Treatment should target the symptoms experienced by the patient. It is now very clear that bereaved individuals who have Major Depressive Disorder (MDD) respond to antidepressant medication and/or psychotherapy similarly to those who are not bereaved. A very interesting recent study suggests that treatment of MDD as early as a month after the death may be extremely helpful and prevent later symptoms. Similarly, for those who meet criteria for PTSD, it makes sense to provide treatment similar to that used with other PTSD patients. However, the most common post bereavement problems centre around traumatic grief reactions, and unfortunately, few treatments have been developed or tested for symptoms of Traumatic Grief. Studies of early intervention for grief document some reduction in grief symptoms, with support groups showing efficacy equal to that of active psychotherapy.An early study of a behavioural therapy called “guided mourning” also appeared to have beneficial effects, although grief outcome was not measured. A specific “Traumatic Grief Treatment” (TGT) is currently undergoing randomized controlled testing. In a pilot study, TGT had a large effect size, even taking into consideration individuals who did not complete the full course of the treatment (Shear, 2001).
Components of this treatment include:
- 1- Providing information about bereavement and grief to bereaved individuals and their families.
- 2- The bereaved describing the deceased and relating the history of the relationship with the deceased.
- 3- Relating the story of the death and its aftermath.
- 4- Careful assessment of current grief levels, target grief levels, and components of grief (i.e., cognitive, behavioural, and somatic)
Reviewing the bereaved’ s personal goals and determining how
the bereaved person will know when these goals have been met.
- 5- Carefully managed imaginal exposure to the death and related events.
- 6- In vivo exposure to situations that are avoided and/or response
prevention for situations of preoccupation.
- 7- Focusing on positive memories of the deceased.
Therapists should undertake imaginal exposure only if they are familiar with this technique and with emotion control techniques. The remainder of the treatment may be of help alone, but it has not been tested. It is also important to evaluate the bereaved person’s social support system and encourage engagement with existing supportive people. To date, no treatment has been proven effective in the early stages of bereavement, and there is some indication that for some people formal grief counselling can do more harm than good. In light of this, caution may be indicated.
Guidelines for early treatment in the acute phase of traumatic grief include:
- Allowing the bereaved person to talk about the nature and
circumstances of their loss according to their own readiness (without probing)
- 2- Educating about the course of bereavement and what to expect.
- 3- Assessing for possible troubling symptoms like an unusual intensity of grief reactions or intrusive thoughts.
- 4- Encouraging, as much as possible without intruding, the use of social support and the broadening of activities.
- 5- Encouraging positive memories and a feeling of connection to the deceased, which may help supplant traumatic memories.
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