May 31, 2005 -- Dealing with death is part of life but for some people the grief associated with losing a loved one is so crippling that it dominates their lives for years to come.
It is estimated that as many as a million Americans a year develop a chronic, disabling condition known as "complicated grief" brought on by the loss of someone they love. The symptoms differ from normal depression, and now new research suggests that the treatment should as well. In the latest issue of The Journal of the American Medical Association, researchers report that an intensive program targeting grief
symptoms was more effective than traditional psychotherapy for alleviating the disabling symptoms associated with prolonged mourning.
'Stuck in Grief'
Virginia Eskridge, 61, tells WebMD that she had been "stuck in grief" for two decades when she went through the program, which was developed by psychiatrist Katherine Shear, MD, and colleagues at the University of Pittsburgh.
Eskridge's second husband died of a brain tumor in the early 1980s, just a few years after their marriage. Even 20 years later, she says, she still broke down in tears when she tried to say his name and had constant intrusive feelings of guilt associated with the suffering he experienced.
"He went through a lot of unnecessary pain because we tried so hard to save him," she says. "They gave him four kinds of chemo, and radiation, and we got him into an experimental drug program. I now know that his type of tumor is uniformly fatal, but we didn't know that at the time. And I loved him so much that I was desperate for him to live."
Grief Remains Center Stage
Eskridge was among 95 people with prolonged grief enrolled in a University of Pittsburgh study. Symptoms of complicated grief last more than six months after the death of a loved one.
Shear tells WebMD that, like Eskridge, the participants had all or some of the symptoms associated with complicated grief including:
- A sense of disbelief regarding the death long after it has occurred
- Recurrent pangs of painful emotions with intense yearning and longing for the dead loved one
- Avoidance of situations and activities that are reminders of the loved one
- A preoccupation with distressing thoughts about the death
While all of these emotions are normal after the loss of a loved one, Shear says that over time these feeling should become less intense. For some people this happens in a few months, for others a few years.
"When you lose someone you love you never stop feeling sad about it," she says. "But in normal grieving it doesn't stay the dominant focus of your mental life. With complicated grief these feelings stay center stage."
Shear says her program merges some of the most effective treatments for depression and post-traumatic stress disorderpost-traumatic stress disorder but targets issues associated with death and separation.
In one exercise, patients carry on imagined conversations with their dead loved one, exploring unresolved issues. In another, patients talk in detail about their loved one's actual death and later listen to taped recordings of their musings.
"Once they hear themselves talking about it, the death does not stay so intrusive in their thoughts," she says.
In another exercise, patients were asked to think about specific personal goals that they would have if their grief was not so strong and to take steps to accomplish them.
"Standard bereavement counseling encourages patients to move forward with their lives after they start to feel better," she says. "The treatment we developed encourages people to move forward with their lives at the same time as they are dealing with the loss."
Over the course of the three-year study, 51% of the participants who got the targeted complicated grief treatment showed significant improvements, compared with 28% of those treated with more traditional psychotherapy. Patients who got the targeted treatment also responded much faster.
"Our treatment findings suggest that complicated grief is a specific condition in need of a specific treatment," Shear and colleagues write.
Virginia Eskridge is a believer. Although she was highly skeptical when she entered the program, she says the treatment has helped change her life.
"I still have occasional downtimes, but they don't seem to be centered around my husband like they used to be," she says. "They are more about just dealing with the day-to-day realities of life."
In an editorial accompanying the study, University of Chicago psychiatrist Richard M. Glass, MD, addresses concerns that the concept of complicated grief is simply "another example of the medicalization of various aspects of the human condition." In this case, mourning loss.
"The answer to the question 'Is grief a disease?' is 'sometimes,'" he writes. "The painful process of normal grief following bereavement certainly warrants sympathy and concern, along with the support of family and friends. Complicated grief warrants more research about effective ways to prevent and treat it."