Demystifying Disorders: Prolonged Grief Disorder

Unlock the complexities of Prolonged Grief Disorder (PGD) and discover how it challenges the natural grieving process as defined in the DSM-5-TR. Explore how PGD differs from typical grief, with symptoms that persist beyond usual timelines. We'll guide you through the dual process model of grief and attachment theory, shedding light on why some individuals struggle to adapt naturally to loss. Our discussion also covers key assessment tools like the Prolonged Grief Disorder-13 (PG-13) and Brief Grief Questionnaire (BGQ), which are essential for evaluating the severity and impact of grief. Along the way, we introduce vital grief-related terms such as anticipatory grief, complicated grief, and disenfranchised grief, providing a thorough groundwork in understanding PGD.

Step into the therapeutic world with the poignant case of Sarah, who navigates the turbulent waters of PGD after losing her teenage son. We emphasize the importance of building a robust therapeutic alliance, and share strategies that help integrate loss into life's narrative without diminishing the memory of a loved one. Discover how cognitive restructuring, narrative reconstruction, and exposure-based techniques, including the impactful empty chair method, offer pathways to healing. This episode also underscores the delicate balance between validating profound grief and promoting healthy adaptation, while highlighting the increased suicide risk associated with PGD. Finally, we remind therapists to be mindful of their own grief journeys and potential countertransference, ensuring they remain effective in supporting clients on their path to recovery.

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Chapters

• 0:00 Understanding Prolonged Grief Disorder and Treatment
• 8:37 Healing Through Grief and Therapy

Transcript

Speaker 1: 0:05

Let's discuss prolonged grief disorder, pgd, and what you need to know for your licensure exam. Pgd represents a significant advancement in the understanding of pathological grief responses. This condition in the DSM-5-TR describes a persistent and pervasive grief response that extends beyond expected social, cultural or religious norms. According to the DSM-5-TR, the diagnostic criteria for PGD include experiencing the death of someone close to the person, followed by a persistent grief response characterized by intense yearning and longing for the deceased person or preoccupation with thoughts or memories of them. These symptoms must persist for at least 12 months in adults and six months in children. Your client must experience at least three of the following symptoms nearly every day Identity disruption. Marked sense of disbelief about the death, avoidance of reminders of the loss, intense emotional pain, difficulty moving on, emotional numbness, feeling that life is meaningless and intense loneliness. These symptoms must cause clinically significant distress or impairment in functioning and exceed cultural, religious or age-appropriate norms. The basic assumptions underlying PGD center on the understanding that grief itself is a natural, adaptive response to loss, but becomes problematic when it persists beyond expected timeframes and significantly impairs daily functioning. The grief response in itself serves an important psychological and social function in processing loss and maintaining connections with deceased loved ones. However, when grief becomes prolonged and intense, it can interfere with the natural adaptation process and lead to significant psychological distress and functional impairment. Key concepts in understanding PGD include the dual process model of grief, which suggests that healthy grief involves oscillation between loss-oriented and restoration-oriented coping. Pgd often involves becoming stuck in loss-oriented coping, preventing the natural movement between the two processes of loss-oriented and restoration-oriented. Another crucial concept is the role of attachment theory in grief responses, where the severity of PGD symptoms often correlates with the client's attachment style and the nature of their relationship with the deceased and the nature of their relationship with the deceased. Continuing bonds, which represent the ongoing internal relationship with the deceased, are also fundamental to understanding PGD. The progression of PGD typically follows several stages, though these are not strictly linear. Initially, clients experience acute grief characterized by intense emotional pain and preoccupation with the loss. In typical grief, this naturally transitions to integrated grief, where the loss becomes part of one's life narrative. In PGD, clients become stuck in acute grief, unable to progress to integration. This can lead to a tertiary stage where maladaptive coping mechanisms and complicated emotions become entrenched further, impeding the natural grief process.

Speaker 1: 3:12

Assessment instruments used in treating PGD include for assessing prolonged grief disorder, pgd use the following assessment tools that evaluate different aspects of grief severity and impact. Prolonged grief disorder 13, pg-13. This is considered the gold standard for PGD assessment. It evaluates the core symptoms defined in the diagnostic criteria, including yearning, emotional pain and functional impairment. Brief Grief Questionnaire BGQ A quick five-item screening tool that can help identify individuals who may need more comprehensive assessment. Inventory of Complicated Grief ICG provides a detailed assessment of grief symptoms and their intensity, particularly useful for tracking changes over time.

Speaker 1: 3:58

Grief Cognition's Questionnaire GCQ. This questionnaire helps identify maladaptive thoughts and beliefs related to the loss that may be maintaining grief symptoms. The Work and Social Adjustment Scale WSS evaluates functional impairment across different life domains, which is crucial for understanding the impact of PGD. Phq-9 helps distinguish between normal grief reactions and clinical depression by measuring specific depressive symptoms like changes in sleep, appetite and mood. Mood GAD-7 identifies anxiety symptoms that may complicate the grief response, as heightened anxiety is common after a significant loss and may require specific interventions. Columbia Suicide Severity Rating Scale systematically assesses suicide risk, which is crucial since bereaved individuals have a higher suicide risk, particularly in cases where the loss was due to suicide. Patient Health Questionnaire 9, phq-9, for diagnosing comorbid depression and also track treatment progress by measuring symptom severity changes over time. Generalized Anxiety Disorder 7, gad-7, for evaluating anxiety symptoms. Columbia Suicide Severity Rating Scale for Suicide Risk Assessment as grief can increase suicide risk.

Speaker 1: 5:14

Techniques to Use in Treating PGD. Cognitive Restructuring Technique this approach involves identifying and modifying maladaptive thoughts and beliefs about loss, death and the implications for the future. You guide clients in examining thoughts such as I should have done more or I'll never be happy again, helping them develop more balanced and realistic perspectives while validating their emotional experience. Exposure-based techniques this method involves gradually confronting avoided situations, memories or reminders of the loss. You carefully guide clients through systematic exposure to these triggers, while providing support and teaching coping skills. This might include visiting meaningful places, looking at photographs or discussing memories of the deceased. Narrative reconstruction this technique involves helping clients construct a coherent narrative of their loss experience and integrate it into their broader life story. You help your clients tell their stories, process difficult moments and find meaning in their experiences, while maintaining a healthy, continuing bond with the deceased. Empty chair technique A powerful intervention where clients engage in dialogue with the deceased, expressing unresolved feelings and thoughts. Your role is to facilitate this process, helping clients process emotions and work toward the resolution of unfinished business Terms associated with prolonged grief you should know for your licensing exam.

Speaker 1: 6:45

Anticipatory grief the grief experience that occurs before an actual loss, common in cases of terminal illness. Complicated grief an older term for prolonged grief disorder, referring to grief that becomes stuck and impairs functioning. Continuing bonds the ongoing internal relationship maintained with the deceased, which can be either adaptive or maladaptive. Disenfranchised grief grief that is not socially acknowledged or validated, such as the loss of an ex-spouse or a miscarriage. Grief oscillation the natural movement between loss-focused and restoration-focused coping in healthy grief. Processing Loss-oriented the aspects of grief that focus directly on processing the death and the relationship with the deceased. Restoration-oriented the aspects of grief that involve adjusting to life changes and moving forward after a loss. Dual process model of grief the concept that healthy grieving involves oscillating between loss-oriented and restoration-oriented activities rather than focusing exclusively on either one.

Speaker 1: 7:51

Acute grief is the initial intense period of grief immediately following a loss, characterized by strong emotions, physical symptoms and disruption to daily functioning. Typical grief follows a generally expected pattern where the intensity of grief symptoms gradually decreases over time as the person adapts to the loss, though there may be periodic increases in grief intensity during significant dates or reminders. Integrated grief is when the loss becomes a part of the person's life narrative, where they can think about their loved one with less emotional pain, while engaging in meaningful activities and relationships, though the loss remains a part of their identity. Here's what you might see with a client experiencing prolonged grief disorder.

Speaker 1: 8:38

Sarah, a 45-year-old woman, sought therapy two years after losing her teenage son in a car accident Notice the time frame here. She presented with classic PGD symptoms, including intense preoccupation with her son's death, avoidance of places they frequented together and a persistent sense of disbelief about the loss. Initially, you should focus on building a strong therapeutic alliance and normalizing Sarah's grief experience Using cognitive restructuring. Address Sarah's belief that moving forward meant forgetting her son. Through narrative reconstruction, sarah may begin to integrate the loss into her life story. Finding ways to honor her son's memory while engaging in present-focused living Exposure work would assist her in gradually returning to places she had avoided, while the empty chair technique can allow her to express unresolved feelings to her son.

Speaker 1: 9:33

In summary, understanding and treating PGD requires a delicate balance between validating the profound nature of loss while facilitating healthy adaptation. You should remember that grief is highly clientized and influenced by cultural, religious and personal factors. The goal of treatment is not to eliminate grief or memories of the deceased, but to help clients integrate the loss into their life narrative while restoring functional capacity. Regular assessment of suicide risk is essential, as PGD can significantly increase risk. You should also maintain awareness of your own grief experiences and countertransference issues when working with PGD clients. The therapeutic relationship provides a crucial foundation for all interventions, and progress should be measured not just by symptom reduction, but by the client's ability to engage in meaningful life activities while maintaining healthy, continuing bonds with the deceased.