Complicated Grief Treatment

What’s the difference between normal and complicated grief? Read on to see how to treat complicated grief and see additional resources, including grief support groups and self-help techniques.

Grief is the natural process of coming to terms with a loss. In the early stages of grief, people often experience shock or denial. Then the loss starts to sink in, and they begin to mourn. As they mourn, people process emotions and adjust to the way the loss has changed their lives. The final phase of grief is finding a way to retain a connection with the person they have lost while reclaiming joy and meaning in their lives.

Support groups for the bereaved exist in many communities and can be an essential grief recovery resource for people who do not pursue formal grief treatment. Talking to others who have been through the same experience is all some people need to heal from grief. When people do seek professional support, the grief treatment plan a counselor develops with them often uses a process model of grief to help them identify grief-related tasks they need to complete.

In some cases, people struggle to move on from the acute phase of grief. The unresolved loss continues to affect how they feel, their physical health and even what they believe about the world. Prolonged grief can develop into complicated grief disorder, a mental health condition that resembles major depressive disorder and shares many of its risks, including suicide.

Complicated grief treatment can help. Traditional forms of therapy, like cognitive-behavioral and interpersonal therapy, can successfully treat complicated grief by assisting people to shift their thinking and process their emotions. Some clinicians offer complicated grief disorder treatment that directly targets symptoms of emotional numbing, avoidance and hopelessness.

Grief Counseling

The primary form of treatment for grief is grief counseling or grief therapy. Though they are sometimes used interchangeably, these terms may refer to different interventions. Counseling is a broader term that can include advice-giving and pastoral care, while therapy is more likely to refer to the provision of psychotherapy (talk therapy) according to a specific therapeutic method.

In cases of normal grief, any form of counseling or therapy can provide the empathetic support and guidance a person needs to help them move through the grieving process. Grief treatment plans often assign different tasks to different stages. These tasks can include working through denial, releasing guilt or blame, processing feelings and adjusting to secondary losses.

Training in formal psychotherapeutic methods is usually required for a therapist to provide effective treatment for complicated grief. Psychotherapy for grief may focus on trauma, cumulative grief or other factors that can cause prolonged or chronic grief reactions.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a popular evidence-based therapeutic method for treating depression, anxiety, substance use disorders and many other mental health conditions. A CBT approach is based on the theory that thinking drives emotion and behavior, and that it is easier to change a person’s thinking than to change ingrained emotional patterns or behavior directly. By helping people identify and challenge their irrational or destructive beliefs, CBT can also reduce the emotional pain and reactive behavior that these thoughts cause.

Cognitive behavioral therapy for grief helps people challenge thoughts about a loss that causes them pain. For example, if a person believes they will never feel happy again, a counselor can help them explore whether that is something they can know and if the opposite might be true.

For people with complicated grief, CBT often focuses on four goals:

1. Integrating the loss into autobiographical memory
2. Challenging negative generalizations about people and life
3. Providing alternatives to anxious or depressive avoidance strategies
4. Addressing misinterpretations of grief reactions and false beliefs about loss

In cognitive behavioral therapy for complicated grief, people learn about the grief process, challenge hopeless thoughts and practice healthy coping skills. Another goal of CBT for grief is helping people find meaning by developing narratives that integrate the loss. Ruminating on thoughts of blame can trigger feelings of guilt or anger; developing a narrative about the loss that does not assign blame can alleviate these negative feelings.

Complicated Grief Therapy

Complicated grief therapy (CGT) is a manual-based therapeutic method for treating prolonged grief disorder. It is based on ideas from attachment theory, interpersonal therapy, CBT and exposure therapy. It incorporates the following techniques:

• Recalling, visualizing and emotionally reprocessing loss-related events
• Maintaining a grief monitoring diary to track grief reactions and triggers
• Exploring personal aspirations that can reawaken joy and meaning

People experiencing complicated grief often avoid anything that reminds them of the loss, making it hard for them to express or resolve their feelings. Frequently, CGT guides a person through progressive exposure to bereavement cues and helps them process the feelings they previously avoided.

Studies show that people who receive CGT have better therapeutic outcomes than people who receive other interventions for complicated grief. People who receive CGT experience more significant improvements in functioning at work and home and reduced symptoms of complicated grief like sadness, guilt and social avoidance.

Medications for Grief

There is no formal medication for grief. Most clinicians will not prescribe medication to someone merely because they are grieving. However, since grief shares symptoms with depression, antidepressants are occasionally prescribed to people who are having acute or prolonged grief reactions. These medications are usually prescribed in conjunction with therapy. Sometimes, benzodiazepines are prescribed to address grief-related anxiety or insomnia.

Antidepressants

Research on prescribing antidepressants for grief shows that selective serotonin reuptake inhibitors like citalopram can enhance complicated grief treatment and improve depressive symptoms in people with prolonged grief disorder. People who have an existing depressive disorder at the time of a loss can also benefit from antidepressant therapy.

Benzodiazepines

Some physicians prescribe benzodiazepines for grief when people struggle with prolonged anxiety and restlessness at night after a loss. However, research suggests that benzodiazepines do not have much of an impact on grief-related symptoms and many clinicians believe the risk of benzodiazepine dependence outweighs the benefit of using them to treat grief-related anxiety or insomnia.

Additional Grief Management Techniques

Therapy and other mental health interventions are essential for people with complicated grief disorder. For people with normal grief, a do-it-yourself approach to grief management can be enough. The following techniques can help people recover from grief.

• Seeking support: Support can come in many forms. Some people are more comfortable talking about their grief with loved ones, while others may prefer going to a local grief support group.
• Exploring memories and emotions: In addition to talking about loss and the feelings it provokes, other grief management techniques that can help people process grief include writing in a journal or reminiscing while listening to music.
• Practicing self-care: General self-care is essential for people who are grieving. Eating healthy meals, exercising and getting adequate sleep can help people maintain the strength and clarity to cope with acute grief.
• Building something: Engaging in creative practices or constructive hobbies can distract from painful feelings. It can also help people actively process emotions and memorialize the person who has died.
• Taking action: Doing charitable work or participating in activities that were meaningful to the person who has died can foster a sense of connection with them and help the bereaved person.

One of the most crucial grief management techniques is anticipating grief-related triggers and planning for birthdays, anniversaries and holidays that trigger memories and feelings of loss. Ways to cope with these triggers include talking to others in the days leading up to the occasion and holding a memorial ceremony, observance or ritual on that day.

How to Help a Grieving Loved One

Many people aren’t sure how to help someone who is grieving. They struggle to find something to say that will reassure the bereaved and make them feel better. These well-meaning gestures can backfire. Many common platitudes like, “At least they’re in a better place,” can inadvertently hurt or offend people who are grieving.

People trying to figure out how to help someone cope with grief don’t need to say anything at all. Sometimes the best way to help someone who is grieving is to listen to them without trying to make them feel better. Grieving people often struggle with intense emotions that make other people uncomfortable. They may receive subtle messages from others that they should not feel the way they do or that they should temper their expressions of grief. Simply providing a space in which a grieving person can openly express their emotions can be profoundly healing.

The dual-process model of grief further illuminates how to help a loved one who is grieving. According to this theory, people don’t just need help with the emotional aspects of loss. After the death of a loved one, people also have to adjust to secondary losses like changes in their identity and financial circumstances. These adjustments can be overwhelming. In the acute phase of grief, even everyday activities like cooking and cleaning can be unmanageable. Offering to help people with these activities can make a huge difference for them.

Grief Support Groups

Many hospices run local grief support groups that they open to the public for free. These groups provide a safe space where people can talk about topics that might be hard to share with family members or friends. Participating in these groups can help people feel understood and alleviate feelings of loneliness and isolation.

Doing an online search for “grief support groups near me” can help people find local grief support listings and links to online grief support groups and message boards. The following websites provide local grief support group search tools:

• GriefShare’s Group Locator
• Grief.com’s Support Group Directory
• Psychology Today’s Support Group Finder

People who have suffered specific kinds of loss and want to talk to others who have gone through the same thing can find specialized support groups for people who have lost a loved one to suicide, homicide, substance use or other traumatic events.

Grief Hotlines

Sometimes, people feel too vulnerable to talk to a loved one or don’t feel comfortable sharing certain thoughts with peers in a support group. Other people may use these resources during the day but become overwhelmed by sudden, intense feelings late at night when everyone they know is asleep. On such occasions, people can benefit from calling a grief hotline or grief helpline. The grief recovery helpline run by the Grief Recovery Institute can be reached at 1-800-445-4808. Local listings or online searches may show that local grief hotlines and helplines are available. The Grief Recovery Institute also offers online one-on-one grief counseling.

Treating Grief and Co-Occurring Substance Abuse

When people use substances to cope with grief, they are at risk of developing substance use disorders and prolonged grief reactions. While substance use can provide temporary relief from overwhelming emotions, chronic use worsens anxiety, depression and other negative psychological states by affecting levels of dopamine, serotonin and other brain chemicals.

Co-occurring grief and substance abuse can prolong grief by blocking or distorting the memories and emotions people need to process to come to terms with a loss. Emotional avoidance can be both a symptom and a causeof complicated grief. Using substances can sustain this cycle of avoidance and keep people stuck in chronic grief.

Traditional approaches to substance abuse treatment required people to treat a substance use disorder first and maintain abstinence from use for some time before addressing grief or other deep emotional issues. Since then, research has revealed that it is more effective to address co-occurring conditions at the same time, including complicated grief.

In integrated treatment programs, people can participate in treatment groups for substance use disorders while receiving individual therapy for complicated grief. This combination therapy allows them to address cravings to use substances at the same time they are processing and learning how to cope with emotions and memories no longer blocked by substance use.

Goals of Grief Treatment

Treatment goals for grief therapy vary depending on the model of grief and the therapeutic method a therapist uses. Some therapists emphasize personal narratives and the search for meaning, while others focus on facilitating emotional expression. Short-term treatment plan goals for grief and loss often reflect these different approaches, while long-term goals are usually similar regardless of therapeutic approach.

The model of grief developed by Harvard psychology professor J. William Worden lists four tasks of mourning that encompass these shared long-term goals:

1. Accept the reality of a loss
2. Work through the emotional pain of grief
3. Adjust to life without the person who has died
4. Retain a connection with that person while building a new life

Therapists who use Elizabeth Kubler-Ross’s five stages of grief may describe long-term goals as moving from denial to acceptance, while those who use the dual process model may list processing emotions and adjusting to secondary losses as goals. These point to the same themes of recovery as Worden’s four tasks. Ultimately, the goal of grief treatment is not to get over grief or stop feeling the ache of loss, but to integrate that ache into a new vision of life.

Grief can be one of life’s most painful experiences. Trying to cope with grief while using substances can prolong this pain. If you are struggling with a substance use disorder and unresolved grief, there is help. The Recovery Village operates facilities across the United States that provide integrated treatment options for people with substance use disorders and co-occurring conditions. Contact The Recovery Village to learn more about how treatment can help you heal.

Editor – Camille Renzoni

Cami Renzoni is a creative writer and editor for The Recovery Village. As an advocate for behavioral health, Cami is certified in mental health first aid and encourages people who face substance use disorders to ask for the help they deserve. Read more

Medically Reviewed By – Stephanie Hairston, MSW

Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more