Surviving violent, traumatic loss after severe political persecution: lessons from the evaluation of a Venezuelan asylum seeker

In July 2019, the United Nations High Commissioner for Refugees (UNHCR) released a report urging the Venezuelan government to take immediate action to address the ‘grave violations of economic, social, civil, political and cultural rights’ occurring in the country. This case study highlights the human rights violations occurring in Venezuela through the case of a Venezuelan woman who experienced political persecution and traumatic loss resulting from her opposition to the ruling socialist party. As the clinical team of evaluators explored the mental health effects of surviving threats on her own life and the politically motivated assassination of her husband, it was agreed that the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition did not fully capture the extent of her suffering. Case discussion broadens the lens beyond the client’s experiences of posttraumatic stress disorder (PTSD) and depression to include persistent complex bereavement disorder, and emphasises the importance of addressing the sequelae of traumatic loss in a multifaceted way that broadens understanding of emotional functioning postmigration.

Behavioral Activation and Therapeutic Exposure vs. Cognitive Therapy for Grief Among Combat Veterans: A Randomized Clinical Trial of Bereavement Interventions

Approximately two-thirds of Operations Enduring Freedom, Iraqi Freedom, and New Veterans reported knowing someone who was killed or seriously injured, lost someone in their immediate unit, or personally saw dead or seriously injured Americans (Hoge et al., 2004; Thomas et al., 2010; Toblin et al., 2012). Thus, it is not surprising that prevalence of Persistent Complex Bereavement Disorder (PCBD) is high in these groups. Importantly, PCBD impact appears to be independent of both Post-Traumatic Stress Disorder (PTSD) and Major Depressive Disorder (Bonnano, 2007), 2 disorders that are also highly prevalent in these groups, thus tailored treatments for grief are indicated. The Department of Veterans Affairs suggests Cognitive Therapy for Grief as a first line psychotherapy, however treatments relatively more focused on behavior change and exposure to grief cues also may be useful for this population. To address this question, the present study used a randomized controlled trial to compare a 7-session program of Behavioral Activation and Therapeutic Exposure for Grief vs. Cognitive Therapy for Grief among 155 OIF/OEF/OND veterans. Both treatments produced significant treatment gains over baseline, and these improvements were maintained over 6-month followup; however no differences were observed between groups. Given equal efficacy, implications for matching treatment to patient characteristics are discussed.

Worden’s Task-Based Model for Treating Persistent Complex Bereavement Disorder During the Coronavirus Disease-19 Pandemic: A Narrative Review

BACKGROUND: A wide range of studies has shown that the coronavirus disease (COVID)-2019 pandemic could cause many deaths on the global scale by the end of 2020 because of the high speed of transmission and predicted case-fatality rates. AIM: This paper is a narrative review aiming to address the treatment of persistent complex bereavement disorder (PCBD) during the COVID-19 crisis using Worden’s task-based model. MATERIALS AND METHODS: Related papers published from 2000 to 2020 were searched in the EMBASE, PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar databases. Bereavement, COVID-19, pandemics, and Worden’s task-based model constituted the search terms. A narrative technique was implemented (including reading, writing, thinking, interpreting, arguing, and justifying) for material synthesis and creating a compelling and cohesive story. RESULTS: A few studies have specifically addressed the grief experiences within the COVID-19 crisis. They managed to identify some potential obstacles to grieving during the pandemic, namely, “anticipatory grief” and “multiple losses.” This study tried to use Worden’s task-based model to address the treatment of PCBD during the pandemic. CONCLUSIONS: Despite the paucity of information, Worden’s task-based model seems to have a considerable impact on the reduction of the PCBD symptoms. Nonetheless, further research is needed to perceive the effect of this approach on PCBD during the COVID-19 pandemic.

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.