‘Exposure Therapy’ may help with Prolonged Grief Disorder
Exposure therapy is an approach where the person deals with the feared or upsetting subject in a safe environment with someone trained in how to help the patient relax and cope. It appears to help survivors struggling with prolonged grief better than another type of therapy alone, the study found.
Prolonged grief disorder, also called complicated grief, is an ongoing yearning for a dead loved one. It’s associated with emotional pain, difficulty accepting the death, a sense of meaninglessness and bitterness, and difficulty engaging in new activities.
“Prolonged grief disorder is a big public health issue,” said lead researcher Richard Bryant, a professor of psychology at the University of New South Wales in Sydney, Australia.
“We know that 7 to 10 percent of all bereaved people will develop prolonged grief disorder,” he said.
Prolonged grief disorder leads to mental health problems, suicidal thoughts, poor health behaviors and heart problems, Bryant said. The condition is often mistaken for depression, but is very different, he added.
For the study, Bryant and colleagues randomly assigned 80 people suffering from prolonged grief disorder to 10 weeks of two-hour group cognitive behavioral therapy (CBT) sessions. The aim of cognitive behavioral therapy is to halt ineffective and damaging patterns of thinking.
Patients also had four individual sessions where they either relived the experience of their loved one’s death (“exposure therapy”) or had behavioral therapy alone and could talk about whatever they liked.
After six months, the researchers found that the exposure therapy participants showed greater improvement in prolonged grief disorder, depression and social functioning than those who had behavioral therapy alone.
Only about 15 percent of those who had exposure therapy still suffered from prolonged grief disorder, compared with 38 percent of those who had cognitive behavioral therapy alone, the study found.
“It is critical to develop best treatments. Generic grief counseling is not very effective, and many patients are mistakenly treated with antidepressants,” Bryant said.
To overcome the condition, it’s important to ensure the right diagnosis is made, he said. Then, psychological therapy should be given that encompasses emotional engagement with memories, re-framing beliefs about oneself and one’s future, and building new relationships and goals, he explained.
The report was published online Oct. 22 in JAMA Psychiatry.
“This study shows the value of helping people think about the time of the death,” said Dr. Katherine Shear, a director of the Center for Complicated Grief at Columbia School of Social Work in New York City.
“People need an acceptable account of the circumstances of the death consistent with a belief in the world as essentially benign,” she said. In other words, they need to accept dying as a natural part of living and not see it as a punishment.
Simon Rego, director of psychology training at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said prolonged grief disorder is not officially recognized as a psychological disorder. Even so, although some controversy exists around exactly how and when it should be diagnosed, “the syndrome is thought to pose a serious public health problem,” he said.
Grief-focused cognitive behavioral therapy — CBT plus exposure therapy — has been shown in the research to be effective in treating prolonged grief disorder, Rego said.
However, he added, many clinicians are unaware of this treatment option for prolonged grief disorder. Instead, Rego said, they “rely on providing interventions to grieving people that are not empirically supported, or are reluctant to use exposure therapy because of the misconception that it can increase the patient’s distress.”
For more on prolonged grief disorder, visit the Center for Complicated Grief.
SOURCES: Richard Bryant, Ph.D., professor, psychology, University of New South Wales, Sydney, Australia; M. Katherine Shear, M.D., professor, psychiatry, Columbia University School of Social Work, director, Center for Complicated Grief, New York City; Simon Rego, Psy.D., director, psychology training, Montefiore Medical Center/Albert Einstein College of Medicine, New York City; Oct. 22, 2014, JAMA Psychiatry, online
Last Updated: Oct. 23, 2014
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