Traumatic Grief and Prolonged Grief Disorder Therapy in Austin, TX
Understanding Traumatic Grief and Prolonged Grief Disorder
Written by Alex Penrod, MS, LPC, LCDC - Licensed Professional Counselor in the state of Texas and Certified Clinical Trauma Professional II
Grief is a natural response to loss, but for some individuals, the mourning process becomes deeply complicated, lasting longer than expected and severely disrupting their lives. Traumatic grief and Prolonged Grief Disorder (PGD) are two distinct yet interconnected experiences that require specialized attention and treatment.
Defining Traumatic Grief and Prolonged Grief Disorder
Traumatic Grief: Traumatic grief occurs when a person experiences a loss under traumatic circumstances—such as sudden, violent, or unexpected death. This type of grief not only includes the profound sadness of loss but also symptoms of trauma like flashbacks, avoidance, and hyperarousal, often making the grieving process feel overwhelming and unmanageable.
Prolonged Grief Disorder (PGD): Prolonged Grief Disorder is a specific mental health condition where normal grief reactions persist for an extended period (over 12 months for adults) and significantly impair daily functioning. PGD differs from natural grief in its intensity, duration, and impact on a person’s ability to engage in life after the loss. The condition may include yearning for the deceased, emotional numbness, and difficulty accepting the loss.
Symptoms of Traumatic Grief and Prolonged Grief Disorder
Individuals with traumatic grief or PGD often experience a combination of trauma and grief symptoms, such as:
Intense longing or yearning for the deceased
Inability to accept the death, often feeling disbelief or numbness
Intrusive thoughts about the deceased or traumatic aspects of the loss
Avoidance behaviors related to reminders of the deceased or the traumatic event
Hypervigilance or being easily startled, often tied to the traumatic nature of the loss
Depression or persistent sadness that doesn’t improve over time
Guilt related to the death or circumstances surrounding the loss
Diagnostic Criteria for Prolonged Grief Disorder
According to the DSM-5-TR, diagnostic criteria for PGD include:
Symptoms last for at least 12 months after the loss in adults, or 6 months for children and adolescents.
A grief response characterized by an intense longing/yearning for the deceased person and/or preoccupation with thoughts and memories of the person to a degree it impairs or interferes with functioning nearly every day for at least the last month.
In addition, the bereaved person experiences at least 3 of the following 8 symptoms at a level that impairs or interferes with daily functioning:
Identity disruption (such as feeling as though part of oneself has died).
Marked sense of disbelief about the death.
Avoidance of reminders that the person is dead.
Intense emotional pain (such as anger, bitterness, sorrow) related to the death.
Difficulty with reintegration (such as problems engaging with friends, pursuing interests, planning for the future).
Emotional numbness (absence or marked reduction of emotional experience).
Feeling that life is meaningless.
Intense loneliness (feeling alone or detached from others).
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of daily functioning.
The grief response is beyond the expected cultural, religious, or age-related norms.
The symptoms are not better explained by major depressive disorder, posttraumatic stress disorder, substance use, or a medical condition.
PGD is not simply extended sadness; it is a clinical condition requiring targeted interventions.
Prevalence of Prolonged Grief Disorder
An estimated 7-10% of adults who experience a loss will develop the persistent symptoms of prolonged grief disorder.
Risk Factors for the Development of Prolonged Grief Disorder
In the context of prolonged grief disorder (PGD), risk factors can be categorized into pre-loss and post-loss factors.
Pre-loss risk factors include:
A history of psychiatric disorders, especially depression and anxiety
Lack of social support
Childhood adversities, like trauma or insecure attachment
The nature of the relationship with the deceased (e.g., dependency)
Post-loss risk factors include:
The suddenness or violence of the death
Lack of social or community support post-loss
Limited opportunities for grieving
Complications like financial difficulties
Evidence-Based Treatments for Traumatic Grief and PGD
Treating traumatic grief and Prolonged Grief Disorder often involves addressing both the traumatic aspect of the loss and the persistent grief. Evidence-based treatments include:
Cognitive Behavioral Therapy (CBT): CBT helps individuals identify and challenge unhelpful thoughts and beliefs related to the loss and trauma. This treatment can be effective in reducing avoidance behaviors and managing grief-related emotions.
Complicated Grief Therapy (CGT): Specifically designed to treat PGD, CGT focuses on helping individuals process their grief while reducing trauma symptoms. It includes elements of exposure therapy and interpersonal therapy to help clients adapt to life after loss.
Prolonged Exposure Therapy: This trauma-focused therapy involves helping individuals confront their memories of the traumatic loss in a controlled, therapeutic setting, allowing them to process these experiences and reduce their emotional intensity.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): For individuals dealing with trauma alongside grief, TF-CBT provides tools to manage trauma symptoms while working through the grief process.
The Role of EMDR in Processing Grief
Eye Movement Desensitization and Reprocessing (EMDR) therapy is a powerful intervention that can aid in the healing process for individuals suffering from traumatic grief or PGD. EMDR works by helping individuals process both the traumatic event and the grief associated with the loss.
Desensitizing Traumatic Memories: EMDR allows clients to process the distressing memories associated with the traumatic loss, reducing the intensity of emotional and physical reactions to these memories.
Processing Grief in a Healthy Way: By reprocessing these memories, individuals can move beyond the trauma and begin to engage in a more adaptive grieving process, making room for emotional healing and acceptance of the loss.
Reduction of Trauma Symptoms: EMDR can help reduce trauma-related symptoms such as flashbacks, nightmares, and hyperarousal, which are often intertwined with traumatic grief.
EMDR provides a structured yet flexible approach to addressing both the trauma and prolonged aspects of grief, making it a key therapeutic tool for individuals stuck in complicated grief patterns. Specific protocols for addressing grief with EMDR have been developed that target key components unique to grief and traumatic grief experiences. My approach involves a combination of cognitive behavioral therapy, supportive talk therapy, narrative therapy, somatic experiencing interventions, and EMDR to help develop coping skills and process through grief and trauma at a pace that an individual can tolerate.
Conclusion
Traumatic grief and Prolonged Grief Disorder can be devastating, but with the right interventions, healing is possible. Evidence-based therapies like Cognitive Behavioral Therapy, Complicated Grief Therapy, and trauma-focused treatments, including EMDR, can help individuals process their grief, overcome trauma, and restore a sense of meaning and peace in their lives.
If you or someone you know is struggling with prolonged or traumatic grief, I’d be happy to assist you with a free 15-minute consultation to discuss how my therapeutic approach can help.