49 Clients

with CG typically experience prolonged, intense painful emotions; rumination, often around themes of self-blame; and maladaptive behaviors, including avoidance of triggers to the extent that functioning is disrupted.50 Although the causes are not yet understood, the mechanism is believed to be incomplete processing of information about the death. Specifically, the mental representation of the attachment figure is disrupted, such that the loss is acknowledged in declarative memory but not in implicit memory. This leads to a lack of acceptance of the finality Inhibitors,research,lifescience,medical of the loss. Moreover, the exploratory system does not re-engage, such that the grieving individual can become distanced from other people Inhibitors,research,lifescience,medical and the world generally. Thus, the basic principle underlying

CGT is that grief is a natural, adaptive process.51 This implies that treatment of CG involves removing the impediments to successful resolution of the grieving process. Through a variety of loss- and restoration-focused techniques, the therapist works to facilitate the progress of grief to help the client come to terms with the death. A number of investigations have provided empirical support for this model of treatment. After initial Inhibitors,research,lifescience,medical pilot studies showed promising results,52,53 CGT was compared with standard IPT in a randomized trial with 83 adult outpatients with complicated grief.45 Participants in both conditions received 16 individual sessions of psychotherapy. Treatment response was defined Inhibitors,research,lifescience,medical as a score of 1 or 2 (“very much improved” or “much improved”) on the interviewer-rated Clinical Global Impression Improvement scale and as time to a 20-point or better decrease in scores on the self-reported Inventory of Complicated Grief. Response rates were higher (51 % vs 28%) and time to response faster in the CGT group than in the IPT group. A secondary analysis Inhibitors,research,lifescience,medical examining the impact of naturalistic pharmacotherapy on participants in this trial found that

response rates in the CGT group were higher among those taking antidepressant medications, and that this effect was mediated by reduced attrition among those taking medications.54 Among patients receiving CGT, 42% of those not taking antidepressants, vs only 9% of those taking such medication, terminated the trial prematurely. By contrast, in the IPT condition, only Sodium butyrate 30% of those taking medications and 23% of those not taking medications dropped out. These data Sunitinib suggest that CGT may be a challenging treatment, particularly for individuals who are not also taking medication. Investigators have subsequently tested CGT with Japanese women bereaved by violent death55 and in substance abusers56; results suggest that the benefits of treatment are not restricted to Western cultures or individuals without comorbid drug or alcohol abuse. Description of the treatment As noted above, the theory includes elements drawn from both IPT and CBT.