Healthy Living

Prolonged Grief – A Novel New Therapy

An estimated 10 million Americans suffer from “prolonged, complicated grief,” a type of grief disproportionately affects the elderly and is characterized by feelings of emotional numbness following the death of a loved one. This is a disorder that falls outside the spectrum of mental health diagnoses listed in the DSM-5, the standard treatment guidelines of mental disorders used by mental health professionals in the U.S. Could there be a short-term talk therapy available to help elderly move past this grief? Researchers at the University of South Florida are about to find out.

USF’s Dr. Kevin Kip, and Dr. Cindy Tofthagen, have initiated a two-year NIH-funded study examining the effectiveness of Accelerated Resolution Therapy in treating people over 65 who are suffering from prolonged, complicated grief. Accelerated Resolution Therapy is an evidenced–based psychotherapy that aims to resolve a traumatic memory through a combination of relaxation and memory visualization techniques. The therapy’s distinct features include use of horizontal eye movements and memory reconsolidation, which have been proven to provide effective relief from the strong physical and emotional reactions associated with PTSD, trauma, anxiety, performance and depression, in as few as 1-5 sessions, with the average being four sessions.

The therapy’s proven results have prompted Outback Steakhouse co-founder Chris T. Sullivan to start ART International, a nonprofit that is looking to expand the reach of this therapy by offering clinician trainings in more than 100 cities in 2018 for community-based therapists who are interested in becoming certified in providing Accelerated Resolution Therapy. More information on ART International’s training sessions can be found on their website at https://artherapyinternational.org/.

Drs. Kevin Kip and Cindy Tofthagen use $275,000 National Institute on Aging grant to embark on two-year study An estimated 10 million Americans suffer from what experts call “prolonged, complicated grief.”

This type of grief, which disproportionately affects the elderly, is characterized by a daily yearning for the deceased individual, feeling emotionally numb and having difficulty moving on with life.

“There’s a trauma aspect to the grief,” said Dr. Kevin Kip, a USF Distinguished Health Professor, epidemiologist and biostatistician, who notes that prolonged, complicated grief is a significant cause of depression, anxiety, suicide and poor physical health in older adults. “It’s a longing for the person, an empty purpose to life. These people are haunted by the death and are continually ruminating about it. In that way, it’s a lot like post-traumatic stress disorder [PTSD].”

Kip and his USF Health College of Nursing colleague, Dr. Cindy Tofthagen, PhD, ARNP, AOCNP, FAANP, are embarking on a two-year study looking at a type of psychotherapy—called accelerated resolution therapy, or ART—that has been proven effective with sexual assault victims and military personnel suffering with PTSD. The study, funded with a $275,000 grant from the National Institute on Aging, will examine the usefulness of ART in treating 50 senior citizens who have had an immediate family member in hospice care die within the last 12 to 18 months. The seniors must be suffering with prolonged, complicated grief, as determined by a qualified clinician.

Unlike traditional “talk” therapies used to treat conventional grief, ART focuses on two things: desensitizing the patient to the signs of physical distress (a fast heartbeat, nausea, etc.) that emerge when thoughts of the death arise and re-imagining the past with the loved one in a more positive way.

The desensitization is achieved by asking the patient to first recognize and label the uncomfortable physical feelings, and then to follow the clinician’s hand as it moves left to right.

“This simple act is stress reducing and helps the patient become desensitized to those unsettling physical sensations,” Kip said.

The next step with ART is to bring up the memories that are packing such an emotional wallop–and then reframe them.

“We might ask patients what life was like when the loved one was sick,” Kip said. “Then we might ask them to add some memories of what life was like before he or she was ill. Basically, we’re asking them to add positive material to the memory.”

“That re-imagining is done all while following the clinician’s hand, an important piece of ART therapy,” he said. “When you ask the brain to do two things at once, you tax working memory. And when you overload the memory, it dilutes some of the emotionality of a traumatic experience. When you go to store that memory back in the file cabinet of your brain, it’s modified to include new, more positive information.”

ART has never been studied as a therapy for complicated grief, but both Kip and Tofthagen are excited by its promise, noting that it could be a cost-effective and time-saving solution for grief-stricken spouses, especially since seniors with prolonged, complicated grief can develop other health issues.

“Multiple losses compound the trauma that people are going through,” Tofthagen said. “If they don’t have good coping skills, they may never be able to get back to normal life, and that affects their health. They develop cancer more often, heart disease and depression. It’s like a cascade.”

If the results are promising, noted the researchers, it could lead to a larger study to include multiple sites in order to get a wider sampling of patients.

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