Complicated grief: implications for the treatment of post-traumatic stress disorder in couples

Abstract

Complicated grief has many interfaces with post-traumatic stress disorder (PTSD) including avoidance, flashbacks and shattered assumptions. Increasing use of cognitive behavioural therapy (CBT) models in grief work are drawing on lessons learned in PTSD treatment. However, models used in grief work, such as attachment, the Dual Process Model (Stroebe & Schut, 1999) and Psychosocial Transition Theory (Parkes, 1993), are less commonly applied to understanding and treating PTSD. This paper gives an overview of how these theories explain complicated grief and PTSD and considers implications they have on treatment of couples, based on literature review and clinical experience. Treatment implications include treating PTSD before traumatic grief, working with intra-couple coping style differences, promoting acceptance and forgiveness and taking a full attachment history.

The Temporal Relationship Between Change in Symptoms of Prolonged Grief and Posttraumatic Stress Following Old Age Spousal Bereavement

“…), and the potential mediating role of PGS in the relationship between time and PTS (see Fig. ), using lower level mediation that is a statistical technique that facilitates the investigation of change in variables across time (representing Level 1 of the analysis), nested within participants (representing Level 2 of the analysis) . This statistical technique is flexible and powerful, as it allows the number of observations to vary between participants, and effectively handles missing data .…”

“…In a study of traumatic adult bereavement, a substantial proportion of bereaved adults with PGS did not present with PTS, whereas most participants with high levels of PTS also presented with PGS . The mixed results have contributed to different opinions about optimal approaches to treating these conditions, with some prioritizing PTS, whereas others suggest first focusing on PGS . A significant limitation of studies to date is the reliance on cross‐sectional designs, which preclude the establishing of temporal precedence of the disorders.…”

Memoria traumática: estrategias de afrontamiento adaptativas e inadaptativas

“…Perdonar puede ser la única posibilidad que posee el ser humano para reelaborar cognitiva y emocionalmente un pasado objetivamente inmodificable. El perdón es una estrategia de afrontamiento relacionada con la salud mental y el bienestar (Davis et al, 2016;Toussaint, Shield & Slavich, 2016), que, entre otros aspectos, posibilita la reducción de los síntomas del trastorno de estrés postraumático (Swan & Scott, 2009). La fuerza del perdón permite a la persona romper con la irreversibilidad de lo ya sucedido y proyectarla hacia el futuro (Beristáin, 2004).…”

Working with teens through grief and loss: a resource manual

“…Bowlby' s Attachment and Loss (1969) outlined the manner in which patterns of grieving are influenced, positively and negatively by the experiences one has in his or her family of origin. Since his original research, numerous others have continued to explore how origins of attachment are linked to the consequences of separation (Archer, 1999;Jeffreys, 2005 ;Parkes 1985 ;Stroebe, 2002;Swan & Scott 2009). Youth who have secure attachments are able to develop close relationships with others, express their thoughts, feelings and needs openly and feel valued and self worthy (Swan & Scott, 2009).…”

“…Since his original research, numerous others have continued to explore how origins of attachment are linked to the consequences of separation (Archer, 1999;Jeffreys, 2005 ;Parkes 1985 ;Stroebe, 2002;Swan & Scott 2009). Youth who have secure attachments are able to develop close relationships with others, express their thoughts, feelings and needs openly and feel valued and self worthy (Swan & Scott, 2009). Consequently, youth whose parents are emotionally or physically unavailable, intrusive, or abusive may develop insecure attachments.…”