Complicated grief helped by cognitive restructuring and exposure therapy

The death of a loved one can precipitate the devastating clinical condition known as “complicated grief” (CG). In a study reported in Journal of Consulting and Clinical Psychology, maladaptive thinking and behaviors were described as significant contributors to CG. The effectiveness of cognitive-behavioral therapy (CBT) was compared with nonspecific supportive counseling (SC). In this study, CBT methods included cognitive restructuring and exposure.

People suffering with CG often avoid reminders of the loss, which, the authors suggested, “is a key maintaining factor in CG.” Recovery was aided when patients “gradually confront these reminders and elaborate on the implications of the loss.” For example, patients were asked to recount the story of the loss, and therapists identified aspects that were particularly distressing. Homework assignments were aimed at gradually increasing exposure to the reality of the loss.

The study results showed CBT to be more effective than SC and the authors concluded that helping patients to confront and work through the loss is important in treating CG.

Study authors: P. A. Boelen, J. de Keijser, M. A. van den Hout, J. van den Bout 




Refractory angina (chronic chest pain) positively affected by CBT

People with chronic refractory angina are frequently hospitalized with severe chest pain. A recent study in the Journal of Pain and Symptom Management indicates that outpatient cognitive-behavioral therapy improves angina status and quality of life, and reduces hospital admissions. In this study, after patients participated in a brief CBT protocol, admissions for chest pain were reduced from 2.40 per patient per year to 1.78. Only 8 myocardial infarctions (MI) were recorded in the year after in enrollment the program, whereas 32 were recorded in the year prior. Additionally, overall mortality was lower than in comparable groups treated with surgery.

Patients who are incapacitated by angina suffer “intense anxiety and apprehension” as a result of the pain itself, and of their assumptions about what the pain indicates about their underlying heart conditions. Using a 5-item questionnaire, patients’ misconceptions and counter-therapeutic beliefs and behaviors were identified. One typical finding was that angina patients avoid exercise, for example, because of a mistaken belief that it will damage their hearts. This maladaptive behavior, which results from this misconception, actually increases their risk of MI. The authors challenged these beliefs and offered evidence-based, alternative explanations for their symptoms.

The authors indicate that brief outpatient CBT was effectively used to educate patients and demystify angina, which produced “an immediate and sustained reduction in hospital admission.”

Study authors: R. K. G. Moore, D. G. Groves, J. D. Bridson, A. D. Grayson, H. Wong, A. Leach, R. J. P. Lewin, M. R. Chester