Translated article: Cognitive-Behavioral Therapy for Complicated Grief

Acute grief, albeit often a painful experience, is a normal
reaction to the loss of a significant other; yet, most bereaved
persons recover from grief without professional
help. A minority of bereaved persons, however, experiences
persistent and disabling grief symptoms, also
termed complicated grief. Complicated grief as a distinct
diagnostic entity receives increasing attention, partly because
of its consideration in the revisions of the established
classification systems (‘International Statistical
Classification of Diseases and Related Health Problems’
(ICD-11) and ‘Diagnostic and Statistical Manual of Mental
Disorders’ (DSM-5)). In the diagnostic process, both potential
overdiagnosis (pathologizing normal grief) and
misdiagnosis of complicated grief need to be considered.
Interventions aimed at all bereaved persons (universal
prevention) showed only minimal effectiveness.
Whether complicated grief can be prevented in high-risk
populations or in highly distressed acute mourners is
still being critically discussed. Recent randomized controlled
trials, however, demonstrated the efficacy of disorder-
specific interventions. A broad evidence base supports
both exposition to grief- or loss-associated stimuli
and cognitive restructuring of grief-specific dysfunctional
beliefs as parts of a cognitive-behavioral treatment.
Setting new goals for a life without the deceased is also
often incorporated in the treatment. Additionally, behavioral
activation demonstrated preliminary positive effects
for the treatment of complicated grief. Next to faceto-
face psychotherapy, internet-based treatment approaches
yielded promising results. However, further
research is needed concerning, e.g., the differential effectiveness
of specific treatment components.