Grief resolution therapy

MODERATOR- MS VIDYASHREE SHETTY

PRESENTER- DR SANDESH HEGDE
OBJECTIVES
INTRODUCTION
STAGES OF GRIEF
NORMAL GRIEF
COMPLICATED GRIEF
INTERVENTIONS
SCALES
INTRODUCTION
• Bereavement is used to refer to the fact of the loss.

• The term grief should then be used to describe the emotional, cognitive, functional and
behavioral responses to the death.

• Also, grief is often used more broadly to refer to the response to other kinds of loss;
INTRODUCTION
With loss and death come bereavement, grief, and mourning.
 Bereavement - the process of adjusting to the death of a loved one.
 Grief - the complex emotional responses that one has during the bereavement process, such as
experiencing sorrow, hurt, anger, guilt, confusion, and so on Hooyman & Kiyak, 2002; Santrock,
2006
Mourning - the culturally structured patterns and expectations of how individuals express their
grief Hooyman & Kiyak, 2002.
Grieving is a natural process which can be very important toward coping constructively with loss
and death Attig, 1996
“Each person’s grief is like all other people’s grief; each
person’s grief is like some other person’s grief; and each
person’s grief is like no other person’s grief.”
Disenfranchized Grief
Refers to losses in the mourner’s life of relationships that are not socially
sanctioned.
Examples-
Extra-marital affair
Related concepts
SOCIALLY NEGATED LOSSES are those losses that society treats as non-losses.

An example of this would be pregnancy loss, either spontaneous or induced.

SOCIALLY UNSPEAKABLE LOSSES- specific losses about which the mourner has a difficult
time talking.
Common examples would be death by suicide and death by AIDS.
Mummification
Described by Gorer in 1965
Grief reaction in which the deceased individual's belongings and, in
extreme cases, his or her corpse are preserved as if he or she was still
alive.
MELANCHOLIA BY FREUD
• Freud proposed that a bereaved individual must engage in ‘grief work’ to properly heal from a loss.
• Grief work is the process by which an individual breaks their bond to the deceased, adjusts to their new life,
and forms new relationships with others.
• According to this Freudian theory, the best way to overcome grief is to throw oneself into other aspects of
life
KUBLER ROSS STAGES OF
GRIEF

DENIAL ANGER BARGAINING

DEPRESSION ACCEPTANCE
DENIAL
ANGER
BARGAINING
DEPRESSION
ACCEPTANCE
Dual Process Model (DPM)

Margaret Stroebe and Henk Schut

This theory suggests that grieving individuals engage with
• Stress involved in loss
• The stress involved in returning to normalcy.
Individuals oscillate between two states:

LOSS-ORIENTATION (LO)
RESTORATION-ORIENTATION (RO).
Emotion-focussed coping, where different Problem-focussed coping, where the griever
tactics are used to avoid the negative emotions makes active efforts to confront and overcome
associated with loss (Fiore, 2019; stressors
Schoenmakers, 2015).
Normal Grief
• Variable.
• Why evaluate?
• EXCESSIVE VIGILANCE -Risk for intervening in a normal
process and possibly derailing it.
• IGNORANCE- Failure to recognize complicated grief and/or
depression occurring in the wake of a loved one’s death.
• Risk for inattention to, or ineffective treatment of, clinically
important problems.
Influencing factors-
• The individual’s preexisting personality,
• Attachment style,
• Genetic makeup and unique vulnerabilities;
• Age and health;
• Spirituality and cultural identity;
• Supports and resources;
• The number of losses;
• The nature of the relationship (e.g., interdependent vs. distant, loving vs. ambivalent);
• The relation (parent vs. child vs. spouse vs. sibling vs. friend, etc.);
• Type of loss (sudden and unanticipated vs. gradual and anticipated, or natural causes vs. suicide, accident or
homicide)
Types

Acute Grief Integrating

or
Abiding
Grief
ICD-11- Prolonged Grief Disorder
• History of bereavement after the death of a partner, parent, child, or other loved one
• At least one of the following symptoms: A persistent and pervasive longing for the deceased; a persistent
and pervasive preoccupation with the deceased.
• At least one symptom of intense emotional pain: sadness, guilt, anger, denial, blame; difficulty accepting
the death; feeling one has lost a part of one’s self; an inability to experience positivemood; emotional
numbness; difficulty in engaging with social or other activities
• The disturbance causes significant impairment in personal, family, social, educational, occupational, or
other important areas of functioning.
• Time and impairment: persisted for an abnormally long period of time (more than 6 months at a
minimum); following the loss, clearly exceeding expected social, cultural, or religious norms for the
individual’s culture and context.
Prolonged Grief Disorder- DSM-V
A. The death, at least 12 months ago, of a person who was close to the bereaved
B. Since the death, the development of a persistent grief response characterized by one or both of the following
symptoms, which have been present most days to a clinically significant degree.
In addition, the symptom(s) has occurred nearly every day for at least the last month:
1. Intense yearning/longing for the deceased person.
2. Preoccupation with thoughts or memories of the deceased person (in children and adolescents, preoccupation
may focus on the circumstances of the death).
C. Since the death, at least three of the following symptoms have been present most days to a clinically
significant degree. In addition, the symptoms have occurred nearly every day for at least the last month:
1. Identity disruption (e.g., feeling as though part of oneself has died) since the death.
2. Marked sense of disbelief about the death.
3. Avoidance of reminders that the person is dead (in children and adolescents, may be characterized by
efforts to avoid reminders).
4. Intense emotional pain (e.g., anger, bitterness, sorrow) related to the death.
5. Difficulty reintegrating into one’s relationships and activities after the death (e.g., problems engaging with
friends, pursuing interests, or planning for the future).
6. Emotional numbness (absence or marked reduction of emotional experience) as a result of the death.
7. Feeling that life is meaningless as a result of the death.
8. Intense loneliness as a result of the death.
D. The disturbance causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning.

E. The duration and severity of the bereavement reaction clearly exceed expected social, cultural, or religious
norms for the individual’s culture and context .

F. The symptoms are not better explained by another mental disorder, such as major depressive disorder or
posttraumatic stress disorder, and are not attributable to the physiological effects of a substance (e.g.,
medication, alcohol) or another medical condition.
Bereavement vs Clinical
Depression
Resolution therapies
Complicated Grief Therapy.
Cognitive Behavioural Therapy.
Grief counselling and Grief Therapy
Accelerated resolution therapy
Acceptance and commitment therapy
Empty chair techniques.
Support Groups.
Complicated Grief Therapy

Providing Managing
information to help emotional pain and Thinking about the Reconnecting with
patients understand monitoring future, others,
and accept grief, symptoms,

Telling the story of Learning to live with Connecting with

the death, reminders memories.
Complicated Grief Therapy
Components of
attachment theory,

Cognitive-behavioral
therapy (CBT),

Other approaches to
facilitate natural adaptive
processes to loss.
Complicated Grief Therapy
Focus on both loss and resto-ration, in alignment with the dual process model of grief.

The loss-Accepting the reality of the death and changing the relationship with the person who
died.

The restoration-Working toward aspirational goals in the absence of the individual who died
and having a sense of competence and satisfaction in the world without the deceased
Evidence
RCT of 395 patientswith prolonged grief disorder,
Patients were randomly assigned to receive CGT augmented with the antidepressant
citalopram,
CGT plus placebo, citalopram only, or placebo only. In this study, those receiving CGT (with
citalopram or placebo) showed greater reductions in prolonged grief disorder symptoms and
suicidal ideation than those on a pillalone.
What to say to someone who has lost a
loved one
: It is common to feel awkward when trying to comfort someone who is grieving. Many
people do not know what to say or do.
The following are suggestions to use as a guide.
Acknowledge the situation.
Express your concern.
Be genuine in your communication and don’t hide your feelings.
Ask how he or she feels.
Helping people in grief

1. Listen empathetically
2. Accept the feelings and emotions
3. Offer reassurance without minimizing loss
Comments to AVOID

● “I know how you feel.”

● “It’s part of God’s plan.”
● “Look at what you have to be thankful for.”
● “He’s in a better place now.”
● “This is behind you now; it’s time to get on with your life.”
● Statements that begin with “You should” or “You will.” “Have you thought about...” or
“You might...”
CBT
Cognitive Reframing or Restructuring

Targeting Behaviors:

Developing a New Narrative:

Evidence
Prolonged grief disorder and its symptoms in bereaved children and adolescents can be
effectively treated by CBT interventions. The superior long-term effects of CBT Grief-
Help relative to supportive counseling suggest that this treatment successfully
strengthens children and adolescents in facing challenges brought about by
bereavement.

(Boelen, P. A., Lenferink, L. I. M., & Spuij, M. (2021). CBT for prolonged grief in children
and adolescents: A randomized clinical trial. The American Journal of Psychiatry, )
Grief counselling and Grief therapy

Grief therapy, on the other hand, refers to

Grief counseling refers to the interventions those techniques and interventions that a
counselors make with people recent to a death professional makes with persons experiencing
loss to help facilitate them with the various one of the complications to the mourning
tasks of mourning. process that keeps grief from progressing to an
adequate adaptation for the mourner.
1. Rule Out Physical Disease
2. Set Up the Contract and Establish an Alliance
3. Revive Memories of the Deceased
4. Assess the Mourning Tasks With Which the PatientIs Struggling
5. Deal With Affect or Lack of Affect Stimulated by Memories
6. Explore and Defuse Linking Objects
7. Help the Patient Acknowledge the Finality of the Loss
8. Help the Patient Design a New Life Without the Deceased
9. Assess and Help the Patient Improve Social Relationships
10. Help the Patient Deal With the Fantasy of Ending Grieving
Accelerated Resolution Therapy (ART)

Imaginal Rescripting of Lateral eye

exposure events movements
ART – evidence
Results suggests that ART presents an effective and less time-intensive intervention for CG in
older adults.

(Buck, Harleah G et al. “Accelerated Resolution Therapy: Randomized Controlled Trial of a

Complicated Grief Intervention.” The American journal of hospice & palliative care )
Acceptance and Commitment Therapy
Accepting negative feelings and emotions

Distancing from negative feelings and emotions in order to understand them better

Focusing on the present

Observing yourself experiencing different situations and circumstances

Identifying your values

Overcoming difficulties through the use of the previous techniques

Empty Chair Technique

exploring emotion

movement
between
chairs
dialogue with another, either
in imagining another person
or an aspect of oneself
Support Groups
1. Meeting other people with similar problems.
2. Sharing your own struggles in a therapeutic setting.
3. Learning to relate to strangers
4. Finding insight into yourself and your actions
Pharmacotherapy
Antidepressants in combination with CBT have also been shown to
improve comorbid depression symptoms, but they may have limited
effects on grief-specific symptoms.
CGT in combination with citalopram showed additive benefit for
depression symptoms compared with CGT plus placebo; no
differences in grief symptoms were found. .
 Mild and not associated with suicidal risk or melancholic
features, support and watchful waiting might be an appropriate
initial choice.
Assessment Methods
Conclusion
Unique
Complicated grief- chronic and persistent if left alone.
Combination of psychotherapy and pharmacotherapy.
Being self aware about own losses helps provide sensitive and enlightened care.
REFERENCES
1. Boelen, P. A., Lenferink, L. I. M., & Spuij, M. (2021). CBT for prolonged grief in
children and adolescents: A randomized clinical trial. The American Journal of
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2. Buck, H. G., Cairns, P., Emechebe, N., Hernandez, D. F., Mason, T. M., Bell, J., Kip,
K. E., Barrison, P., & Tofthagen, C. (2020). Accelerated resolution therapy:
Randomized controlled trial of a complicated grief intervention. The American
Journal of Hospice & Palliative Care, 37(10), 791–799.
https://doi.org/10.1177/1049909119900641
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https://www.talkspace.com/blog/grief-therapy-techniques/
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