Mariken Spuij

An Open Trial of ‘Grief-Help’: A Cognitive-Behavioural Treatment for Prolonged Grief in Children and Adolescents : CBT for Childhood PGD

In the past years, there is growing recognition of a syndrome of disturbed grief referred to as prolonged grief disorder (PGD). Although mostly studied in adults, clinically significant PGD symptoms have also been observed in children and adolescents. To date, no effective treatment for childhood PGD yet exists. We recently developed a nine-session cognitive-behavioural treatment for childhood PGD combined with five sessions of parental counselling. In the current article, we present outcomes of treatment of 10 consecutive children and adolescents turning to our university clinic with elevated PGD symptoms as their primary problem and main reason to seek therapy. Patients were significantly improved at post-treatment, with large improvements in self-rated PGD and post-traumatic stress (effect sizes > 0.8) and small to moderate improvement in depression and parent-rated internalizing and externalizing problems (0.2 < effect sizes < 0.8). Additional predictor analysis of outcomes suggested that, among other things, this treatment approach is less efficacious for children and adolescents further removed from loss and those confronted with suicidal loss. That said, the treatment appears promising, and controlled evaluation is clearly indicated.

Rouw en verliesverwerking door jeugdigen

SamenvattingHet verlies van een dierbare is een ontwrichtende gebeurtenis. Desondanks is nog nauwelijks onderzoek gedaan naar verliesverwerking door jeugdigen. Bij volwassenen is er overtuigende evidentie voor het bestaan van gecompliceerde rouw; het heeft een eigen fenomenologie en is te onderscheiden van depressie en posttraumatische stress-stoornis. Voorts is aangetoond dat specifieke cognitief gedragstherapeutische interventies effectief zijn in de behandeling van rouwproblematiek. Op basis van de huidige inzichten is het waarschijnlijk dat gecompliceerde rouw als aparte stoornis in de dsm-v wordt opgenomen. Onderzoek naar gecompliceerde rouw bij jeugdigen is nodig om de opgelopen achterstand in te halen.

Negative Cognitions in Loss-Related Emotional Distress in Adolescent Girls: A Preliminary Study

Some adolescents confronted with loss develop symptoms of complicated grief, depression, and anxiety. Little is known about mechanisms causing such problems in this group. Cognitive behavioral theories of grief hypothesize that negative cognitions are pivotal in emotional problems after loss. The current preliminary study tested this hypothesis among 30 adolescent girls (13–18 years). Findings showed that different types of negative cognitions were significantly associated with complicated grief and depression severity. Global negative beliefs about life and the self and catastrophic misinterpretations of grief reactions were most strongly linked with symptoms. Findings support cognitive behavioral theories of grief.

Prolonged grief and posttraumatic stress in bereaved children: A latent class analysis

Few studies have yet examined subgroups among children (aged 8-18) confronted with the death of a close loved one, characterized by different profiles of symptoms of prolonged grief disorder (PGD) and symptoms of bereavement-related posttraumatic stress disorder (PTSD). This study sought to identify such subgroups and socio-demographic and loss-related variables associated with subgroup membership. We used data from 332 children, most of whom (> 80%) were confronted with the death of a parent, mostly (> 50%) due to illness. Latent class analysis revealed three classes of participants: a resilient class (38.6%), a predominantly PGD class (35.2%), and a combined PGD/PTSD class (26.2%). Class membership was associated with self-rated levels of depression and functional impairment, and parent-rated behavioural problems. No significant between-class differences on demographics or loss-related variables were found. The current findings of distinct classes of PGD, and PGD plus PTSD attest to the construct validity of PGD as a distinct disorder, and can inform theory building and the development of diagnostic instruments relevant to children with pervasive distress following loss.