Treatment Study Results
Shear et al. (2014). Treatment of complicated grief in elderly persons: a randomized clinical trial. JAMA psychiatry, 71(11), 1287-1295.
This was our second study of CGT and it compared CGT to IPT in older adults whose mean age was 66 years. Similar to our first study, CGT was significantly more effective for complicated grief, but not for depression. In this study the response rate to CGT was more than twice that of IPT. Additionally this is one of the few psychotherapy trials targeting older adults.
Shear et al. (2016). Optimizing treatment of complicated grief: a randomized clinical trial. JAMA psychiatry, 73(7), 685-694.
This four-site study was designed to examine the efficacy of antidepressant medication when administered with or without CGT. Results showed that CGT was significantly more effective than a pill placebo and also significantly more effective than citalopram. The study did not show a difference between citalopram and placebo, when administered either with or without CGT.
About Complicated Grief and Complicated Grief Treatment
Shear, M. K. & Bloom, C. G. (2017). Complicated grief treatment: An evidence-based approach to grief therapy. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 35(1), 6-25. This paper provides a comprehensive overview of CGT. The empirical research that underlies the decisions about CGT procedures is outlined. Clinicians will find a session by session descrition of what we do in CGT. This is an excellent summary of the treatment for anyone who wants to know what we do.
Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372(2), 153-160. This clinical practice article provides an overview of the clinical presentation, diagnosis and treatment approach for complicated grief. The paper contains a summary of the ICD11 guideline as a useful diagnostic tool. It also summarizes treatment studies published before 2015. A case example illustrates the approach discussed.
Simon, N. (2013) Treating Complicated Grief. JAMA, 310, 416-423.
This Clinical Crossroads provides a discussion of a case example of Complicated Grief. Readers will find information about differential diagnosis and management, with an emphasis on pharmacotherapy. However, since publication of this paper, pharmacologic treatment has not been shown to be efficacious.
Glickman, K., Shear, M. K., & Wall, M. M. (2017). Mediators of outcome in complicated grief treatment. Journal of clinical psychology, 73(7), 817-828.
This paper reports on an analysis of our first CGT study that examines mediators of response among participants who completed all sessions of CGT or IPT. Findings suggest that resolution of guilt and successfully avoidance are two of the main ways CGT helps people.
Young et al. (2012). Suicide bereavement and complicated grief. Dialogues in clinical neuroscience, 14(2), 177.
This paper reports on a sub-analysis of suicide bereaved participants from our four-site study. Findings show greater similarities than differences between suicide bereaved and other bereaved individuals in this study. Still, there are some differences in co-occurring disorders and in types of troubling thoughts among suicide bereaved compared to other bereaved.
Assessment and Diagnosis
Reynolds, C. F., Cozza, S. J., & Shear, M. K. (2017). Clinically relevant diagnostic criteria for a persistent impairing grief disorder: putting patients first. Jama psychiatry, 74(5), 433-434. This paper compares CG and PGD criteria and explains why CG criteria are preferred. CG, but not PGD criteria have adequate clinical utility. PGD criteria were developed in a limited sample of spousally bereaved individuals using a time frame of 6 months post loss. This very early time frame may explain the difficulty in identifying individuals with persistent impairing grief.
Mauro et al. (2017). Performance characteristics and clinical utility of diagnostic criteria proposals in bereaved treatment-seeking patients. Psychological medicine, 47(4), 608-615. This article compares the rates of diagnosis of CG in a large clinical sample of treatment seeking individuals using the different proposed diagnostic criteria. It shows that DSM 5 PCBD and Plos Medicine PGD criteria fail to meet criteria for clinical utility.
Cozza et al. (2016). Performance of DSM-5 persistent complex bereavement disorder criteria in a community sample of bereaved military family members. American Journal of Psychiatry, 173(9), 919-929.
This article compares the rates of diagnosis of CG in a large community sample of bereaved military family members using the different proposed diagnostic criteria. Results are almost identical to those found in our clinical sample. DSM 5 PCBD and Plos Medicine PGD criteria fail to meet criteria for clinical utility.