Complicated grief is ...

More to follow ...

I wrote a blog post yesterday morning setting the scene for a two day workshop I was about to go to with Professor Kathy Shear on her treatment approach for complicated grief.  Well, how did the day go?  It was very interesting, inspiring, and also a little too much "simply sitting listening" for my tastes. It's hard to know what the best design for this kind of two day seminar should be. I strongly suspect though that just sitting taking in, even such excellent information with the opportunity for regular questions, isn't the most effective way of transferring knowledge.  Hard to do it, but more active audience participation would probably serve the workshop's goals even better.  Despite this, the material being shared was great ... really fascinating and important.

I was struck by a couple of papers on grief that I read last year.  One was Kathy Shear & colleagues' "Treatment of complicated grief in elderly persons: a randomized clinical trial" and the other was Bryant et al's "Treating prolonged grief disorder: a randomized clinical trial."   I was impressed because Shear's paper showed clear benefits of one treatment over a valid active comparison treatment.  Trials showing better outcomes of treatments that have been compared with "treatment as usual" (TAU) or "waiting list control" are two a penny.  However an intervention that produces an obviously better outcome than a valid alternative intervention makes me sit up and take notice.

Here are half a dozen studies on the long-term effects of various forms of abuse & deprivation.  Paras et al systematically reviewed the association between a history of sexual abuse and a lifetime diagnosis of a somatic disorder.  They found significant links with functional gastrointestinal disorders, nonspecific chronic pain, psychogenic seizures, and chronic pelvic pain.  When analysis was restricted to studies where sexual abuse was defined as rape, they also found an association with fibromyalgia.  Abstracts and links, for this research paper and the further papers described, can be found lower down this page.   

Here are half a dozen papers with anxiety relevance.  The first couple are about the interaction between genetic vulnerability (or resilience) and childhood experience.  The Stevens et al paper is an update on the large body of research looking at psychological genetic vulnerability/resilience in macaque monkeys and how this interacts with parenting quality to lead, or not lead, to emotional and neurophysiological disturbances in adulthood.  The Battaglia paper particularises this gene/environment investigation by looking at the connections between early human childhood separation anxiety, loss of a parent, and panic disorder in adulthood.  

Yesterday and today are a check-in time with my friend Larry.  I've written in a previous blog post how Larry and I have met every three or four months for many years specifically to review how our lives are going and to plan and prioritize our goals for the next few months.  "Taking charge" of our lives in this kind of way makes huge sense.  For example the self-determination literature (S-DT)  highlights the importance of making autonomous decisions about what we put our energy into.  This S-DT research and much other work (e.g. a recent study on goal-setting) also emphasises that this kind of approach is a core component of growing wellbeing in one's life.  Yeats wrote something like "A friend is someone who sees the potential in you and helps you to live it."  Meeting with an old friend in the way Larry and I have done, is certainly an example of what Yeats was talking about.

Sadness.  I woke feeling sad ...

Five of these six studies are from last month's American Journal of Psychiatry.  Kendler et al discuss the many similarities and only occasional differences between bereavement-related and other life event-related depression - an issue explored further in Maj's editorial.  Li et al show that depression in pregnancy (exacerbated further by stressful life events and obesity) increases the risk of preterm delivery.  Miklowitz reviews research on the value of adjunctive psychotherapy for bipolar disorder sufferers (already taking medication) and discusses the various ways it can be helpful.  Oquendo et al (in a freely viewable editorial) argue that suicidal behaviour should be placed on a "separate axis" in the next version of the DSM diagnostic system.  Finally Vertanen et al, in an interesting study, demonstrate that increased hospital overcrowding - measured by bed occupancy rates - is associated with increased use of antidepressants by hospital staff.

Kendler, K. S., J. Myers, et al. (2008). "Does Bereavement-Related Major Depression Differ From Major Depression Associated With Other Stressful Life Events?" Am J Psychiatry 165(11): 1449-1455.  [Abstract/Full Text]