What is Complicated Grief Therapy?

Grief especially after the loss of a loved one can be debilitating. Indeed there is a medical term for persistent grief that prevents one from resuming one's life for many months after the loss; it is called Complicated Grief:

"[F]or those who are significantly and functionally impaired by prolonged grief symptoms for at least one month after six months of bereavement. It is distinguished from non-impairing grief and other disorders (such as major depressive disorder and posttraumatic stress disorder)."

This definition distinguishes complicated grief from depression and non-impairing grief. It is normal for a person to experience grief but then heal over time. The problem is when healing doesn't begin (Mayo Clinic):

"Most people experiencing normal grief and bereavement have a period of sorrow, numbness, and even guilt and anger. Gradually these feelings ease, and it's possible to accept loss and move forward. For some people, feelings of loss are debilitating and don't improve even after time passes. This is known as complicated grief, sometimes called persistent complex bereavement disorder. In complicated grief, painful emotions are so long lasting and severe that you have trouble accepting the loss and resuming your own life."

Last week, a new study in JAMA investigated two possible treatments for complicated grief. Researchers compared the efficacy of a treatment specially designed for complicated grief (complicated grief therapy or CGT) to a treatment designed for depression (interpersonal psychotherapy or IPT).

"A randomized trial comparing treatments for older adults with complicated grief (CG) reports better response with therapy designed to treat the stress response of CG than with interpersonal psychotherapy (IPT), an effective evidence-based treatment for depression. [...]

The proportion of participants who responded to CGT was 70.5% vs 32% for IPT. The CGT group also showed greater improvement in illness severity; 64.1% of the individuals in the IPT group were still moderately ill at the end of the intervention compared with 35.2% in the CGT group."

Thus, CGT was approximately twice as effective as IPT at treating complicated grief. WebMD had an excellent interview with the lead author of the study Dr. Katherine Shear who helped to explain Complicated Grief Therapy. Grief is a natural adaptive process that must be allowed to happen instead of avoided:

"They have difficulty comprehending the reality of the death," said lead researcher Dr. M. Katherine Shear, a professor of psychiatry at Columbia University School of Social Work.

In other words, the person is in denial, and the most effective therapy is to have the person come to terms with the loss:

"In treatment for complicated grief, people are asked to visualize the loved one's death and tell the story of what happened, she explained. The story is recorded and patients are asked to listen to the tape at home.

"That's a very emotionally activating exercise," Shear said. Reliving the death "jump-starts the process of coming to terms with the death," Shear said. People are also asked to identify things they avoid for fear they'll be reminded of their loss, and start doing those things, Shear explained."

In the interview, Dr. Shear highlights an important distinction between grief and depression:

'Both complicated grief and depression involve tremendous sadness, but the hallmark of depression is the inability to have positive feelings, Shear said. "Grief is the form love takes after someone dies," Shear said. "It has a lot of positive emotions."

So if you know someone who is experiencing complicated grief, make sure they find the proper medical treatment, which may include complicated grief therapy.

Figure 1. The severity of complicated grief after the loss of a loved one can be alleviated by complicated grief therapy (CGT).