Advertisement

Multidimensional Grief Therapy: Pilot Open Trial of a Novel Intervention for Bereaved Children and Adolescents

  • Ryan M. Hill
  • Benjamin Oosterhoff
  • Christopher M. Layne
  • Evan Rooney
  • Stephanie Yudovich
  • Robert S. Pynoos
  • Julie B. KaplowEmail author
Original Paper
  • 22 Downloads

Abstract

Objectives

This study describes a pilot open trial of Multidimensional Grief Therapy, an assessment-driven, phasic individual therapy for bereaved youth. This study provides a preliminary outcome evaluation with respect to maladaptive grief reactions, post-traumatic stress symptoms, and depressive symptoms in bereaved youth.

Methods

The sample consisted of 65 bereaved youth (ages 6–17 years, M = 11.62, SD = 2.76; 53% female; 33.3% Hispanic, 31.8% African American/Black, 27.3% Caucasian, 6.1% mixed/biracial, 1.5% Native American). The study utilized a single-group open trial design. Youth referred to the study due to the death of a loved one completed measures of grief reactions, posttraumatic stress symptoms, and depressive symptoms. Measures were also completed following Phases I and II of the treatment.

Results

Youth who completed Phase I (n = 42) reported significant reductions from baseline, with large to very large effect sizes (Cohen’s D range = 0.77−1.35) for all three domains of maladaptive grief, post-traumatic stress symptoms, and depressive symptoms. Youth who completed Phase II (n = 22) exhibited significant reductions from the end of Phase I, with medium to large effect sizes (range = 0.57–0.90) for two domains of maladaptive grief as well as for posttraumatic stress symptoms and depressive symptoms.

Conclusions

Although further evaluations using a wider array of outcomes are needed to evaluate MGT and the maintenance of treatment gains over time, the present study provides preliminary evidence supporting MGT as an individual treatment for bereaved youth experiencing maladaptive grief reactions, post-traumatic stress, and depressive symptoms.

Keywords

Bereavement Grief Posttraumatic stress disorder Treatment effectiveness Depression 

Notes

Acknowledgements

This research was supported by grants from the Substance Abuse and Mental Health Service Administration (SM-16008 and SM-062111), both given to J.K.

Author Contributions

R.M.H.: Completed the data analysis and prepared the initial and revised manuscript draft. B.O.: Assisted with data analysis and data preparation. C.M.L.: Collaborated with writing the manuscript. E.R.: Assisted with the writing and preparation of the manuscript. S.Y.: Assisted with execution of the study. RSP: Collaborated in editing the manuscript. J.B.K.: Designed and executed the study; collaborated in the writing and editing of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration. The Baylor College of Medicine IRB approved this study.

Informed Consent

Informed consent/assent was obtained from all individual participants included in this study.

References

  1. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders. 5th edn. Arlington, VA: Author.Google Scholar
  2. Angold, A., Costello, E. J., Messer, S. C., & Pickles, A. (1995). Development of a short questionnaire for use in epidemiological studies of depression in children and adolescents. International Journal of Methods in Psychiatric Research, 5(4), 237–249.Google Scholar
  3. Ayers, T. S., Wolchik, S. A., Sandler, I. N., Twohey, J. L., Weyer, J. L., Padgett-Jones, S., & Kriege, G. (2014). The family bereavement program: Description of a theory-based prevention program for parentally-bereaved children and adolescents. OMEGA—Journal of Death and Dying, 68(4), 293–314.Google Scholar
  4. Bados, A., Balaguer, G., & Saldaña, C. (2007). The efficacy of cognitive–behavioral therapy and the problem of drop‐out. Journal of Clinical Psychology, 63(6), 585–592.Google Scholar
  5. Berg, L., Rostila, M., & Hjern, A. (2016). Parental death during childhood and depression in young adults—a national cohort study. Journal of Child Psychology and Psychiatry, 57(9), 1092–1098.Google Scholar
  6. Boelen, P., Lenferink, L., Nickerson, A., & Smid, G., Clinical Psychology and Experimental Psychopathology (2018). Evaluation of the factor structure, prevalence, and validity of disturbed grief in DSM-5 and ICD-11. Journal of Affective Disorders, 240, 79–97.Google Scholar
  7. Boelen, P. A., van den Hout, Marcel, A., & van den Bout, J. (2006). A cognitive-behavioral conceptualization of complicated grief. Clinical Psychology: Science and Practice, 13(2), 109–128.Google Scholar
  8. Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162(2), 214–227.Google Scholar
  9. Breslau, N., Peterson, E. L., Poisson, L. M., Schultz, L. R., & Lucia, V. C. (2004). Estimating post-traumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events. Psychological Medicine, 34(5), 889–898.Google Scholar
  10. Cerel, J., Fristad, M. A., Verducci, J., Weller, R. A., & Weller, E. B. (2006). Childhood bereavement: psychopathology in the 2 years postparental death. Journal of the American Academy of Child & Adolescent Psychiatry, 45(6), 681–690.Google Scholar
  11. Clark, D. C., Pynoos, R. S., & Goebel, A. E. (1994). Mechanisms and processes of adolescent bereavement. New York, NY: Cambridge University Press.Google Scholar
  12. Claycomb, M. A., Charak, R., Kaplow, J., Layne, C. M., Pynoos, R., & Elhai, J. D. (2016). Persistent complex bereavement disorder symptom domains relate differentially to PTSD and depression: A study of war-exposed Bosnian adolescents. Journal of Abnormal Child Psychology, 44(7), 1361–1373.Google Scholar
  13. Cohen, J. (1969). Statistical power analysis for the behavioral sciences. San Diego, CA: Academic Press.Google Scholar
  14. Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2017). Treating trauma and traumatic grief in children and adolescents. 2nd edn. New York, NY: Guilford Publications.Google Scholar
  15. Cohen, J. A., Mannarino, A. P., & Knudsen, K. (2004). Treating childhood traumatic grief: a pilot study. Journal of the American Academy of Child & Adolescent Psychiatry, 43(10), 1225–1233.Google Scholar
  16. Cohen, J. A., Mannarino, A. P., & Staron, V. R. (2006). A pilot study of modified cognitive-behavioral therapy for childhood traumatic grief (CBT-CTG). Journal of the American Academy of Child & Adolescent Psychiatry, 45(12), 1465–1473.Google Scholar
  17. Dillen, L., Fontaine, J. R. J., & Verhofstadt-Denève, L. (2009). Confirming the distinctiveness of complicated grief from depression and anxiety among adolescents. Death Studies, 33(5), 437–461.Google Scholar
  18. Elhai, J. D., Layne, C. M., Steinberg, A. M., Brymer, M. J., Briggs, E. C., Ostrowski, S. A., & Pynoos, R. S. (2013). Psychometric properties of the UCLA PTSD reaction index. Part II: Investigating factor structure findings in a national clinic‐referred youth sample. Journal of Traumatic Stress, 26(1), 10–18.Google Scholar
  19. Geronazzo-Alman, L., Fan, B., Duarte, C. S., Layne, C. M., Wicks, J., Guffanti, G., & Hoven, C. W. (2019). The distinctiveness of grief, depression, and posttraumatic stress: lessons from children after 9/11. Journal of the American Academy of Child & Adolescent Psychiatry.  https://doi.org/10.1016/j.jaac.2018.12.012, in press.
  20. Goenjian, A. K., Karayan, I., Pynoos, R. S., Minassian, D., Najarian, L. M., Steinberg, A. M., & Fairbanks, L. A. (1997). Outcome of psychotherapy among early adolescents after trauma. American Journal of Psychiatry, 154(4), 536–542.Google Scholar
  21. Grassetti, S. N., Herres, J., Williamson, A. A., Yarger, H. A., Layne, C. M., & Kobak, R. (2015). Narrative focus predicts symptom change trajectories in group treatment for traumatized and bereaved adolescents. Journal of Clinical Child & Adolescent Psychology, 44(6), 933–941.Google Scholar
  22. Guldin, M., Li, J., Pedersen, H. S., Obel, C., Agerbo, E., Gissler, M., & Vestergaard, M. (2015). Incidence of suicide among persons who had a parent who died during their childhood: A population-based cohort study. JAMA Psychiatry, 72(12), 1227–1234.Google Scholar
  23. Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59(1), 12–19.Google Scholar
  24. Kaplow, J. B., Howell, K. H., & Layne, C. M. (2014). Do circumstances of the death matter? Identifying socioenvironmental risks for grief-related psychopathology in bereaved youth. Journal of Traumatic Stress, 27(1), 42–49.Google Scholar
  25. Kaplow, J. B., Layne, C. M., Oosterhoff, B., Goldenthal, H., Howell, K. H., Wamser‐Nanney, R., & Pynoos, R. (2018). Validation of the persistent complex bereavement disorder (PCBD) checklist: A developmentally informed assessment tool for bereaved youth. Journal of Traumatic Stress, 31(2), 244–254.Google Scholar
  26. Kaplow, J. B., Layne, C. M., & Pynoos, R. S. (2019a). Persistent complex bereavement disorder. In M. Prinstein, E. Youngstrom, E. Mash, & R. Barkley (eds). Treatment of disorders in children and adolescence. 4th edn. New York, NY: Guilford.Google Scholar
  27. Kaplow, J. B., Layne, C. M., Pynoos, R. S., & Saltzman, W. R., (2019b). Multidimensional grief therapy: A flexible approach to assessing and supporting bereaved youth. New York: Cambridge University Press, in press.Google Scholar
  28. Kaplow, J. B., Layne, C. M., Saltzman, W. R., Cozza, S. J., & Pynoos, R. S. (2013). Using multidimensional grief theory to explore the effects of deployment, reintegration, and death on military youth and families. Clinical Child and Family Psychology Review, 16(3), 322–340.Google Scholar
  29. Kaplow, J. B., Saunders, J., Angold, A., & Costello, E. J. (2010). Psychiatric symptoms in bereaved versus nonbereaved youth and young adults: a longitudinal epidemiological study. Journal of the American Academy of Child & Adolescent Psychiatry, 49(11), 1145–1154.Google Scholar
  30. Lambert, M. J., & Ogles, B. M. (2009). Using clinical significance in psychotherapy outcome research: the need for a common procedure and validity data. Psychotherapy Research, 19(4–5), 493–501.Google Scholar
  31. Layne, C. M., Kaplow, J. B., Oosterhoff, B., Hill, R., & Pynoos, R. S. (2017). The interplay between posttraumatic stress and grief reactions in traumatically bereaved adolescents: When trauma, bereavement, and adolescence converge. Adolescent Psychiatry, 7, 220–239.Google Scholar
  32. Layne, C. M., Kaplow, J. B., & Pynoos, R. S. (2014). Persistent complex bereavement disorder (PCBD) checklist—Youth version 1.0. Los Angeles, CA: University of California, Los AngelesGoogle Scholar
  33. Layne, C. M., Pynoos, R. S., Saltzman, W. R., Arslanagić, B., Savjak, N., Popović, T., & Houston, R. (2001). Trauma/grief-focused group psychotherapy: School-based postwar intervention with traumatized Bosnian adolescents. Group Dynamics: Theory, Research, and Practice, 5(4), 277–290.Google Scholar
  34. Layne, C. M., Saltzman, W. R., Poppleton, L., Burlingame, G. M., Pašalić, A., Duraković, E., & Steinberg, A. M. (2008). Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial. Journal of the American Academy of Child & Adolescent Psychiatry, 47(9), 1048–1062.Google Scholar
  35. Lenferink, L., Nickerson, A., de Keijser, J., Smid, G., & Boelen, P. (2018). Trajectories of grief, depression, and posttraumatic stress in disaster-bereaved people. Depression and Anxiety.  https://doi.org/10.1002/da.22850.
  36. Luecken, L. J., Hagan, M. J., Sandler, I. N., Tein, J., Ayers, T. S., & Wolchik, S. A. (2010). Cortisol levels six-years after participation in the family bereavement program. Psychoneuroendocrinology, 35(5), 785–789.Google Scholar
  37. Maciejewski, P., Maercker, A., Boelen, P., & Prigerson, H. (2016). “Prolonged grief disorder” and “persistent complex bereavement disorder”, but not “complicated grief”, are one and the same diagnostic entity: An analysis of data from the Yale Bereavement Study. World Psychiatry, 15(3), 266–275.Google Scholar
  38. Melhem, N. M., Moritz, G., Walker, M., Shear, M. K., & Brent, D. (2007). Phenomenology and correlates of complicated grief in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 46(4), 493–499.Google Scholar
  39. Melhem, N. M., Porta, G., Shamseddeen, W., Walker Payne, M., & Brent, D. A. (2011). Grief in children and adolescents bereaved by sudden parental death. Archives of General Psychiatry, 68(9), 911–919.Google Scholar
  40. Melhem, N. M., Walker, M., Moritz, G., & Brent, D. A. (2008). Antecedents and sequelae of sudden parental death in offspring and surviving caregivers. Archives of Pediatrics & Adolescent Medicine, 162(5), 403–410.Google Scholar
  41. O’Donnell, K., Dorsey, S., Gong, W., Ostermann, J., Whetten, R., Cohen, J. A., & Whetten, K. (2014). Treating maladaptive grief and posttraumatic stress symptoms in orphaned children in Tanzania: Group‐based trauma‐focused cognitive–behavioral therapy. Journal of Traumatic Stress, 27(6), 664–671.Google Scholar
  42. Oosterhoff, B., Kaplow, J. B., & Layne, C. M. (2018). Links between bereavement due to sudden death and academic functioning: Results from a nationally representative sample of adolescents. School Psychology Quarterly, 33(3), 372–380.  https://doi.org/10.1037/spq0000254.
  43. Pham, S., Porta, G., Biernesser, C., Walker Payne, M., Iyengar, S., Melhem, N., & Brent, D. (2018). The burden of bereavement: Early-onset depression and impairment in youths bereaved by sudden parental death in a 7-year prospective study. American Journal of Psychiatry, 175(9), 887–896.Google Scholar
  44. Pynoos, R. S., Steinberg, A. M., Layne, C. M., Liang, L., Vivrette, R. L., Briggs, E. C., & Fairbank, J. A. (2014). Modeling constellations of trauma exposure in the national child traumatic stress network core data setPsychological Trauma: Theory, Research, Practice, and Policy, 6(Suppl 1), S9–S17.Google Scholar
  45. Rolon-Arroyo, B., Rooney, E., Kaplow, J. B., Calhoun, K., Layne, C. M., Steinberg, A., & Pynoos, R. (2017). Psychometric properties of the UCLA PTSD Reaction Index for DSM-5 (RI-5): identifying clinically significant PTSD in culturally diverse youth. Poster presented at the Annual Meeting of the International Society for Trau matic Stress Studies, Chicago, IL.Google Scholar
  46. Salloum, A. (2008). Group therapy for children after homicide and violence: A pilot study. Research on Social Work Practice, 18(3), 198–211.Google Scholar
  47. Salloum, A., & Overstreet, S. (2008). Evaluation of individual and group grief and trauma interventions for children post disaster. Journal of Clinical Child & Adolescent Psychology, 37(3), 495–507.Google Scholar
  48. Salloum, A., & Overstreet, S. (2012). Grief and trauma intervention for children after disaster: Exploring coping skills versus trauma narration. Behaviour Research and Therapy, 50(3), 169–179.Google Scholar
  49. Saltzman, W., Layne, C., Pynoos, R., Olafson, E., Kaplow, J., & Boat, B. (2017). Trauma and grief component therapy for adolescents: a modular approach to treating traumatized and bereaved youth. New York, NY: Cambridge University Press.Google Scholar
  50. Saltzman, W. R., Pynoos, R. S., Layne, C. M., Steinberg, A. M., & Aisenberg, E. (2001). Trauma- and grief-focused intervention for adolescents exposed to community violence: Results of a school-based screening and group treatment protocol. Group Dynamics: Theory, Research, and Practice, 5(4), 291–303.Google Scholar
  51. Sandler, I., Ayers, T. S., Tein, J., Wolchik, S., Millsap, R., Khoo, S. T., & Coxe, S. (2010). Six-year follow-up of a preventive intervention for parentally bereaved youths: A randomized controlled trial. Archives of Pediatrics & Adolescent Medicine, 164(10), 907–914.Google Scholar
  52. Sandler, I. N., Ayers, T. S., Wolchik, S. A., Tein, J., Kwok, O., Haine, R. A., & Griffin, W. A. (2003). The family bereavement program: Efficacy evaluation of a theory-based prevention program for parentally bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 71(3), 587–600.Google Scholar
  53. Sandler, I. N., Ma, Y., Tein, J., Ayers, T. S., Wolchik, S., Kennedy, C., & Millsap, R. (2010). Long-term effects of the family bereavement program on multiple indicators of grief in parentally bereaved children and adolescents. Journal of Consulting and Clinical Psychology, 78(2), 131–143.Google Scholar
  54. Sandler, I., Tein, J., Wolchik, S., & Ayers, T. S. (2016). The effects of the family bereavement program to reduce suicide ideation and/or attempts of parentally bereaved children six and fifteen years later. Suicide & Life-Threatening Behavior, 46(Suppl 1(2)), S32–S38.Google Scholar
  55. Sandler, I. N., Wolchik, S. A., Ayers, T. S., Tein, J., & Luecken, L. (2013). Family bereavement program (FBP) approach to promoting resilience following the death of a parent. Family Science, 4(1), 87–94.Google Scholar
  56. Shapiro, D. N., Howell, K. H., & Kaplow, J. B. (2014). Associations among mother-child communication quality, childhood maladaptive grief, and depressive symptoms. Death Studies, 38(1–5), 172–178.Google Scholar
  57. Spuij, M., van Londen-Huiberts, A., & Boelen, P. A. (2013). Cognitive-behavioral therapy for prolonged grief in children: Feasibility and multiple baseline study. Cognitive and Behavioral Practice, 20(3), 349–361.Google Scholar
  58. Spuij, M., Dekovic, M., & Boelen, P. A. (2015). An open trial of ‘grief‐help’: cognitive–behavioural treatment for prolonged grief in children and adolescents.Clinical Psychology & Psychotherapy, 22(2), 185–192.Google Scholar
  59. Spuij, M., Prinzie, P., Zijderlaan, J., Stikkelbroek, Y., Dillen, L., Roos, C., & Boelen, P. A. (2012). Psychometric properties of the Dutch inventories of prolonged grief for children and adolescents.Clinical Psychology & Psychotherapy, 19(6), 540–551.Google Scholar
  60. Tabachnick, B. G. & Fidell, L. S. (2013). Using multivariate statistics. 6th edn. Boston, MA: Pearson.Google Scholar
  61. Thapar, A., & McGuffin, P. (1998). Validity of the shortened mood and feelings questionnaire in a community sample of children and adolescents: A preliminary research note. Psychiatry Research, 81(2), 259–268.Google Scholar
  62. Tingey, R., Lambert, M., Burlingame, G., & Hansen, N. (1996). Assessing clinical significance: Proposed extensions to method. Psychotherapy Research, 6(2), 109–123.Google Scholar
  63. UN Children’s Fund (UNICEF) (2013). UNICEF Annual Report 2012. ISBN:978-92-806-4693-1, http://www.refworld.org/docid/51ee31214.html. Accessed 3 Aug 2018.
  64. Wamser-Nanney, R., & Steinzor, C. E. (2017). Factors related to attrition from trauma-focused cognitive-behavioral therapy. Child Abuse & Neglect, 66, 73–83.Google Scholar
  65. Wardecker, B. M., Kaplow, J. B., Layne, C. M., & Edelstein, R. S. (2017). Caregivers’ positive emotional expression and children’s psychological functioning after parental loss. Journal of Child and Family Studies, 26(12), 3490–3501.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ryan M. Hill
    • 1
  • Benjamin Oosterhoff
    • 2
  • Christopher M. Layne
    • 3
    • 4
  • Evan Rooney
    • 1
  • Stephanie Yudovich
    • 1
  • Robert S. Pynoos
    • 3
    • 4
  • Julie B. Kaplow
    • 1
    Email author
  1. 1.Baylor College of Medicine/Texas Children’s HospitalHoustonUSA
  2. 2.Department of PsychologyMontana State UniversityBozemanUSA
  3. 3.UCLA/Duke National Center for Child Traumatic StressLos AngelesUSA
  4. 4.Department of Psychiatry and Biobehavioral SciencesUniversity of California, Los AngelesLos AngelesUSA

Personalised recommendations