Therapy of limited benefit after suicide in family

NEW YORK (Reuters Health) - Family-based cognitive-behavioral therapy has little effect on many of the aspects of the bereavement following the suicide of a spouse or other family member, Dutch physicians have found.

On the other hand, the cognitive-behavioral therapy approach seems to reduce participants' perceptions of blame and prevent maladaptive grief reactions, they report in BMJ Online First.

Earlier trials of psychotherapy among bereaved families have yielded conflicting results, at least partly because they were poorly designed and involved small sample sizes.

Marieke de Groot, at the University of Groningen, and team members explain that "complicated grief" has an unusually long duration of symptoms, which include avoiding reminders of the dead person and having feelings of purposelessness, yearning, disbelief and bitterness. The researchers' goal was to prevent this complicated grief from taking over the subjects' lives.

Cognitive-behavioral therapy emphasizes the role of thinking in what we do and how we feel. Overall, it has two critical components: functional analysis and skills training. It is a short-term, comparatively brief approach that proposes the concept that thoughts cause feelings and behaviors, not external things, like people, situations and events.

The investigators evaluated 122 first-degree relatives or spouses of 70 people who had committed suicide. The subjects were randomly assigned to an intervention group and a usual care group that included 31 families.

The cognitive-behavioral therapy program involved four 2-hour sessions with a trained psychiatric nurse, conducted between 3 and 6 months after the suicide. The intervention was designed to "to offer relatives a reference frame for their grief reactions, engage emotional processing, enhance effective interaction, and improve problem solving," de Groot and associations explain.

Patient assessments were made 2.5 months after the suicide and a final follow-up took place after 13 months.

The intervention group and the usual-care group did not differ significantly in traumatic grief scores, depression, or suicidal thoughts at either follow-up time.