Patient personality and time-limited group psychotherapy for complicated grief

We used a randomized clinical trial to investigate the interaction of two patient personality characteristics (quality of object relations [QOR] and psychological mindedness [PM]) with two forms of time-limited, short-term group therapy (interpretive and supportive) for 139 psychiatric outpatients with complicated grief. Findings differed depending on the outcome variable (e.g., grief symptoms, general symptoms) and the statistical criterion (e.g., statistical significance, clinical significance, magnitude of effect). Patients in both therapies improved. For grief symptoms, a significant interaction effect was found for QOR. High-QOR patients improved more in interpretive therapy and low-QOR patients improved more in supportive therapy. A main effect was found for PM. High-PM patients improved more in both therapies. For general symptoms, clinical significance favored interpretive therapy over supportive therapy. Clinical implications concerning patient-treatment matching are discussed.     

Interpersonal predictors of group therapy outcome for complicated grief

This study investigated three aspects of patients' interpersonal functioning as predictors of outcome for two forms of group psychotherapy for complicated grief. Patients presented with a variety of death losses and met criteria for complicated grief. The three aspects of interpersonal functioning were the patient's (1) attachment to the lost person, (2) quality of object relations (QOR), and (3) level of recent social role functioning. A more secure attachment to the lost person and better social role functioning were associated with more favorable outcome in both forms of therapy. In addition, patients with higher QOR had more favorable outcome in interpretive therapy while lower QOR patients had more favorable outcome in supportive therapy. The results suggest that each aspect of interpersonal functioning is important to consider when treating patients for complicated grief.     

Quality of object relations as a moderator of the relationship between pattern of alliance and outcome in short-term individual psychotherapy

In this study, we investigated the personality variable quality of object relations (QOR) as a moderator of the relationship between the pattern of the therapeutic alliance and treatment outcome in two forms (interpretive, supportive) of short-term individual psychotherapy. In a sample of 72 psychiatric outpatients who completed interpretive therapy, QOR emerged as a moderator for the outcome factor general symptomatology and dysfunction. For high-QOR patients, an increasing level of alliance was directly related to benefit, whereas for low-QOR patients, a decreasing level of alliance was directly related to benefit. An explanation for these findings emphasized the importance of patients repeating their typical pattern of maladaptive interpersonal behavior in the therapy sessions in the context of the therapist working with the transference. In a sample of 72 psychiatric outpatients who completed supportive therapy, QOR did not emerge as a moderator. These findings in combination with evidence from previous studies suggest that QOR should be investigated as a moderator variable in future studies of short-term psychotherapy.     

NEO-five factor personality traits as predictors of response to two forms of group psychotherapy

The relationships between patient personality variables and outcome for 107 psychiatric outpatients with complicated grief who completed either interpretive or supportive short-term group therapy were investigated. The personality variables were assessed prior to treatment with the NEO-Five Factor Inventory (NEO-FFI). For patients in both forms of therapy, extraversion, conscientiousness, and openness were directly associated with favorable treatment outcome. In contrast, neuroticism was inversely related to favorable outcome for patients in both forms of therapy. Agreeableness was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but not for those in supportive therapy. The results highlight the importance of assessing patient personality in order to predict response to short-term group therapy. Possible explanations and clinical implications of these findings are discussed.     

The Psychology of Crime by David Abrahamsen

Abstract

This study investigated the relationships between initial level of alliance, pattern of alliance over sessions, and outcome in a sample of 107 patients who completed short–term group therapy for complicated grief. Both patient–rated alliance and therapist–rated alliance were studied. For patient–rated alliance, both the initial level of alliance and the linear pattern of alliance were directly and significantly related to favorable outcome. For therapist–rated alliance, no significant direct relationships with outcome were found. Instead, significant interaction effects were found. For patients with relatively high initial alliance, the greater the increase in alliance over sessions, the better the outcome. For patients with relatively low initial alliance, the greater the decrease in alliance over sessions, the better the outcome. Explanations for the findings are considered as well as possible clinical implications.     

A short-term grief and loss therapy group: Group members' experiences

Abstract

This article is an evaluative study of a short-term grief and loss therapy group conducted at a large Midwestern university's counseling center. The group was held for students who had experienced loss through death of a significant person. The author examines brief group psychotherapy, special considerations of the college student's grief experience, an adaptation of the brief group model for grieving students, and data gathered from the members of the therapy group. Students' scores on a grief instrument showed mixed results. Group members made journal entries at four times during the group experience. They reported that the group was a supportive and helpful experience; five of Yalom's (1995) eleven therapeutic factors could be discerned. Recommendations regarding the treatment of grieving students in a group setting are made.     

Countertransference in Activity Group Therapy

A controlled, clinical trial investigation of short-term psychoanalytically oriented group psychotherapy (STG) was conducted which included eight psychotherapy groups led by experienced therapists. Patient psychological mindedness (PM) was investigated as a selection criterion and prognostic variable. Seventy-nine psychiatric outpatients experiencing prolonged or delayed grief reactions were matched for level of PM and then randomly assigned to STG or a wait list. There was repeated measurement of several areas and sources of outcome. Results indicated a strong main effect for STG but not for PM on outcome, and minimal evidence for an interaction effect. Benefits were maintained at six-month follow-up. Psychological mindedness emerged as highly predictive of attrition. A clinical discussion is presented wherein the efficacy of STG is considered as reflecting a good patient—treatment match.     

Predictors of complicated grief

Abstract

This study examined whether process variables predict an outcome of complicated grief. A turbulent and prolonged grief was predicted to occur after the death of a spouse in subjects who had self-blame, used the deceased for an extension of self, had ambivalence toward the deceased, or overcontrolled emotional responses. Ninety subjects were examined at 6, 14, and 25 months after the loss via a self-report battery of process variables and a structured clinical interview designed to assess symptoms. Subjects with complicated grief were compared with those with normative grief. Predictions were supported only in tertiary data analyses; they were not supported well in the primary and secondary statistical analyses. The authors concluded that either self-reports of process variables are inadequate measures or the theory that led to these measures and predictions is in need of revision.     

Therapeutic alliance and cohesion variables as predictors of outcome in short-term group psychotherapy

The current study explored the relative ability of aggregate therapeutic alliance and cohesion variables to predict short-term group therapy outcome. Data were collected from a comparative trial of two forms of time-limited group psychotherapy for complicated grief (Piper, McCallum, Joyce, Rosie, & Ogrodniczuk, 2001). The therapeutic alliance and elements of the cohesion construct were measured from the perspectives of each patient and the group therapist at intervals during the groups; scores were aggregated across assessments. Hierarchical multiple regression analyses, adjusting for the effects of treatment approach (interpretive vs. supportive) and specific group membership, demonstrated that the patient-rated alliance was a consistent predictor of outcome. Two cohesion measures, reflecting other participants' (therapist, other members) views of the patient's "fit" with the group, also accounted for variation in outcome. Implications of the findings for research and clinical practice, and the limitations of the measurement approach taken in this study, are considered.     

A controlled study of effectiveness and patient suitability for short-term group psychotherapy

A controlled, clinical trial investigation of short-term psychoanalytically oriented group psychotherapy (STG) was conducted which included eight psychotherapy groups led by experienced therapists. Patient psychological mindedness (PM) was investigated as a selection criterion and prognostic variable. Seventy-nine psychiatric outpatients experiencing prolonged or delayed grief reactions were matched for level of PM and then randomly assigned to STG or a wait list. There was repeated measurement of several areas and sources of outcome. Results indicated a strong main effect for STG but not for PM on outcome, and minimal evidence for an interaction effect. Benefits were maintained at six-month follow-up. Psychological mindedness emerged as highly predictive of attrition. A clinical discussion is presented wherein the efficacy of STG is considered as reflecting a good patient-treatment match.     

The influence of contextual contrast on syntactic processing: evidence for strong-interaction in sentence comprehension

The present study compares the processing of unambiguous restrictive and non-restrictive relative clauses (RCs) within both a null context and a supportive discourse using a self-paced reading methodology. Individuals read restrictive RCs more slowly than non-restrictive RCs in a null context, but processed restrictive RCs faster than non-restrictive RCs in supportive context, resulting in an interaction between context and RC type. These results provide evidence for two theoretical points. First, principles analogous to those in referential theory [Altmann G. T. M., & Steedman, M. (1988). Interaction with context during human sentence processing. Cognition, 30, 191-238; Crain, S., & Steedman, M. (1985). On not being led up the garden path: The use of context by the psychological parser. In D. Dowty, L. Karttunnen, A. Zwicky (Eds.), Natural language parsing. Cambridge, UK: Cambridge University Press] apply not only in resolving ambiguity but also in processing unambiguous sentences. Second, the discourse context can guide and facilitate interpretive processing. This result suggests that intrasentential factors such as syntax are not autonomous from contextual processing, contrary to the modularity hypothesis [Fodor, J. A. (1983). Modularity of mind. Cambridge, MA: MIT Press].     

Trauma-Focused CBT for Traumatic Grief in Military Children

Although military children are typically as resilient as the general child population, the ongoing conflict has exposed military children to unusual stressors such as repeated deployment, severe injury, or the death of a parent or sibling. U.S. forces have experienced more than 5,600 casualties during Operation Iraqi Freedom and Operation Enduring Freedom, with growing numbers of suicides among Service members. These deaths have affected thousands of military children. Most bereaved military children experience adaptive grief characterized by deep sadness, longing for the deceased person, and being comforted by positive memories of the deceased. A smaller number of military children develop childhood traumatic grief, characterized by trauma symptoms that interfere with adaptive grieving. Children with traumatic grief get “stuck” on the traumatic aspects of the death such as picturing the imagined or real details of the death; imagining the pain their loved one experienced in the moments before dying; wishing for revenge; and becoming angry at those who do not understand or share the child’s thoughts and feelings about the death. These children avoid reminders of the deceased person. Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based treatment for children with trauma symptoms including those with traumatic grief. TF-CBT may be particularly suitable for military families. This article describes the clinical application of TF-CBT for traumatic grief in military children.     

Upward and Downward Counterfactual Thought After Loss: A Multiwave Controlled Longitudinal Study

Counterfactual thoughts, mental simulations about how a situation may have turned out differently (i.e., “if only …, then …”), can reduce mental health after stressful life-events. However, how specific counterfactual thought types relate to post-loss mental health problems is unclear. We hypothesized that self-referenced upward counterfactuals (i.e., “If only I had done …, then the current situation would be better”) may serve as cognitive avoidance, thereby perpetuating loss-related distress. Conversely, downward counterfactuals (i.e., “If … had happened, then the current situation could have been [even] worse”) may facilitate benefit finding, thereby reducing distress. In a longitudinal survey, self-referent, other-referent, and nonreferent upward counterfactuals, and nonreferent downward counterfactuals were assessed at baseline. Prolonged grief and depression symptoms were assessed at baseline, and 6- and 12-month follow-ups. Multiple regression analyses assessed associations between counterfactual thoughts and symptom levels in 65 recently bereaved people who generated counterfactual thoughts about the loss-event. Moderator analyses assessed the unicity of significant effects in the previous step, by comparing these effects in 59 people generating loss-related counterfactuals with those in 59 propensity-score matched participants generating counterfactuals about other negative life-events. Multivariate analyses showed that nonreferent upward counterfactuals were uniquely strongly positively associated with prolonged grief and depression symptoms concurrently. Self-referent upward counterfactuals were uniquely positively associated with prolonged grief and depression symptoms longitudinally. Moderator analyses confirmed that thinking about how one’s (in)actions could prevent a death uniquely exacerbated prolonged grief and depression severity. Prolonged grief treatment may be improved by targeting self-blame and guilt.     

The value of RCT evidence depends on the quality of statistical analysis

The authors examined statistical practices in 193 randomized controlled trials (RCTs) of psychological therapies published in prominent psychology and psychiatry journals during 1999-2003. Statistical significance tests were used in 99% of RCTs, 84% discussed clinical significance, but only 46% considered-even minimally-statistical power, 31% interpreted effect size and only 2% interpreted confidence intervals. In a second study, 42 respondents to an email survey of the authors of RCTs analyzed in the first study indicated they consider it very important to know the magnitude and clinical importance of the effect, in addition to whether a treatment effect exists. The present authors conclude that published RCTs focus on statistical significance tests ("Is there an effect or difference?"), and neglect other important questions: "How large is the effect?" and "Is the effect clinically important?" They advocate improved statistical reporting of RCTs especially by reporting and interpreting clinical significance, effect sizes and confidence intervals.     

Does worry affect adjustment to bereavement? A longitudinal investigation

Background and objectives: Repetitive thought is a trans-diagnostic risk-factor for development of psychopathology. Research on repetitive thought in bereaved individuals has focused primarily on clarifying the role of rumination, repetitive thinking about past negative events and/or negative emotions. While detrimental effects of rumination have been demonstrated following bereavement, surprisingly few studies have aimed to clarify the role of worry, repetitive thinking about potential future negative events, in adjustment to loss. This study sought to fill this gap in knowledge. Methods/Design: One hundred eighty-three bereaved individuals (85.3% women) filled out questionnaires on sociodemographic and loss-related characteristics, worry, and symptom measures of depression, anxiety, and prolonged grief. After six months, 155 participants completed worry and symptom measures again. Using multiple regression analyses, concurrent and longitudinal associations between loss-related variables, worry, and symptoms of psychopathology were examined. Results: Main results were that worry was strongly positively associated with symptoms of anxiety, depression and prolonged grief concurrently and also predicted higher levels of anxiety, depression and prolonged grief longitudinally. Conclusions: Findings suggest that worry influences adjustment to bereavement negatively and may be a potential target in grief therapy, especially when aiming to reduce anxiety.     

The effect of hypnosis therapy on the symptoms and disease activity in Rheumatoid Arthritis

Abstract

The present study aimed to assess the effectiveness of clinical hypnosis on the symptoms and disease activity of Rheumatoid Arthritis (RA). Sixty six RA patients participated in a controlled group design. Twenty six patients learnt the hypnosis intervention, 20 patients were in a relaxation control group and 20 patients were in a waiting-list control group. During hypnosis, patients developed individual visual imagery aimed at reducing the autoimmune activity underlying the RA and at reducing the symptoms of joint pain, swelling and stiffness. Subjective assessments of symptom severity and body and joint function, using standardised questionnaires and visual analogue scales, were obtained. Objective measures of disease activity via multiple blood samples during the therapy period and at the two follow-ups were also taken. These measurements were of erythrocyte sedimentation rate. C-reactive protein, haemoglobin and leukocyte total numbers. Results indicate that the hypnosis therapy produced more significant improvements in both the subjective and objective measurements. above relaxation and medication. Improvements were also found to be of clinical significance and became even more significant when patients practised the hypnosis regularly during the follow-up periods.     

The Effectiveness of Group Metacognitive Therapy for Generalised Anxiety Disorder: A Pilot Study

Generalised anxiety disorder (GAD) responds well to individually delivered metacognitive therapy (MCT). The current study investigated the effectiveness of MCT administered to groups of patients with GAD in a general outpatient treatment centre. Thirty-three consecutively referred adult patients with GAD were assessed before treatment (pretreatment), after the last treatment session (posttreatment), and six months after treatment had ended (follow-up). Analyses of treatment effects were conducted for all patients entering the study (i.e., intent-to-treat analysis, using the last-observation-carried-forward procedure), and repeated for the patients who completed treatment (completers analysis), using paired samples t-tests. Further, effect sizes (ESs) and indices of clinical significance were calculated, and compared with those reported in studies into the efficacy and effectiveness of individually delivered MCT for GAD. Among both the intent-to-treat and the completers sample, large pre- to posttreatment reductions in symptoms of worry, trait-anxiety, and general psychopathology. The magnitude of change and the degree of clinical significance were smaller than those reported in studies into the effectiveness of individually delivered MCT for GAD, whereas the attrition rate (27 %) was higher. It is tentatively concluded that MCT for GAD can be effectively delivered in a group format in a heterogenous clinical practice setting. Further evaluation is clearly indicated.     

Parallel Process

Summary

This article addresses parallel processes between the author (a therapist) and client when each are mourning the death of their mother. Similarities and differences in their experience and reaction are discussed. The effect of the client's unexpressed grief from her early childhood loss is explored. The author also examines her own, more recent loss and develops a new perspective on its consequences. Tools are presented to help the client work on her grief, especially when the issue is “motherloss.” The impact of the therapeutic process on the client and author is delineated, and the client's reactions to ending her therapy are analyzed.     

The nature of grief: Loss of love relationships in young adulthood

Abstract

Grieving following the loss of a love relationship in young adulthood was examined. College students completed the loss version of the Grief Experience Inventory (GEI), another questionnaire, and an adaptation of the Texas Revised Inventory of Grief (TRIG). The results indicated that the more intimate the relationship had been, the greater the grief experienced. In addition, the more marriage had been considered, the greater the grief. Grief was disenfranchised primarily by family members, unless marriage had been considered. Few gender differences were seen, except that women both considered marriage and initiated the breakup more often. The specific feelings attached to the grieving were noted more often on the TRIG adaptation than on the GEI. The findings point to the significance of recognizing grief reactions in counseling and psychotherapy for depression in young adults.     

Level of alliance, pattern of alliance, and outcome in short-term group therapy

This study investigated the relationships between initial level of alliance, pattern of alliance over sessions, and outcome in a sample of 107 patients who completed short-term group therapy for complicated grief. Both patient-rated alliance and therapist-rated alliance were studied. For patient-rated alliance, both the initial level of alliance and the linear pattern of alliance were directly and significantly related to favorable outcome. For therapist-rated alliance, no significant direct relationships with outcome were found. Instead, significant interaction effects were found. For patients with relatively high initial alliance, the greater the increase in alliance over sessions, the better the outcome. For patients with relatively low initial alliance, the greater the decrease in alliance over sessions, the better the outcome. Explanations for the findings are considered as well as possible clinical implications.