Cognitive behavior therapy (CBT) focused on the grief has been shown in the past to be effective. A study just published (Bryant et al., 2014) showed that adding four sessions of weekly individual therapy focusing on exposure to memories about the death to ten sessions of group psychotherapy improved outcomes. Patients in whom exposure was added showed greater improvement in depression, negative appraisals, and functional impairment.

I will discuss CBT for prolonged grief in a separate post in the future. But for now we need to know exactly how the exposure done in this study so that we can use it for our patients with prolonged grief.

First, the patients were educated about how exposure therapy works and about why it is important to reduce avoidance of memories of the deceased and to integrate the loss into the patient’s memory. Then, in the session, patients were asked to relive the time they experienced the death of the person. A key technique for doing this was to ask the patient to talk in first person and in the present tense about their emotional, cognitive, sensory, and somatic reactions to the death. This was continued for about 40 minutes. If any patients completed the narrative in less than 40 minutes, then they were asked to repeat the narrative until a total of about 40 minutes had gone by. Every 10 minutes, patients were asked to about how distressed they were. This was done in order to make sure that the patients were emotionally involved in the narrative.The same procedure was followed for the four sessions of exposure but in the later sessions the therapists focused patients’ attention on the specific aspects of their memories that had elicited the most distress. Patients were also asked to similarly practice exposure at least once between the sessions.