Science Behind Our Work

Our approach to understanding and treating complicated grief is to merge clinical knowledge and skills with scientific methods.

In this way we developed clinical assessment and treatment tools that can be used with confidence. Our team of seasoned clinicians, expert biostatisticians and basic researchers has extensive clinical and research experience. The Center for Complicated Grief was founded because of the need to disseminate the tools and knowledge gained from our successful clinical research program.

We have examined many aspects of complicated grief, for example sleep, dreams, daily routines, panic and anxiety symptoms, mania and depression. We have developed and tested assessment measures that enable clinicians to identify and characterize CG including a screening instrument, a structured diagnostic interview and a clinical global severity and improvement rating as well as questionnaires focusing on typical beliefs in CG and on avoidance. We have tested questionnaires that assess yearning and current attachment relationship functioning. We now have a reliable method of diagnosing the syndrome of complicated grief.

Our instruments can help you screen people for CG, assess grief-related impairment, overall CG severity and the type and extent of common grief complications.

We designed a treatment approach that uses information from laboratory research and incorporates strategies and techniques from several different evidence based psychotherapy models.

Laboratory research includes studies of psychological, physiological and neurobiological effects of close relationships, response to separation, loss, trauma and stress and studies of adaptation and growth in response to loss and other adversity. We were guided in our treatment development by questions about what exactly is lost when a loved one dies, what is needed to adapt to the loss and what can get in the way of adaptation?. The answers led to selection of treatment objectives that, in turn, directed our choice of strategies and procedures.

CGT makes the assumption that loss of a close relationship has far-reaching consequences for day-to-day psychological and physical functioning including the way we think, feel and behave and our sense of self. Adaptation to such a loss takes time and requires that we accept the reality, reconfigure our relationship to the deceased person and redefine our life goals and plans. A further assumption is that we do this naturally unless something impedes adaptation. Therefore CGT goals are to foster these natural adaptive processes and to resolve grief complications. We use strategies and techniques from cognitive behavioral therapy, interpersonal psychotherapy, motivational interviewing and positive psychology.

CGT is a well-described and well-tested method for helping people with complicated grief.

We first pilot tested the treatment and then studied CGT in rigorously designed randomized controlled trials (RCTs) funded by the National Institute of Mental Health. These treatment studies were performed in five different clinical research laboratories located in four cities and involved five different groups of therapists and assessment raters. Results were consistent across all studies and all laboratories. Approximately 70% of study participants who received CGT were much improved. This outcome was significantly better than the comparison treatments.

Colleagues around the world e.g., Japan, Ireland, Norway, Canada, Hong Kong, Australia, Italy, Denmark, have developed CGT programs, adapting the treatment for their culture. Others are working to develop alternative methods of helping people with CG and alternative methods of delivering CGT are under development. We are optimistic that the field will continue to grow and with it options for people with CG to get effective help will expand.