New treatment for extreme grief.

Severe grief may be a unique mental disorder, according to a new psychiatric study. People who exhibit prolonged, debilitating grief after a loved one's death often improve markedly upon receiving a novel type of psychotherapy that focuses on finding ways to adjust to the loss, says a team led by psychiatrist Katherine Shear of the University of Pittsburgh School of Medicine.

Current psychiatric diagnoses don't include what these investigators refer to as complicated grief. In Shear's view, this condition becomes apparent 6 months or more after the death of a loved one. Symptoms consist of disbelief regarding the death, anger and bitterness over the death, intense yearning for the deceased, and intrusive thoughts about how the loved one died.

The researchers developed a form of psychotherapy for complicated grief that calls for repeatedly confronting one's negative reactions to a loss as well as identifying and working toward personal goals. This treatment offers better, faster help for complicated grief symptoms than does a standard form of psychotherapy that targets grief-related depression and social problems, Shear and her coworkers report in the June 1 Journal of the American Medical Association.

The investigators randomly assigned 95 adults with complicated grief symptoms to one or the other of the two treatments. After 16 sessions, half of the patients receiving the new treatment showed substantial improvement, compared with only one-quarter of those getting standard psychotherapy. Signs of improvement, such as articulating new goals, typically appeared after four sessions of the new treatment and after eight sessions of standard psychotherapy.--B.B.