None listed
Conditions
Brief summary
Complicated grief shares a number of common features with post traumatic stress disorder (PTSD), which is often treated using eye movement desensitisation reprocessing (EMDR). Given the similarities between PTSD and complicated, there is hope that EMDR may also be effective in treating complicated grief. To date, only one study has documented the results of EMDR with grief client. Although the findings indicated a potential economic benefit in terms of shorter treatment times, the study described had limitations which prevented the results from being generalised. This study aims to explore the efficacy of Eye Movement Desensitisation Reprocessing (EMDR) in the treatment of grief by using a randomised controlled trial to compare it with a more traditional cognitive-behavioural therapy (CBT) approach. It will address methodological flaws of the only previous study of EMDR and grief by using random allocation to assign participants to treatment groups, as well as have participants act as their own wait-list controls prior to commencing treatment. Answers will be sought to the following questions: 1) Does EMDR for grief result in more beneficial treatment outcomes than CBT? 2) Is the rate of improvement significantly greater in the EMDR than the CBT treatment approach? 3) Do certain individual factors predict response to treatment? Based on previous studies, both groups are likely to experience significant reductions in the intrusions of unwanted memories, anxiety, and depression. In addition it is likely that they will experience significant improvements in quality of life and behaviours such as sleeping, positive memories of the loved one, avoidance of known triggers and nightmares at post-test (as measured by the Quality of Life Scale and a behavioural questionnaire). It is anticipated that the rate of reductions and improvements as detailed above will be significantly greater in EMDR participants compared to CBT participants. Relative to CBT, it is expected that EMDR participants will experience significantly greater reductions in the intrusive and avoidance effects of the loss, anxiety, depression and grief, and significantly greater improvements in quality of life and behaviours such as sleeping, positive memories of the loved one, avoidance of known triggers and nightmares at post-test.
Interventions
Arm 1 - Eye-Movement Desensitisation Reprocessing (EMDR) Treatment Condition.
Participants will receive seven treatment sessions, conducted on a weekly basis. The duration of all sessions will be 90 minutes each.
The first session will consist of an initial intake interview. The initial intake interview will provide some psychoeducation regarding EMDR and then focus on taking a brief client history. The purpose of the interview is two-fold: assessing the client’s suitability for EMDR and iden
Arm 1 - Eye-Movement Desensitisation Reprocessing (EMDR) Treatment Condition. Participants will receive seven treatment sessions, conducted on a weekly basis. The duration of all sessions will be 90 minutes each. The first session will consist of an initial intake interview. The initial intake interview will provide some psychoeducation regarding EMDR and then focus on taking a brief client history. The purpose of the interview is two-fold: assessing the client’s suitability for EMDR and identifying key distressing memories to be focused on during treatment. Participants will be asked to rate the distress aroused by recalling the memory using the Subjective Units of Discomfort Scale (SUDS; Wolpe, 1991). The SUDS is an 11 point scale, whereby a 10 indicates the highest degree of distress and 0 indicated an absence of distress. Before the conclusion of the intake session, participants will be taught a relaxation exercise, also known as a ‘safe place’ exercise and commonly used in EMDR. This exercise can be taught quite quickly and is used to assist participants in lowering their level of distress and becoming calm. If any participant remains highly distressed (indicated verbally by a SUDS score of 7 or more), an additional deep breathing exercise and repetition of the safe place exercise will be delivered. Both exercises will be taught by the attending psychologist. Participants will be prompted to use these exercises during therapy sessions when they show signs of distress and will be advised they are free to practice them on their own, between sessions as well. Following the interview, the researchers will score the dissociative experiences scale (DES-II). As EMDR is not considered a suitable treatment in situations where the individual is still experiencing numbness, denial or dissociation, participants who exhibit these tendencies (according to researchers’ judgement) or score above 30 on the dissociative experiences scale (DES-II) will be excluded from the study. The following six sessions of treatment will follow a scripted protocol for grieving individuals as set out by Luber (2009). To briefly describe one of the key elements of EMDR: desensitization involves the participant simultaneously focusing on a distressing memory and visually tracking the therapist’s finger, which is moved bilaterally in front of the participant’s eye in a precisely prescribed manner. The shifts of focus are continued until the person reports that their distress (as measured by SUDS scale levels of 0, 1 or 2) is reduced. Through this dual attention, as well as the installation of a positive belief afterwards, the distressing memories as well as any associated memories are systematically reprocessed and through exposure the participant is desensitised to the accompanying distress. Participants will be asked to complete the behavioural record each week between sessions for the duration of treatment. As adapted from Luber (2009), sessions two to seven will target the participants’ following areas of grief: 2) Actual events, including the loved one’s suffering or death 3) Intrusive images 4) Nightmare images (assessment measures re-administered following session) 5) Present triggers 6) Issues of personal responsibility, mortality or previous unresolved losses 7) Creating a future template, conclusion (assessment measures re-administered following session) Arm 2 - Cognitive Behavioural Therapy (CBT) Treatment Condition Participants will receive seven treatment sessions, conducted on a weekly basis. The duration of all sessions will be 90 minutes each. Each session will be administered one on one with a psychologist. In short, CBT assists participants in understanding the relationships between their thoughts, feelings and behaviours and teaching them how to identify and change unhelpful thoughts, behaviours and feelings. It requires active participation on the part of the participant, including homework between sessions. Participants will be asked to complete the behavioural record each week between sessions for the duration of treatment. Treatment sessions will be adapted from a protocol set out by Rosner, Pfoh and Kotoucova (2011), covering the following components: 1. Administer measures; relaxation and safe place imagery; psychoeducation handout for homework 2. Psychoeducation on normal and complicated grief; introduction to complicated grief model; identification of dysfunctional thoughts 3. Rumination and guilt; emotions and perceptions 4. Worst moments: confrontation in sensu 5. Worst moments and identifications of “hot spots”; confrontation, cognitive restructuring and acceptance 6. Preparation and dialogical work for “walk to the grave” 7. Memento and future, New Life
Sponsors
Murdoch University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used) (Outcomes Assessor)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Participants must be over 18 years of age Participants must report experiencing grief, relating to the death of somebody important to them. The death must have occurred more than 6 months prior to enrolment in the study.
Exclusion criteria
Involvement in any legal matters pertaining to the death of the person the participant is grieving for (with the exception of will/estate matters). Scores above 30 on the Dissociative Experiences Scale (DES-II).
Outcome results
None listed