E. Frank et al., PHENOMENOLOGY AND TREATMENT OF BEREAVEMENT-RELATED DISTRESS IN THE ELDERLY, International clinical psychopharmacology, 12, 1997, pp. 25-29
While brief periods of bereavement-related distress should be neither
pathologized nor treated, periods of distress lasting several months t
hat meet criteria for major depressive episode and, in particular, for
what we now refer to as traumatic grief reactions, are strongly assoc
iated with considerable psychiatric and physical morbidity and deserve
careful clinical attention. Our current efforts at treatment developm
ent for traumatic grief come directly from treatment for Post-Traumati
c Stress Disorder. We conceptualize this as a nine-session interventio
n with an emphasis on reliving the moment of the death, saying goodbye
to the deceased, and in vivo exposure to situations that the subject
has come to avoid since the death. As yet, we have no objective data o
n the outcome of this procedure in traumatic grievers, but clinical ou
tcomes have been consistent with Foa's theory that re-experiencing the
trauma and exposure to avoided situations under controlled conditions
ultimately leads to reductions in subjective distress. We are current
ly planning an open treatment development trial of this form of trauma
tic grief therapy. Assuming outcomes are positive, we plan to test it
in a randomized controlled trial comparing the efficacy of this interv
ention with a more standard form of non-behavioral psychotherapy and w
ith pharmacotherapy.