DOCSLIB.ORG

Complicated Grief

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Complicated Grief COMPLICATED GRIEF Published as a public service by The Hospice Support Fund a program of New Hope Foundation P.O. Box 1839 Merrifield, VA 22116-8039 M8245CG Grief is normal. Grief is a common, natural response one experiences after a significant and Most people assume the grieving person will permanent loss. Grief is usually caused by death have feelings of loss and sadness soon after the of the loved one, but may be caused by the death death or separation, which lessen over time as of a pet, the end of a relationship (i.e. divorce), or the person moves through the stages of grief. the loss of property.1 Over time, grief lessens in In fact, most people do not experience grief in intensity and the grieving individual returns to a this way.4 For many people, grief is never really normal or near normal level of functioning. over. Instead, the grieving person finds herself in one of four categories: resilience, chronic grief, Complicated grief, on the other hand, is abnormal. depressed improved, and chronic depression.5 It is a state of intense, unrelenting, and disabling People who grieve in one of these four normal sorrow. Complicated grief is a distinct psychiatric ways regain a reasonable level of functioning; syndrome requiring specific treatment. people with complicated grief do not. What is “normal” grief? Resilience While everyone agrees grief is normal, few People who experience the resilience grief people agree on a precise definition of “normal” pattern show very few signs of grief, sadness, grief. Grief is a complex reaction that includes or loss. Instead, they show a relatively low level emotional, physical, cognitive, and psychological of chronic distress or simply no outward signs components. of grief whatsoever. This pattern was previously considered abnormal. People with this grieving One of the oldest and well-known models of grief style were encouraged to “let out their emotions” is the five-stage model proposed by Elizabeth and “stop trying to be strong.” Kübler-Ross. She said a grieving individual will normally progress through denial, anger, Careful research of the resilience pattern has bargaining, and depression and then ultimately revealed it is not abnormal at all. In fact, 46% of come to accept the loss.2 Newer research people experience grief in a resilience pattern.4,6,7 suggests many people do not experience grief Moreover, people in this category have positive in a sequential order and may also experience coping styles and healthy adjustment to the loss. symptoms such as emotional numbness, They have few or no symptoms of depression yearning, and despair.3 at six or 18 months after the loss.6 Not only is resilience the most common grief pattern, but it Perhaps because of this multistage progression, appears to cause the least number of functional grief has been viewed as something from which and psychological problems. Resilient grievers one “recovers.” Grief is a process, not a state. It experience and express positive emotions and progresses in fits and starts and may ebb and flow. remember their lost love one fondly. Individuals It is generally felt in waves of intense sadness, in this group may experience occasional pangs loss, and separation. One does not simply “get of loss and continued yearning, but still function over” the loss of a loved one, just as one does at their normal level.8 not get over graduation or a wedding. The loss of a loved one is a major life event that will be Chronic Grief remembered and contemplated. It will cause emotions that may be unpleasant, painful, and A small percentage of people experiencing grief powerful. One hopes the waves of emotion even will manifest a chronic grief pattern. People in out into ripples over time.4 this category will experience significant pangs 2 of loss and sadness and sustained yearning for four patterns are distinct from complicated grief. the lost individual. Chronic grief occurs most commonly in widows/widowers who were quite Complicated Grief: Features and Symptoms dependent on their deceased spouse. Chronic grief eventually resolves within four years on Approximately 7% of those who experience grief average as the person integrates the loss into will develop complicated grief.9 The rate is even normal living.8 higher among those who have suffered the loss of a life partner or child, especially to a violent Depressed Improved death. Complicated grief is most common in women over the age of 60.9 One in ten individuals who have lost a spouse exhibit a depressed improved pattern grieving.6 Complicated grief is an unusually severe and This pattern occurs most often when the prolonged form of grief that impairs the sufferer’s deceased suffered a long health problem prior to ability to function.10 In most cases, people with death or the couple had an unhappy relationship. complicated grief will experience persistent, The depressed phase of the depressed improved intense yearning and sadness accompanied pattern occurs before the loss and the improved by frequent thoughts of the deceased and an phase begins upon death. The grieving inability to accept the person is gone. Sufferers individual is able to focus on positive memories tend to ruminate on the factors surrounding the of the deceased, finds meaning in the loss of the death itself. For example, sufferers may be angry deceased, and visualizes/experiences the benefits with those they deem responsible for the death or of living without the deceased. The loss of a guilty that they did not do more to prevent death loved one is the loss of a chronic stressor. Thus, or prolong the life of the deceased.10 death releases the grieving person from a difficult Like those with post-traumatic stress disorder, relationship or from caregiving duties associated people with complicated grief tend to avoid with caring for a chronically ill loved one. situations that may evoke feelings of grief or reminders of loss. On the other hand, this same Chronic Depression person may spend inordinate amounts of time viewing photos, mementos, or belongings of the People who experience the chronic depression deceased. pathway of grief share an important feature with the depressed improved individual, namely In some cases, the person with complicated experience depression before the loved one dies. grief has a diminished sense of self, meaning the Unlike people in the third group, the depression sufferer cannot imagine a life without the lost of chronically depressed grievers does not begin loved one, causing the sufferer to withdraw from to resolve with the loved one’s death. Instead, work, family, and social ties. As a result, the the depression remains or worsens. The ongoing sufferer’s support system is strained, frustrating depression may last for four years or more after family members and friends, causing them to the loss and may reflect a long-standing mood further distance themselves from the grieving disorder rather than simple grief.2 person. Thus, the sufferer’s sense of isolation is perpetuated. In summary, resilience, chronic grief, depressed improved, and chronic depression are considered The most common features of complicated grief normal pathways or patterns of grief. Those who are yearning for the deceased and feeling upset by experience one of these four patterns of grief memories of the deceased. In a survey of nearly may experience mild functional difficulty, yet all 300 patients with complicated grief, researchers 3 identified the most common symptoms, in order Diagnostic and Statistical Manual (DSM) to of decreasing frequency:11 diagnose mental health conditions, diseases, • Yearning for the deceased (88% of those and syndromes. Currently, there is no entry for surveyed) complicated grief in the latest edition of the • Feeling upset by memories of the DSM, the DSM-5. deceased (82%) • Loneliness (81%) Complicated grief is called Persistent Complex • Feeling life is empty (80%) Bereavement Disorder in the DSM-5 and is • Disbelief (76%) discussed in appendix of the manual entitled • Inability to accept the death (70%) “Conditions for Further Study.”12 It is quite possible the next edition of the DSM will include Complicated Grief: Diagnosis full diagnostic criteria for this disorder, but the next update is not anticipated until at least 2025. Ordinarily, psychiatrists and psychologists in the Here is the description of Persistent Complex United States use diagnostic criteria laid out in Bereavement Disorder in the appendix of the the American Psychiatric Association’s DSM. Provisional DSM-5 Criteria for Persistent Complex Bereavement Disorder12 The individual experienced the death of someone with whom he or she had a close relationship. Since the death, at least 1 of the following symptoms is experienced on more days than not and to a clinically significant degree has persisted for at least 12 months after the death in the case of bereaved adults and 6 months for bereaved children: • Persistent yearning or longing for the deceased. In young children, yearning may expressed in play and behavior, including behaviors that reflect being separated from, and also reuniting with, a care-giver or other attachment figure. • Intense sorrow and emotional pain in response to the death. • Preoccupation with the deceased. • Preoccupation with the circumstances of the death. In children this preoccupation with the deceased may be expressed through the themes of play and behavior and may extend to preoccupation with possible death of others close to them. Since the death, at least 6 of the following symptoms are experienced on more days than not and to a clinically significant degree, and they have persisted for at least 12 months after the death in the case of bereaved adults and 6 months for bereaved children: • Reactive distress to death: • Marked difficulty accepting the death.
Load more

Recommended publications
  • Family and Caregiver Education BEREAVEMENT
    Family and Caregiver Education BEREAVEMENT Why do I feel guilty? Guilt often plays a part in normal grieving. It seems to surface as one “reviews” the sequence of events leading up to and including the death of a loved one. This review process is natural. In fact, it is part of the healing process. But as one reviews, alternative choices and responses become apparent in hindsight. That’s when guilt can rear its head. Actually, there have been nine types of guilt identified in relation to the grieving process: * Death Causation Guilt Can occur whether the person was actually directly responsible for the death, or not at all responsible. The perception of responsibility is the driving factor. Illness-Related Guilt Focuses on the time period prior to and including the illness of a person who has died. Examples include: not believing the person was ill, not noticing symptoms that led to the illness and the death, saying or doing something negative during the illness, being angry at the person for being ill, etc. Role Guilt A role is an expected set of behaviors. When a person we care about dies, guilt may emerge concerning, “what I should have done with, or for,” this person (in relation to our role as parent, spouse, etc.). If Only Guilt Stems from the belief that the bereaved survivor could have done something to change the course of the illness and/or death. Much of it falls into the category of Magical Thinking (doing something, or failing to do something, that any reasonable person would say had no relationship to the death; but nonetheless, the person feels responsible for the death in some way).
    [Show full text]
  • Tips for Survivors: COPING with GRIEF AFTER COMMUNITY VIOLENCE
    ∙ Tips for Survivors: COPING WITH GRIEF AFTER COMMUNITY VIOLENCE It is not uncommon for individuals and communities as year. It’s different for each person depending on his or her a whole to experience grief reactions and anger after an health, coping styles, culture, family supports, and other life incident of community violence. Grief is the normal response experiences. How long people grieve may also depend on the of sorrow, emotion, and confusion that comes from losing resilience of the community and the ability of its members to someone or something important to you. Most people will take on roles and responsibilities that will help restore the basic experience a natural occurrence of grief after the death of needs of the community, such as getting children back to a loved one, but grief and anger can be the result of other school and businesses back to working again. types of losses. In situations of community violence, people may experience the loss of their sense of safety, their trust Reactions to Community Violence in Children in those who live in their neighborhood, or their trust in local government. The trauma and grief of community violence Witnessing community violence and death can be traumatic can be experienced by all involved. experiences that cause negative mental health outcomes, particularly for children. Close relationships are important to This tip sheet contains information about some of the signs children’s development, and the loss of family or a community of grief and anger and provides useful information about member can represent the loss of social capital—the emotional how to cope with grief.
    [Show full text]
  • Empathy and Support Those Bereaved & Grieving
    INCREASE EMPATHY AND SUPPORT THOSE BEREAVED & GRIEVING “Empathy is a strange and powerful thing. There is no script. There is no right way or wrong way to do it. It’s simply listening, holding space, withholding judgement, emotionally connecting and communicating that incredibly healing message of ‘You’re not alone.’” Brene Brown Bereavement and grief can be challenging in ‘normal’ times. However, the current pandemic has exacerbated this with an increased loss of life together with restrictions around how we are able to grieve due to the social distancing and lockdown measures in place. Supporting someone who is grieving can feel uncomfortable and difficult for a number of reasons: Emotions are contagious When someone is feeling an emotion we experience a similar feeling in ourselves. Whilst this is largely unconscious, being a function of our mirror neurons, when we feel an emotion that is unpleasant such as anger, pain, sadness or depression, there is a tendency to try to ‘get rid’ of the emotion leading us to either suppress it or fix it. This can be expressed in a variety of ways: • Saying sentences that start with ‘at least’ for example ‘at least they had a good life’ or ‘at least you had a good relationship with them’ • Offering advice or suggestions such as ‘what would you like to do to make you happy?’ or ‘keep yourself busy to distract yourself’ • Offering different perspective such as ‘keep smiling, it could be worse’ or ‘they aren’t suffering any more’ Whilst these are well-intentioned with the aim of helping the other person, what this actually does is invalidate the emotion the person is feeling as well as not allowing them to interpret their feelings and come up with effective ways to process them.
    [Show full text]
  • About Emotions There Are 8 Primary Emotions. You Are Born with These
    About Emotions There are 8 primary emotions. You are born with these emotions wired into your brain. That wiring causes your body to react in certain ways and for you to have certain urges when the emotion arises. Here is a list of primary emotions: Eight Primary Emotions Anger: fury, outrage, wrath, irritability, hostility, resentment and violence. Sadness: grief, sorrow, gloom, melancholy, despair, loneliness, and depression. Fear: anxiety, apprehension, nervousness, dread, fright, and panic. Joy: enjoyment, happiness, relief, bliss, delight, pride, thrill, and ecstasy. Interest: acceptance, friendliness, trust, kindness, affection, love, and devotion. Surprise: shock, astonishment, amazement, astound, and wonder. Disgust: contempt, disdain, scorn, aversion, distaste, and revulsion. Shame: guilt, embarrassment, chagrin, remorse, regret, and contrition. All other emotions are made up by combining these basic 8 emotions. Sometimes we have secondary emotions, an emotional reaction to an emotion. We learn these. Some examples of these are: o Feeling shame when you get angry. o Feeling angry when you have a shame response (e.g., hurt feelings). o Feeling fear when you get angry (maybe you’ve been punished for anger). There are many more. These are NOT wired into our bodies and brains, but are learned from our families, our culture, and others. When you have a secondary emotion, the key is to figure out what the primary emotion, the feeling at the root of your reaction is, so that you can take an action that is most helpful. .
    [Show full text]
  • Acute Stress Disorder
    Trauma and Stress-Related Disorders: Developments for ICD-11 Andreas Maercker, MD PhD Professor of Psychopathology, University of Zurich and materials prepared and provided by Geoffrey Reed, PhD, WHO Department of Mental Health and Substance Abuse Connuing Medical Educaon Commercial Disclosure Requirement • I, Andreas Maercker, have the following commercial relaonships to disclose: – Aardorf Private Psychiatric Hospital, Switzerland, advisory board – Springer, book royales Members of the Working Group • Christopher Brewin (UK) Organizational representatives • Richard Bryant (AU) • Mark van Ommeren (WHO) • Marylene Cloitre (US) • Augusto E. Llosa (Médecins Sans Frontières) • Asma Humayun (PA) • Renato Olivero Souza (ICRC) • Lynne Myfanwy Jones (UK/KE) • Inka Weissbecker (Intern. Medical Corps) • Ashraf Kagee (ZA) • Andreas Maercker (chair) (CH) • Cecile Rousseau (CA) WHO scientists and consultant • Dayanandan Somasundaram (LK) • Geoffrey Reed • Yuriko Suzuki (JP) • Mark van Ommeren • Simon Wessely (UK) • Michael B. First WHO Constuencies 1. Member Countries – Required to report health stascs to WHO according to ICD – ICD categories used as basis for eligibility and payment of health care, social, and disability benefits and services 2. Health Workers – Mulple mental health professions – ICD must be useful for front-line providers of care in idenfying and treang mental disorders 3. Service Users – ‘Nothing about us without us!’ – Must provide opportunies for substanve, early, and connuing input ICD Revision Orienting Principles 1. Highest goal is to help WHO member countries reduce disease burden of mental and behavioural disorders: relevance of ICD to public health 2. Focus on clinical utility: facilitate identification and treatment by global front-line health workers 3. Must be undertaken in collaboration with stakeholders: countries, health professionals, service users/consumers and families 4.
    [Show full text]
  • Identifying and Managing Preparatory Grief Ad Depression at the End of Life
    END-OF-LIFE CARE Identifying and Managing Preparatory Grief and Depression at the End of Life VYJEYANTHI S. PERIYAKOIL, M.D., and JAMES HALLENBECK, M.D. Stanford University School of Medicine, Stanford, California Grief and depression present similarly in patients who are dying. Conventional symp- toms (e.g., frequent crying, weight loss, thoughts of death) used to assess for depres- O A patient infor- sion in these patients may be imprecise because these symptoms are also present in mation handout on dying and prepara- preparatory grief and as a part of the normal dying process. Preparatory grief is expe- tory grief, written by rienced by virtually all patients who are dying and can be facilitated with psychosocial the authors of this support and counseling. Ongoing pharmacotherapy is generally not beneficial and may article, is provided even be harmful to patients who are grieving. Evidence of disturbed self-esteem, hope- on page 897. lessness, an active desire to die and ruminative thoughts about death and suicide are indicative of depression in patients who are dying. Physicians should have a low thresh- old for treating depression in patients nearing the end of life because depression is associated with tremendous suffering and poor quality of life. (Am Fam Physician 2002;65:883-90,897-8. Copyright© 2002 American Academy of Family Physicians.) istinguishing between grief physiologic changes associated with dying. and depression in patients Survey instruments designed to detect depres- who are dying can be difficult. sion have not been well studied in patients Many of the signs and symp- who are dying and lack specificity because toms traditionally used to questions addressing somatic, functional and Ddiagnose depression are also present in affective criteria can generate false-positive patients who are grieving (Figure 1).Weight results.
    [Show full text]
  • Social-Emotional Development in the First Three Years Establishing the Foundations
    ISSUE BRIEF Social-Emotional Development in the First Three Years Establishing the Foundations This issue brief, created by The Pennsylvania State University with support from the Robert Wood Johnson Foundation, is one of a series of briefs that addresses the need for research, practice and policy on social and emotional learning (SEL). SEL is defined as the process through which children and adults acquire and effectively apply the knowledge, attitudes, and skills necessary to understand and manage emotions, set and achieve positive goals, feel and show empathy for others, establish and maintain positive relationships, and make responsible decisions. Learn more at www.rwjf.org/socialemotionallearning. 1 | The Pennsylvania State University © 2018 | April 2018 ISSUE BRIEF Executive Summary In the first three years of life, children achieve remarkable advances in social and emotional development (SED) that establish a foundation for later competencies. Yet even in the first three years, these achievements can be threatened by exposure to elevated stresses of many kinds. Family poverty, marital conflict, parental emotional problems, experiences of trauma, neglect, or abuse and other adversities cause some infants and toddlers to experience anxious fearfulness, overwhelming sadness, disorganized attachment, or serious problems managing behavior and impulses. Programs to strengthen early SED focus on at least two people—including the child and the caregiver—because the development of healthy early SED relies on positive, supportive relationships.
    [Show full text]
  • Social and Emotional Skills Well-Being, Connectedness and Success
    Social and Emotional Skills Well-being, connectedness and success ©OECD FOREWORD Contents Foreword Foreword 3 Education systems need to prepare students for continuous effort to create the kind of binding social their future, rather than for our past. In these times, capital through which we can share experiences, ideas Introduction 4 digitalisation is connecting people, cities and continents and innovation and build a shared understanding among to bring together a majority of the world’s population in groups with diverse experiences and interests, thus 01. Measuring Social and Emotional Skills 5 ways that vastly increases our individual and collective increasing our radius of trust to strangers and institutions. potential. But the same forces have made the world also 02. Social and emotional skills drive critical life outcomes 10 more volatile, more complex, and more uncertain. And Over the last years, social and emotional skills have when fast gets really fast, being slow to adapt makes been rising on the education policy agenda and in the 03. The impact of specific social and emotional skills on life outcomes 17 education systems really slow. The rolling processes of public debate. But for the majority of students, their automation, hollowing out jobs, particularly for routine development remains a matter of luck, depending on ○ Conscientiousness – getting things done, as required and in time 17 tasks, have radically altered the nature of work and life whether this is a priority for their teacher and their and thus the skills that are needed for success. For those school. A major barrier is the absence of reliable metrics ○ Openness to experience – exploring the world of things and ideas 20 with the right human capacities, this is liberating and in this field that allow educators and policy-makers to exciting.
    [Show full text]
  • Using Acceptance and Commitment Therapy to Negotiate Losses and Life Transitions
    Article 12 Using Acceptance and Commitment Therapy to Negotiate Losses and Life Transitions Stacy Speedlin, Kevin Milligan, Shane Haberstroh, and Thelma Duffey Speedlin, Stacy, Ph.D., LPC, LCDC, is an adjunct professor at the University of Texas at San Antonio. Milligan, Kevin, M.A., LPC is a doctoral student at the University of Texas at San Antonio. Haberstroh, Shane, Ed.D., LPC is an associate professor at the University of Texas at San Antonio. Duffey, Thelma, Ph.D., LPC is department chair and full professor at the University of Texas at San Antonio. Abstract In this article, we describe the application of acceptance and commitment therapy (ACT) on clients coping with grief and loss. As a theoretical approach to grief counseling, we examine how ACT’s six core processes can be applied. ACT’s philosophical foundation and six core processes work effectively within the context of the grief counseling session. We suggest ACT strategies for working with clients who have experienced loss. Keywords: grief, loss, counseling, strategies for grief counseling, acceptance and commitment therapy, ACT Loss is endemic to the human condition. Individuals experience loss during expected life transitions, while other times, they face multiple, unexpected losses that can leave them devastated and isolated (Horn, Crews, & Harrawood, 2013). Clients requesting grief counseling can present with a myriad of losses, including death, divorce, loss of a job, or loss of a child through separation. Others may seek counseling due to transitional losses like moving away from home, starting a new career, or questioning the very meaning of their life choices. A client may seek counseling for depression and may likely also reveal losses pertaining to lifestyle, hopes and aspirations.
    [Show full text]
  • Supporting Students Through Loss: an Empathic Programmatic Intervention
    West Chester University Digital Commons @ West Chester University West Chester University Master’s Theses Masters Theses and Doctoral Projects Spring 2020 Supporting Students Through Loss: An Empathic Programmatic Intervention Jack Horne jh826049@wcupa.edu Follow this and additional works at: https://digitalcommons.wcupa.edu/all_theses Recommended Citation Horne, Jack, "Supporting Students Through Loss: An Empathic Programmatic Intervention" (2020). West Chester University Master’s Theses. 114. https://digitalcommons.wcupa.edu/all_theses/114 This Thesis is brought to you for free and open access by the Masters Theses and Doctoral Projects at Digital Commons @ West Chester University. It has been accepted for inclusion in West Chester University Master’s Theses by an authorized administrator of Digital Commons @ West Chester University. For more information, please contact wcressler@wcupa.edu. A Thesis Presented to the Faculty of the Department of Educational Foundations and Policy Studies West Chester University West Chester, Pennsylvania In Partial Fulfillment of the Requirements for the Degree of Master of Science By Jack Horne May 2020 Dedication For my mom. I love you and miss you every single day. Acknowledgements Writing this thesis during a global pandemic was a herculean task and I have so many loved ones to thank for getting to this point. First, I would like to thank my dear friend Matheeha, who has been such an inspiration to me for her bravery, strength, and positive attitude. You’re the best! Unfortunately, I lack the space to list my entire cohort by name, but all of you have impacted my life in amazing ways, and I’m so thankful I got to spend the last two years with such wonderful people.
    [Show full text]
  • Group Interventions for Bereavement Following Traumatic Events
    GROUP INTERVENTIONS FOR TREATMENT OF PSYCHOLOGICAL TRAUMA MODULE 10: GROUP INTERVENTIONS FOR BEREAVEMENT FOLLOWING TRAUMATIC EVENTS By Maureen M. Underwood, LCSW, CGP Group Interventions for Treatment of Psychological Trauma Module 10: Group Interventions for Bereavement Following Traumatic Events ©2004 American Group Psychotherapy Association 287 ABOUT THE AUTHOR MAUREEN M. UNDERWOOD, L.C.S.W., CGP has over 30 years of experience in the field of loss and bereavement. She has extensive experience and publications in the area of crisis intervention with children related to death and trauma. She has published structured curricula in several areas related to loss and trauma in childhood, specifically parental illness and death, and suicide and is nationally recognized for her training programs on these subjects. She has provided support services to a variety of populations in the aftermath of the events of 9/11 including children, families, and first responders. Group Interventions for Treatment of Psychological Trauma Module 10: Group Interventions for Bereavement Following Traumatic Events ©2004 American Group Psychotherapy Association 288 I. INTRODUCTION Bereavement following any loss is challenging. While there is increasingly more information about the process of mourning and the tasks that are intrinsic to recovery (Worden, 1982), there is also more documentation about the myriad of problems on emotional, physical, economic and social levels that are often secondary to the process, even when it is considered to be uncomplicated (Osterweis, Solomon, & Green, 1984). When bereavement is complicated by any one of a number of factors, the possibility of an increasingly negative outcome is even greater (Raphael, 1993). Complicated bereavement is unfortunately not uncommon.
    [Show full text]
  • Treatment of Prolonged Grief Disorder in Combat Veterans NCT02283333
    Study Cover Page Official Study Title: Treatment of Prolonged Grief Disorder in Combat Veterans NCT02283333 Protocol date: August 4, 2014 Data Analytic Plan Baseline data were compared across groups using t-tests for continuous variables and chi- square tests for proportion variables to examine differences in demographic factors, pre- treatment symptom intensity (i.e., grief, depression, and PTSD), and co-variates that are particularly relevant to research with veterans (i.e., social support, time since death, and overall number of sessions completed). No differences in scores or proportionate representation were noted in terms of any demographic, baseline symptoms, or potential covariates. Next, repeated measures analysis of variance were conducted to determine the relative effectiveness of BATE-G vs. CT-G in terms of grief (i.e., ICG-R), depression (i.e., BDI-II) and PTSD (i.e., PCL-5) symptom outcomes. Although no covariation control (i.e., ANCOVA) was employed because covariates did not differ between groups. Baseline scores on primary dependent measures were included in the ANOVA model to test overall effects of time. The intent to treat (ITT) sample served as the primary analytic sample, and missing data were conservatively replaced through total sample mean substitution, which shares variance of missing data across groups and lessens likelihood of finding spuriously significant results. All analyses were repeated with the ‘per protocol’ sample, here defined as those who completed at least 5 of the 7 sessions specified in each treatment protocol. No differences in statistical significance were noted for any variable between ITT and per protocol samples, and thus the ITT sample data alone are reported.
    [Show full text]