Psychotherapy and Prolonged Grief Disorder

Grief is one not only one the sadness and lowest points in a person’s life, it can also be the most disabling. In the past few decades, researchers have diligently been examining the difficulty many people have processing grief and have discovered that around 10 percent of people have a more prolonged type of grieving experience.

Prolonged grief disorder (PGD) is a newly proposed mental health condition that consists of symptoms of unusually prolonged and disabling grief. As compare to other forms of grief – such as complicated grief  – the bereaved person with PGD feels a constant inability to adjust to life without the person or pet who has past.

Historically, known psychiatric disorders triggered by bereavement included major depression, posttraumatic stress disorder (PTSD) and generalized anxiety disorder. Research has suggested that PGD is a distinctive syndrome different from these disorders as well as ordinary grief.

Diagnostic Criteria for PGD

Mental health professionals have  been suggesting the inclusion of PGD in the The Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) for the past decade. The following is an example of the proposed diagnostic criteria:

  1. Death of a close other
  2. Yearning for the deceased daily or to a disabling degree
  3. Confusion about one’s role in life or diminished sense of self
  4. Difficulty accepting the loss
  5. Avoidance of reminders of the reality of the loss
  6. Inability to trust others since the loss
  7. Bitterness or anger related to the loss
  8. Difficulty moving on with life (e.g., making new friends, pursuing interests)
  9. Emotional numbness since the loss
  10. Feeling that life is unfulfilling, empty, or meaningless since the loss
  11. Feeling stunned, dazed, or shocked by the loss
  12. Preoccupation with the deceased and/or circumstances of the death
  13. At least 6 months have passed since the death
  14. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning
  15. The disturbance is not better accounted for by major depressive disorder, generaThe disturbance is not better accounted for by major depressive disorder, generalized anxiety disorder, or posttraumatic stress disorder.
  16. The bereavement reaction must be out of proportion or inconsistent with cultural or religious norms

Treatment of PGD

Research has suggested that PGD can be identified as a distinctive disorder and that psychotherapy can reduce PGD symptoms.  Psychotherapy for adults with PGD can be beneficial. Cognitive– behavioral grief-targeted interventions were found to be more effective than nonspecific therapy. In one study, 100 participants who received 16 sessions of either interpersonal therapy tailored to target PGD had better results than those receiving regular therapy.

Other effective aspects of PGD therapy include encouraging patients to address the loss and the restoration-focused tasks of grieving. In addition, emphasis is placed on processing the loss and recovering satisfying life functioning and purposeful engagement.

Research has not supported the assumption that the moment of death is the most distressing experience for most bereaved individuals or that repeated exposure to such memories help during treatment. Rather than emphasize repeated exposure to the death, research has recommended that clinicians focus on restoration-focused interventions that involve behavioral activation and encourage increased engagement with the outside world.

As PGD treatment gains mainstream acceptance within professional psychology, mental health practitioners can identify implementation barriers to inform further development of effective therapies for the disorder.

Randi Fredricks, Ph.D.

References

Djelantik AAAMJ, Smid GE, Kleber RJ, Boelen PA. (2017). Do prolonged grief disorder symptoms predict post-traumatic stress disorder symptoms following bereavement? A cross-lagged analysis. Compr Psychiatry. 2017 Sep 12;80:65-71.

Kersting, A., Dolemeyer, R., Steinig, J., Walter, F., Kroker, K., Baust, K., & Wagner, B. (2013). Brief Internet-based intervention reduces posttraumatic stress and prolonged grief in parents after the loss of a child during pregnancy: A randomized controlled trial. Psychotherapy and Psychosomatics, 82, 372–381.

Shear, K., Frank, E., Houck, P. R., & Reynolds, C. F. III (2005). Treatment of complicated grief: A randomized controlled trial. JAMA: Journal of the American Medical Association, 293, 2601–2608.

Steenkamp, M. M., Litz, B. T., Gray, M. J., Lebowitz, L., Nash, W., Conoscenti, L., Amidson, A., & Lang, A. (2011). A brief exposure-based intervention for service members with PTSD. Cognitive and Behavioral Practice, 18, 98 –107.

Wittouck, C., Van Autreve, S., De Jaegere, E., Portzky, G., van Heeringen, K. (2011). The prevention and treatment of complicated grief: A metaanalysis. Clinical Psychology Review, 31, 69 –78.