From the Guidelines
The treatment of Cynthia's grief reaction should focus on supportive psychotherapy combined with possible short-term medication if symptoms are severe. Initially, I recommend a combination of individual counseling sessions with a therapist experienced in grief counseling, meeting weekly for at least 8-12 weeks. Cognitive-behavioral therapy (CBT) or interpersonal therapy can be particularly effective for processing grief, as supported by recent guidelines 1. If Cynthia is experiencing significant insomnia, short-term use of a non-benzodiazepine sleep aid like zolpidem 5mg at bedtime for 2-4 weeks may be appropriate. For severe anxiety symptoms, a short course of an SSRI such as sertraline starting at 25mg daily and increasing to 50mg daily after one week might be beneficial, continuing for 6-12 months with gradual tapering, as suggested by studies on anxiety management in patients with cancer 1. Support groups specific to her type of loss can provide additional comfort and normalization of her grief experience. Physical activity (30 minutes daily), maintaining social connections, and establishing healthy sleep routines are important complementary approaches. The goal is to help Cynthia process her grief rather than suppress it, as grief is a natural response to loss that requires emotional processing for healthy adaptation. Medication should be viewed as an adjunct to therapy rather than the primary treatment unless symptoms are significantly impairing functioning. It's also essential to recognize the potential for complicated grief and to provide referrals to psychosocial team members when appropriate, as recommended by the American Society of Clinical Oncology consensus guideline 1. Additionally, acknowledging the complexity of grief and bereavement, especially in the context of the COVID-19 pandemic, and addressing anticipatory grief, preparing families for bereavement, and helping families come to terms with their loss are crucial aspects of palliative care 1.
From the Research
Treatment Options for Complicated Grief (CG)
The treatment for Complicated Grief (CG) can involve various approaches, including:
- Pharmacological interventions:
- Tricyclic antidepressants may be effective in treating CG, although they may be more efficacious for depressive symptoms than for grief-specific symptoms 2
- Selective serotonin reuptake inhibitors (SSRIs) have shown preliminary support for being effective in the treatment of CG, both as a standalone treatment and in conjunction with psychotherapeutic interventions 2
- Psychotherapies:
- Behavioral therapy, third-wave cognitive behavior therapy, family therapy, psychodynamic therapy, and cognitive therapy have been found to be statistically effective in reducing grief symptoms 3
- Cognitive behavior therapy (CBT) has been found to have the highest acceptability and may be more beneficial for reducing secondary outcomes such as depression, PTSD, and anxiety 3
- Specific treatment manuals:
- An integrative cognitive behavioral treatment manual for complicated grief disorder (CG-CBT) has been described, which involves 25 individual sessions and three treatment phases 4
Key Considerations
- It is essential to differentiate between normal grief reactions and complicated grief, as well as other psychiatric diagnoses such as depression and PTSD 5, 6, 4
- A proper therapeutic milieu and rehabilitation approach can be crucial in managing grief and promoting self-worth 5
- High-quality trials are needed to provide more robust evidence for the effectiveness of different treatment approaches for CG 3