About 70% of older adults with complicated grief improved with targeted exposure-based counseling, compared with 32% who underwent interpersonal therapy, according to a randomized trial.
Response rates were sustained 6 months later, reflecting positive results from an earlier study of complicated grief therapy (CGT) in middle-aged patients, reported Dr. Katherine Shear of Columbia University College of Physicians and Surgeons, New York, and her associates.
“Complicated grief is an underrecognized public health problem that likely affects millions of people in the United States, many of them elderly,” the investigators wrote. Symptoms often resemble depression but do not benefit from interpersonal therapy to the extent that depression does (JAMA Psychiatry 2014 Sept. 23 [doi: 10.1001/jamapsychiatry.2014.1242]).For the study, 151 bereaved adults with scores of at least 30 on the Inventory of Complicated Grief underwent 16 individual weekly sessions of either CGT or interpersonal therapy. About 81% of patients were women; average age was 66 years. The CGT intervention included work with grief-monitoring diaries, memories, and photographs, discussions of goals, and imaginary conversations with the deceased, while patients in interpersonal therapy discussed the death, positive and negative aspects of their relationships with the deceased, and how to develop satisfying relationships in the present.
Symptoms and measures of work and social impairment improved significantly faster with CGT than with interpersonal therapy, the researchers noted. The response rate for exposure-based therapy was 70.5%, compared with 32% for interpersonal therapy (relative risk, 2.20; 95% confidence interval, 1.51-3.22; P less than .001). Six months after baseline, 100% of CGT patients had maintained their improvement, compared with 86.4% of patients who underwent interpersonal therapy, they added.
“Complicated grief is a stress response syndrome, and CGT uses revisiting procedures derived from prolonged exposure for PTSD,” said Dr. Shear and associates. “Older adults appear to tolerate emotional activation reasonably well and respond to these procedures similarly to younger adults.”
The National Institute of Mental Health funded the study. Dr. Shear reported receiving a contract from Guilford Press to write a book on grief. The other authors reported no conflicts of interest.