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Treating Complicated Grief after Trauma
June 10, 2017 @ 8:00 am - 9:00 am
Presenter: M. Katherine Shear, M.D., Director, Center for Complicated Grief
Abstract: Loss of a loved one is one of life’s most stressful experiences and is a risk factor for the onset of a range of mental and physical disorders. About 60 million people die every year worldwide. Bereaved friends and relatives typically experience a period of painful acute grief during which they gradually adapt to living in a world without their loved one. Adaptation requires the bereaved person to learn how to accept the reality of the loss, to re-envision a future with a sense of purpose and meaning and possibilities for happiness and to re-establish and maintain a sense of connection to the deceased person. As the bereaved person adapts to their loss, grief is integrated and finds a place in their life.
Acute grief is an emotionally activated experience and adaptation is a learning process that requires effective emotion regulation. Difficulty with emotion regulation, or the occurrence of maladaptive thoughts or dysfunctional behaviors can impede adaptation producing a recently recognized condition variously called complicated grief, traumatic grief, prolonged grief disorder or persistent complex bereavement disorder. Complicated grief causes significant interference in social, personal and occupational functioning and without treatment, it tends to be chronic and persistent. Two decades of work by our research group has led to the development and testing of validated diagnostic criteria and evidence for efficacy of a short-term targeted adaptive grief therapy that has produced an overall 70% response rate.
A substantial minority of deaths occur violently, by suicide, homicide, accidents, natural disaster or war. The stress and disruption caused by a violent death can be even greater than with natural death. The process of adaptation to loss is often slower and more painful after a violent death and there is a higher likelihood of the onset or worsening of a health or mental health problem, with especially elevated rates of complicated or traumatic grief. This presentation will focus on two decades of work by our research group that has led to the development and testing of validated diagnostic criteria and a proven efficacious treatment. Colleagues in Japan have been leaders in implementing this treatment outside of the United States. Their work has focused primarily on complicated grief following traumatic loss.
Our 16-session manualized treatment approach focuses on resolving grief complications and facilitating adaptation to loss. The foundation for this treatment includes extensive social psychology research that has been validated across cultures. The principles and strategies are informed by information from studies of attachment theory, self-determination theory, psychological immune system, self-compassion and research on emotion regulation and implicit and explicit memory. Data supporting treatment efficacy and diagnostic validity are drawn from clinical studies and from a military family bereavement survey. Our studies currently represent the only ones to include validated diagnostic criteria for this syndrome and the only replicated treatment outcomes studies. Our clinical trials have shown strong efficacy of this treatment for individuals experiencing violent loss as well as death by natural causes. The conceptual framework and supporting empirical data for diagnosis and treatment will be presented as well as clinical strategies for recognition and treatment of complicated grief following violent death.