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Study focuses on treating people to cope by Mary Helen Yarborough Public Relations Losing a significant other is often the most stressful, and sometimes most traumatic event in a person’s life. While most people experience normal bereavement after such a loss, many people are overcome by their loved one’s death. People who are having trouble with bereavement become too socially isolated as they get into a pattern of avoiding activities with others. They may also move through life with a sense of denial that their significant other has passed on.   Men take loss of a spouse particularly hard, more so than women. In fact, the mortality rate of older men who lose a spouse is much higher than non-widowers. Some widowers died within three years of the loss, said Ron Acierno, Ph.D., who is leading a new treatment study by MUSC on complicated bereavement.   Acierno’s study focuses on treating people experiencing “complicated bereavement,” which is different from the normal bereavement process. Complicated bereavement is not simply depression. Rather, it has symptoms of major depression combined with anxiety symptoms that resemble a milder version of post traumatic stress disorder (PTSD). Approximately one-third of all persons experiencing the death of a loved one suffers from complicated bereavement. Given that death is an inevitable part of life,the prevalence of this problem is very high.   Funded by a treatment development grant from the National Institute of Aging, Acierno’s study is unique in that it combines two psychological (non-pharmacological) treatments that are effective for other disorders, and adapts them for complicated bereavement. MUSC’s program is the first in the nation to try this approach.   “In this treatment, which is only five sessions long, we avoid the psychobabble,” Acierno said. “Instead, we focus on increasing social activities and reducing avoidance and withdrawal. This is simple and it works. The treatment is made to complement, rather than replace, any existing group treatments in which more existential issues are discussed. While sitting in group and talking about one’s loss may be helpful, it does not seem to be sufficient, and that’s where our treatment comes into play.”   MUSC’s program applies an adaptation of Behavioral Activation for Depression, a treatment developed by Neil Jacobson, Ph.D., of the University of Washington; and Exposure Treatment for PTSD, a treatment developed by Edna Foa, Ph.D., of the University of Pennsylvania. The MUSC adaptation of Behavioral Activation was facilitated by Carl LeJuez, Ph.D., of the University of Maryland who has modified this treatment for other problem areas and is a consultant on the MUSC grant.   The treatment, developed and refined over the past year, requires participants age 55 and older to produce a daily schedule of planned behaviors that include what Acierno calls “fun or functional” activities. That is, behaviors the participant enjoys, such as going to dinner with a friend, or behaviors the participant must complete that will give him or her a sense of satisfaction, such as cleaning the house or paying bills. Importantly, and consistent with exposure treatment for PTSD, the action plan, which is formally written out on a calendar, also requires the individual to identify activities or issues that are being avoided because they remind them of their loss, and to schedule and complete these activities, too.   “The action plan is formally written out on a calendar. We identify obstacles to successful completion of activities, such as transportation, that have to be resolved. The focus of the treatment is on making maximal use of community resources,” said Acierno. The program also is being designed to be easily exportable and inexpensive for other grief counselors.   The treatment program starts with a short video that provides the rationale for the treatment and gives some concrete examples. This video also is a training guide for therapists to keep them on track with the "active behavioral" nature of the intervention.   “It’s too easy to fall into a pattern of discussion and talking about things rather than changing behaviors, which is what this treatment is all about,” Acierno said. Participants are given five individual sessions of treatment. Scheduled activities are modified, whenever possible, to enhance social interaction.   “One of the biggest risk factors for geriatric depression is social isolation, which, unfortunately, is often a natural consequence of spousal death,” Acierno said. “When we are thinking of activities for the calendar, we might ask what someone may want to do for fun. They might say they like to read. So we say, ‘fine, but instead of doing it at home, let’s schedule reading at Barnes & Noble where there is a coffee shop, big comfortable chairs, and the potential to interact with people.’ We want to make sure they limit their isolation whenever possible.”   Acierno said he is working with MUSC, local hospice and religious organizations to recruit participants. However, anyone interested in participating or referring someone to this study can contact Acierno at 792-2949 or his coordinator, Sarah Mullane, at 792-8068.     Friday, Nov. 3, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.