Psychotherapy with survivors of the Beverly Hills Supper Club fire

Treating complicated grief and posttraumatic stress in homicidally bereaved individuals: A randomized controlled trial

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.

Treatment of victims of trauma

The psychiatric sequelae of trauma have been most often discussed in relation to disasters, both natural and man-made, and military conflict. This may sometimes lead psychiatrists to think of posttraumatic stress disorder (PTSD) and other posttraumatic mental illnesses as being somewhat exotic and unusual in general psychiatric practice. In this paper, I propose that PTSD and related disorders are actually common psychiatric problems which require treatment.

An Exploratory Study of Post-Traumatic Stress Disorder Symptoms among Bereaved Children

Purpose:

This study reports on the incidence of post-traumatic stress disorder (PTSD) symptoms among a sample ( n = 46) of bereaved children. PTSD symptoms in children who have experienced loss due to an expected death through illness have not been previously studied.

Method:

An exploratory cross-sectional design was used to compare Impact of Event Scale (IES) scores between two groups of bereaved children. One group experienced the sudden, unexpected death of a family member; the second group experienced the expected death of a family member following protracted illness.

Findings:

Overall, almost two-thirds of the children were found to be experiencing moderate to severe levels of PTSD related symptoms of intrusion and avoidance as measured by the IES. Additionally, there was no significant difference in the IES scores of the two groups of children.

Implications:

Findings are discussed in relation to current practice with and research on bereaved children.

Associations between prolonged grief disorder, depression, posttraumatic stress disorder, and anxiety in Rwandan genocide survivors

A number of studies have demonstrated that symptoms of prolonged grief disorder (PGD) represent a symptom cluster distinct from bereavement-related depression, anxiety, and posttraumatic stress disorder (PTSD). The aim of the present study was to confirm and extend these findings using the most recent criteria defining PGD. The authors interviewed a total of 400 orphaned or widowed survivors of the Rwandan genocide. The syndromes were strongly linked to each other with a high comorbidity. Principal axis factoring resulted in the emergence of 4 different factors. The symptoms of depression, along with the cognitive, emotional, and behavioral symptoms of PGD, loaded on the first factor, symptoms of anxiety on the second factor, symptoms of PTSD on the third factor, and the separation distress symptoms of PGD on the fourth factor. This indicates that the concept of PGD includes symptoms that are conceptually related to depression. However, the symptom cluster of separation distress presents a grief-specific dimension that may surface unrelated to depressive symptoms.

Role of psychotherapy in the management of psychiatric diseases

Psychotherapy plays an essential role in the treatment of mental disorders. The use and research of psychological treatment strategies increased drastically over the past decade. The general efficacy of psychotherapy for the treatment of psychiatric diseases is proved and documented in several meta-analyses. Psychotherapy re-searchers have found solutions for acceptable study designs which account for the special character of these interventions and studied the efficacy of psychotherapeutic treatment in more than 1000 intervention trials.Meanwhile evidence-based psychotherapy approaches tailored to a specific diagnosis are dominating the field and question the basis of psychotherapy schools.A new field of research in psychotherapy is the neurobiological basis of mental disorders and the demonstration of neurobiological changes with psycho-therapeutic treatment.

Pilot study on traumatic grief treatment program for Japanese women bereaved by violent death

This pilot study aimed to refine a treatment approach for traumatic grief due to violent loss. Our Traumatic Grief Treatment Program, a modification of Shear's complicated grief treatment (Shear et al., 2005), comprises psychoeducation, in vivo exposure, imaginal exposure, discussion of memories about and imaginal conversation with the deceased. Thirteen of 15 Japanese women suffering from posttraumatic stress disorder (PTSD) due to traumatic grief completed 12 to 16 weekly individual sessions based on their therapists' recommendations. Assessment scales included the Inventory of Complicated Grief, the Impact of Event Scale-Revised, and the Center for Epidemiologic Studies Depression Scale. There was significant reduction in symptom severity at treatment end, and symptom levels remained low throughout the 12-month follow-up period. Based on Jacobson's Reliable Change Index, 46% showed change on all 3 measures. These findings suggest that our treatment model may be feasible for treating traumatic grief with PTSD in non-Western settings.

A case for establishing complicated grief as a distinct mental disorder in DSM-V

In this paper, we contend that complicated grief (CG) constitutes a distinct psychopathological diagnostic entity and thus warrants a place in standardized psychiatric diagnostic taxonomies. CG is characterized by a unique pattern of symptoms following bereavement that are typically slow to resolve and can persist for years if left untreated. This paper will demonstrate that existing diagnoses are not sufficient, as the phenomenology, risk factors, clinical correlates, course, and outcomes for CG are distinct from those of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and adjustment disorder (AD). It is argued that the establishment of CG as a diagnostic entity is essential because its symptoms are associated with enduring mental and physical health morbidity and require specifically designed clinical interventions. We conduct a critical review of all published evidence on this topic to date, demonstrating that the advantages of standardizing the diagnostic criteria of CG outweigh the disadvantages. In addition, recommendations for future lines of research are made. This paper concludes that CG must be established in the current nosology to address the needs of individuals who are significantly suffering and impaired by this disorder.

Anticipating loss and other temporal stressors predict traumatic stress symptoms among partners of metastatic/recurrent breast cancer patients

This study examined pre- and post-loss levels of posttraumatic stress symptoms (intrusion and avoidance) in partners of metastatic/recurrent breast cancer patients, and the relationship of these symptoms to past, current, and anticipatory stressors. The results indicate that 34% (17/50) of the partners experienced clinically significant symptom levels prior to the patients' deaths. Prior to loss, partners' symptoms were positively associated with their current level of perceived stress and anticipated impact of the loss; whereas following loss, partners' symptoms were predicted by higher pre-loss levels of symptoms, past family deaths, and anticipated impact of the loss. Limitations and treatment implications of the present research and directions for future research are discussed.

Countertransference and disaster psychiatry: from Buffalo Creek to 9/11

This article describes issues of countertransference in disaster psychiatry and makes use of specific examples from therapists working in the aftermath of the terrorist attacks of September 11, 2001.

Debriefing: its evolution and current status

Debriefing, like trauma counseling, and even grief counseling, has been taken up as an instant solution. Some suggest it is a part of the trauma industry. It may be seen as something to hold onto in the face of disaster or other chaos, because it offers the security of a structure, some sense of control over what to do to help when one wishes to undo what has happened, help others and the self, to make meaning of a horrific or shocking experience. The need to pursue a way of responding suggests that those who would offer help fear being overwhelmed, or do not trust their normal compassionate, protecting, and comforting responses. It would be sad if these spontaneous, caring, and altruistic reactions that so bind human society in times of tragedy were devalued or put aside, for they, ultimately are the beginning of the healing process.

Trauma and bereavement: examining the impact of sudden and violent deaths

The intersection between trauma and bereavement has only recently been explored. Prior studies of bereavement have often neglected to measure posttraumatic stress disorder (PTSD) symptoms; the few that have offer equivocal findings concerning the role of PTSD symptomatology following loss. Few studies have explored the relationship between PTSD and the other psychological sequelae more commonly associated with loss. The current investigation assessed PTSD symptoms over time following the death of a spouse, using violence and the suddenness of the loss as potential outcome predictors. In addition, the relationship between PTSD and depression symptoms was assessed. Violent death predicted PTSD symptoms and the persistence of depression over time. The suddenness of the loss was not related to PTSD symptoms. This investigation suggests that violent death results in development of PTSD symptoms over and above the normal grief response and thus, may contribute to a more severe grief response.

Single-session early psychological interventions following traumatic events

Single-session early psychological interventions became widely advocated during the 1980s and 1990s as a way to prevent the development of psychological sequalae following traumatic events. There have now been 13 randomised controlled trials of single-session interventions within 1 month of a traumatic event. Notwithstanding their methodological shortcomings and clinical heterogeneity, the results are neutral overall in terms of clinical effectiveness. Possible explanations include a failure to encourage individuals' personal coping mechanisms and defence mechanisms and that insufficient time was allowed for habituation to intense exposure to occur. With the present evidence, the routine use of single-session interventions following traumatic events cannot be justified. This does not mean that there should be nothing offered, as many individuals involved in traumatic events clearly have emotional needs. Hopefully, future research will identify alternative forms of early intervention that prove useful to those individuals who would otherwise develop more significant psychological difficulties.

Traumatization in Survivors of Multiple Aids-Related Loss

This article intends to demonstrate that surviving multiple AIDS-related loss can be traumatizing. Certain characteristics of AIDS as a disease combine with the cumulative impact of multiple loss to heighten traumatic stress in a combined environment of helpless uncertainty and ongoing distress. The focused, community wide impact of AIDS, especially in the gay community, fosters both collective and individual traumatization. Classic symptoms of traumatization arise in survivors of multiple AIDS loss including emotional and social withdrawal and disturbing intrusive recollections. Lifton's conceptualization of the “death imprint” and Seligman's theories of learned helplessness are applied. Implications for treatment and recovery are explored.

Psychosocial treatments for posttraumatic stress disorder: a critical review

Posttraumatic stress disorder (PTSD) has been the subject of growing recognition since its inception in 1980. Owing in part to the relatively recent inclusion of PTSD in the psychiatric nomenclature, research is only beginning to address its treatment in methodologically rigorous studies. In this review, we discuss issues such as prevalence of trauma and of PTSD, and gold standards for treatment outcome research. We then critically review the extant literature on the treatment of PTSD. Finally, we include a discussion of issues specific to various trauma populations and factors that may influence treatment efficacy across types of trauma.

Dissociative responses in the immediate aftermath of the Oakland/Berkeley firestorm

This study examined relationships between dissociative symptoms experienced in the immediate aftermath of the Oakland/Berkeley firestorm and contact with the fire, life events, demographic variables, and actions taken after learning about the fire. One hundred eighty-seven participants completed self-report measures about their experiences during and immediately following the fire. Dissociative symptoms were significantly related to contact with the fire, sex, and stressful life events. Also, dissociative symptoms were significantly related to engaging in certain activities, such as trying to get closer to the fire and going into blocked-off areas and crossing police barricades. These results suggest that dissociative symptoms may merit special attention in intervention focusing on the immediate aftermath of disaster.

Issues and implications in the counseling of survivors of multiple AIDS-related loss

Survivors of multiple AIDS-related loss face a unique phenomenon for which existing theories and diagnostic criteria regarding grief and trauma are inadequate. Unresolved grief and complicated bereavement are normal responses to multiple loss. This distinctive experience and the resulting symptoms have implications for counselors. Suggestions are offered for counselors to help clients process the aggregate and individual losses arising from this experience. AIDS provides a rare opportunity to analyze concurrent traumatization and complicated bereavement occurring on an ongoing basis. This analysis and its implications may therefore be useful in the future in regard to tragedies that share these characteristics.

Hypnotherapy for traumatic grief: janetian and modern approaches integrated

Traumatic grief occurs when psychological trauma obstructs mourning. Nosologically, it is related to pathological grief and posttraumatic stress disorder (PTSD). Therapeutic advances from both fields make it clear that the trauma per se must be accessed before mourning can proceed. The gamut of psychotherapies has been employed, but hypnosis appears to be the most specific. Pierre Janet provided a remarkably modern conceptual basis for diagnosis and treatment based on a dissociation model. His approach is combined with contemporary innovations to present a systematic and integrated account of hypnotherapy for traumatic grief.

On-Site Work Evaluations: Desensitisation for Avoidance Reactions Following Severe Hand Injuries

This study examined on-site work evaluations as an environmental exposure strategy to promote return to work in 15 recalcitrant patients who had failed to benefit from established methods of reducing post-traumatic stress disorder symptoms. Following the on-site work evaluation, 87% of these patients were able to use visualisation of the work setting to further desensitize themselves and returned to work within the next eight weeks. All 87% have continued to be employed at six and twelve month follow-ups. This approach holds promise for assisting patients with hand injuries who develop post-traumatic stress disorder and fail to respond to traditional psychological strategies.

Theoretical and empirical issues in the treatment of post-traumatic stress disorder in Vietnam veterans

This article reviews the current status of research on the treatment of combat-related post-traumatic stress disorder (PTSD) in Vietnam veterans. Dynamic, behavioral, and biochemical models of treatment are presented, along with the findings of relevant treatment outcome studies. Examination of the treatment procedures employed in available studies revealed that direct therapeutic exposure to the memories of trauma emerged as the PTSD treatment technique common to all three theoretical models. The need for controlled investigations of the clinical efficacy of exposure-based interventions for combat-related PTSD is discussed. In addition, several other issues relevant to PTSD treatment research are presented and discussed, including the potential utility of studying untrained coping behavior in combat veterans; the effects of using heterogeneous subject samples in PTSD treatment research; and issues related to the measurement of treatment outcome.