Moving forward with the loss of a loved one: treating PTSD following traumatic bereavement with cognitive therapy

Abstract

Traumatic loss is associated with high rates of post-traumatic stress disorder (PTSD) and appears to inhibit the natural process of grieving, meaning that patients who develop PTSD after loss trauma are also at risk of experiencing enduring grief. Here we present how to treat PTSD arising from traumatic bereavement with cognitive therapy (CT-PTSD; Ehlers et al., 2005). The paper describes the core components of CT-PTSD for bereavement trauma with illustrative examples, and clarifies how the therapy differs from treating PTSD associated with trauma where there is no loss of a significant other. A core aim of the treatment is to help the patient to shift their focus from loss to what has not been lost, from a focus on their loved one being gone to considering how they may take their loved one forward in an abstract, meaningful way to achieve a sense of continuity in the present with what has been lost in the past. This is often achieved with imagery transformation, a significant component of the memory updating procedure in CT-PTSD for bereavement trauma. We also consider how to approach complexities, such as suicide trauma, loss of a loved one in a conflicted relationship, pregnancy loss and loss of life caused by the patient. Key learning aims (1) To be able to apply Ehlers and Clark’s (2000) cognitive model to PTSD arising from bereavement trauma. (2) To recognise how the core treatment components differ for PTSD associated with traumatic bereavement than for PTSD linked to trauma where there is no loss of life. (3) To discover how to conduct imagery transformation for the memory updating procedure in CT-PTSD for loss trauma.

Living with loss: a cognitive approach to prolonged grief disorder – incorporating complicated, enduring and traumatic grief

“…Social and inter-personal considerations Neimeyer and colleagues (2000) posit that the experience of grief is an active process that is personal and inherently social in nature. The social context (Bonanno and Kaltman, 1999;Walter, 1999), cultural factors (Klass and Chow, 2011), and human values (Maercker et al, 2009) can influence how an individual psychologically and emotionally processes loss. Dyregrov et al (2003) highlighted that psychosocial problems, such a self-isolation, are associated with postloss mental health problems.…”

Cognitive therapy for PTSD following birth trauma and baby loss: clinical considerations

“…When parents are struggling with the loss of a child, it can help to think about how they can take the baby forward with them through imagery, a personal value, behaviour or activity (see Wild et al ., 2023). Samira described her pregnancy as her ‘ray of sunshine’.…”

“…of baby looking calm, not suffering and at peace now) can be helpful to update these distressing hotspots (see below). See Wild et al (2023) for a detailed description of how to transform images of loss.…”

CBT 50 years on: a celebration of empirically grounded and evidence-based psychological therapy

“…Similarly, tCBT also published special issue papers in areas such as adapting CBT for those with intellectual disabilities (Dagnan et al ., 2023), working with PTSD following traumatic bereavement (Wild et al ., 2023), involving loved ones in the treatment of OCD to maximise treatment benefit (Philpot et al ., 2022), the examination of common misconceptions around CT-PTSD (Murray et al ., 2022), a new take on Beckian CBT for GAD (Gústavsson et al ., 2022), a single case design report looking at difficult-to-treat depression (Barton et al ., 2022), a summary of tCBT papers on working with older adults (Charlesworth, 2022), an examination of the experience of CBTp trainees (Newman-Taylor et al ., 2022) plus a significant new paper clarifying the role of persistent negative self-evaluation in social anxiety from the Oxford group (Warnock-Parkes et al ., 2022).…”