Research Points to New Method of Treating Severe Grief

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A new study describes an especially intense form of bereavement that lasts for years and is difficult to treat. But researchers think they may have found a way to treat it, involving intense therapy in which patients were asked to recall the specifics of the death and imagine talking out their feelings with the loved one.

STEVE INSKEEP, host:

For some people, an endless feeling of grief might be a medical condition. According to psychiatrists writing in today's Journal of the American Medical Association, some people are not able to pull their lives together even 10 years after the death of a loved one and they suggest people with intense and lasting grief could benefit from a new kind of treatment. NPR's Joanne Silberner has more.

JOANNE SILBERNER reporting:

Psychiatrist Katherine Shear of the University of Pittsburgh has been working for years with patients who seem to be permanently and deeply bereaved. She says it's different from normal grief.

Ms. KATHERINE SHEAR (Psychiatrist, University of Pittsburgh): Grief is often as we know a very, very painful emotional state. You get the disbelief and you get also very intense yearning and longing for the person. You get very preoccupied with thoughts and memories and feelings about the person who died. And you kind of withdraw a bit from your ongoing life.

SILBERNER: But within months, most people are able to get used to the loss. For some other people, grief persists.

Ms. SHEAR: When you're years out from the death, two years, three years, four years out of the death, and you're still experiencing that, you know, you're kind of stuck in the initial grief response.

SILBERNER: Some of her patients have not been able to work. Others say they're on autopilot, just going through the motions of life. Shear estimates 10 to 20 percent of bereaved people get stuck in what she is calling complicated grief. That's about one million Americans a year. The condition isn't officially recognized yet as a psychiatric disorder. She figured one way to get it acknowledged was to see if the condition responds to a specialized treatment. She and her colleagues designed an approach similar to what's used in post-traumatic stress disorder.

Ms. SHEAR: The person is asked to close their eyes and imagine themselves back at the time of the actual death and tell the story of the death as though it's happening in the present and that story is tape recorded. The therapist is providing some comments during the story, and when it's over, the therapist gives the tape to the patient and asks them to listen to it when they're at home.

SILBERNER: So that they gradually become desensitized. And in the second exercise, the therapist guides them through an imaginary conversation with their loved one. In her research, Shear studied 95 people with complicated grief that lasted anywhere from six months to 35 years. Half of them got a form of cognitive behavioral therapy which included talking about their grief. The other half got the specialized treatment that included recalling the death and the imaginary conversation. Half of those who got the specialized treatment improved compared to only a quarter who got the normal treatment. Psychiatrist Richard Glass wrote an editorial about the research. He says the approach should only be done by trained therapists.

Mr. RICHARD GLASS (Psychiatrist): It's such a painful experience that goes to the center of a person's life if they could have gone through the grief period sort of on their own, or with the help and support of family and friends, they would have done that.

SILBERNER: Like Shear, Glass thinks complicated grief is a real condition, different from depression in that remains focused on the loss of the loved one. However, Glass says, not much is known about it yet.

Mr. GLASS: One thing we don't know for sure about it yet is how prevalent is this. The group at Pittsburgh gave an estimate on it that may be a reasonable one of it being fairly common, but we don't know that for sure. There haven't been really good surveys of this to know how common it is among people who've been bereaved.

SILBERNER: And Glass would like to know if there are measurable changes in the brain itself like there are with depression and post-traumatic stress disorder. Researcher Katherine Shear would like to know if there are treatments with better response rates than 50 percent.

Joanne Silberner, NPR News.

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