Harvard Mental Health Letter

In brief: Treating complicated grief

In Brief

Treating complicated grief

According to one 2005 study, a specialized treatment may be particularly effective for a common bereavement reaction that resembles post-traumatic stress disorder (PTSD) as much as typical grief. The symptoms of complicated grief include persistent disbelief about the death, anger and bitterness over the loss, guilty feelings about the deceased person, and repeated waves of painful longing. As in PTSD, patients may also suffer from intrusive thoughts and images of the death and a tendency to avoid people, places, and situations reminiscent of the deceased. Complicated grief is more likely to develop after a death that occurs in youth or is violent, sudden, or unexpected.

The study participants were 83 patients suffering from complicated grief symptoms six months after the death of a parent, wife, husband, child, other relative, or close friend. They were assigned to 16 weekly sessions of either standard interpersonal therapy or complicated grief therapy.

Interpersonal therapy explores the patient's relationship with the deceased person, emphasizing disputes, role transitions, and grief. Complicated grief therapy is a modified version that includes cognitive behavioral approaches to mitigating the effects of trauma and relieving stress. It involves a "dual process" in which patients concentrate alternately on adjusting to the loss and restoring a satisfying life. The therapy includes exercises that force them to confront situations and people they have been avoiding. They are asked to close their eyes and tell the story of the death, then repeatedly listen to tapes of the recitation at home. They relate memories of the deceased and hold imaginary conversations with him or her, taking both sides, under the guidance of the therapist. To help restore some joy to their lives, they are encouraged to think about what they would want for themselves if their grief were not so overpowering.

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