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An open trial of meaning-centered grief therapy: Rationale and preliminary evaluation

Published online by Cambridge University Press:  26 January 2019

Wendy G. Lichtenthal ,
Corinne Catarozoli ,
Melissa Masterson ,
Elizabeth Slivjak ,
Elizabeth Schofield ,
Kailey E. Roberts ,
Robert A. Neimeyer ,
Lori Wiener ,
Holly G. Prigerson  and
David W. Kissane
...Show all authors
Wendy G. Lichtenthal*
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, NY Weill Cornell Medicine, New York, NY
Corinne Catarozoli
Affiliation:
Weill Cornell Medicine, New York, NY
Melissa Masterson
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, NY
Elizabeth Slivjak
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, NY
Elizabeth Schofield
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, NY
Kailey E. Roberts
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, NY
Robert A. Neimeyer
Affiliation:
The University of Memphis, Memphis, TN
Lori Wiener
Affiliation:
National Cancer Institute, Bethesda, MD
Holly G. Prigerson
Affiliation:
Weill Cornell Medicine, New York, NY
David W. Kissane
Affiliation:
The University of Notre Dame Australia, Fremantle, Western Australia Monash University, Melbourne, Australia
Yuelin Li
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, NY
William Breitbart
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, NY Weill Cornell Medicine, New York, NY
*
Author for correspondence: Wendy G. Lichtenthal, Ph.D., Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, New York 10022. Email: lichtenw@mskcc.org
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Abstract

Objective

To determine the preliminary feasibility, acceptability, and effects of Meaning-Centered Grief Therapy (MCGT) for parents who lost a child to cancer.

Method

Parents who lost a child to cancer and who were between six months and six years after loss and reporting elevated levels of prolonged grief were enrolled in open trials of MCGT, a manualized, one-on-one cognitive-behavioral-existential intervention that used psychoeducation, experiential exercises, and structured discussion to explore themes related to meaning, identity, purpose, and legacy. Parents completed 16 weekly sessions, 60–90 minutes in length, either in person or through videoconferencing. Parents were administered measures of prolonged grief disorder symptoms, meaning in life, and other assessments of psychological adjustment preintervention, mid-intervention, postintervention, and at three months postintervention. Descriptive data from both the in-person and videoconferencing open trial were pooled.

Result

Eight of 11 (72%) enrolled parents started the MCGT intervention, and six of eight (75%) participants completed all 16 sessions. Participants provided positive feedback about MCGT. Results showed postintervention longitudinal improvements in prolonged grief (d = 1.70), sense of meaning (d = 2.11), depression (d = 0.84), hopelessness (d = 1.01), continuing bonds with their child (d = 1.26), posttraumatic growth (ds = 0.29–1.33), positive affect (d = 0.99), and various health-related quality of life domains (d = 0.46–0.71). Most treatment gains were either maintained or increased at the three-month follow-up assessment.

Significance of results

Overall, preliminary data suggest that this 16-session, manualized cognitive-behavioral-existential intervention is feasible, acceptable, and associated with transdiagnostic improvements in psychological functioning among parents who have lost a child to cancer. Future research should examine MCGT with a larger sample in a randomized controlled trial.

Keywords

MeaningProlonged griefExistentialBereaved parentsPsychotherapy
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 1 , February 2019 , pp. 2 - 12
Copyright
Copyright © Cambridge University Press 2019 

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References

Aboujaoude, E, Salame, W, and Naim, L (2015) Telemental health: A status update. World Psychiatry 14(2), 223–230. doi:10.1002/wps.20218.Google Scholar
American Cancer Society (2018) Cancer facts & figures 2018. Atlanta: American Cancer Society.Google Scholar
Barrera, M, O'Connor, K, D'Agostino, NM, et al. (2009) Early parental adjustment and bereavement after childhood cancer death. Death Studies 33(6), 497–520. doi:10.1080/07481180902961153.Google Scholar
Beck, AT, Weissman, A, Lester, D, et al. (1974) The measurement of pessimism: the hopelessness scale. Journal of Consulting and Clinical Psychology 42(6), 861–865.Google Scholar
Bjelland, I, Dahl, AA, Haug, TT, et al. (2002) The validity of the Hospital Anxiety and Depression Scale. An updated literature review. Journal of Psychosomatic Research 52(2), 69–77. doi:S0022399901002963 [pii].Google Scholar
Boelen, PA (2006) Cognitive-behavioral therapy for complicated grief: Theoretical underpinnings and case descriptions. Journal of Loss & Trauma 11(1), 1–30.Google Scholar
Boelen, PA and van den Bout, J (2002) Positive thinking in bereavement: Is it related to depression, anxiety, or grief symptomatology? Psychological Reports 91(3 Pt 1), 857–863. doi:10.2466/pr0.2002.91.3.857.Google Scholar
Bowlby, J (1978) Attachment theory and its therapeutic implications. American Society for Adolescent Psychiatry 6, 5–33.Google Scholar
Breitbart, W, Pessin, H, Rosenfeld, B, et al. (2018) Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer. Cancer 124(15), 3231–3239. doi:10.1002/cncr.31539.Google Scholar
Breitbart, W, Poppito, S, Rosenfeld, B, et al. (2012) Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of Clinical Oncology 30(12), 1304–1309. doi:10.1200/JCO.2011.36.2517.Google Scholar
Breitbart, W and Poppito, SR (2014) Individual meaning-centered psychotherapy for patients with advanced cancer: A treatment manual. Oxford: Oxford University Press.Google Scholar
Breitbart, W, Rosenfeld, B, Gibson, C, et al. (2010) Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psychooncology 19(1), 21–28. doi:10.1002/pon.1556.Google Scholar
Breitbart, W, Rosenfeld, B, Pessin, H, et al. (2015) Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology 33(7), 749–754. doi:10.1200/JCO.2014.57.2198.Google Scholar
Bryant, RA, Kenny, L, Joscelyne, A, et al. (2017) Treating prolonged grief disorder: A 2-year follow-up of a randomized controlled trial. Journal of Clinical Psychiatry 78(9), 1363–1368. doi:10.4088/JCP.16m10729.Google Scholar
Butler, AC, Chapman, JE, Forman, EM, et al. (2006) The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review 26(1), 17–31. doi:S0272-7358(05)00100-5 [pii] 10.1016/j.cpr.2005.07.003.Google Scholar
Cohen, SR, Mount, BM, Bruera, E, et al. (1997) Validity of the McGill Quality of Life Questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine 11(1), 3–20. doi:10.1177/026921639701100102.Google Scholar
D'Agostino, NM, Berlin-Romalis, D, Jovcevska, V, et al. (2008) Bereaved parents' perspectives on their needs. Palliative and Supportive Care 6(1), 33–41. doi:S1478951508000060 [pii] 10.1017/S1478951508000060.Google Scholar
Davies, R (2004) New understandings of parental grief: Literature review. Journal of Advanced Nursing 46(5), 506–513. doi:10.1111/j.1365-2648.2004.03024.x.Google Scholar
Engelkemeyer, SM and Marwit, SJ (2008) Posttraumatic growth in bereaved parents. Journal of Trauma and Stress 21(3), 344–346. doi:10.1002/jts.20338.Google Scholar
Field, NP, GalOz, E, and Bonanno, GA (2003) Continuing bonds and adjustment at 5 years after the death of a spouse. Journal of Consulting and Clinical Psychology 71(1), 110–117.Google Scholar
Fletcher, TL, Hogan, JB.Keegan, F, et al. (2018) Recent advances in delivering mental health treatment via video to home. Current Psychiatry Reports 20(8), 56. doi:10.1007/s11920-018-0922-y.Google Scholar
Frankl, VE (1959/1992) Man's search for meaning (revised ed.). Boston: Beacon Press.Google Scholar
Frueh, BC, Monnier, J, Yim, E, et al. (2007) A randomized trial of telepsychiatry for post-traumatic stress disorder. Journal of Telemedicine and Telecare 13(3), 142–147. doi:10.1258/135763307780677604.Google Scholar
Germain, V, Marchand, A, Bouchard, S, et al. (2010) Assessment of the therapeutic alliance in face-to-face or videoconference treatment for posttraumatic stress disorder. Cyberpsychology, Behavior and Social Networking 13(1), 29–35. doi:10.1089/cpb.2009.0139.Google Scholar
Hilty, DM, Ferrer, DC, Parish, MB, et al. (2013) The effectiveness of telemental health: A 2013 review. Telemedicine Journal and e-Health 19(6), 444–454. doi:10.1089/tmj.2013.0075.Google Scholar
Langarizadeh, M, Tabatabaei, MS, Tavakol, K, et al. (2017) Telemental health care, an effective alternative to conventional mental care: A systematic review. Acta Informatica Medica 25(4), 240–246. doi:10.5455/aim.2017.25.240-246.Google Scholar
Lannen, PK, Wolfe, J, Prigerson, HG, et al. (2008) Unresolved grief in a national sample of bereaved parents: impaired mental and physical health 4 to 9 years later. Journal of Clinical Oncology 26(36), 5870–5876. doi:10.1200/jco.2007.14.6738.Google Scholar
Lejuez, CW, Hopko, DR, and Hopko, SD (2001) A brief behavioral activation treatment for depression. Treatment manual. Behavior Modification 25(2), 255–286. doi:10.1177/0145445501252005.Google Scholar
Li, J, Laursen, TM, Precht, DH, et al. (2005) Hospitalization for mental illness among parents after the death of a child. New England Journal of Medicine 352(12), 1190–1196. doi:352/12/1190 [pii] 10.1056/NEJMoa033160.Google Scholar
Li, J, Precht, DH, Mortensen, PB, et al. (2003) Mortality in parents after death of a child in Denmark: A nationwide follow-up study. Lancet 361(9355), 363–367. doi:S0140-6736(03)12387-2 [pii].Google Scholar
Lichtenthal, W (2011) Using mixed methods data to adapt Meaning-Centered Psychotherapy for bereaved parents and breast cancer survivors. Psychooncology 20(Suppl. 2), 15.Google Scholar
Lichtenthal, WG (2018a) Supporting the bereaved in greatest need: We can do better. Palliative and Supportive Care. 16(4), 371–374. doi:10.1017/S1478951518000585.Google Scholar
Lichtenthal, WG (2018b) When those who need it most use it least: Facilitating grief support for those at greatest risk. Grief Matters: The Australian Journal of Grief and Bereavement 21(1), 27–31.Google Scholar
Lichtenthal, WG, Applebaum, A, and Breitbart, W (2011a) Using mixed methods data to adapt Meaning-Centered Psychotherapy for bereaved parents. Paper presented at the International Psycho-Oncology Society 13th World Congress, Antalya, Turkey.Google Scholar
Lichtenthal, WG and Breitbart, W (2015) The central role of meaning in adjustment to the loss of a child to cancer: Implications for the development of meaning-centered grief therapy. Current Opinion in Supportive and Palliative Care 9(1), 46–51. doi:10.1097/spc.0000000000000117.Google Scholar
Lichtenthal, WG and Cruess, DG (2010) Effects of directed written disclosure on grief and distress symptoms among bereaved individuals. Death Studies 34(6), 475–499. doi:10.1080/07481187.2010.483332.Google Scholar
Lichtenthal, WG, Currier, JM, Neimeyer, RA, et al. (2010) Sense and significance: A mixed methods examination of meaning making after the loss of one's child. Journal of Clinical Psychology 66(7), 791–812. doi:10.1002/jclp.20700.Google Scholar
Lichtenthal, WG, Lacey, S, Roberts, K, et al. (2017) Meaning-centered grief therapy. In Meaning-centered psychotherapy in the cancer setting. Breitbart, WS (ed.), pp. 88–99. New York, NY: Oxford University Press.Google Scholar
Lichtenthal, WG, Roberts, K, Bohn, T, et al. (2011b) Barriers to mental health service use among parents who lost a child to cancer. Paper presented at the American Psychosocial Oncology Society Annual Meeting, Anaheim, CA.Google Scholar
Lichtenthal, WG, Roberts, K., & Shuk, E. (2011c) Meaning in parents bereaved by cancer: A mixed methods study. Paper presented at the Association of Death Education and Counseling 33rd Annual Conference, Miami, FL.Google Scholar
Lichtenthal, WG, Sweeney, CR, Roberts, KE, et al. (2015) Bereavement follow-up after the death of a child as a standard of care in pediatric oncology. Pediatric Blood & Cancer 62 (Suppl. 5), S834–S869. doi:10.1002/pbc.25700.Google Scholar
Maccallum, F and Bryant, RA (2013) A cognitive attachment model of prolonged grief: Integrating attachments, memory, and identity. Clinical Psychology Review 33(6), 713–727. doi:10.1016/j.cpr.2013.05.001.Google Scholar
MacKinnon, CJ, Smith, NG, Henry, M, et al. (2015) Reconstructing meaning with others in loss: A feasibility pilot randomized controlled trial of a bereavement group. Death Studies 39(7), 411–421. doi:10.1080/07481187.2014.958628.Google Scholar
Neimeyer, RA (2000) Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies 24(6), 541–558.Google Scholar
Neimeyer, RA (2001a). Reauthoring life narratives: Grief therapy as meaning reconstruction. Israel Journal of Psychiatry and Related Sciences 38(3–4), 171–183.Google Scholar
Neimeyer, RA (2001b) Meaning reconstruction & the experience of loss. Washington, DC: American Psychological Association.Google Scholar
Neimeyer, RA (in press) Meaning reconstruction in bereavement: Development of a research program. Death Studies.Google Scholar
Oliver, LE (1999) Effects of a child's death on the marital relationship: A review. Omega: Journal of Death and Dying 39(3), 197–227.Google Scholar
Ong, AD, Fuller-Rowell, TE, & Bonanno, GA (2010) Prospective predictors of positive emotions following spousal loss. Psychology and Aging 25(3), 653–660. doi:10.1037/a0018870.Google Scholar
Prigerson, HG, Horowitz, MJ, Jacobs, SC, et al. (2009a) Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine 6(8), e1000121. doi:10.1371/journal.pmed.1000121.Google Scholar
Prigerson, HG, Horowitz, MJ, Jacobs, SC, et al. (2009b) Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine 6(8), e1000121. doi:10.1371/journal.pmed.1000121.Google Scholar
Rando, TA (1986) Parental loss of a child. Champaign, IL: Research Press Co.Google Scholar
Reker, GT (1992) Manual of the Life Attitude Profile-Revised (LAP-R). Trent University, Peterborough, ON: Student Psychologists Press.Google Scholar
Ronen, R, Packman, W, Field, NP, et al. (2009) The relationship between grief adjustment and continuing bonds for parents who have lost a child. Omega (Westport) 60(1), 1–31.Google Scholar
Rounsaville, BJ, Carroll, KM, and Onken, LS (2001) A stage model of behavioral therapies research: Getting started and moving on from Stage I. Clinical Psychology: Science and Practice 8, 133–142.Google Scholar
Ruskin, PE, Silver-Aylaian, M, Kling, MA, et al. (2004) Treatment outcomes in depression: Comparison of remote treatment through telepsychiatry to in-person treatment. American Journal of Psychiatry 161(8), 1471–1476. doi:10.1176/appi.ajp.161.8.1471.Google Scholar
Spielberger, CD (1983) Manual for the State-Trait Anxiety Inventory (Revised). Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Stroebe, MS and Schut, H (2001) Meaning making in the dual process model of coping with bereavement. In Meaning reconstruction and the experience of loss. Neimeyer, RA (ed.), pp. 55–73. Washington, DC: American Psychological Association.Google Scholar
Swift, JK and Greenberg, RP (2012) Premature discontinuation in adult psychotherapy: A meta-analysis. Journal of Consulting and Clinical Psychology 80(4), 547–559. doi:10.1037/a0028226.Google Scholar
Tatrow, K and Montgomery, GH (2006) Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: A meta-analysis. Journal of Behavioral Medicine 29(1), 17–27. doi:10.1007/s10865-005-9036-1.Google Scholar
Tedeschi, RG and Calhoun, LG (1996) The Posttraumatic Growth Inventory: Measuring the positive legacy of trauma. Journal of Trauma and Stress 9(3), 455–471.Google Scholar
Tolin, DF (2010) Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clinical Psychology Review 30(6), 710–720. doi:10.1016/j.cpr.2010.05.003.Google Scholar
Tracey, TJ and Kokotovic, AM (1989) Factor structure of the Working Alliance Inventory. Psychological Assessment 1, 207–210.Google Scholar
Verhagen, SJ, Hasmi, L, Drukker, M, et al. (2016) Use of the experience sampling method in the context of clinical trials. Evidence Based Mental Health 19(3), 86–89. doi:10.1136/ebmental-2016-102418.Google Scholar
Ware, JE Jr. and Sherbourne, CD (1992) The MOS 36-item Short-Form Health Survey (SF-36). I. Conceptual framework and item selection. Medical Care 30(6), 473–483.Google Scholar
Watson, D, Clark, LA, and Tellegen, A (1988) Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology 54(6), 1063–1070.Google Scholar
Wheeler, I (1993) The role of meaning and purpose in life in bereaved parents associated with a self-help group: Compassionate friends. Omega: Journal of Death and Dying 28(4), 261–271.Google Scholar
Wheeler, I (2001) Parental bereavement: The crisis of meaning. Death Studies 25(1), 51–66.Google Scholar
Zigmond, AS and Snaith, RP (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavia 67(6), 361–370.Google Scholar