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A cognitive approach to persistent complex bereavement disorder (PCBD)

Published online by Cambridge University Press:  27 November 2017

Michael Duffy*
Affiliation:
Queen's University Belfast, School of Social Sciences, Education and Social Work, Belfast
Jennifer Wild
Affiliation:
University of Oxford–Experimental Psychology, South Parks Road, Oxford OX1 3UD
*
*Author for correspondence: Dr Michael Duffy, Queen's University Belfast, School of Social Sciences, Education and Social Work, Belfast. E-mail: michael.duffy@qub.ac.uk

Abstract

Persistent complex bereavement disorder (PCBD) has been included in the appendix of the fifth edition of the Diagnostic and Statistical Manual for Mental Disorders as a condition for further study, and a new diagnostic category of prolonged grief disorder (PGD) is likely to be added to the International Statistical Classification of Diseases and Related Health Problems (ICD-11) (Maercker et al., 2013). Whilst there is increasing evidence that prolonged grief has distinct characteristics (Bryant, 2012), there are clinical features that overlap with post-traumatic stress disorder (PTSD), such as intrusive memories, emotional numbing, and avoidance of trauma or loss reminders. Here we describe how the cognitive model for persistent PTSD (Ehlers and Clark, 2000) and trauma-focused cognitive therapy for PTSD (Ehlers et al., 2005) have been helpful in treating persistent complex grief.

Information

Type
Special Issue: Complexity within Cognitive Behaviour Therapy
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

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References

Further reading

Boelen, PA, van den Hout, MA, van den Bout, J (2006). A cognitive-behavioral conceptualization of complicated grief. Clinical Psychology: Science and Practice 13, 109128.Google Scholar
Ehlers, A, Clark, DM (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy 38, 319345.CrossRefGoogle ScholarPubMed
Neimeyer, RA, Keese, NJ, Fortner, BV (2000). Loss and meaning reconstruction: Proposition and procedures. In Malkinson, R., Rubin, S., and Witztum, E. (eds), Traumatic and Non-Traumatic Loss and Bereavement, pp. 197230. Madison, CT: Psychosocial Press.Google Scholar

References

American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Washington, DC: APA.Google Scholar
Barnes, JB, Dickstein, BD, Maguen, S, Neria, Y, Litz, BT (2012). The distinctiveness of prolonged grief and posttraumatic stress disorder in adults bereaved by the attacks of September 11th. Journal of Affective Disorders 136, 366369. doi: 10.1016/j.jad.2011.11.022 Google Scholar
Boelen, PA, de Keijser, J, van den Hout, MA, van den Bout, J (2007). Treatment of complicated grief: a comparison between cognitive behaviour therapy and supportive counselling. Journal of Consulting and Clinical Psychology 75, 277284.Google Scholar
Boelen, PA, Lensvelt-Mulders, GJLM (2005). Psychometric properties of the Grief Cognitions Questionnaire (GCQ). Journal of Psychopathology and Behavioral Assessment 27, 291303. doi: 10.1007/s10862-005-2409-5 Google Scholar
Boelen, PA, van den Bout, J, de Keijser, J (2003). Traumatic grief as a disorder distinct from bereavement-related depression and anxiety: a replication study with bereaved mental health care patients. American Journal of Psychiatry 160, 13391341.Google Scholar
Boelen, PA, van den Hout, MA, van den Bout, J (2006). A cognitive-behavioral conceptualization of complicated grief. Clinical Psychology: Science and Practice 13, 109128.Google Scholar
Bonanno, GA (2009). The Other Side of Sadness: What the New Science of Bereavement tells us about Life after Loss. New York, NY: Basic Books.Google Scholar
Bonanno, GA, Keltner, D (1997). Facial expressions of emotion and the course of conjugal bereavement. Journal of Abnormal Psychology 106, 126137. doi: 10.1037/0021-843X.106.1.126 Google Scholar
Bonanno, GA, Wortman, CB, Lehman, DR, Tweed, RG, Haring, M, Sonnega, J, Carr, D, Nesse, RM, Arbor, A (2002). Resilience to loss and chronic grief: a prospective study from pre-loss to 18-months post-loss. Journal of Personality and Social Psychology 83, 11501164.Google Scholar
Borkovec, TD, Wilkinson, L, Folensbee, R, Lerman, C (1983). Stimulus control applications to the treatment of worry. Behaviour Research and Therapy 21, 247251.Google Scholar
Bryant, RA (2012). Grief as a psychiatric disorder. British Journal of Psychiatry 201, 910.Google Scholar
Coffman, SJ, Martell, CR, Dimidjian, S, Gallop, R, Hollon, SD (2007). Extreme non-response in cognitive therapy: can behavioural activation succeed where cognitive therapy fails? Journal of Consulting and Clinical Psychology 75, 531541.Google Scholar
Currier, JM, Holland, JM, Neimeyer, RA. (2006). Sense-making, grief, and the experience of violent loss: toward a mediational model. Death Stud 30, 403–428.Google Scholar
Diminich, ED, Bonanno, GA (2014). Faces, feelings, words: divergence across channels of emotional responding in complicated grief. Journal of Abnormal Psychology 123, 350361.Google Scholar
Duffy, M, Bolton, D, Gillespie, K, Ehlers, A, Clark, DM (2013). A community study of the psychological effects of the Omagh car bomb on adults. PLOS ONE 8, e76618. doi: https://doi.org/10.1371/journal.pone.0076618 Google Scholar
Duffy, M, McDermott, M, Percy, A, Ehlers, A, Clark, DM, Fitzgerald, M, Moriarty, J (2015). The effects of the Omagh bomb on adolescent mental health: a school-based study. BMC Psychiatry 15, 18. doi: 10.1186/s12888-015-0398-9 Google Scholar
Dunmore, E, Clark, DM, Ehlers, A (1997). Cognitive factors in persistent versus recovered post-traumatic stress disorder after physical or sexual assault: a pilot study. Behavioural and Cognitive Psychotherapy 26, 147159.Google Scholar
Ehlers, A (2006). Understanding and treating complicated grief: what can we learn from posttraumatic stress disorder? Clinical Psychology: Science and Practice 13, 135140.Google Scholar
Ehlers, A, Clark, DM (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy 38, 319345.Google Scholar
Ehlers, A, Clark, DM, Hackmann, A, McManus, F, Fennell, M (2005). Cognitive therapy for post-traumatic stress disorder: development and evaluation. Behaviour Research and Therapy 43, 413431.Google Scholar
Ehlers, A, Mayou, RA, Bryant, B (1998). Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. Journal of Abnormal Psychology 107, 508519.Google Scholar
Ehlers, A, Wild, J (2015). Cognitive therapy for PTSD: updating memories and meanings of trauma. In Schnyder, U and Cloitre, M (eds), Evidence-Based Treatments for Trauma-Related Psychological Disorders: A Practical Guide for Clinicians. Switzerland: Springer. doi: 101007/978-3-319-07109-1-9 Google Scholar
Eisma, MC, Schut, HA, Stroebe, MS, Boelen, PA, van den Bout, J, Stroebe, W (2015). Adaptive and maladaptive rumination after loss: a three-wave longitudinal study. British Journal of Clinical Psychology 54, 163180. doi: 10.1111/bjc.12067.Google Scholar
Foa, EB, Cahill, SP (2001). Psychological therapies: emotional processing. In Smelser, NL and Bates, PB (eds), International Encyclopedia of the Social and Behavioral Sciences, pp. 1236312369. Oxford: Elsevier.Google Scholar
Jacobs, S, Hansen, F, Kasl, S, Ostfeld, A, Berkman, L, Kim, K (1990). Anxiety disorders during acute bereavement: risk and risk factors. Journal of Clinical Psychiatry 51, 69274.Google Scholar
Jordan, AH, Litz, BT (2014). Prolonged grief disorder: diagnostic, assessment, and treatment considerations. Professional Psychology: Research and Practice 45, 180187.Google Scholar
Kersting, A, Brahler, E, Glaesmer, H, Wagner, B (2011). Prevalence of complicated grief in a representative population-based sample. Journal of Affective Disorders 131, 339343. doi: 10.1016/j.jad.2010.11.032 Google Scholar
Klass, D, Chow, AYM (2011). Culture and ethnicity in experiencing, policing, and handling grief. In Neimeyer, Robert A, Harris, Darcy L, Winokuer, Howard R and Thornton, Gordon F. (eds), Grief and Bereavement in Contemporary Society: Bridging Research and Practice, pp. 341354. New York: Routledge.Google Scholar
Latham, AE, Prigerson, HG (2004). Suicidality and bereavement: complicated grief as psychiatric disorder presenting greatest risk for suicidality. Suicide and Life-Threatening Behaviors 34, 350362. doi: 10.1521/suli.34.4.350.5373 Google Scholar
Lichtenthal, WG, Nilsson, M, Kissane, DW, Breitbart, W, Kacel, E, Jones, EC, Prigerson, HG (2011). Under-utilization of mental health services among bereaved caregivers with prolonged grief disorder. Psychiatric Service 62, 12251229. doi: 10.1176/appi.ps.62.10.1225 Google Scholar
Maercker, A, Mohiyeddini, C, Muller, M, Xie, W, Yang, ZH, Wang, J, Muller, J (2009). Traditional versus modern values, self perceived inter-personal factors and posttraumatic stress in Chinese and German crime victims. Psychology and Psychotherapy: Theory, Research and Practice 82, 219232.Google Scholar
Maercker, A, Brewin, CR, Bryant, RA, Cloitre, M, Reed, GM, van Ommeren, M, Saxena, S (2013). Proposals for mental disorders specifically associated with stress in the International Classification of Diseases-11. Lancet 381, 16831685. doi: 10.1016/S0140- 6736(12)62191-6 Google Scholar
Malkinson, R (2010). Cognitive behavioural grief therapy: the ABC model of rational-emotion behavour therapy. Psychological Topics 19, 289305.Google Scholar
Malkinson, R, Ellis, A (2000). The application of rational-emotive behavior therapy (REBT) in traumatic and non-traumatic loss. In Malkinson, R, Rubin, S and Witztum, E (eds),Traumatic and Non-Traumatic Bereavement: Clinical Theory and Applications, pp. 173195. Madison, CT: Psychosocial Press.Google Scholar
Meert, KL, Shear, K, Newth, CJ, Harrison, R, Berger, J, Zimmerman, J, Anand, KJS, Carcillo, J, Donaldson, AE, Dean, JM, Willson, DF, Nicholson, C (2011). Follow-up study of complicated grief among parents eighteen months after a child's death in the pediatric intensive care unit. Journal of Palliative Medicine 14, 207214.Google Scholar
Michael, T, Halligan, SL, Clark, DM, Ehlers, A (2007). Rumination in post-traumatic stress disorder. Depression and Anxiety 24, 307317. doi: 10.1002/da.2022 CrossRefGoogle Scholar
Murphy, SA, Braun, T, Tillery, L, Cain, KC, Johnson, LC, Beaton, RB (1999). PTSD among bereaved parents following the violent deaths of their 12- to 28-year-old children: a longitudinal prospective analysis. Journal of Traumatic Stress 12, 273291.CrossRefGoogle ScholarPubMed
Papa, A, Rummel, C, Garrison-Diehn, C, Sewell, MT (2013a). Behavioral activation for pathological grief. Death Studies 37, 913936. doi: https://doi.org/10.1080/07481187.2012.692459 Google Scholar
Papa, A, Sewall, MT, Garrison-Diehn, C, Rummel, C (2013b). A randomized open trial assessing the feasibility of behavioral activation for pathological grief responding. Behavior Therapy 44, 639650. doi: 10.1016/j.beth.2013.04.009 Google Scholar
Prigerson, HG, Bierhals, AJ, Kasl, SV, Reynolds, CF, Shear, MK, Day, N, Beery, LC, Newsom, JT, Jacobs, SC (1997). Traumatic grief as a risk factor for mental and physical morbidity. American Journal of Psychiatry 154, 616623.Google ScholarPubMed
Prigerson, HG, Horowitz, MJ, Jacobs, SC, Parkes, CM, Aslan, M, Goodkin, K, Raphael, B et al. (2009). Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. PLOS Medicine 6, e1000121. doi: 10.1371/journal.pmed .1000121 Google Scholar
Prigerson, HG, Maciejewski, PK, Reynolds, CF III, Bierhals, AJ, Newsom, JT, Fasiczka, A, Frank, E, Doman, J, Miller, M (1995). Inventory of complicated grief: a scale to measure maladaptive symptoms of loss. Psychiatry Research 59, 6579.Google Scholar
Rando, T (1993). Treatment of Complicated Mourning. Champaign, IL: Research Press.Google Scholar
Schut, HAW, de Keijser, J, van den Bout, J, Dijkhuis, JH (1991). Post-traumatic stress symptoms in the first year of conjugal bereavement. Anxiety Research 4, 225234.Google Scholar
Shear, K, Frank, E, Houck, PR, Reynolds, CF (2005). Treatment of complicated grief: a randomized controlled trial. Journal of the American Medical Association 293, 26012608.Google Scholar
Shear, MK, McLaughlin, KA, Ghesquiere, A, Gruber, MJ, Sampson, NA, Kessler, RC (2011). Complicated grief associated with Hurricane Katrina. Depression and Anxiety 28, 648657. doi: 10.1002/da.20865 CrossRefGoogle ScholarPubMed
Skritskaya, NA, Mauro, C, Olonoff, M, Qiu, X, Duncan, S, Wang, Y, Duan, N, Lebowitz, B, Reynolds, CF III, Simon, NM, Zisook, S, Shear, MK (2017). Measuring maladaptive cognitions in complicated grief: introducing the Typical Beliefs Questionnaire. American Journal of Geriatric Psychiatry 25, 541550. doi: https://doi.org/doi:10.1016/j.jagp.2016.09.003 Google Scholar
Speckens, AEM, Ehlers, A, Hackmann, A, Ruths, FA, Clark, DM (2007). Intrusive memories and rumination in patients with post-traumatic stress disorder: a phenomenological comparison. Memory 15, 249257.CrossRefGoogle ScholarPubMed
Spuij, M, Prinzie, P, Boelen, PA (2017). Psychometric properties of the Grief Cognitions Questionnaire for Children (GCQ-C). Journal of Rational-Emotive and Cognitive-Behavioral Therapy 35, 6077. doi: 10.1007/s10942-016-0236-0 Google Scholar
Steenkamp, MM, Litz, BT, Gray, MJ, Lebowitz, L, Nash, W, Conoscenti, L, Amidson, A, Lang, A (2011). A brief exposure-based intervention for service members with PTSD. Cognitive and Behavioral Practice 18, 98107. doi: 10.1016/j.cbpra.2009.08.006 Google Scholar
Stroebe, MS, Schut, H (1999). The dual process model of coping with loss. Death Studies 23, 128.Google Scholar
Stroebe, M, Schut, H, Finkenhauer, C (2001). The traumatization of grief? A framework for understanding the trauma–bereavement interface. Israeli Journal of Psychiatry and Related Sciences 38, 185201.Google Scholar
Watkins, ER (2009). Depressive rumination: investigating mechanisms to improve cognitive-behavioral treatments. Cognitive Behavioral Therapy 38, 814.Google Scholar
Watkins, ER, Scott, J, Wingrove, J, Rimes, KA, Bathurst, N, Steiner, H, Kennel-Webb, S, Moulds, M, Malliaris, Y (2007). Rumination-focused cognitive behaviour therapy for residual depression: a case series. Behaviour Research and Therapy 45, 21442154.Google Scholar
World Health Organization (WHO) (2012). ICD-11 Beta: Mental and Behavioural Disorders. Geneva: WHO.Google Scholar
Wild, J, Smith, KV, Thompson, E, Béar, F, Lommen, MJJ, Ehlers, A (2016). A prospective study of pre-trauma risk factors for post-traumatic stress disorder and depression. Psychological Medicine 46, 25712582. doi: 10.1017/S0033291716000532 Google Scholar
Wittouck, C, Van Autreve, S, De Jaegere, E, Portzky, G, van Heeringen, K (2011). The prevention and treatment of complicated grief: a meta-analysis. Clinical Psychology Review 31, 6978. doi: 10.1016/j.cpr.2010.09.005 Google Scholar
Wortman, CB, Silver, RC (1989). The myths of coping with loss. Journal of Consulting and Clinical Psychology 57, 349357.Google Scholar
Zisook, S, Shuchter, SR, Sledge, PA, Paulus, M, Judd, LW (1994). The spectrum of depressive phenomena after spousal bereavement. Journal of Clinical Psychiatry 55, 2936.Google Scholar
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