The effectiveness of psychotherapeutic interventions for bereaved persons: a comprehensive quantitative review

Restorative Retelling for Violent Death: An Investigation of Treatment Effectiveness, Influencing Factors, and Durability

Many adults who have lost a loved one to violent death suffer from depression, posttraumatic stress disorder (PTSD), and complicated grief. Limited research has examined structured group interventions for violent death survivors or characteristics (e.g., types of loss, quality and type of relationship with the deceased) that may impact response to intervention. This records review of 91 survivors examined the effectiveness of Restorative Retelling (RR), a brief structured group intervention for violent loss survivors. Participants completed depression, PTSD, and complicated grief measures at pre- and post-treatment and at 1-year follow-up for a subset of participants. Findings revealed statistically significant changes in depression and PTSD symptoms (Cohen's d values ranged from .33-.46) at post-treatment, with significant changes observed across all domains at 1-year follow-up. Treatment response appeared to be influenced by high distress, gender, and relationship with the deceased. Results imply a large-scale randomized control trial to determine treatment efficacy.

The Grief and Meaning Reconstruction Inventory (GMRI): Initial Validation of a New Measure

Although increasing numbers of grief theorists, researchers, and therapists have begun to focus on the quest for meaning in lives disrupted by loss, no convenient and psychometrically validated measure of meanings made specifically in bereavement has been available to guide their efforts. To construct such a measure, the authors began with a systematic content analysis of sense-making, benefit finding, and identity reconstruction themes gleaned from the narrative responses of a sample of 162 adults who were diverse in their age, ethnicity, relationship to the decedent, cause of death, and severity of their grief response. These were then formulated into a set of 65 candidate items in a Likert scale format representing the level of the respondent's endorsement of the item in the past week. Subsequent administration to a second sample of 300 bereaved respondents permitted factor analysis of this pilot version of the Grief and Meaning Reconstruction Inventory (GMRI), and reduced the items to 29, which loaded on 5 distinct factors, labeled Continuing Bonds, Personal Growth, Sense of Peace, Emptiness and Meaninglessness, and Valuing Life. Both the overall GMRI and its constituent factors showed good internal consistency and strong convergent validity in the form of negative correlations with established measures of bereavement-related negative emotions, symptoms of complicated grief, and more general psychological distress and mental health symptomatology, and positive correlations with grief related personal growth. The authors close by noting several specific research and clinical applications of the measure, which could play a useful role in testing and refining contemporary models of meaning made in the wake of loss.

Evaluation of the CHUMS Child Bereavement Group: A Pilot Study Examining Statistical and Clinical Change

This article describes the largest evaluation of a UK child bereavement service to date. Change was assessed using conventional statistical tests as well as clinical significance methodology. Consistent with the fact that the intervention was offered on a universal, preventative basis, bereaved young people experienced a statistically significant, small to medium-sized decrease in symptoms over time. This change was equivalent across child age and gender. Type of bereavement had a slight impact on change when rated by parents. Potential clinical implications are highlighted, and various limitations are discussed that we hope to address using an experimental design in future research.

Randomised controlled trial of a cognitive narrative intervention for complicated grief in widowhood

OBJECTIVE

The implementation of bereavement interventions is frequently requested, and its effectiveness has been controversial. The aim of this study is to evaluate the effectiveness of a cognitive narrative intervention for complicated grief (CG) for controlling post-traumatic and depressive issues.

METHOD

The study is a randomised controlled trial and uses the Socio Demographic Questionnaire (SDQ), the Inventory of Complicated Grief (ICG), the Beck Depression Inventory (BDI) and the Impact of Events Scale-Revised (IES-R). There were three phases in the study: (1) The SDQ and CG evaluations were applied to bereaved elders (n = 82). The bereaved elders with the 40 highest ICG values (≥25) were randomly allocated into two groups: the intervention group (n = 20) and control group (n = 20); (2) participants were evaluated using the BDI and IES-R and the IG gave informed consent to participate in an intervention with four weekly 60-min sessions addressing recall, emotional and cognitive subjectivation, metaphorisation and projecting. (3) Two months later, the ICG, BDI and IES-R assessments were repeated.

RESULTS

Outcome measures showed a statistically significant reduction of CG, depressive and traumatic symptoms compared to the controls. Very high effect sizes for the ICG, BDI and IES-R reflect the effectiveness of the intervention along the longitudinal profile.

CONCLUSIONS

These results reinforce the importance of brief interventions that combine a reduced number of sessions with lower costs, which is reflected in an increased adherence to the programme along with high effectiveness.

Bridging the gaps in palliative care bereavement support: an international perspective

A review of palliative care policies and bereavement support practices in the United States, Canada, United Kingdom, Australia, and Japan demonstrated 4 challenges: questions over providing universal versus targeted support; a lack of clear evidence driving service delivery; informal or no risk assessment; and limited or no evaluation of services. Bridging the gaps between the policy and practice of palliative care bereavement support requires acknowledging the challenges of medical and public health models, improving bereavement need assessment processes, enhancing the role of primary care providers, and extending research to provide an evidence-base for interventions.

Coping processes among bereaved spouses

The authors investigated if an intervention based on the dual process model (vs. traditional bereavement support) enhanced oscillation between loss- (LO) and restoration-oriented (RO) coping of recently bereaved (2-6 months) spouses/partners. Participants were followed over 12 months. The authors found an increased emphasis over time on RO coping, particularly for women and those who were younger; however, no treatment effect was detected. Although patterns in the data are consistent with the model, the authors conclude that it is difficult for interventions to modify LO, RO, and oscillation unless there is sufficient intervention dosage and tailored to those exclusively engaged in one process.

Family Bereavement Program (FBP) Approach to Promoting Resilience Following the Death of a Parent

This paper describes a research-based program designed to promote resilience of parentally-bereaved children and their bereaved surviving parent. A contextual resilience model is described as the conceptual foundation of the program. The program is designed to enhance specific parenting and coping skills and to help caregivers and children accomplish goals they set for themselves at the outset of the program. The content of the twelve-sessions and the approach to teaching and supporting parents work on their program and personal goals are described. Evaluation of the program using a randomized experimental design indicates that the program is effective in promoting resilient outcomes of children and of the bereaved parent six-years following their participation in the program.

Effectiveness of "primary bereavement care" for widows: a cluster randomized controlled trial involving family physicians

Thirty-one family physicians, from 19 primary care teams in Biscay (Spain), were randomly assigned to intervention or control group. The 75 intervention family physicians, after training in primary bereavement care, saw 43 widows for 7 sessions, from the 4th to 13th month after their loss. The 16 control family physicians, without primary bereavement care training, saw 44 widows for 7 ordinary appointments, with the same schedule. Outcome measures were collected at 4, 10, 16, and 24 months after the loss. A linear mixed model was used. No significant differences were found in favor of the intervention group on grief and indeed control group widows experienced more improvement in somatisation, general health, and general emotional outcomes.