From the Guidelines
Grief treatment involves a combination of therapy, support, and sometimes medication, with psychotherapy such as cognitive behavioral therapy (CBT) or complicated grief therapy (CGT) being the primary treatment, as supported by the most recent and highest quality study 1. For most people experiencing normal grief, psychotherapy is typically involving 12-16 weekly sessions. Support groups can also be beneficial, providing connection with others experiencing similar losses. While medication isn't routinely prescribed for normal grief, if depression develops, antidepressants may be considered. Common options include SSRIs like sertraline (50-200mg daily) or fluoxetine (20-80mg daily), typically for 6-12 months. Self-care strategies are essential during grief, including:
- Maintaining regular sleep patterns
- Eating nutritious meals
- Engaging in light exercise
- Practicing mindfulness or relaxation techniques It's essential to understand that grief is a natural response to loss with no fixed timeline, but if symptoms are severe, persistent beyond 6-12 months, include suicidal thoughts, or significantly impair functioning, professional help should be sought immediately, as emphasized in 2. Treatment works by helping process emotions, develop coping strategies, and gradually adapt to life after loss while honoring the memory of what was lost. In the context of the COVID-19 pandemic, experiences of grief and anticipatory grief are subject to change, which stimulates the need for adapting usual approaches to grief support, as discussed in 3. Nursing staff may advocate for accessing and sharing tools and resources that are needed to mitigate (complicated) grief of families, and to help nursing staff cope with their own grief, as recommended in 1. Ultimately, humane and empathetic provision of palliative care including grief and bereavement support should prevail, even in times of the COVID-19 pandemic, as highlighted in 3.
From the Research
Treatment Options for Bereavement (Grief)
The treatment options for bereavement, also known as grief, can vary depending on the individual's needs and the severity of their grief symptoms. Some of the treatment options include:
- Cognitive-behavioral therapy (CBT) 4, 5, 6, 7
- Complicated grief therapy (CGT) 8
- Supportive counseling 4
- Bereavement and support groups 5
- Brief contact interventions (BCIs) 5
- Cognitive therapy for PTSD (CT-PTSD) 6
Effectiveness of Treatment Options
Research has shown that CBT and CGT can be effective in reducing grief symptoms and improving mental health outcomes 8, 4, 5, 6, 7. However, more research is needed to determine the most effective treatment approaches and to identify the individuals who are most likely to benefit from each treatment.
Considerations for Treatment
When providing treatment for bereavement, it is essential to consider the individual's unique needs and circumstances. This may include:
- The severity of their grief symptoms
- Their personal coping style and strengths
- Their social support network
- Any underlying mental health conditions
- The nature of their relationship with the deceased
- The circumstances of the death
Therapeutic Approaches
Therapeutic approaches for bereavement may involve:
- Recognizing and accepting the individual's grief
- Eliciting and compassionately listening to their narratives of their relationship with the deceased and the death
- Regularly "checking in" regarding their grief experiences
- Helping the individual accept and cope with the loss
- Assisting them with adaptation to life without the deceased
- Implementing CGT's seven core themes, including understanding and accepting grief, managing painful emotions, and establishing an enduring connection with memories of the person who died 8