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      Narrative reconstruction therapy for prolonged grief disorder—rationale and case study


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          Prolonged grief disorder (PGD) is a potentially disabling condition affecting approximately 10% of bereaved people. It has been suggested that the impaired integration of the loss memory, as expressed in recurrent memories of the loss and disorganization of memory, is involved in the development of PGD. Narrative reconstruction (NR), originally designed for the treatment of posttraumatic stress disorder (PTSD) in an integrative therapy module, and consisting of exposure to the loss memory, detailed written reconstruction of the loss memory narrative and an elaboration of the personal significance of that memory for the bereaved, has been shown to be effective in the treatment of intrusion symptoms.


          In light of findings that cognitive behavior therapy (CBT), including cognitive restructuring and exposure, is effective in the treatment of PGD, we suggest the implementation of a somewhat novel therapy module, NR, for the treatment of intrusive phenomena in bereaved patients.


          The rationale for the implementation of NR for PGD and a case study of the treatment of a woman suffering from PGD after the death of her father are presented. Therapy took place in a university outpatient training clinic.


          Evaluations conducted before and after treatment and at a 3-month follow-up demonstrated the effectiveness of NR in reducing symptoms of PGD and depression. The analysis of spontaneous narratives recorded before and after treatment showed an increased organization of the narratives.


          This case report demonstrates an adaptation of NR for the treatment of PGD. The results provide preliminary support for the effectiveness of NR for PGD. The significance of the study and its limitations are discussed.

          Highlights of the article
          • Prolonged grief disorder (PGD) affects approximately ten percent of bereaved people.

          • Narrative Reconstruction (NR), an integrative therapy module originally used for PTSD patients, was adapted for PGD.

          • NR consists of exposure to the loss memory, detailed written reconstruction of the loss and an elaboration its significance and meaning for the bereaved.

          • NR was demonstrated in a case study. It was well tolerated and effective in the treatment of PGD.

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          Most cited references 57

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          The development of a Clinician-Administered PTSD Scale.

          Several interviews are available for assessing PTSD. These interviews vary in merit when compared on stringent psychometric and utility standards. Of all the interviews, the Clinician-Administered PTSD Scale (CAPS-1) appears to satisfy these standards most uniformly. The CAPS-1 is a structured interview for assessing core and associated symptoms of PTSD. It assesses the frequency and intensity of each symptom using standard prompt questions and explicit, behaviorally-anchored rating scales. The CAPS-1 yields both continuous and dichotomous scores for current and lifetime PTSD symptoms. Intended for use by experienced clinicians, it also can be administered by appropriately trained paraprofessionals. Data from a large scale psychometric study of the CAPS-1 have provided impressive evidence of its reliability and validity as a PTSD interview.
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            Treatment of complicated grief: a randomized controlled trial.

            Complicated grief is a debilitating disorder associated with important negative health consequences, but the results of existing treatments for it have been disappointing. To compare the efficacy of a novel approach, complicated grief treatment, with a standard psychotherapy (interpersonal psychotherapy). Two-cell, prospective, randomized controlled clinical trial, stratified by manner of death of loved one and treatment site. A university-based psychiatric research clinic as well as a satellite clinic in a low-income African American community between April 2001 and April 2004. A total of 83 women and 12 men aged 18 to 85 years recruited through professional referral, self-referral, and media announcements who met criteria for complicated grief. Participants were randomly assigned to receive interpersonal psychotherapy (n = 46) or complicated grief treatment (n = 49); both were administered in 16 sessions during an average interval of 19 weeks per participant. Treatment response, defined either as independent evaluator-rated Clinical Global Improvement score of 1 or 2 or as time to a 20-point or better improvement in the self-reported Inventory of Complicated Grief. Both treatments produced improvement in complicated grief symptoms. The response rate was greater for complicated grief treatment (51%) than for interpersonal psychotherapy (28%; P = .02) and time to response was faster for complicated grief treatment (P = .02). The number needed to treat was 4.3. Complicated grief treatment is an improved treatment over interpersonal psychotherapy, showing higher response rates and faster time to response.
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              Posttraumatic stress disorder following assault: the role of cognitive processing, trauma memory, and appraisals.

              Two studies of assault victims examined the roles of (a) disorganized trauma memories in the development of posttraumatic stress disorder (PTSD), (b) peritraumatic cognitive processing in the development of problematic memories and PTSD, and (c) ongoing dissociation and negative appraisals of memories in maintaining symptomatology. In the cross-sectional study (n = 81), comparisons of current, past, and no-PTSD groups suggested that peritraumatic cognitive processing is related to the development of disorganized memories and PTSD. Ongoing dissociation and negative appraisals served to maintain PTSD symptoms. The prospective study (n = 73) replicated these findings longitudinally. Cognitive and memory assessments completed within 12-weeks postassault predicted 6-month symptoms. Assault severity measures explained 22% of symptom variance; measures of cognitive processing, memory disorganization, and appraisals increased prediction accuracy to 71%.

                Author and article information

                Eur J Psychotraumatol
                Eur J Psychotraumatol
                European Journal of Psychotraumatology
                Co-Action Publishing
                04 May 2016
                : 7
                [1 ]Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
                [2 ]Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
                Author notes
                [* ]Correspondence to: Tuvia Peri, Department of Psychology, Bar-Ilan University, 5290002 Ramat Gan, Israel, Email: tperi@ 123456yahoo.com

                Responsible Editor: Rita Rosner, KU Eichstaett-Ingolstadt, Germany.

                © 2016 Tuvia Peri et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License, allowing third parties to copy and redistribute the material in any medium or format, and to remix, transform, and build upon the material, for any purpose, even commercially, under the condition that appropriate credit is given, that a link to the license is provided, and that you indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.

                Bereavement and Complicated Grief

                Clinical Psychology & Psychiatry

                narrative reconstruction, pgd, bereavement, ptsd, cbt, case study


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