Complicated Grief Complicated to Treat

New therapy that combines depression and PTSD techniques works, study finds

Serena Gordon

Serena Gordon

Updated on May 31, 2005

TUESDAY, May 31, 2005 (HealthDay News) -- Sadness and feelings of loss are normal parts of the grieving process, but for some people the death of a loved one triggers a phenomenon dubbed complicated grief, which resembles both major depression and post-traumatic stress disorder (PTSD).

Because existing treatments haven't worked for people with complicated grief, University of Pittsburgh School of Medicine researchers have developed a promising technique that combines interpersonal depression treatment with PTSD treatment.

The good news: The combination therapy had a 51 percent response rate compared with 28 percent for standard depression treatment.

"Complicated grief is a very underrecognized problem. It's not in the literature, and there's a lot of confusion in identifying complicated grief. We're trying to tease apart normal bereavement and the bereaved people who need help, and figure out how to provide appropriate treatment," said study author Dr. Katherine Shear, a professor of psychiatry.

"When we took a close look at grief symptoms, we saw some components that are like PTSD, so we integrated some PTSD treatment with interpersonal depression treatment," she said. "It was more effective in treating complicated grief symptoms than interpersonal depression treatment."

Results of the study appear in the June 1 issue of the Journal of the American Medical Association.

As many as 10 percent to 20 percent of all bereaved people suffer complicated grief, the study stated. Each year, about 2.5 million people die in the United States, leaving behind an average of five bereaved people each. That means that as many as 1 million Americans a year experience complicated grief.

Complicated grief isn't diagnosed unless symptoms have continued for at least six months after the death. Some of the symptoms of complicated grief are sadness, preoccupation with thoughts of the deceased, feelings of guilt due to past interactions with the deceased, intrusive images of the person dying, and a yearning or longing for the deceased, according to the study.

"Most people with complicated grief report that their family and friends are telling them to move on," said Shear. "But they still feel stuck and preoccupied with the death. They have difficulty accepting the death, almost to the point of disbelief."

Her study included 83 women and 12 men between the ages of 18 and 85 who were diagnosed with complicated grief.

The average time since their loved one had died was slightly more than two years. For about one-third of the group, the death of their loved ones had been violent.

The study volunteers were randomly assigned into two groups. The first group, which included 46 people, received standard interpersonal depression therapy. The second group -- 49 people -- received complicated grief treatment. Both groups had 16 sessions of therapy.

Some of the exercises in complicated grief therapy included telling and retelling the story of the death, having an imaginary conversation with the deceased, being asked to think about what their life would be like if their grief wasn't so intense, and setting goals and coming up with ways to meet those goals.

Both treatments were successful for some of the study participants, but complicated grief treatment was nearly twice as effective. Just over half of those in the complicated grief treatment group responded to treatment, while only 28 percent in the standard depression treatment group did.

However, the treatment isn't for everyone. Twelve percent in the complicated grief treatment dropped out, saying it was too difficult for them or they didn't believe that telling the painful story of their loved ones' death would help.

"Our treatment findings suggest that complicated grief is a specific condition in need of a specific treatment," wrote the researchers.

"Normal grief is very painful, but it's not a disorder. It's a normal part of the human condition that can be helped by support from friends and family and culturally sanctioned rituals and procedures," said Dr. Richard Glass, who wrote an accompanying editorial in the same issue of the journal. Glass is the deputy editor at JAMA and a clinical professor of psychiatry at the Pritzker School of Medicine at the University of Chicago.

"That's different from what appears to be a disorder: complicated grief. It's grief that doesn't go away and persists. Many people, if they think about friends and relatives, may know a person affected by this, but right now we don't have a solid sense of how many people this affects," Glass said.

What is known, however, is that "standard treatment for depression doesn't really work for complicated grief. This new treatment worked better than standard treatment," Glass added.

Because the technique is new, Shear said that if you seek treatment for complicated grief, it's reasonable to ask your therapist if he or she is familiar with complicated grief treatment.

More information

The American Cancer Society offers information about coping with grief.

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