The Impact of Separation in Bereavement and Prolonged Grief Disorder
John Graham, MD, PhD, DMin, Institute for Spirituality and Health, Houston, TX; and Kerry Horrell, PhD, Baylor College of Medicine, Houston, TX
The impact of separation upon the loss of a loved one is great with adverse psychophysiological and spiritual effects on the individual’s life. Over 2.8 M deaths occur annually in the United States and at least that many experience breavement. As high as 7-15% of bereaved individuals go on to experience prolonged grief disorder (PGD) which can last for years with dangerously low heart rate variability (HRV) levels, and a higher incidence of morbidity and mortality (Galbadage et al., 2020; Szuhany et al., 2021).
Importantly, the fields of psychiatry and psychology have continued to differentiate acute grief and prolonged grief from depression and posttraumatic stress (APA, 2022; Boelen & Lenferink, 2020). Specifically, prolonged grief disorder is a distinguishable psychiatric illness from major depressive disorder and has unique treatment considerations.
A ten-year experience facilitating a bereavement support group affirmed the impact of prolonged grief disorder for many attendees. This prompted the creation of a mixed-method (qualitative and quantitative) study with participants who underwent six weeks of daily Heart Rate Variability Biofeedback, an intervention that has been shown to be effective for many chronic conditions (Lin et al. 2019).
The qualitative aspect of the study included pre-and post-study interviews and the Two-Tack Bereavement Questionnaire (Rubin et al., 2020). The quantitative aspect of the study included pre- and post-study levels of HRV and hair cortisol levels.
The impact of separation at death of a loved one can be devastating. This talk will emphasize the importance of a bereavement support group, the use of HRV biofeedback, and identify ways individuals can manage their prolonged grief. Although a pilot study cannot confirm the value of HRV biofeedback in prolonged grief disorder, however, the findings encourage a larger randomized control trial.
References:
American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing. https://www.psychiatry.org/psychiatrists/practice/dsm
Boelen, P.A. & Lenferink, L.I. (2020). Symptoms of prolonged grief, posttraumatic stress, and depression in recently bereaved people: Symptom profiles, predictive value, and cognitive behavioural correlates. Social Psychiatry and Psychiatric Epidemiology, 55, 765–777. https://doi.org/10.1007/s00127-019-01776-w
Galbadage, T., Peterson, B. M., Wang, D. C., Wang, J. S., & Gunasekera, R. S. (2020). Biopsychosocial and spiritual implications of patients with COVID-19 dying in isolation. Frontiers in Psychology, 11(Article t88623), 1-6. https://doi.org/10.3389/fpsyg.2020.588623
Lin, I., Fan, S., Yen, C., Yeh, Y., Tang, T., Huang, M., Liu, T., Wang, P., Lin, H., Tsai, H. & Tsai, Y. (2019). Heart rate variability biofeedback increased autonomic activation and improved symptoms of depression and insomnia among patients with major depressive disorder. Clinical Psychopharmacology and Neuroscience, 17(2), 222-232. https://doi.org/10.9758/cpn.2019.17.2.222
Rubin, S. S., Malkinson R., & Witztum, E. (2020). Traumatic bereavements: Rebalancing the relationship with the Two-Track Model of Bereavement. Front Psychiatry, 11. Article 537596, 1-12. https://doi.org/10.3389/fpsyt.2020.537596
Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). Prolonged grief disorder: course, diagnosis, assessment, and treatment. Focus, 19(2), 161-172. https://doi.org/10.1176/appi.focus.20200052