Glickman Kim, Shear M Katherine, Wall Melanie
Social Work, York College/CUNY, Jamaica, NY, USA.
School of Social Work, Columbia University, New York, NY, USA.
Clin Psychol Psychother. 2016 Mar-Apr;23(2):118-24. doi: 10.1002/cpp.1940. Epub 2014 Dec 22.
The present study examines a more fine-grained analysis of anxiety-related and depression-related outcomes amongst a sample of treatment completers who were assigned to complicated grief treatment (CGT) (n = 35) or interpersonal psychotherapy (IPT) (n = 34) in a previously reported randomized controlled trial. We examined effects of antidepressant use and measures of anxiety and depression, focusing especially on guilt related to the death or deceased and grief-related avoidance in order to further understand the differential effectiveness of CGT and IPT amongst participants who received the full course of treatment. Analyses showed that CGT produced greater reductions in anxiety and depressive symptoms including negative thoughts about the future and grief-related avoidance. CGT's advantage over IPT in lowering depression was most pronounced amongst those not taking antidepressants. Our results further elucidate CGT effects and support the idea that CG and major depressive disorder are distinct conditions.
Targeted treatment for complicated grief (CG) produces benefits in associated mood and anxiety symptoms and CG symptoms. Amongst patients with CG, interpersonal psychotherapy seems relatively ineffective in ameliorating depressive symptoms. Grief-related depressive symptoms may not respond to standard treatments unless CG symptoms are also addressed. Reducing grief-related symptoms, such as anxieties about the future, guilt related to the death or deceased and avoidance of reminders of the loss may be important aspects in reducing CG.
本研究对在先前一项随机对照试验中被分配到复杂哀伤治疗（CGT）组（n = 35）或人际心理治疗（IPT）组（n = 34）的治疗完成者样本中的焦虑相关和抑郁相关结果进行了更细致的分析。我们研究了抗抑郁药使用情况以及焦虑和抑郁测量指标的影响，特别关注与死亡或逝者相关的内疚感以及与哀伤相关的回避行为，以便进一步了解CGT和IPT在接受完整疗程治疗的参与者中的不同疗效。分析表明，CGT在减轻焦虑和抑郁症状方面效果更显著，包括对未来的消极想法以及与哀伤相关的回避行为。CGT在降低抑郁方面相对于IPT的优势在未服用抗抑郁药的人群中最为明显。我们的结果进一步阐明了CGT的效果，并支持了复杂哀伤（CG）和重度抑郁症是不同病症的观点。
针对复杂哀伤（CG）的靶向治疗在相关情绪和焦虑症状以及CG症状方面产生了益处。在患有CG的患者中，人际心理治疗在改善抑郁症状方面似乎相对无效。与哀伤相关的抑郁症状可能对标准治疗无反应，除非CG症状也得到解决。减少与哀伤相关的症状，如对未来的焦虑、与死亡或逝者相关的内疚感以及避免回忆失去的事情，可能是减轻CG的重要方面。
