The Effectiveness of a Forgiveness Intervention on Mental Health in Bereaved Parents—A Pilot Study

The aim of this pilot study was to test the effectiveness of an educational forgiveness intervention on mental health in grieving parents. 21 grieving parents were randomly assigned to the experimental group (in which the educational forgiveness intervention occurred) and to the control group (in which a psycho-education grief intervention with a humanistic approach took place). Participants in both groups completed 12 individual hourly sessions for three months. The results showed that participants in the experimental group achieved statistically greater improvement in forgiveness towards others, self-forgiveness, and a greater decrease in depression in the post-test and follow-up test; a greater decrease in anxiety and anger in the post-test; as well as higher improvement in the post-traumatic growth in the follow-up test, four months after the end of the intervention. We highlight the potential benefits of using a forgiveness intervention with bereaved parents.

Intervention Program to Improve Grief-Related Symptoms in Caregivers of Patients Diagnosed With Dementia

The objectives of the present study were to adapt a grief intervention program to family caregivers of patients with dementia, and assess its effectiveness in improving the symptoms of grief and other health-related variables. The intervention was based on Shear and Bloom's grief intervention program, with the necessary adaptations for use in the grieving process for a family member's illness. A total of 52 family caregivers of individuals with dementia participated. They were evaluated using a battery of self-report measures assessing grief, overload, resilience, post-traumatic growth, experiential avoidance, health-related quality of life, and benefits of care. The results suggest that the program is effective in improving grief symptoms, caregiver burden, resilience, post-traumatic growth, and quality of life of family caregivers. It is necessary to create and implement interventions targeting caregivers' feelings and manifestations of ambiguous grief, because there is a lack of programs providing an efficient solution for the mental and physical health of caregivers, and because of the human and socioeconomic cost involved in neglecting this group.

Bereavement Interventions in the Setting of Cancer Care

Grieving often begins at the time of cancer diagnosis, continuing as the patient faces numerous role and functional losses, surging when death is anticipated, and typically manifesting most intensely for the relatives after the patient’s death. This chapter focuses on how providers may support those who are grieving, describing common grief reactions, risk factors for poor bereavement outcomes, and interventions that have garnered empirical support in the growing grief intervention evidence base. Supportive psychotherapy normalizes grief, educates about adaptive reactions to loss and change, explores any maladaptive coping, and assesses for complicated grief. Psycho-oncologists can continue family-centered care through bereavement by providing empirically supported grief interventions or making appropriate referrals when there is a need for more specialized grief support. The strongest intervention effects are likely to be seen when targeting high-risk or symptomatic individuals at least six months postloss. Given the substantial variability in the quality of grief intervention research, future clinical trials should utilize rigorous methods, while remaining mindful of ethical research practices with vulnerable bereft individuals. Notably, there has been limited research focusing specifically on those bereaved by cancer, who often have traumatic experiences and vulnerabilities. In addition, more resources are needed to implement evidence-based bereavement care in oncology settings.

Effects of Grief Focused Intervention on the Mental Health of Dementia Caregivers: Systematic Review and Meta-Analysis

Background: The objectives of this study were to systematically review the effects of grief-focused interventions, applied to dementia caregivers, on emotional burden including sadness and to provide baseline information for dementia caregivers to maintain mental health by identifying the effect size of intervention using a meta-analysis. Methods: We evaluated literature published from Jan 1, 2000, to Jun 28, 2019. Consequently, we selected five studies to conduct a systematic review. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields was used for conducting a quality assessment on the selected literature. Results: The results of the quality assessment showed that the score ranged from 11 to 24 points: one strong, one good, two adequate, and one limited. When the meta-mean was compared before and after grief intervention, the effect size of the random-effect model was 0.31 (95% CI: -0.07, 0.69) showed ‘intermediate effect’, but the confidence interval was not significant. Conclusion: The grief intervention for dementia caregivers revealed a moderate effect but it was not significant. In order to prove the effectiveness of grief intervention for dementia caregivers, a meta-analysis targeting RCT studies is needed.

Lessons Learned in a Community-Based, Randomized Controlled Trial of a Complicated Grief Intervention

Complicated grief (CG), severe, prolonged (>12 months) grieving, disproportionately affects older adults. A prospective two-group, waitlisted RCT examined whether four sessions of Accelerated Resolution Therapy (ART) was effective in informal caregivers by comparing pre-to-post ART changes and investigating variation in treatment response by baseline CG levels. Inclusion: ≥60 years, Inventory of Complicated Grief >25. Paired t-tests of mean (SD) differences compared pre- to post-ART; pre-ART to 8-week follow-up, and post-ART to 8-week follow-up; then stratified by median baseline level of CG. Mean (SD) age of 54 participants was 68.7 (7.2) years, 85% female, and 93% white. Significantly greater CG reduction (-22.8 (10.3)) vs. waitlist (-4.3 (6.0)) was found. Within-participant effect sizes from baseline to 8-weeks post treatment were 1.96 (95% CI: 1.45, 2.47; p<0.0001). Treatment effects did not substantially differ by baseline levels. Lesson learned was that it was possible to successfully recruit and treat CG in the community.

Systematic Review of Grief Interventions

Grief interventions address pain and suffering in response to the death of a significant other. Evidence-based grief psychotherapies treat normative grief to symptoms of persistent complex bereavement disorder, the latter of which is characterized by difficulty accepting the loss and persistent yearning for the decedent. We reviewed published randomized controlled trials (RCT) of grief-focused psychotherapies to test two hypotheses. First, participants receiving grief-focused psychotherapies should demonstrate decline of grief symptoms from pre- to post-intervention. Second, participants receiving grief-focused psychotherapies should demonstrate lower grief symptoms post-intervention than participants receiving control treatments. Published studies were identified using academic search engines (Web of Science, PsycInfo, and Google Scholar) and by reviewing reference sections of published RCTs. Twelve published RCTs were identified. Effect sizes (Hodges’ g) and confidence intervals were calculated. Results support our first hypothesis and partially support our second hypothesis. Grief-related symptoms declined from pre- to post-intervention (g ranged from -0.39 to -2.51), with all studies reporting statistically significant effects. When comparing post-intervention differences in grief-focused psychotherapies versus control groups, effects were more variable (g ranged from -2.40 to 3.02), with seven studies demonstrating greater improvement among grief intervention recipients than control treatment recipients. Grief interventions appear to be effective for reducing grief-related symptoms pre- to post-intervention. However, they were only more effective than control treatments in just over half of published RCTs. While grief interventions were more effective, point estimate ranges are wide, suggesting that treatment effectiveness probably depends on factors other than the treatments themselves.

Accelerated Resolution Therapy: Randomized Controlled Trial of a Complicated Grief Intervention

Background and Objectives: Complicated grief (CG) is severe, prolonged (>12 months) grieving. Complicated grief disproportionately affects older adults and is associated with negative physical/psychological effects. Although treatment options exist, those which do are time-intensive. We report on a randomized clinical trial (RCT) which examined whether accelerated resolution therapy (ART), a novel mind-body therapy, is effective in treating CG, post-traumatic stress disorder (PTSD), and depression among hospice informal caregivers. Research Design and Methods: Prospective 2 group, wait-listed RCT. All participants were scheduled to receive 4 ART sessions. Inclusion: ≥60 years, inventory of CG >25, and PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition >33 or Psychiatric Diagnostic Screen Questionnaire PTSD subscale >5. Exclusion: Major psychiatric disorder, other current psychotherapy treatment. Depression was measured by the Center for Epidemiologic Studies Depression. Results: Mean (standard deviation [SD]) age of 54 participants was 68.7 (7.2) years, 85% female, and 93% white. Participants assigned to ART reported significantly greater mean (SD) CG reduction (−22.8 [10.3]) versus Wait-list participants (−4.3 [6.0]). Within-participant effect sizes (ESs) for change from baseline to 8-week post-treatment were CG (ES = 1.96 (95% confidence interval [CI]: 1.45-2.47; P < .0001), PTSD (ES = 2.40 [95% CI: 1.79-3.00]; P < .0001), depression (ES = 1.63 [95% CI: 1.18-2.08; P < .0001). Treatment effects did not substantially differ by baseline symptom levels. Discussion and Implications: Results suggests that ART presents an effective and less time-intensive intervention for CG in older adults. However, it should undergo further effectiveness testing in a larger, more diverse clinical trial with a focus on determining physiological or behavioral mechanisms of action.

A COMPLICATED GRIEF INTERVENTION PROGRAMME (CGIP) FOR SOCIAL WORKERS

Grief is a well-described concept in the literature, but complicated grief only recently became the concern of professionals working in this field. The necessity for a complicated grief intervention programme became evident after a fruitless search to find South African literature and interventions on the topic. This article describes the Complicated Grief Intervention Programme (CGIP) with the Complicated Grief Intervention Model (CGIM) as framework for intervention. The focus is on intervention techniques such as desensitisation, visualisation, use of the client-log, miracle questions, metaphors, rituals and humour. The CGIP is a time-limited intervention programme and consists mainly of interventions implemented during the three steps of the CGIM namely, assessment, implementation and evaluation/termination. Although the CGIP has not been widely tested, it holds the potential to serve as a guideline for social workers and other professionals working in the field of grief and bereavement.

Effectiveness of a Grief Intervention for Caregivers of People With Dementia

In this article, we report on the structure and effectiveness of a grief management coaching intervention with caregivers of individuals with dementia. The intervention was informed by Marwit and Meuser’s Caregiver Grief Model and considered levels of grief, sense of empowerment, coping, and resilience using five methods of delivery. Results indicate that the intervention had significant positive effects on caregivers’ levels of grief and increased their levels of empowerment, coping, and resilience. The intervention was found to be effective across caregivers’ characteristics as well as across five delivery modalities. Through description of this intervention, as well as outcome, this research contributes to the body of knowledge about caregivers’ disenfranchised grief and ways to effectively address it.