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      Improving the understanding and treatment of complex grief: an important issue for psychotraumatology

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          Abstract

          In the Netherlands, every year 500,000 people are confronted with the death of a close relative. Many of these people experience little emotional distress. In some, bereavement precipitates severe grief, distress, and dysphoria. A small yet significant minority of bereaved individuals develops persistent and debilitating symptoms of persistent complex bereavement disorder (PCBD) (also termed prolonged grief disorder), posttraumatic stress disorder, and depression. Knowledge about early identification of, and preventive care for complex grief has increased. Moreover, in recent years there has been an increase in treatment options for people for whom loss leads to persistent psychological problems. That said, preventive and curative treatments are effective for some, but not all bereaved individuals experiencing distress and dysfunction following loss. This necessitates further research on the development, course, and treatment of various stages of complex grief, including PCBD.

          Highlights of the article
          • “Complex grief” is an informal term referring to debilitating, non-normative grief.

          • It will likely be named Prolonged Grief Disorder in the forthcoming ICD-11.

          • It is named Persistent Complex Bereavement Disorder in DSM-5.

          • Research on the development, course, and treatment of complex grief is needed.

          • This research should address different stages and manifestations of complex grief.

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          Most cited references53

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          Diagnostic and statistical manual of mental disorders.

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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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              Treatment of complicated grief: a comparison between cognitive-behavioral therapy and supportive counseling.

              Few studies have examined treatments for complicated grief--a debilitating condition that can develop after the loss of a loved one. This study compared the effectiveness of cognitive-behavioral therapy with a nonspecific treatment with supportive counseling (SC). Using a minimization method, 54 mourners with clinically significant levels of complicated grief were allocated to 1 of 3 treatment conditions: (a) a condition of 6 sessions of cognitive restructuring (CR) and 6 sessions of exposure therapy (ET; CR + ET), (b) a condition in which these interventions were applied in reversed order (ET + CR), and (c) 12 sessions of SC. Outcomes showed that the 2 cognitive-behavioral therapy conditions produced more improvement in complicated grief and general psychopathology than SC in the completers and intention-to-treat groups. Comparison of the cognitive-behavioral conditions showed that "pure" exposure was more effective than "pure" cognitive restructuring, that adding ET to CR led to more additional improvement than adding CR to ET, and that ET + CR was more efficacious than CR + ET. Effect sizes of ET + CR were encouraging and compare favorably with those found in earlier bereavement intervention studies. Copyright 2007 APA, all rights reserved.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                EJPT
                European Journal of Psychotraumatology
                Co-Action Publishing
                2000-8066
                23 September 2016
                2016
                : 7
                : 10.3402/ejpt.v7.32609
                Affiliations
                [1 ]Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
                [2 ]Arq Psychotrauma Expert Group, Diemen, The Netherlands
                Author notes
                [* ]Correspondence to: Paul A. Boelen, Department of Clinical Psychology, Utrecht University, PO Box 80140, NL-3508 TC Utrecht, The Netherlands, Email: P.A.Boelen@ 123456uu.nl

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

                Article
                32609
                10.3402/ejpt.v7.32609
                5035770
                27667723
                96420def-2c14-48dc-90e0-d528f1a4d906
                © 2016 Paul A. Boelen

                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.

                History
                : 11 July 2016
                : 29 July 2016
                : 23 August 2016
                Categories
                Inaugural Lecture

                Clinical Psychology & Psychiatry
                grief,persistent complex bereavement disorder,prolonged grief disorder,treatment,stepped care

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