When Healing From Grief Is Stalled

By definition, grief is the natural response to losing either a person, or a meaningful possession. During the gradual healing process that follows, most people who experience loss begin with intensely felt “acute” grief, then go on to eventually reach a stage of “integrated” grief, in which they can move forward in their lives while still feeling the loss. Though this healing process is experienced by most people who have suffered a loss, one to two percent of people face greater difficulties, and experience what is known as “prolonged grief.” 

Prolonged grief happens when the person feels stuck in a state of prolonged “acute” grief, experiencing continued ruminations, avoidance and other extremely limiting feelings and behaviors. The risk for prolonged grief is slightly increased after a loss by suicide; this has been attributed to feelings of shame and guilt, along with slightly increased rates of depression and PTSD.

In 2009 and 2012, AFSP funded four researchers to add a group of survivors of suicide loss to their study on prolonged grief treatment funded by the National Institute of Mental Health. The study’s investigators — Dr. Katherine Shear from Columbia University; Dr. Sidney Zisook from the University of California, San Diego; Dr. Naomi Simon from Harvard University; and Dr. Charles Reynolds from the University of Pittsburgh — sought to examine the effect of Prolonged Grief Treatment.

Prolonged Grief Treatment is a systematic, 16-week treatment that assists people in working through their experiences and grief. Clinician training for Prolonged Grief Treatment is offered by Dr. Shear at the Center for Complicated Grief at Columbia University.

At the beginning of the study, participants with prolonged grief who were bereaved by suicide were found to be very similar to those who lost someone due to accident/homicide; or by natural causes in terms of the severity of prolonged grief and depressed mood. Those with prolonged grief who were bereaved by suicide, though, were more likely to have had major depression, PTSD and suicidal ideation at the beginning of the study and in their past. They also had more difficulty managing tasks at home and their private and social leisure activities. No other differences were identified.

In the study, treatment was offered to participants who were randomly assigned to one of four groups. People received either placebo medication or the antidepressant citalopram, with or without Prolonged Grief Treatment. It was found that medication alone was not sufficient, and that Prolonged Grief Treatment with or without antidepressant medication was most beneficial.

Most people who are bereaved by suicide do not experience prolonged grief. When healing is stalled and grief is unrelenting, Prolonged Grief Treatment can help a person get unstuck and healthily continue on to a pathway of integrated grief in which their loss is still with them, but so is living.

For more information on prolonged grief treatment, click here.