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Niemeyer H, Knaevelsrud C, Schumacher S, Engel S, Kuester A, Burchert S, Muschalla B, Weiss D, Spies J, Rau H, Willmund GD. Evaluation of an internet-based intervention for service members of the German armed forces with deployment-related posttraumatic stress symptoms. BMC Psychiatry 2020; 20:205. [PMID: 32375754 PMCID: PMC7204035 DOI: 10.1186/s12888-020-02595-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 04/12/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The present study was designed to evaluate the efficacy of a therapist-guided internet-based cognitive-behavioral therapy (iCBT) intervention for service members of the German Armed Forces with posttraumatic stress disorder (PTSD). The iCBT was adapted from Interapy, a trauma-focused evidence-based treatment based on prolonged exposure and cognitive restructuring. It lasted for 5 weeks and included 10 writing assignments (twice a week). The program included a reminder function if assignments were overdue, but no multimedia elements. Therapeutic written feedback was provided asynchronously within one working day. METHODS Male active and former military service members were recruited from the German Armed Forces. Diagnoses were assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) and the Mini-International Neuropsychiatric Interview. Psychopathology was assessed at pre-treatment, post-treatment, and 3-month follow-up. Severity of PTSD was the primary outcome and anxiety was the secondary outcome. Participants were randomly allocated to a treatment group that received iCBT immediately or to a waitlist group that received iCBT after 6 weeks. Due to the overall small sample size (n = 37), the two groups were collapsed for the statistical analyses. Change during the intervention period was investigated using latent-change score models. RESULTS Improvements in the CAPS-5 were small and not statistically significant. For anxiety, small significant improvements were observed from pre- to follow-up assessment. The dropout rate was 32.3%. CONCLUSIONS The low treatment utilization and the high dropout rate are in line with previous findings on treatment of service members. The interpretation of the current null results for the efficacy of iCBT is limited due to the small sample size, however for military samples effect estimates were also smaller in other recent studies. Our results demonstrate the need to identify factors influencing treatment engagement and efficacy in veterans. TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN12616000956404.
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Affiliation(s)
- Helen Niemeyer
- Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195, Berlin, Germany.
| | - Christine Knaevelsrud
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Sarah Schumacher
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Sinha Engel
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Annika Kuester
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Sebastian Burchert
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Beate Muschalla
- grid.6738.a0000 0001 1090 0254Department of Clinical Psychology, Psychotherapy and Diagnostics, Institute of Psychology, Technische Universität Braunschweig, Braunschweig, Germany
| | - Deborah Weiss
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Jan Spies
- grid.14095.390000 0000 9116 4836Division of Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Freie Universität Berlin, Schwendenerstr. 27, 14195 Berlin, Germany
| | - Heinrich Rau
- German Armed Forces, Military Hospital Berlin, Department for Military Mental Health, Berlin, Germany
| | - Gerd-Dieter Willmund
- German Armed Forces, Military Hospital Berlin, Department for Military Mental Health, Berlin, Germany
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Meichsner F, O'Connor M, Skritskaya N, Shear MK. Grief Before and After Bereavement in the Elderly: An Approach to Care. Am J Geriatr Psychiatry 2020; 28:560-569. [PMID: 32037292 DOI: 10.1016/j.jagp.2019.12.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 02/01/2023]
Abstract
Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly; it can also precede the death. Knowledge about four distinct forms of grief can aid clinicians with the conceptualization of grief, and the assessment and care of grievers. First, predeath grief is experienced by many caregivers of terminally ill patients. Second, acute grief arises immediately after the death of a loved one; and third, this normally evolves to a permanent state of integrated grief after a process of adaptation. Finally, failure of adaptation results in Prolonged Grief Disorder (PGD) which has been recently included in ICD-11. The hallmark feature of PGD is intense longing for the deceased or persistent preoccupation with the deceased that lasts longer than 6 months after the death. Validated instruments are available to assist practitioners with assessment of predeath grief and screening for PGD, thereby enabling identification of patients in need of additional support. Increased risks of morbidity and mortality following bereavement are important health issues for clinicians to be aware of. All grievers can benefit from support focused on understanding their grief, managing emotional pain, thinking about the future, strengthening their relationships, telling the story of the death, learning to live with reminders of the deceased, and connecting with memories. A short-term evidence-based intervention for PGD is based upon these seven themes and is efficacious in the elderly. Caregivers of the terminally ill benefit from psychological support that validates and normalizes their grief experiences and helps them recognize and accept their losses.
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Affiliation(s)
- Franziska Meichsner
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt (FM), Frankfurt, Germany.
| | - Monique O'Connor
- Perth Clinic Medical Suites (MO), West Perth, Western Australia, Australia
| | - Natalia Skritskaya
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
| | - M Katherine Shear
- Center for Complicated Grief, Columbia School of Social Work (NS, MKS), New York, NY
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Geležėlytė O, Gailienė D, Latakienė J, Mažulytė-Rašytinė E, Skruibis P, Dadašev S, Grigienė D. Factors of Seeking Professional Psychological Help by the Bereaved by Suicide. Front Psychol 2020; 11:592. [PMID: 32322225 PMCID: PMC7156641 DOI: 10.3389/fpsyg.2020.00592] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/12/2020] [Indexed: 11/15/2022] Open
Abstract
Background Studies show that people bereaved by suicide often feel a strong need for professional help. It is hypothesized that aspects related to suicide bereavement, such as stigmatization, shame or guilt, hinder help-seeking process of the bereaved. However, little is known about help-seeking behaviors of people who has lost someone due to suicide. Aims This study was conducted to attain a better understanding of the contributing factors, including the specific features of grief following suicide, to help-seeking behaviors of the bereaved by suicide. Methods The sample consisted of 82 adults bereaved by suicide (64 female; average age 37.79, SD = 14.33). Instruments assessing stigmatization, shame, guilt levels, well-being, tendency to disclose emotional distress and attitudes toward seeking professional psychological help were used. The participants were also asked an open-ended question what professional help-seeking barriers they had encountered. Comparisons between the groups, logistic regression analysis and thematic analysis of the qualitative data were performed. Results The findings revealed that bereaved participants who sought professional psychological help reported experiencing stigmatization and feeling guilty after the loss significantly more often. Also the results showed that attitudes toward mental health specialists had the highest prognostic value in predicting help-seeking behaviors of the bereaved. The participants themselves identified the gaps in the health care system as main barriers to seeking help. Conclusion The results challenge previously spread notion that stigmatization, guilt and shame after suicide can act only as help-seeking barriers.
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Affiliation(s)
- Odeta Geležėlytė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Danutė Gailienė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Jolanta Latakienė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Eglė Mažulytė-Rašytinė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Paulius Skruibis
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Said Dadašev
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Dovilė Grigienė
- Suicide Research Centre, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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Luppa M, Löbner M, Pabst A, Schlapke C, Stein J, Riedel-Heller SG. Effectiveness and feasibility of internet-based and mobile-based interventions for individuals experiencing bereavement: a systematic review protocol. BMJ Open 2020; 10:e036034. [PMID: 32327480 PMCID: PMC7204864 DOI: 10.1136/bmjopen-2019-036034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Internet-based and mobile-based interventions (IMIs) provide an innovative and efficient self-management tool for mental health problems. This systematic review aims to summarise and critically evaluate studies addressing the effectiveness and feasibility of IMIs for normal and complicated grief in bereaved adults. METHODS AND ANALYSIS The databases MEDLINE, Cochrane Library, PsycINFO, Embase and Web of Science and Google Scholar (for 'grey' literature) will be systematically searched for feasibility studies or randomised controlled trials of IMIs for bereaved adults who were experiencing normal/complicated grief. Data will be extracted and evaluated independently by two reviewers from studies eligible for inclusion. Quality of evidence will be assessed, and results will be synthesised qualitatively and pooled meta-analytically, if sufficient outcome data are available. Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards and Grades of Recommendation, Assessment, Development and Evaluation methodology will be used. ETHICS AND DISSEMINATION No primary data will be collected; thus, ethical approval is not required. The results will be disseminated through a peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER CRD42019131428.
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Affiliation(s)
- Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Christine Schlapke
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
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Xiu D, Chow AYM, Tang S. Predictive factors for differential changes in grief symptoms following group bereavement intervention for Chinese widowed older adults. Clin Psychol Psychother 2020; 27:267-277. [PMID: 31944474 DOI: 10.1002/cpp.2425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 12/29/2019] [Accepted: 01/06/2020] [Indexed: 11/09/2022]
Abstract
This study aimed to delineate changes in the patterns of prolonged grief severity in widowed adults following group bereavement interventions and to identify the predictive factors impacting these patterns. We performed a secondary analysis of data from a randomized trial of 125 Chinese widowed older adults who participated in either LOGBI or DPGBI. Self-ratings of prolonged grief symptoms via Inventory of Complicated Grief (ICG) were subjected to latent class growth analysis to identify subgroups according to symptomatic changes among baseline, post-treatment, and 8-week follow-up. Multinomial regression analysis examined whether participant classification could be predicted by demographics, loss-related characteristics, and the relationship with the deceased and baseline symptom severity. In the results, intervention sample comprised 96 completers with an attendance greater than 60%. A three-class categorization yielded the best model fit for changes in prolonged grief severity for both randomized and intervention samples: improved class (41.6% in the randomized sample, 42.8% in the intervention sample), partial responded class (48.1%/45.5%), and relapse class (10.3%/11.8%). Older widowed adults experiencing a high level of grief at baseline and bereavement following chronic illness had an elevated risk of symptomatic relapse after the completion of intervention. These findings indicated that Chinese widowed adults experienced different changing patterns of prolonged grief severity following group bereavement interventions. Practically, widowed adults with a higher risk of symptomatic relapse might need more intensive or longer term intervention or follow-up support.
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Affiliation(s)
- Daiming Xiu
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Suqin Tang
- Department of Sociology, Law School, Shenzhen University, Shenzhen, China
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56
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Online-group intervention after suicide bereavement through the use of webinars: study protocol for a randomized controlled trial. Trials 2020; 21:45. [PMID: 31915044 PMCID: PMC6951011 DOI: 10.1186/s13063-019-3891-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction The death of a significant person through suicide is a very difficult experience and can have long-term impact on an individual’s psychosocial and physical functioning. However, there are only few studies that have examined the effects of interventions in suicide survivors. In the present study, we examine an online-group intervention for people bereaved by suicide using a group-webinar. Methods The intervention was developed based on focus groups with the target group. The cognitive-behavioral 12-module webinar-based group intervention focuses on suicide bereavement-related themes such as feelings of guilt, stigmatization, meaning reconstruction and the relationship to the deceased. Further, the webinar includes testimonial videos and psychoeducation. The suicide survivors are randomized to the intervention or the waiting list in a group-cluster randomized controlled trial. Primary outcomes are suicidality (Beck Scale for Suicide Ideation) and depression (Beck Depression Inventory-II) and secondary outcomes are symptoms of prolonged grief disorder (Inventory of Complicated Grief-German Version ), posttraumatic stress disorder ( Revised Impact of Event Scale ), stigmatization (Stigma of Suicide and Suicide Survivor ) and posttraumatic cognitions (Posttraumatic Cognitions Inventory). Discussion Previous studies of Internet-based interventions for the bereaved were based on writing interventions showing large treatment effects. Little is known about the use of webinars as group interventions. Advantages and challenges of this novel approach of psychological interventions will be discussed. Trial registration German Clinical Trials Register, DRKS00014426. Registered on 12 April 2018. Protocol Version 3, 21.10.2019.
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57
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Simon NM, Shear K, Reynolds CF, Cozza SJ, Mauro C, Zisook S, Skritskaya N, Robinaugh DJ, Malgaroli M, Spandorfer J, Lebowitz B. Commentary on evidence in support of a grief-related condition as a DSM diagnosis. Depress Anxiety 2020; 37:9-16. [PMID: 31916663 PMCID: PMC7430251 DOI: 10.1002/da.22985] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/03/2019] [Accepted: 10/31/2019] [Indexed: 12/11/2022] Open
Abstract
The death of a loved one is one of life's greatest stressors. Most bereaved individuals experience a period of acute grief that diminishes in intensity as they adapt to the changes brought about by their loss. Over the past four decades, a growing body of research has focused on a form of prolonged grief that is painful and impairing. There is a substantial and growing evidence base that supports the validity and significance of a grief-related disorder, including the clinical value of being able to diagnose it and provide effective targeted treatment. ICD-11 will include a new diagnosis of prolonged grief disorder (PGD). DSM-5 called this condition persistent complex bereavement disorder (PCBD) and included it in Section III, signaling agreement that a diagnosis is warranted while further research is needed to determine the optimal criteria. Given the remaining uncertainties, reading this literature can be confusing. There is inconsistency in naming the condition (including complicated grief as well as PGD and PCBD) and lack of uniformity in identifying it, with respect to the optimal threshold and timeframe for distinguishing it from normal grief. As an introductory commentary for this Depression and Anxiety special edition on this form of grief, the authors discuss the history, commonalities, and key areas of variability in identifying this condition. We review the state of diagnostic criteria for DSM-5 and the current ICD-11 diagnostic guideline, highlighting the clinical relevance of making this diagnosis.
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Affiliation(s)
- Naomi M. Simon
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | | | | | - Stephen J. Cozza
- Center for the Study of Traumatic Stress, Uniformed Services University for the Health Sciences
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY
| | - Sidney Zisook
- University of California San Diego and San Diego Healthcare System, San Diego, CA
| | | | - Donald J. Robinaugh
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, MA
| | - Matteo Malgaroli
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Julia Spandorfer
- Department of Psychiatry, NYU Langone Health/NYU School of Medicine, New York, NY
| | - Barry Lebowitz
- University of California San Diego and San Diego Healthcare System, San Diego, CA
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Iglewicz A, Shear MK, Reynolds CF, Simon N, Lebowitz B, Zisook S. Complicated grief therapy for clinicians: An evidence-based protocol for mental health practice. Depress Anxiety 2020; 37:90-98. [PMID: 31622522 DOI: 10.1002/da.22965] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/07/2019] [Accepted: 08/20/2019] [Indexed: 11/07/2022] Open
Abstract
In the United States alone, about 10 million persons are newly bereaved each year. Most do not require professional intervention or treatment, but many can benefit from targeted support. However, a significant minority of bereaved persons experience intense, prolonged and disabling grief symptoms associated with considerable morbidity and mortality (aka, "Complicated Grief"). Individuals with Complicated Grief require more formal interventions. In this article, we describe a compassionate and evidence-based approach to bereavement-care that can be provided in varied mental health settings. For individuals struggling with acute grief, clinicians can help by providing recognition and acceptance of the grief, eliciting and compassionately listening to their narratives of their relationship with the deceased and the death, and regularly "checking in" regarding their grief experiences. For bereaved persons who are experiencing Complicated Grief, we recommend an evidence-based approach to bereavement-care, complicated grief therapy (CGT), that involves helping the individual accept and cope with the loss while simultaneously assisting them with adaptation to life without the deceased. We describe ways of implementing CGT's seven core themes: (1) understanding and accepting grief, (2) managing painful emotions, (3) planning for a meaningful future, (4) strengthening ongoing relationships, (5) telling the story of the death, (6) learning to live with reminders, and (7) establishing an enduring connection with memories of the person who died. This work can be done in a variety of settings, taking into consideration the needs of the patient, the limitations of the setting, and the skills and experiences of each clinician.
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Affiliation(s)
- Alana Iglewicz
- Veterans Affairs San Diego Healthcare System, La Jolla, California.,Department of Psychiatry, University of California San Diego, La Jolla, California
| | - M Katherine Shear
- Columbia University School of Social Work and College of Physicians and Surgeons, Columbia University, New York, New York
| | - Charles F Reynolds
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Naomi Simon
- Department of Psychiatry, NYU Langone Health, NYU School of Medicine, New York, New York
| | - Barry Lebowitz
- Department of Psychiatry, University of California San Diego, La Jolla, California
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego, La Jolla, California
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Wojtkowiak J, Lind J, Smid GE. Ritual in Therapy for Prolonged Grief: A Scoping Review of Ritual Elements in Evidence-Informed Grief Interventions. Front Psychiatry 2020; 11:623835. [PMID: 33613334 PMCID: PMC7887294 DOI: 10.3389/fpsyt.2020.623835] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 12/28/2020] [Indexed: 11/13/2022] Open
Abstract
The aim of this article of to analyze ritual in evidence-informed treatments for prolonged and traumatic grief. A scoping review is conducted in order to give an overview of existing literature on ritual and symbolic interventions in grief therapies for prolonged grief and the type of evidence supporting these interventions. The 22 studies reported in this review reveal a variety of ritual elements ranging from symbolic expression and interaction, writing assignments, dialogue with the deceased or an imaginary person, to farewell ceremonies at the end of the treatment. The interventions are studied within different populations (e.g., bereaved spouses, perinatal loss, grief after violent death, and genocide). Almost all studies show significant effects of the grief treatment, trauma and related symptoms. However, the effects are mostly measured for the entire treatment and not separately for the ritual intervention. In the discussion we focus on the role of ritual and culture in prolonged grief treatment.
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Affiliation(s)
- Joanna Wojtkowiak
- Department of Humanist Chaplaincy Studies, University of Humanistic Studies, Utrecht, Netherlands
| | - Jonna Lind
- ARQ National Psychotrauma Center, Diemen, Netherlands
| | - Geert E Smid
- Department of Humanist Chaplaincy Studies, University of Humanistic Studies, Utrecht, Netherlands.,ARQ National Psychotrauma Center, Diemen, Netherlands
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Wagner B, Rosenberg N, Hofmann L, Maass U. Web-Based Bereavement Care: A Systematic Review and Meta-Analysis. Front Psychiatry 2020; 11:525. [PMID: 32670101 PMCID: PMC7327548 DOI: 10.3389/fpsyt.2020.00525] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based interventions have been introduced as novel and effective treatments for mental disorders and, in recent years, specifically for the bereaved. However, a systematic summary of the effectiveness of online interventions for people experiencing bereavement is still missing. OBJECTIVE A systematic literature search was conducted by four reviewers who reviewed and meta-analytically summarized the evidence for web-based interventions for bereaved people. METHODS Systematic searches (PubMed, Web of Science, PsycInfo, PsycArticles, Medline, and CINAHL) resulted in seven randomized controlled trials (N = 1,257) that addressed adults having experienced bereavement using internet-based interventions. We used random effects models to summarize treatment effects for between-group comparisons (treatment vs. control at post) and stability over time (post vs. follow-up). RESULTS All web-based interventions were based on cognitive behavioral therapy (CBT). In comparison with control groups, the interventions showed moderate (g = .54) to large effects (g = .86) for symptoms of grief and posttraumatic stress disorder (PTSD), respectively. The effect for depression was small (g = .44). All effects were stable over time. A higher number of treatment sessions achieved higher effects for grief symptoms and more individual feedback increased effects for depression. Other moderators (i.e. dropout rate, time since loss, exposure) did not significantly reduce moderate degrees of heterogeneity between the studies. LIMITATIONS The number of includable studies was low in this review resulting to lower power for moderator analyses in particular. CONCLUSIONS Overall, the results of web-based bereavement interventions are promising, and its low-threshold approach might reduce barriers to bereavement care. Nonetheless, future research should further examine potential moderators and specific treatment components (e.g. exposure, feedback) and compare interventions with active controls.
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Affiliation(s)
- Birgit Wagner
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Nicole Rosenberg
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Laura Hofmann
- Clinical Psychology and Psychotherapy, Medical School Berlin, Berlin, Germany
| | - Ulrike Maass
- Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
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Wilson DM, Errasti-Ibarrondo B, Rodríguez-Prat A. A Research Literature Review to Determine How Bereavement Programs Are Evaluated. OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:831-858. [PMID: 31430222 DOI: 10.1177/0030222819869492] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A review of all 44 research reports published between 2000 and 2018 on bereavement program evaluation was undertaken to identify evaluation methods and assess their apparent efficacy. Bereavement program evaluations varied considerably, with multiple data collection methods per study common (61.4%) over single methods (38.6%). Among these evaluation methods, a self-devised questionnaire was most often used (59.1%), followed by qualitative interviewing (36.4%), and the use of 1 or more of 35 data collection instruments such as grief inventories or depression scales (40.9%). Evaluative data were usually only collected once (77.3%), typically around program completion. Formal bereavement program evaluation appears to be ad hoc and sporadic, and potentially unlikely to provide the type and quality of information needed to retain, improve, expand, or abandon programs. Evaluation method developments including evaluation standards are needed to ensure recipients and others benefit as expected from bereavement programs.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Johannsen M, Damholdt MF, Zachariae R, Lundorff M, Farver-Vestergaard I, O'Connor M. Psychological interventions for grief in adults: A systematic review and meta-analysis of randomized controlled trials. J Affect Disord 2019; 253:69-86. [PMID: 31029856 DOI: 10.1016/j.jad.2019.04.065] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/30/2019] [Accepted: 04/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The present meta-analysis evaluates the efficacy of psychological interventions for grief in bereaved adults and explores the possible moderating influence of various study characteristics. METHODS A systematic literature search was conducted by two reviewers who independently searched electronic databases, reviewed and selected eligible studies, and evaluated their methodological quality. RESULTS A total of 31 randomized controlled trials (RCTs) were included in the meta-analysis. Statistically significant pooled effects of psychological intervention on grief symptoms were found for both post-intervention (Hedges's g = 0.41, p > .001, K = 31) and follow-up (g = 0.45, p > .001, K = 18). While generally robust, the effect was smaller at post-intervention when adjusting for possible publication bias (g = 0.31). Compared with the remaining studies, larger post-intervention effect sizes were found for studies with (1) individually delivered interventions (Beta = 0.49, p < .001), (2) the ICG-(R)/PG-13 questionnaire as the grief instrument (Beta = 0.46, p < .001), (3) participants who were ≥6 months post-loss (Beta = 0.58, p < .001), (4) participants included based on high baseline symptom levels (Beta = 0.40, p = .002) and (5) higher study quality (Beta = 0.06, p = .013). LIMITATIONS The included studies were methodologically heterogeneous and their methodological quality varied considerably. Moreover, there were some indications of publication bias. CONCLUSIONS Given the recent introduction of Prolonged Grief Disorder in the ICD-11, the results of the present meta-analysis are timely and of clinical relevance. Based on our results, psychological intervention appears efficacious for alleviating grief symptoms in bereaved adults, with several study characteristics as possible moderators of the effect. The interpretability of the results, however, is challenged by some limitations of the available research, including possible publication bias.
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Affiliation(s)
- M Johannsen
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark.
| | - M F Damholdt
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - R Zachariae
- Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
| | - M Lundorff
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
| | - I Farver-Vestergaard
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
| | - M O'Connor
- Unit for Bereavement Research, Aarhus University, Denmark; Unit for Psychooncology and Health Psychology, Aarhus University Hospital, Aarhus University, Denmark
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Brodbeck J, Berger T, Biesold N, Rockstroh F, Znoj HJ. Evaluation of a guided internet-based self-help intervention for older adults after spousal bereavement or separation/divorce: A randomised controlled trial. J Affect Disord 2019; 252:440-449. [PMID: 31003114 DOI: 10.1016/j.jad.2019.04.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/13/2019] [Accepted: 04/06/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND While several internet interventions target severe prolonged grief symptoms after bereavement, no randomised controlled trial investigated interventions for prolonged grief after separation/divorce. METHODS This randomised controlled trial aimed to evaluate the efficacy of a guided internet-based self-help intervention for prolonged grief symptoms after spousal bereavement or separation/divorce compared to a wait-list control group. Furthermore, we analysed whether the intervention was also efficacious for participants with milder grief symptoms. RESULTS A total of 110 participants were mainly recruited by newspaper articles. Average age was 51 years, 77% were separated/divorced, 79% were female. Dropout rate was 11%. Compared to the control group, the intervention resulted in significant reductions in grief (d = 0.81), depression (d = 0.59), psychopathological distress (d = 0.39) (primary outcomes), embitterment (d = 0.37), loneliness (d = 0.37) and an increase in life satisfaction (d = -0.41) (secondary outcomes). These gains were maintained over three months. Improvements were similar among widowed and separated/divorced participants as well as among participants with low, medium or high levels of grief at baseline. LIMITATIONS Limitations include the self-selective sample and a rather small number of widowed participants. CONCLUSIONS Findings indicate that an internet intervention based on models for coping with grief after bereavement was not only beneficial for widowed but also separated or divorced participants. Furthermore, also participants with lower levels of grief at baseline benefitted from the intervention. This corroborates that indicated prevention efforts for grief are efficacious.
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Affiliation(s)
- Jeannette Brodbeck
- University of Bern, Department of Psychology, Fabrikstrasse 8, 3012 Bern, Switzerland.
| | - Thomas Berger
- University of Bern, Department of Psychology, Fabrikstrasse 8, 3012 Bern, Switzerland.
| | - Nicola Biesold
- University of Bern, Department of Psychology, Fabrikstrasse 8, 3012 Bern, Switzerland.
| | - Franziska Rockstroh
- University of Bern, Department of Psychology, Fabrikstrasse 8, 3012 Bern, Switzerland.
| | - Hans Joerg Znoj
- University of Bern, Department of Psychology, Fabrikstrasse 8, 3012 Bern, Switzerland.
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Rubin M, Hawkins B, Cobb A, Telch MJ. Emotional reactivity to grief-related expressive writing. DEATH STUDIES 2019; 44:552-560. [PMID: 31066631 DOI: 10.1080/07481187.2019.1595219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The efficacy of expressive writing for bereavement remains unclear, although some evidence suggests that writing about positive memories of one's loved one may be particularly beneficial. The current pilot study compared the effects of a brief positive expressive writing intervention for enhancing positive affect among bereaved adults (N = 403). Participants were randomly assigned to write about a positive memory of the deceased person or recent neutral activity. Results revealed no main effect of the positive writing condition on mood change. However, greater positive emotion word use mediated positive affect among those in the positive writing condition.
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Affiliation(s)
- Mikael Rubin
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Baylee Hawkins
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Adam Cobb
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Michael J Telch
- Department of Psychology, The University of Texas at Austin, Austin, TX, USA
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Mauro C, Reynolds CF, Maercker A, Skritskaya N, Simon N, Zisook S, Lebowitz B, Cozza SJ, Shear MK. Prolonged grief disorder: clinical utility of ICD-11 diagnostic guidelines. Psychol Med 2019; 49:861-867. [PMID: 29909789 DOI: 10.1017/s0033291718001563] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The World Health Organization (WHO) International Classification of Disease (ICD-11) is expected to include a new diagnosis for prolonged grief disorder (ICD-11PGD). This study examines the validity and clinical utility of the ICD-11PGD guideline by testing its performance in a well-characterized clinical sample and contrasting it with a very different criteria set with the same name (PGDPLOS). METHODS We examined data from 261 treatment-seeking participants in the National Institute of Mental Health (NIMH)-sponsored multicenter clinical trial to determine the rates of diagnosis using the ICD-11PGD guideline and compared these with diagnosis using PGDPLOS criteria. RESULTS The ICD-11PGD guideline identified 95.8% [95% confidence interval (CI) 93.3-98.2%] of a treatment-responsive cohort of patients with distressing and impairing grief. PGDPLOS criteria identified only 59.0% (95% CI 53.0-65.0%) and were more likely to omit those who lost someone other than a spouse, were currently married, bereaved by violent means, or not diagnosed with co-occurring depression. Those not diagnosed by PGDPLOS criteria showed the same rate of treatment response as those who were diagnosed. CONCLUSIONS The ICD-11PGD diagnostic guideline showed good performance characteristics in this sample, while PGDPLOS criteria did not. Limitations of the research sample used to derive PGDPLOS criteria may partly explain their poor performance in a more diverse clinical sample. Clinicians and researchers need to be aware of the important difference between these two identically named diagnostic methods.
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Affiliation(s)
- Christine Mauro
- Department of Biostatistics,Mailman School of Public Health, Columbia University,722 West 168th Street, 6th floor, New York, NY 10032,USA
| | - Charles F Reynolds
- Department of Biostatistics,Mailman School of Public Health, Columbia University,722 West 168th Street, 6th floor, New York, NY 10032,USA
| | - Andreas Maercker
- Department of Biostatistics,Mailman School of Public Health, Columbia University,722 West 168th Street, 6th floor, New York, NY 10032,USA
| | - Natalia Skritskaya
- Department of Biostatistics,Mailman School of Public Health, Columbia University,722 West 168th Street, 6th floor, New York, NY 10032,USA
| | - Naomi Simon
- Department of Biostatistics,Mailman School of Public Health, Columbia University,722 West 168th Street, 6th floor, New York, NY 10032,USA
| | - Sidney Zisook
- Department of Biostatistics,Mailman School of Public Health, Columbia University,722 West 168th Street, 6th floor, New York, NY 10032,USA
| | - Barry Lebowitz
- Department of Biostatistics,Mailman School of Public Health, Columbia University,722 West 168th Street, 6th floor, New York, NY 10032,USA
| | - Stephen J Cozza
- Department of Biostatistics,Mailman School of Public Health, Columbia University,722 West 168th Street, 6th floor, New York, NY 10032,USA
| | - M Katherine Shear
- Department of Biostatistics,Mailman School of Public Health, Columbia University,722 West 168th Street, 6th floor, New York, NY 10032,USA
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Pavlacic JM, Buchanan EM, Maxwell NP, Hopke TG, Schulenberg SE. A Meta-Analysis of Expressive Writing on Posttraumatic Stress, Posttraumatic Growth, and Quality of Life. REVIEW OF GENERAL PSYCHOLOGY 2019. [DOI: 10.1177/1089268019831645] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Expressive writing is beneficial for promoting both positive psychological and physical health outcomes. Unfortunately, inhibiting emotions is related to impairments in psychological and physical health. James Pennebaker and others have used expressive writing as an experimental manipulation to gauge its efficacy in treating a wide variety of physical and psychological outcomes. While many studies have been conducted that examine the efficacy of expressive writing across such outcomes, a considerable amount of these studies tend to neglect necessary considerations, such as different levels of symptomatology, power, and meaningfulness of respective effect sizes. Six previous meta-analyses have been conducted that examine expressive writing’s effect on psychological outcomes. However, these studies focus on the experimental versus control group effect size. Thus, our meta-analysis sought to examine the efficacy of an expressive writing task on only the experimental conditions in studies measuring posttraumatic stress, posttraumatic growth, and quality of life using random effects models. Results indicated a small overall effect size for posttraumatic stress and negligible to small effect sizes for posttraumatic growth and quality of life. However, those studies requiring a diagnosis of posttraumatic stress disorder (PTSD) exhibited a medium to large effect size. Implications for future research design and interpretation of published research are discussed.
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67
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Milman E, Neimeyer RA, Fitzpatrick M, MacKinnon CJ, Muis KR, Cohen SR. Rumination moderates the role of meaning in the development of prolonged grief symptomatology. J Clin Psychol 2019; 75:1047-1065. [DOI: 10.1002/jclp.22751] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 11/19/2018] [Accepted: 12/27/2018] [Indexed: 02/04/2023]
Affiliation(s)
- Evgenia Milman
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | | | - Marilyn Fitzpatrick
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | | | - Krista R. Muis
- Department of Educational and Counselling PsychologyMcGill UniversityMontreal Quebec
| | - S. Robin Cohen
- Departments of Oncology and MedicineMcGill UniversityMontreal Quebec
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Ebert DD, Harrer M, Apolinário-Hagen J, Baumeister H. Digital Interventions for Mental Disorders: Key Features, Efficacy, and Potential for Artificial Intelligence Applications. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1192:583-627. [PMID: 31705515 DOI: 10.1007/978-981-32-9721-0_29] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Mental disorders are highly prevalent and often remain untreated. Many limitations of conventional face-to-face psychological interventions could potentially be overcome through Internet-based and mobile-based interventions (IMIs). This chapter introduces core features of IMIs, describes areas of application, presents evidence on the efficacy of IMIs as well as potential effect mechanisms, and delineates how Artificial Intelligence combined with IMIs may improve current practices in the prevention and treatment of mental disorders in adults. Meta-analyses of randomized controlled trials clearly show that therapist-guided IMIs can be highly effective for a broad range of mental health problems. Whether the effects of unguided IMIs are also clinically relevant, particularly under routine care conditions, is less clear. First studies on IMIs for the prevention of mental disorders have shown promising results. Despite limitations and challenges, IMIs are increasingly implemented into routine care worldwide. IMIs are also well suited for applications of Artificial Intelligence and Machine Learning, which provides ample opportunities to improve the identification and treatment of mental disorders. Together with methodological innovations, these approaches may also deepen our understanding of how psychological interventions work, and why. Ethical and professional restraints as well as potential contraindications of IMIs, however, should also be considered. In sum, IMIs have a high potential for improving the prevention and treatment of mental health disorders across various indications, settings, and populations. Therefore, implementing IMIs into routine care as both adjunct and alternative to face-to-face treatment is highly desirable. Technological advancements may further enhance the variability and flexibility of IMIs, and thus even further increase their impact in people's lives in the future.
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Affiliation(s)
- David Daniel Ebert
- Department of Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, 1881 BT, Amsterdam, The Netherlands.
| | - Mathias Harrer
- Clinical Psychology and Psychotherapy, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | | | - Harald Baumeister
- Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
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Meichsner F, Theurer C, Wilz G. Acceptance and treatment effects of an internet-delivered cognitive-behavioral intervention for family caregivers of people with dementia: A randomized-controlled trial. J Clin Psychol 2018; 75:594-613. [PMID: 30597537 DOI: 10.1002/jclp.22739] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/11/2018] [Accepted: 11/19/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The study evaluated the efficacy of an internet-delivered cognitive-behavioral intervention for caregivers of people with dementia and examined acceptance of program characteristics. METHOD Thirty-nine caregivers (M age = 62.11 ± 9.67, 78.4% female) were enrolled in a 2 × 3 randomized-controlled trial (RCT) that compared an intervention and wait-list control group. A cognitive-behavioral intervention program was adapted for delivery via an internet platform. Participants exchanged eight weekly messages with a therapist. RESULTS Treatment satisfaction and acceptance of the program were high. Well-being increased over the intervention duration and intervention group participants were better able to cope with the anticipated death of the care recipient and utilized more psychosocial resources after the intervention ended. Effects were not maintained until follow-up and there were no treatment effects for depression and burden of care. CONCLUSIONS Internet-delivered cognitive-behavioral interventions are suitable for caregivers. A larger RCT needs to investigate possible combinations of classic and internet-delivered programs and confirm efficacy.
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Affiliation(s)
- Franziska Meichsner
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Christina Theurer
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
| | - Gabriele Wilz
- Department of Counseling and Clinical Intervention, Institute of Psychology, Friedrich Schiller University Jena, Jena, Germany
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Rosner R, Pfoh G, Kotoučova M, Comtesse H. Integrative kognitive Verhaltenstherapie für die anhaltende Trauerstörung: Vorstellung eines Behandlungsmanuals. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000489509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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71
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Nakajima S. Complicated grief: recent developments in diagnostic criteria and treatment. Philos Trans R Soc Lond B Biol Sci 2018; 373:20170273. [PMID: 30012739 PMCID: PMC6053994 DOI: 10.1098/rstb.2017.0273] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/12/2022] Open
Abstract
Although grief is a natural response to loss among human beings, some people have a severe and prolonged course of grief. In the 1990s, unusual grief persisting with a high level of acute symptoms became known as 'complicated grief (CG)'. Many studies have shown that people who suffer from CG are at risk of long-term mental and physical health impairments and suicidal behaviours; it is considered a pathological state, which requires clinical intervention and treatment. DSM-5 (2013 Diagnostic and statistical manual of mental disorders, 5th edn) proposed 'persistent complex bereavement disorder' as a psychiatric disorder; it is similar to CG in that it is a trauma- and stress-related disorder. In recent years, there has been considerable research on the treatment of CG. Randomized controlled trials have suggested the efficacy of cognitive behavioural therapy including an exposure component that is targeted for CG. However, experts disagree about the terminology and diagnostic criteria for CG. The ICD-11 (International classification of diseases, 11th revision) beta draft proposed prolonged grief disorder as a condition that differs from persistent complex bereavement disorder with respect to terminology and the duration of symptoms. This divergence has arisen from insufficient evidence for a set of core symptoms and the biological basis of CG. Future studies including biological studies are needed to reach consensus about the diagnostic criteria for CG.This article is part of the theme issue 'Evolutionary thanatology: impacts of the dead on the living in humans and other animals'.
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Affiliation(s)
- Satomi Nakajima
- Department of Human Sciences, Musashino University, 3-3-3 Ariake, Koto-ku, Tokyo 135-8181, Japan
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72
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Treml J, Kersting A. [Prolonged grief disorder]. DER NERVENARZT 2018; 89:1069-1078. [PMID: 30116835 DOI: 10.1007/s00115-018-0577-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Grief is a natural response to the loss of a loved one and its intensity usually lessens over time. Approximately 10% of bereaved persons, however, experience persistent symptoms resulting in the development of a prolonged grief disorder (PGD). A PGD shows a distinct symptom cluster and is considered for inclusion as a diagnosis in the upcoming revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11). It is distinct from other mental disorders but symptoms overlap, especially with major depression and posttraumatic stress disorder. In addition to diagnostic criteria and differential diagnosis, the following article also describes prevalence rates, comorbidities, risk factors as well as treatment options for PGD.
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Affiliation(s)
- J Treml
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
| | - A Kersting
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Leipzig, Semmelweisstr. 10, 04103, Leipzig, Deutschland
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Rachyla I, Pérez-Ara M, Molés M, Campos D, Mira A, Botella C, Quero S. An internet-based intervention for adjustment disorder (TAO): study protocol for a randomized controlled trial. BMC Psychiatry 2018; 18:161. [PMID: 29855281 PMCID: PMC5984386 DOI: 10.1186/s12888-018-1751-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adjustment Disorder (AjD) is a common and disabling mental health problem. The lack of research on this disorder has led to the absence of evidence-based interventions for its treatment. Moreover, because the available data indicate that a high percentage of people with mental illness are not treated, it is necessary to develop new ways to provide psychological assistance. The present study describes a Randomized Controlled Trial (RCT) aimed at assessing the effectiveness and acceptance of a linear internet-delivered cognitive-behavioral therapy (ICBT) intervention for AjD. METHODS A two-armed RCT was designed to compare an intervention group to a waiting list control group. Participants from the intervention group will receive TAO, an internet-based program for AjD composed of seven modules. TAO combines CBT and Positive Psychology strategies in order to provide patients with complete support, reducing their clinical symptoms and enhancing their capacity to overcome everyday adversity. Participants will also receive short weekly telephone support. Participants in the control group will be assessed before and after a seven-week waiting period, and then they will be offered the same intervention. Participants will be randomly assigned to one of the 2 groups. Measurements will be taken at five different moments: baseline, post-intervention, and three follow-up periods (3-, 6- and 12-month). BDI-II and BAI will be used as primary outcome measures. Secondary outcomes will be symptoms of AjD, posttraumatic growth, positive and negative affect, and quality of life. DISCUSSION The development of ICBT programs like TAO responds to a need for evidence-based interventions that can reach most of the people who need them, reducing the burden and cost of mental disorders. More specifically, TAO targets AjD and will entail a step forward in the treatment of this prevalent but under-researched disorder. Finally, it should be noted that this is the first RCT focusing on an internet-based intervention for AjD in the Spanish population. TRIAL REGISTRATION ClinicalTrial.gov: NCT02758418 . Trial registration date 2 May 2016.
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Affiliation(s)
| | - Marian Pérez-Ara
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands, Palma de Mallorca, Spain
| | - Mar Molés
- Universitat Jaume I, Castellón, Spain
| | | | - Adriana Mira
- Universitat Jaume I, Castellón, Spain
- Universidad de Zaragoza, Campus Universitario de Teruel, Teruel, Spain
| | - Cristina Botella
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Santiago, Spain
| | - Soledad Quero
- Universitat Jaume I, Castellón, Spain
- CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Santiago, Spain
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Wenn J, O'Connor M, Breen LJ, Rees CS. Exploratory study of metacognitive beliefs about coping processes in prolonged grief symptomatology. DEATH STUDIES 2018; 43:143-153. [PMID: 29474138 DOI: 10.1080/07481187.2018.1440032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite research examining the role of metacognitive beliefs about coping processes in maintaining psychological disorders, to date, no studies have explored their role in the maintenance of prolonged grief. Twelve semistructured interviews were conducted with bereavement specialists and bereaved people with elevated grief to identify metacognitive beliefs about coping processes relevant to prolonged grief. Analysis revealed several metacognitive beliefs potentially driving maladaptive coping processes used by people with prolonged grief symptomatology. Findings may underpin the development of interventions that aim to modify unhelpful metacognitive beliefs that perpetuate maladaptive coping processes.
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Affiliation(s)
- Jenine Wenn
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Moira O'Connor
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Lauren J Breen
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Clare S Rees
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
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Ebert DD, Van Daele T, Nordgreen T, Karekla M, Compare A, Zarbo C, Brugnera A, Øverland S, Trebbi G, Jensen KL, Kaehlke F, Baumeister H. Internet- and Mobile-Based Psychological Interventions: Applications, Efficacy, and Potential for Improving Mental Health. EUROPEAN PSYCHOLOGIST 2018. [DOI: 10.1027/1016-9040/a000318] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract. The majority of mental health disorders remain untreated. Many limitations of traditional psychological interventions such as limited availability of evidence-based interventions and clinicians could potentially be overcome by providing Internet- and mobile-based psychological interventions (IMIs). This paper is a report of the Taskforce E-Health of the European Federation of Psychologists’ Association and will provide an introduction to the subject, discusses areas of application, and reviews the current evidence regarding the efficacy of IMIs for the prevention and treatment of mental disorders. Meta-analyses based on randomized trials clearly indicate that therapist-guided stand-alone IMIs can result in meaningful benefits for a range of indications including, for example, depression, anxiety, insomnia, or posttraumatic stress disorders. The clinical significance of results of purely self-guided interventions is for many disorders less clear, especially with regard to effects under routine care conditions. Studies on the prevention of mental health disorders (MHD) are promising. Blended concepts, combining traditional face-to-face approaches with Internet- and mobile-based elements might have the potential of increasing the effects of psychological interventions on the one hand or to reduce costs of mental health treatments on the other hand. We also discuss mechanisms of change and the role of the therapist in such approaches, contraindications, potential limitations, and risk involved with IMIs, briefly review the status of the implementation into routine health care across Europe, and discuss confidentiality as well as ethical aspects that need to be taken into account, when implementing IMIs. Internet- and mobile-based psychological interventions have high potential for improving mental health and should be implemented more widely in routine care.
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Affiliation(s)
- David D. Ebert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Tom Van Daele
- Department of Applied Psychology, Thomas More University of Applied Sciences, Antwerp, Belgium
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Republic of Cyprus
| | - Angelo Compare
- Human Factors and Technology in Healthcare, University of Bergamo, Bergamo, BG, Italy
| | - Cristina Zarbo
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | - Agostino Brugnera
- Department of Human and Social Science, University of Bergamo, Bergamo, Italy
| | | | - Glauco Trebbi
- Trebbipsicologie, Luxembourg & Societé Luxembourgeoise de Psychologie SLP, Luxembourg
| | | | - Fanny Kaehlke
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, University of Ulm, Germany
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Bartl H, Hagl M, Kotoučová M, Pfoh G, Rosner R. Does prolonged grief treatment foster posttraumatic growth? Secondary results from a treatment study with long-term follow-up and mediation analysis. Psychol Psychother 2018; 91:27-41. [PMID: 28737261 DOI: 10.1111/papt.12140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 05/24/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Prolonged grief disorder (PGD) is a persistent and disabling kind of grief reaction that can be treated effectively with psychotherapeutic interventions. There has been limited investigation of whether these interventions can also enhance positive outcomes of bereavement, such as posttraumatic growth or benefit finding. DESIGN As part of secondary analyses in a randomized controlled trial evaluating integrative cognitive-behavioural therapy for PGD (PG-CBT), the posttraumatic growth trajectories in 51 outpatients with clinically relevant prolonged grief symptoms were followed up from baseline up to 1.5 years. METHODS Immediate treatment effects on posttraumatic growth in comparison with a waiting list control group were evaluated with univariate ANCOVA. Using mediation analysis, we examined the relation between symptom reduction and the short-term treatment effect on posttraumatic growth. For evaluating long-term outcome stability, the immediately treated group and the delayed treatment group were pooled. RESULTS PG-CBT significantly fostered growth in patients suffering from PGD, with a controlled medium effect size of Cohen's d = 0.60 (completer analysis). This effect remained stable up to the 1.5-year follow-up. Grief symptom reduction mediated short-term treatment effects on posttraumatic growth. However, growth also partially mediated treatment effects on prolonged grief symptoms. CONCLUSIONS Taken together, PG-CBT was effective in enhancing the participants' perception of posttraumatic growth, but the definite interaction between symptom reduction and posttraumatic growth remains unclear, as both seemed to influence each other's trajectory in the course of treatment. PRACTITIONER POINTS Integrative CBT for prolonged grief disorder also fostered posttraumatic growth. Post-treatment and 1.5-year follow-up effect sizes for posttraumatic growth were moderate. Whether growth-enhancing techniques are useful in grief treatment needs further research.
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Affiliation(s)
- Helga Bartl
- Department of Psychology, Ludwig Maximilian University of Munich, Germany.,Psychiatric Hospital, kbo-Inn-Salzach-Klinikum, Wasserburg/Inn, Germany
| | - Maria Hagl
- Department of Psychology, Ludwig Maximilian University of Munich, Germany.,Department of Psychology, Catholic University Eichstätt-Ingolstadt, Germany
| | - Michaela Kotoučová
- Department of Psychology, Ludwig Maximilian University of Munich, Germany.,Private practice, Munich, Germany
| | - Gabriele Pfoh
- Department of Psychology, Ludwig Maximilian University of Munich, Germany.,Department of Psychology, Catholic University Eichstätt-Ingolstadt, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Germany
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Hoffmann R, Große J, Nagl M, Niederwieser D, Mehnert A, Kersting A. Internet-based grief therapy for bereaved individuals after loss due to Haematological cancer: study protocol of a randomized controlled trial. BMC Psychiatry 2018; 18:52. [PMID: 29482525 PMCID: PMC5827988 DOI: 10.1186/s12888-018-1633-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/12/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Approximately 10% of the individuals experiencing the death of a loved one develop prolonged grief disorder (PGD) after bereavement. Family members of haematological cancer patients might be particularly burdened since their loss experience is preceded by a very strenuous time of disease and aggressive treatment. However, support needs of relatives of cancer patients often remain unmet, also after the death of the patient. Therapeutic possibilities are enhanced by providing easily available and accessible Internet-based therapies. This study will adapt and evaluate an Internet-based grief therapy for bereaved individuals after the loss of a significant other due to haematological cancer. METHODS The efficacy of the Internet-based grief therapy is evaluated in a randomized controlled trial with a wait-list control group. Inclusion criteria are bereavement due to hematological cancer and meeting the diagnostic criteria for PGD. Exclusion criteria are severe depression, suicidality, dissociative tendency, psychosis, posttraumatic stress disorder, substance use disorder, and current psychotherapeutic or psychopharmacological treatment. The main outcome is PGD severity. Secondary outcomes are depression, anxiety, somatization, posttraumatic stress, quality of life, sleep quality, and posttraumatic growth. Data is collected pre- and posttreatment. Follow-up assessments will be conducted 3, 6, and 12 months after completion of the intervention. The Internet-based grief therapy is assumed to have at least moderate effects regarding PGD and other bereavement-related mental health outcomes. Predictors and moderators of the treatment outcome and PGD will be determined. DISCUSSION Individuals bereaved due to haematological cancer are at high risk for psychological distress. Tailored treatment for this particularly burdened target group is missing. Our study results will contribute to a closing of this healthcare gap. TRIAL REGISTRATION German Clinical Trial Register UTN: U1111-1186-6255 . Registered 1 December 2016.
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Affiliation(s)
- Rahel Hoffmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany.
| | - Julia Große
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Michaela Nagl
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Dietger Niederwieser
- 0000 0001 2230 9752grid.9647.cDivision of Haematology and Medical Oncology, University of Leipzig, Johannisallee 32A, 04103 Leipzig, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Centre Leipzig, Philipp-Rosenthal-Straße 55, 04103 Leipzig, Germany
| | - Anette Kersting
- 0000 0001 2230 9752grid.9647.cDepartment of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
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78
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van Denderen M, de Keijser J, Stewart R, Boelen PA. Treating complicated grief and posttraumatic stress in homicidally bereaved individuals: A randomized controlled trial. Clin Psychol Psychother 2018; 25:497-508. [PMID: 29479767 DOI: 10.1002/cpp.2183] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/11/2022]
Abstract
Homicidally bereaved individuals may experience symptoms of Complicated Grief (CG) and Posttraumatic Stress Disorder (PTSD). This Randomized Controlled Trial examined the effectiveness of an 8-session treatment encompassing Cognitive Behavioural Therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) to reduce self-rated CG and PTSD symptoms in 85 Dutch adult homicidally bereaved men and women. We compared changes in symptoms of CG (assessed using the Inventory of Complicated Grief) and PTSD (assessed using the Impact of Event Scale) between an intervention group and a waitlist control group. The treatment was effective in reducing CG and PTSD symptoms, from pretreatment to posttreatment. It can be concluded that EMDR and CBT seem promising treatments for homicidally bereaved individuals for both men and women, and regardless of the time since the loss. Further research is needed to examine whether a combined treatment of EMDR and CBT together is of added value in situations where grief and trauma are intertwined over offering only one of the two treatment modalities.
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Affiliation(s)
- Mariëtte van Denderen
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands
| | - Roy Stewart
- University of Groningen, University Medical Center Groningen, Department of Health, Sciences, Community & Occupational Medicine, Groningen, The Netherlands
| | - Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, The Netherlands
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79
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Breen LJ, Karangoda MD, Kane RT, Howting DA, Aoun SM. Differences in meanings made according to prolonged grief symptomatology. DEATH STUDIES 2018; 42:69-78. [PMID: 28489494 DOI: 10.1080/07481187.2017.1328467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study investigated differences in specific meanings made following bereavement, according to participants' prolonged grief symptomatology. A survey of 580 bereaved adults (Mage = 61.6 years, 70.7% female) showed 13 meanings predicted symptomatology, with the largest differences between the two lower symptomatology groups and the high symptomatology group; the latter was more likely to report no meaning. The results provide further support for empirically distinct groups within the bereaved population, not only in terms of symptoms, etiology, outcomes, courses, and treatment responses, but also in their meanings made, and may assist in advancing meaning reconstruction interventions.
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Affiliation(s)
- Lauren J Breen
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia
| | - Michelle D Karangoda
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia
| | - Robert T Kane
- a School of Psychology and Speech Pathology , Curtin University , Perth , Australia
| | - Denise A Howting
- b School of Nursing, Midwifery and Paramedicine , Curtin University , Perth , Australia
| | - Samar M Aoun
- b School of Nursing, Midwifery and Paramedicine , Curtin University , Perth , Australia
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80
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Burns E, Prigerson HG, Quinn SJ, Abernethy AP, Currow DC. Moving on: Factors associated with caregivers' bereavement adjustment using a random population-based face-to-face survey. Palliat Med 2018. [PMID: 28627971 DOI: 10.1177/0269216317717370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Providing care at end of life has consequences for caregivers' bereavement experience. 'Difficulty moving on with life' is an informative and unbiased symptom of prolonged grief disorder. Predictors of bereaved caregivers' ability to 'move on' have not been examined across the population. AIM To identify the characteristics of bereaved hands-on caregivers who were, and were not, able to 'move on' 13-60 months after the 'expected' death of someone close. DESIGN The South Australian Health Omnibus is an annual, random, cross-sectional community survey. From 2000 to 2007, respondents were asked about providing care for someone terminally ill and their subsequent ability to 'move on'. Multivariable logistic regression models explored the characteristics moving on and not moving on. SETTING Respondents were aged ⩾15 years and lived in households within South Australia. They had provided care to someone who had died of terminal illness in the preceding 5 years. RESULTS A total of 922 people provided hands-on care. In all, 80% of caregivers (745) had been able to 'move on'. Closeness of relationship to the deceased, increasing caregiver age, caregiver report of needs met, increasing time since loss, sex and English-speaking background were significantly associated with 'moving on'. A closer relationship to the deceased, socioeconomic disadvantage and being male were significantly associated with not 'moving on'. CONCLUSION These results support the relevance of 'moving on' as an indicator of caregivers' bereavement adjustment. Following the outcomes of bereaved caregivers longitudinally is essential if effective interventions are to be developed to minimise the risk of prolonged grief disorder.
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Affiliation(s)
- Emma Burns
- 1 Southern Adelaide Palliative Services, Daw Park, SA, Australia
| | - Holly G Prigerson
- 2 Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,3 Center for Psycho-Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steve J Quinn
- 4 Flinders Centre for Clinical Change, Flinders University, Bedford Park, SA, Australia
| | - Amy P Abernethy
- 5 ImPACT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,6 Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David C Currow
- 1 Southern Adelaide Palliative Services, Daw Park, SA, Australia.,5 ImPACT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,7 Hull York Medical School, University of Hull, Hull, UK
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81
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Enez Ö. Patolojik Yas Terapilerinin Etkinliği: Sistematik Derleme. PSIKIYATRIDE GUNCEL YAKLASIMLAR 2017. [DOI: 10.18863/pgy.295017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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82
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Lenferink LIM, Piersma E, de Keijser J, Smid GE, Boelen PA. Cognitive therapy and eye movement desensitization and reprocessing for reducing psychopathology among disaster-bereaved individuals: study protocol for a randomized controlled trial. Eur J Psychotraumatol 2017; 8:1388710. [PMID: 29163863 PMCID: PMC5687800 DOI: 10.1080/20008198.2017.1388710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 09/21/2017] [Indexed: 01/05/2023] Open
Abstract
Background: Confrontation with a traumatic (e.g. disaster-related) loss is a risk factor for the development of psychopathology, including symptoms of prolonged grief (PG), posttraumatic stress (PTS), and depression. Although interventions have been developed for reducing post-loss psychopathology, more research into the effectiveness of treatment is needed to improve care for bereaved persons. Cognitive therapy (CT) and eye movement desensitization and reprocessing (EMDR) have been shown to be effective in trauma-exposed populations. We hypothesize that CT and EMDR are also effective in reducing symptoms among people exposed to traumatic loss. Objective: In this article we describe the rationale of a randomized controlled trial (RCT) to examine (1) treatment effects of CT and EMDR for reducing PG, PTS, and depression among traumatically bereaved people, and (2) the associations between improvements in PG, PTS, and depression symptoms on the one hand and tentative mechanisms of change, including a sense of unrealness, negative cognitions, avoidance behaviour, and intrusive memories, on the other hand. Method: A two-armed (intervention versus waiting list controls) RCT will be conducted. Participants will be asked to fill in questionnaires prior to treatment, during treatment, and one, 12, and 24 weeks post-treatment. Potential participants are people who have lost one or multiple significant other(s) in the Ukrainian plane disaster in 2014 with clinically significant levels of self-rated PG, PTS, and/or depression. Multiple regression, including analysis of covariance, and multilevel regression analyses will be used. Discussion: There is a need for treatment for psychopathology following traumatic loss. Strengths of this study are the development of a treatment that targets grief and trauma-related complaints and the examination of potential mechanisms of change in CT and EMDR. Bereaved people, clinicians, and researchers could benefit from the results of this study.
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Affiliation(s)
- Lonneke I. M. Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Eline Piersma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Jos de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | | | - Paul A. Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands
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83
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Kersting A, Dölemeyer R, Wagner B, Linde K. Abschied am Beginn des Lebens. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0221-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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84
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Thompson MR, Whiteman AD, Loucks KD, Daudt HML. Complicated Grief in Canada: Exploring the Client and Professional Landscape. JOURNAL OF LOSS & TRAUMA 2017. [DOI: 10.1080/15325024.2017.1358574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
| | | | - Karen D. Loucks
- Bereavement Services, Victoria Hospice, British Columbia, Canada
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85
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86
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Dodd A, Guerin S, Delaney S, Dodd P. Complicated grief: Knowledge, attitudes, skills and training of mental health professionals: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1447-1458. [PMID: 28320560 DOI: 10.1016/j.pec.2017.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/28/2017] [Accepted: 03/05/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE A systematic review and qualitative synthesis was undertaken to deduce the knowledge, attitudes, skills and training of mental health professionals regarding complicated grief (CG). METHODS PsychInfo, Embase, Medline, CINAHL, PBSC, Web of Science and ERIC databases were used to identify relevant literature. Searches were executed from inception to September 2014. RESULTS The electronic search yielded 305 results. Forty-one papers were selected for full text review, 20 were included for analysis. 6 examined primary data, the remaining 14 being reviews, opinion or guideline pieces. CONCLUSIONS Despite the lack of consensus on terminology, criteria and diagnosis, it appears that there is more than sufficient agreement within the CG research community regarding the knowledge and skills required to assist someone presenting with CG. A palpable fear of medicalising grief exists, but this would seem to be based on a conflation of normal grief and CG. This review highlights the mainly unidirectional nature of current research, the voice of the practitioner being largely unheard. A need for and an interest in training in CG was expressed. PRACTICE IMPLICATIONS There is an urgent need to translate research findings into clinical practice. Training must take account of attitudinal barriers to implementation, balancing evidence and stories.
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Affiliation(s)
- Anne Dodd
- UCD School of Psychology, Newman Building, University College Dublin, Belfield, Dublin 4, Ireland; UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Suzanne Guerin
- UCD School of Psychology, Newman Building, University College Dublin, Belfield, Dublin 4, Ireland; UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Susan Delaney
- Irish Hospice Foundation, Morrison Chambers, Nassau St, Dublin 2, Ireland.
| | - Philip Dodd
- St Michael's House Intellectual Disability Service, Ballymun Rd, Dublin 9, Ireland; UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland.
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87
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Linde K, Treml J, Steinig J, Nagl M, Kersting A. Grief interventions for people bereaved by suicide: A systematic review. PLoS One 2017; 12:e0179496. [PMID: 28644859 PMCID: PMC5482439 DOI: 10.1371/journal.pone.0179496] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/31/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Adaption to the loss of a loved one due to suicide can be complicated by feelings of guilt, shame, responsibility, rejection, and stigmatization. Therefore people bereaved by suicide have an increased risk for developing complicated grief which is related to negative physical and mental disorders and an increased risk for suicidal behavior. Grief interventions are needed for this vulnerable population. The aim of this systematic review was to provide an overview of the current state of evidence concerning the effectiveness of interventions that focus on grief for people bereaved by suicide. METHODS We conducted a systematic literature search using PubMed, Web of Science, and PsycINFO for articles published up until November 2016. Relevant papers were identified and methodological quality was assessed by independent raters. A narrative synthesis was conducted. RESULTS Seven intervention studies met the inclusion criteria. Two interventions were based on cognitive-behavioral approaches, four consisted of bereavement groups, and one utilized writing therapy. As five of the seven interventions were effective in reducing grief intensity on at least one outcome measure, there is some evidence that they are beneficial. Bereavement groups tend to be effective in lowering the intensity of uncomplicated grief, as are writing interventions in lowering suicide-specific aspects of grief. Cognitive-behavioral programs were helpful for a subpopulation of people who had high levels of suicidal ideation. LIMITATION On average, methodological quality was low so the evidence for benefits is not robust. The stability of treatment effects could not be determined as follow-up assessments are rare. Generalizability is limited due to homogeneous enrollments of mainly female, white, middle-aged individuals. CONCLUSIONS People bereaved by suicide are especially vulnerable to developing complicated grief. Therefore, grief therapies should be adapted to and evaluated in this population. Prevention of complicated grief may be successful in populations of high risk individuals.
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Affiliation(s)
- Katja Linde
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Jana Steinig
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Michaela Nagl
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
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88
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van Rosmalen-Nooijens K, Lo Fo Wong S, Prins J, Lagro-Janssen T. Young People, Adult Worries: Randomized Controlled Trial and Feasibility Study of the Internet-Based Self-Support Method "Feel the ViBe" for Adolescents and Young Adults Exposed to Family Violence. J Med Internet Res 2017; 19:e204. [PMID: 28606893 PMCID: PMC5484793 DOI: 10.2196/jmir.6004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 11/04/2016] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) are of special interest in a group of children exposed to family violence (FV). Past-year prevalence of exposure to FV is known to be highest in AYAs and has severe consequences. Peer support is an effective approach to behavior change and the Internet is considered suitable as a mode of delivery. OBJECTIVE The study aimed to evaluate both effectiveness and feasibility of a randomized controlled trial (RCT) and feasibility study of the Internet-based self-support method "Feel the ViBe" (FtV) using mixed-methods approach to fully understand the strengths and weaknesses of a new intervention. METHODS AYAs aged 12-25 years and exposed to FV were randomized in an intervention group (access to FtV + usual care) and a control group (minimally enhanced usual care) after they self-registered themselves. From June 2012 to July 2014, participants completed the Impact of Event Scale (IES) and Depression (DEP) and Anxiety (ANX) subscales of the Symptom CheckList-90-R (SCL-90) every 6 weeks. The Web Evaluation Questionnaire was completed after 12 weeks. Quantitative usage data were collected using Google analytics and content management system (CMS) logs and data files. A univariate analysis of variance (UNIANOVA) and mixed model analysis (intention-to-treat [ITT], complete case) were used to compare groups. Pre-post t tests were used to find within-group effects. Feasibility measures structurally address the findings. The CONsolidated Standards Of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth (CONSORT-EHEALTH) checklist was closely followed. RESULTS In total, 31 out of 46 participants in the intervention group and 26 out of 47 participants in the control group started FtV. Seventeen participants (intervention: n=8, control: n=9) completed all questionnaires. Mixed model analysis showed significant differences between groups on the SCL-90 DEP (P=.04) and ANX (P=.049) subscales between 6 and 12 weeks after participation started. UNIANOVA showed no significant differences. Pre-post paired sample t tests showed significant improvements after 12 weeks for the SCL-90 DEP (P=.03) and ANX (P=.046) subscales. Reported mean Web-based time per week was 2.83 with a session time of 36 min. FtV was rated a mean 7.47 (1-10 Likert scale) with a helpfulness score of 3.16 (1-5 Likert scale). All participants felt safe. Two-thirds of the intervention participants started regular health care. CONCLUSIONS No changes on the IES were found. SCL-90 DEP and ANX showed promising results; however, the calculated sample size was not reached (n=18). FtV functions best as a first step for adolescents and young adults in an early stage of change. FtV can be easily implemented without extensive resources and fits best in the field of public health care or national governmental care. TRIAL REGISTRATION Netherlands National Trial Register (NTR): NTR3692; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3692 (Archived by WebCite at http://www.webcitation.org/6qIeKyjA4).
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Affiliation(s)
- Karin van Rosmalen-Nooijens
- Gender & Women's Health, Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
| | - Sylvie Lo Fo Wong
- Gender & Women's Health, Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
| | - Judith Prins
- Department of Medical Psychology, Radboud university medical center, Nijmegen, Netherlands
| | - Toine Lagro-Janssen
- Gender & Women's Health, Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands
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89
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González D, Carvalho M, Cantillo J, Aixalá M, Farré M. Potential Use of Ayahuasca in Grief Therapy. OMEGA-JOURNAL OF DEATH AND DYING 2017; 79:260-285. [DOI: 10.1177/0030222817710879] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The death of a loved one is ultimately a universal experience. However, conventional interventions employed for people suffering with uncomplicated grief have gathered little empirical support. The present study aimed to explore the potential effects of ayahuasca on grief. We compared 30 people who had taken ayahuasca with 30 people who had attended peer-support groups, measuring level of grief and experiential avoidance. We also examined themes in participant responses to an open-ended question regarding their experiences with ayahuasca. The ayahuasca group presented a lower level of grief in the Present Feelings Scale of Texas Revised Inventory of Grief, showing benefits in some psychological and interpersonal dimensions. Qualitative responses described experiences of emotional release, biographical memories, and experiences of contact with the deceased. Additionally, some benefits were identified regarding the ayahuasca experiences. These results provide preliminary data about the potential of ayahuasca as a therapeutic tool in treatments for grief.
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Affiliation(s)
- Débora González
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
| | - María Carvalho
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
- Centro de Estudos em Desenvolvimento Humano (CEDH), Faculdade de Educação e Psicologia, Universidade Católica Portuguesa, Rua Diogo Botelho, Portugal
| | - Jordi Cantillo
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
| | - Marc Aixalá
- ICEERS—International Center for Ethnobotanical Education Research & Service, Roosendaal, The Netherlands
| | - Magí Farré
- Autonomous University of Barcelona, Barcelona, Spain
- Department of Clinical Pharmacology, Hospital Universitari Germans Trias i Pujol (IGTP), Badalona, Spain
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90
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Simblett S, Birch J, Matcham F, Yaguez L, Morris R. A Systematic Review and Meta-Analysis of e-Mental Health Interventions to Treat Symptoms of Posttraumatic Stress. JMIR Ment Health 2017; 4:e14. [PMID: 28526672 PMCID: PMC5451639 DOI: 10.2196/mental.5558] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 01/30/2017] [Accepted: 03/05/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a stress disorder characterized by unwanted intrusive re-experiencing of an acutely distressing, often life-threatening, event, combined with symptoms of hyperarousal, avoidance, as well as negative thoughts and feelings. Evidence-based psychological interventions have been developed to treat these symptoms and reduce distress, the majority of which were designed to be delivered face-to-face with trained therapists. However, new developments in the use of technology to supplement and extend health care have led to the creation of e-Mental Health interventions. OBJECTIVE Our aim was to assess the scope and efficacy of e-Mental Health interventions to treat symptoms of PTSD. METHODS The following databases were systematically searched to identify randomized controlled trials of e-Mental Health interventions to treat symptoms of PTSD as measured by standardized and validated scales: the Cochrane Library, MEDLINE, EMBASE, and PsycINFO (in March 2015 and repeated in November 2016). RESULTS A total of 39 studies were found during the systematic review, and 33 (N=3832) were eligible for meta-analysis. The results of the primary meta-analysis revealed a significant improvement in PTSD symptoms, in favor of the active intervention group (standardized mean difference=-0.35, 95% confidence interval -0.45 to -0.25, P<.001, I2=81%). Several sensitivity and subgroup analyses were performed suggesting that improvements in PTSD symptoms remained in favor of the active intervention group independent of the comparison condition, the type of cognitive behavioral therapy-based intervention, and the level of guidance provided. CONCLUSIONS This review demonstrates an emerging evidence base supporting e-Mental Health to treat symptoms of PTSD.
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Affiliation(s)
- Sara Simblett
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, United Kingdom
| | - Jennifer Birch
- Springfield University Hospital, South West London and St Georges Mental Health NHS Trust, London, United Kingdom
| | - Faith Matcham
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychological Medicine, King's College London, London, United Kingdom
| | - Lidia Yaguez
- King's College Hospital, Clinical Neuropsychology Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Robin Morris
- King's College Hospital, Clinical Neuropsychology Department, King's College Hospital NHS Foundation Trust, London, United Kingdom
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91
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Brodbeck J, Berger T, Znoj HJ. An internet-based self-help intervention for older adults after marital bereavement, separation or divorce: study protocol for a randomized controlled trial. Trials 2017; 18:21. [PMID: 28086836 PMCID: PMC5237350 DOI: 10.1186/s13063-016-1759-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 12/15/2016] [Indexed: 01/07/2023] Open
Abstract
Background Marital bereavement and separation or divorce are among the most stressful critical life events in later life. These events require a dissolution of social and emotional ties, adjustments in daily routine and changes in identity and perspectives for the future. After a normative grief or distress reaction, most individuals cope well with the loss. However, some develop a prolonged grief reaction. Internet-based self-help interventions have proved beneficial for a broad range of disorders, including complicated grief. Based on the task model and the dual-process model of coping with bereavement, we developed a guided internet-based self-help intervention for individuals who experienced marital bereavement, separation or divorce at least 6 months prior to enrolment. The intervention consists of 10 text-based self-help sessions and one supportive email a week. The primary purpose of this study is the evaluation of the feasibility and efficacy of the intervention compared with a waiting control group. The secondary purpose is to compare the effects in bereaved and separated participants. Furthermore, we aim to analyze other predictors, moderators and mediators of the outcome, such as age, psychological distress and intensity of use of the intervention. Methods The design is a randomized controlled trial with a waiting control condition of 12 weeks and a 24-weeks follow-up. At least 72 widowed or separated participants will be recruited via our study website and internet forums. Primary outcomes are reductions in grief symptoms, depression and psychological distress. Secondary outcome measures are related to loneliness, satisfaction with life, embitterment and the sessions. Discussion The trial will provide insights into the acceptance and efficacy of internet-based interventions among adults experiencing grief symptoms, psychological distress and adaptation problems in daily life after spousal bereavement, separation or divorce. Findings will add to existing knowledge by (1) evaluating an internet-based intervention specifically designed for spousal bereavement and its consequences; (2) testing whether this intervention is equally effective for individuals after separation or divorce; and (3) suggesting adaptations to improve the efficacy of the intervention, selective indication and adaptations for different needs. Trial registration ClinicalTrials.gov, NCT02900534. Registered on 1 September 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1759-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeannette Brodbeck
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
| | - Thomas Berger
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland
| | - Hans Joerg Znoj
- Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland
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92
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Boelen PA. Improving the understanding and treatment of complex grief: an important issue for psychotraumatology. Eur J Psychotraumatol 2016; 7:32609. [PMID: 27667723 PMCID: PMC5035770 DOI: 10.3402/ejpt.v7.32609] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 07/29/2016] [Accepted: 08/23/2016] [Indexed: 12/11/2022] Open
Abstract
In the Netherlands, every year 500,000 people are confronted with the death of a close relative. Many of these people experience little emotional distress. In some, bereavement precipitates severe grief, distress, and dysphoria. A small yet significant minority of bereaved individuals develops persistent and debilitating symptoms of persistent complex bereavement disorder (PCBD) (also termed prolonged grief disorder), posttraumatic stress disorder, and depression. Knowledge about early identification of, and preventive care for complex grief has increased. Moreover, in recent years there has been an increase in treatment options for people for whom loss leads to persistent psychological problems. That said, preventive and curative treatments are effective for some, but not all bereaved individuals experiencing distress and dysfunction following loss. This necessitates further research on the development, course, and treatment of various stages of complex grief, including PCBD.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
- Arq Psychotrauma Expert Group, Diemen, The Netherlands;
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93
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Sijbrandij M, Kunovski I, Cuijpers P. EFFECTIVENESS OF INTERNET-DELIVERED COGNITIVE BEHAVIORAL THERAPY FOR POSTTRAUMATIC STRESS DISORDER: A SYSTEMATIC REVIEW AND META-ANALYSIS. Depress Anxiety 2016; 33:783-91. [PMID: 27322710 DOI: 10.1002/da.22533] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/18/2016] [Accepted: 05/22/2016] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Internet-delivered cognitive behavioral therapy (iCBT) is a relatively novel treatment method that may improve the accessibility of mental health care for individuals with posttraumatic stress disorder (PTSD). The aim of this meta-analysis was to evaluate the effectiveness of iCBT compared to inactive (waitlist control and treatment-as-usual (TAU)) and active other interventions in reducing PTSD symptoms. METHODS A meta-analysis of 12 randomized controlled trials (14 comparisons) and 1,306 participants was conducted. RESULTS The pooled effect size of the 11 comparisons (10 studies, 1,139 participants) that compared iCBT to waitlist and TAU control was moderate (g = 0.71, 95% CI [0.49-0.93], P < .001), and showed moderate heterogeneity. The pooled effect size of the three studies (three comparisons) comparing iCBT to other interventions was small (g = 0.28, 95% CI [-0.00 to 0.56], P = .05), with low heterogeneity. CONCLUSION The findings of this systematic review and meta-analysis show that iCBT is an effective treatment for individuals with PTSD and comorbid depressive symptoms. However, further research is needed for effective dissemination of iCBT in clinical practice.
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Affiliation(s)
- Marit Sijbrandij
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands. .,EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, , VU University, , The Netherlands.
| | - Ivo Kunovski
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands
| | - Pim Cuijpers
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, , VU University, , The Netherlands
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94
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Maercker A, Hecker T, Heim E. [Personalized Internet-based treatment services for posttraumatic stress disorder]. DER NERVENARZT 2016; 86:1333-42. [PMID: 26395265 DOI: 10.1007/s00115-015-4332-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Among the most important innovations within the psychotherapeutic care system are the new opportunities in the field of e-mental health. During the past decade, Internet-based and other e-mental health approaches for the treatment of post-traumatic stress disorder and related stress-associated symptoms have been developed in great variety. Solely Internet-based self-help programs are the lowest-threshold approaches in a stepped-care system. By contrast, individualized online psychotherapy and virtual reality programs are at the opposite pole of the spectrum. Approaches in the field of m(obile)-mental health complement these new developments in psychotherapy. The existing evidence supports the clinical efficacy of all the described approaches, although not all have been tested rigorously analog to phase III studies in psychopharmacology. Nonetheless, e-mental health approaches will shape our field more and more in the future.
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Affiliation(s)
- A Maercker
- Psychopathologie & Klinische Intervention, Psychologisches Institut, Universität Zürich, Binzmühlestr. 14/17, 8044, Zürich, Schweiz.
| | - T Hecker
- Psychopathologie & Klinische Intervention, Psychologisches Institut, Universität Zürich, Binzmühlestr. 14/17, 8044, Zürich, Schweiz
| | - E Heim
- Psychopathologie & Klinische Intervention, Psychologisches Institut, Universität Zürich, Binzmühlestr. 14/17, 8044, Zürich, Schweiz
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95
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Holland JM, Currier JM, Neimeyer RA. Meaning Reconstruction in the First Two Years of Bereavement: The Role of Sense-Making and Benefit-Finding. OMEGA-JOURNAL OF DEATH AND DYING 2016. [DOI: 10.2190/fkm2-yjty-f9vv-9xwy] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Contemporary grief theories have highlighted the role of meaning-making in adaptation to bereavement, focusing on two major construals of meaning: making sense of the loss and finding benefit in the experience. The current investigation attempted a conceptual replication of the findings of Davis, Nolen-Hoeksema, and Larson (1998) that suggested that sense-making predicts adaptation to loss in the early period of bereavement, whereas benefit-finding primarily plays an ameliorative role as time progresses. To this end, an ethnically diverse sample of 1,022 recently bereaved college students completed the Inventory of Complicated Grief (ICG) as well as questions that assessed sense-making, benefit-finding, and the circumstances surrounding their losses. Results only partially replicated the findings of Davis and his colleagues, demonstrating that: 1) time since loss bore no relation to grief complications; 2) sense-making emerged as the most robust predictor of adjustment to bereavement; and 3) benefit finding interacted with sense making, with the fewest complications predicted when participants reported high sense, but low personal benefit, in the loss.
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96
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Wagner B, Nagl M, Dölemeyer R, Klinitzke G, Steinig J, Hilbert A, Kersting A. Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder. Behav Ther 2016; 47:500-14. [PMID: 27423166 DOI: 10.1016/j.beth.2016.01.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 01/03/2016] [Accepted: 01/11/2016] [Indexed: 11/15/2022]
Abstract
Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n=69) or a wait-list condition (n=70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination-Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d=1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82≤d≤1.11). In the treatment group significant improvement was still observed for all measures 1year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.
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Affiliation(s)
| | - Michaela Nagl
- University of Leipzig and Leipzig University Medical Center
| | - Ruth Dölemeyer
- University of Leipzig and Leipzig University Medical Center, Integrated Research and Treatment Center (IFB) Adiposity Diseases Germany
| | - Grit Klinitzke
- University of Leipzig and Leipzig University Medical Center, Integrated Research and Treatment Center (IFB) Adiposity Diseases Germany
| | - Jana Steinig
- University of Leipzig and Leipzig University Medical Center, Integrated Research and Treatment Center (IFB) Adiposity Diseases Germany
| | - Anja Hilbert
- University of Leipzig and University of Leipzig Medical Center
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97
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Shear MK, Reynolds CF, Simon NM, Zisook S, Wang Y, Mauro C, Duan N, Lebowitz B, Skritskaya N. Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial. JAMA Psychiatry 2016; 73:685-94. [PMID: 27276373 PMCID: PMC5735848 DOI: 10.1001/jamapsychiatry.2016.0892] [Citation(s) in RCA: 177] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To our knowledge, this is the first placebo-controlled randomized clinical trial to evaluate the efficacy of antidepressant pharmacotherapy, with and without complicated grief psychotherapy, in the treatment of complicated grief. OBJECTIVE To confirm the efficacy of a targeted complicated grief treatment (CGT), determine whether citalopram (CIT) enhances CGT outcome, and examine CIT efficacy without CGT. DESIGN, SETTING, AND PARTICIPANTS Included in the study were 395 bereaved adults who met criteria for CG recruited from March 2010 to September 2014 from academic medical centers in Boston, Massachusetts; New York, New York; Pittsburgh, Pennsylvania; and San Diego, California. Co-occurring substance abuse, psychosis, mania, and cognitive impairment were exclusionary. Study participants were randomized using site-specific permuted blocks stratified by major depression into groups prescribed CIT (n = 101), placebo (PLA; n = 99), CGT with CIT (n = 99), and CGT with PLA (n = 96). Independent evaluators conducted monthly assessments for 20 weeks. Response rates were compared under the intention-to-treat principle, including all randomized participants in a logistic regression with inverse probability weighting. INTERVENTIONS All participants received protocolized pharmacotherapy optimized by flexible dosing, psychoeducation, grief monitoring, and encouragement to engage in activities. Half were also randomized to receive manualized CGT in 16 concurrent weekly sessions. MAIN OUTCOMES AND MEASURES Complicated grief-anchored Clinical Global Impression scale measurments every 4 weeks. Response was measured as a rating of "much improved" or "very much improved." RESULTS Of the 395 study participants, 308 (78.0%) were female and 325 (82.3%) were white. Participants' response to CGT with PLA vs PLA (82.5% vs 54.8%; relative risk [RR], 1.51; 95% CI, 1.16-1.95; P = .002; number needed to treat [NNT], 3.6) suggested the efficacy of CGT, and the addition of CIT did not significantly improve CGT outcome (CGT with CIT vs CGT with PLA: 83.7% vs 82.5%; RR, 1.01; 95% CI, 0.88-1.17; P = .84; NNT, 84). However, depressive symptoms decreased significantly more when CIT was added to treatment (CGT with CIT vs CGT with PLA: model-based adjusted mean [standard error] difference, -2.06 [1.00]; 95% CI, -4.02 to -0.11; P = .04). By contrast, adding CGT improved CIT outcome (CIT vs CGT with CIT: 69.3% vs 83.7%; RR, 1.21; 95% CI, 1.00-1.46; P = .05; NNT, 6.9). Last, participant response to CIT was not significantly different from PLA at week 12 (45.9% vs 37.9%; RR, 1.21; 95% CI, 0.82-1.81; P = .35; NNT, 12.4) or at week 20 (69.3% vs 54.8%; RR, 1.26; 95% CI, 0.95-1.68; P = .11; NNT, 6.9). Rates of suicidal ideation diminished to a substantially greater extent among participants receiving CGT than among those who did not. CONCLUSIONS AND RELEVANCE Complicated grief treatment is the treatment of choice for CG, and the addition of CIT optimizes the treatment of co-occurring depressive symptoms. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01179568.
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Affiliation(s)
- M Katherine Shear
- Columbia School of Social Work, Columbia University College of Physicians and Surgeons, New York, New York2Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | - Charles F Reynolds
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Naomi M Simon
- Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston5Harvard Medical School, Boston, Massachusetts
| | - Sidney Zisook
- Department of Psychiatry, University of California, San Diego7Veterans Affairs San Diego Healthcare System, La Jolla, California8Veterans Medical and Research Foundation, La Jolla, California
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Christine Mauro
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Naihua Duan
- Division of Biostatistics, Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, New York
| | - Barry Lebowitz
- Department of Psychiatry, University of California, San Diego
| | - Natalia Skritskaya
- Columbia School of Social Work, Columbia University College of Physicians and Surgeons, New York, New York
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98
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Complicated Grief Treatment: An Evidence-Based Approach to Grief Therapy. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2016. [DOI: 10.1007/s10942-016-0242-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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99
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Chang JE, Sequeira A, McCord CE, Garney WR. Videoconference Grief Group Counseling in Rural Texas: Outcomes, Challenges, and Lessons Learned. JOURNAL FOR SPECIALISTS IN GROUP WORK 2016. [DOI: 10.1080/01933922.2016.1146376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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100
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de Bitencourt Machado D, Braga Laskoski P, Trelles Severo C, Margareth Bassols A, Sfoggia A, Kowacs C, Valle Krieger D, Benetti Torres M, Bento Gastaud M, Stella Wellausen R, Pigatto Teche S, Laks Eizirik C. A Psychodynamic Perspective on a Systematic Review of Online Psychotherapy for Adults. BRITISH JOURNAL OF PSYCHOTHERAPY 2016. [DOI: 10.1111/bjp.12204] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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