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When grief won't let you move on with your life

Strategies that treat post-traumatic stress disorder may ease the pain, researchers find.

June 06, 2005|Marianne Szegedy-Maszak | Special to The Times

After her 19-year-old daughter's tragic death, Heather Chatterjee frightened herself by wondering how her remaining two children would cope if she too died. Despite dutiful weekly visits to a therapist, Chatterjee suffered from an immobilizing grief that consumed her days. And unbidden thoughts were making matters even worse.

"I was thinking horrible things that I shouldn't have been thinking," says Chatterjee, 42, of Pittsburgh. "I thought, 'Heather, you have to knock this off, you have to do something,' because I was feeling so horrible."

But what? Her visits to the therapist only seemed to reinforce her anguish, rather than help to relieve it. What made it impossible for her to simply mourn and carry on with life like she had done when she lost a loved one before?

Helen Chatterjee is one of the more than 1 million Americans every year whose grief becomes complicated, or traumatic, or pathological. Every year approximately 2.5 million people die in the United States, leaving behind, on average, five bereaved friends and family members. Although profound sadness is inevitable with the loss of a loved one, for most people life resumes its normal pace after a few weeks, or months.

Those like Chatterjee cannot cope even six months after the loss. Some suffer for decades. They are unable to shake a sense of disbelief over the death; they continue to be angry or bitter and long for the deceased. Many are preoccupied with intrusive thoughts about the loved one and the circumstances of the death.

"Grief still occupies the center stage in these people's lives," says Katherine Shear, a professor of psychiatry and director of the bereavement and grief program at the University of Pittsburg Medical School. "Most of what they are thinking is related to the person dying. They fear that if they let go of these recurrent thoughts, they will lose the person forever."

Medical treatments for this kind of grief have generally not been successful. In one analysis of grief treatments, 38% of those who were in grief counseling grew worse.

But a study led by Shear, whose results were published last week in the Journal of the American Medical Assn., suggests that there may be a promising new treatment for those who suffer from this debilitating condition, a treatment that may offer a quicker and more effective way of taking the complication out of grief.

Though this is only one study, future studies are planned to see if the originality of the approach, and the generally positive results, may in fact provide new hope for these patients.

Shear realized that although depression is often a part of this condition, the intrusive thoughts, avoidant behavior, and pervasive anxiety that these people experience are similar to symptoms experience by people with post-traumatic stress disorder (PTSD). Perhaps some of the treatment strategies used for PTSD could be adapted to help those suffering from complicated grief.

After consulting with specialists in the treatment of PTSD, Shear and her colleagues devised a new program that integrated some of these treatment methods into a regimen for complicated grief. Desensitization to the traumatic event has been shown to be particularly effective in treating people with PTSD. One way of treating trauma victims is to record a description of the event, so that they can listen to it over and again.

In 2001, Shear began a study involving 95 patients, predominantly women, ages 18 to 85. Of those who received the experimental therapy, 51% of the participants recovered, contrasted with only 28% who received standard interpersonal psychotherapy. Some participants dropped out of the program, finding the process too painful.

Richard Glass, a psychiatrist at the University of Chicago, called the results of the study "disappointing" in an editorial that accompanied the JAMA article. However, other scientists saw promise in the results.

Sidney Zisook, a professor of psychiatry at the UC San Diego School of Medicine, said the results were impressive when put into context. The group of people who have been suffering intensely is a distinct population that has not responded to a number of therapies, including drug treatment, he said. Given these odds, Zisook calls the study results "very impressive. It's not perfect, but this is a real breakthrough study."

Chatterjee and others who were in the experimental group met with therapists once a week for about four months. In early sessions, Chatterjee described in painful detail the day her daughter, who suffered from bipolar disorder, fell out of a second-story window and died.

As she spoke, the therapist gently questioned her, leading her through the trauma. The sessions were taped, and Chatterjee's "homework" was to listen to the tapes, gradually becoming more desensitized to the painful memories. Another tape was an imaginary conversation with her daughter, in which she articulated her sadness, her anger and her love.

After each session the therapist encouraged Chatterjee to do something for herself, to think of a plan for the rest of the day that was positive. The technique was intended to create an association in her mind between working through the pain and doing something affirmative.

"It was really a gradual process," says Chatterjee. "It just brought me back to life, a little bit at a time."

Grief is resolved, the researchers say, if attention to loss and attention to a new and positive future more or less proceed in concert.

"We describe this as clearing the river of branches so that it can just flow," she said. "We think that the natural form of grief, years after someone dies, is not that it is absent, but that it is integrated into your life."

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