatment and 34 assigned to interpersonal therapy who completed treatment, rates of improvement were 66 percent and 32 percent, respectively. Those in the complicated grief treatment group also responded sooner. People with more intense grief reactions during the first 2 months are more vulnerable to developing complicated grief. Several modifications could improve the success rate of complicated grief treatment. Half of both groups were using antidepressant medication and they tended to do better, so adding an antidepressant to the treatment protocol is one strategy. Those who dropped out of treatment did so because they found that the process was too hard. The concept of complicated grief as a disorder warranting treatment is yet another example of the medicalization of various aspects of the human condition.
Journal of the American Medical Association,
June 2005