This application requests funding for a 5 year study of a treatment for """"""""traumatic grief."""""""" Over 16 million people are bereaved each year in the United States. For a substantial minority, grief is chronic, debilitating, and complicated by psychiatric or medical problems. In these cases, intervention is clearly indicated, yet there is little information about how best to treat such individuals. The field has been slow to develop criteria for abnormal grief reactions, and lack of such criteria has impeded development and testing of treatments. With the aid of a new instrument, the Inventory of Complicated Grief (ICG), we can now reliably identify a syndrome currently designated """"""""traumatic grief."""""""" Found in 20% of bereaved persons, traumatic grief is associated with significant long-term morbidity. Symptoms of traumatic grief are distinct from symptoms of depression, and do not respond to standard treatments for depression. Therefore, we undertook development of a targeted Traumatic Grief Treatment (TGT). Pilot data in 10 patients show a robust treatment effect, much larger than that achieved by published reports of grief counseling. We now propose a randomized controlled trial to test the efficacy of TGT. Our primary aim is to compare effects of traumatic grief treatment (TGT) to a control, interpersonal psychotherapy (IPT) on measures of traumatic grief, depression, anxiety, functional impairment, self esteem and social support. We plan to conduct assessments of all randomized subjects at 16 weeks and 40 weeks. We will conduct exploratory analyses and instrument development to test and refine hypotheses related to putative mechanisms of action of TGT. We hypothesize that TGT will result in significantly greater improvement in traumatic grief than IPT, and that these differences will be sustained at 6-month follow-up. Almost a decade of work on the description and treatment of bereavement-related distress has prepared our research group for the treatment trial we now propose. We have come to understand who among those with bereavement-related symptomatology is at greatest risk for psychiatric and physical morbidity (i.e., those with traumatic grief) and we have developed what appears to be an effective intervention for this treatment-resistant population. The time is propitious for a controlled study of the efficacy of Traumatic Grief Treatment.
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