Experts Outline Keys to Helping People Manage Prolonged, Disabling Grief

While all bereaved people can benefit from compassionate support, patients who experience intense, persistent, and disabling grief following the death of a loved one may require additional interventions. One intervention that may help is complicated grief therapy, wrote Alana Iglewicz, M.D., of the Veterans Affairs San Diego Healthcare System and colleagues in a paper in Depression & Anxiety.

“While everyone grieves in their own way, bereaved individuals often feel a sense of disconnection from themselves; their past, present, and future; and especially from the person who died,” Iglewicz and colleagues wrote. “[O]ver time, most adapt to their loss by accepting its finality and consequences.” Some people, however, may find themselves struggling with a prolonged grief the authors describe as complicated grief (the authors noted that various other terms have been used to describe this condition, including prolonged grief disorder in ICD-11). These people may be at greater risk of psychiatric and general medical conditions, the authors noted.

“[Complicated grief therapy] is based on the premise that grief emerges naturally after a loss and finds a place in our lives as we adapt to the loss,” the authors wrote. “Adapting entails coping with problems as well as envisioning and finding ways to bring joy and satisfaction into ongoing life. When doing [complicated grief therapy], grief is not an intervention target. Rather we seek to facilitate coping and personal growth and to resolve any impediments to this process.”

The authors outlined how mental health professionals can create a space to engage the patient using the following evidence-based guidance:

• Understanding and accepting grief: For example, remind the patient that grief is normal and that he or she is not alone.
• Recognizing painful emotions: For example, encourage the patient to pay attention to how his or her grief changes over the course of the day and what triggers these changes.
• Thinking about a meaningful and fulfilling future: For example, work with the patient to create goals and formulate steps toward reaching these goals.
• Reconnecting with others: For example, encourage the patient to identify at least one confidant.
• Telling the story of loved one’s death: For example, invite the patient to tell the story of his or her loved one’s death repeatedly over several sessions.
• Learning to live with reminders of the deceased: For example, create a list of activities that the patient has been avoiding and encourage the patient to gradually revisit these activities.
• Establishing an enduring connection with memories of the person who died: For example, remind the patient of the role that memories play in relationships with loved ones, even when they are no longer alive.

“We suggest each clinician adapts the principles and procedures of complicated grief therapy in the way that fits their work best. Our experience suggests that patients can benefit greatly from a simple intervention that includes the seven core themes described above,” the authors concluded.

For related information, see the Psychiatric News article “Citalopram May Offer Limited Benefit for Patients With Complicated Grief.”

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