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Bereavement - Treatment

age differences clinical grief prigerson journal psychiatry

While there have been no randomized, controlled, clinical trials of treatment for traumatic grief, inferences can be made from studies done treating PTSD, separation anxiety disorder, and depression.

Pharmacotherapy. Considering a review of this literature done by Jacobs, it seems that selective serotonin reuptake inhibitors might be more effective for the broad range of traumatic grief symptoms than tricyclic antidepressants. The latter tend to affect intrusive, anxious, and depressive symptoms alone, while the former reduce these symptoms as well as manifestations of avoidance, particularly avoidance stemming from distress over reminders of the loss.

Psychotherapy. Though findings have been mixed, both psychodynamically oriented treatments and behavioral/cognitive treatments have, in some studies, demonstrated effectiveness in treating pathological grief. When addressing bereavement-related distress, it is important for the therapist to review the relationship to the deceased person and the circumstances of the death. In addition, the therapist should advise the patient on what to expect from the grieving process. Though as yet there is no treatment designed to specifically address the symptoms of traumatic grief, M. Katherine Shear and Ellen Frank are developing and testing one such therapy based on Edna Foa's treatment for PTSD. Continued strides in this direction are cause for optimism in the search for efficacious treatments for traumatic grief and other bereavementrelated disorders.



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