A qualitative analysis of loss-related memories after cancer loss: a comparison of bereaved people with and without prolonged grief disorder.

Objective: The study aimed to explore the content and features of loss-related memories in a sample of individuals bereaved by cancer with and without a probable diagnosis of prolonged grief disorder/persistent complex bereavement disorder (PGD/PCBD). Methods: Semi-structured interviews with 28 bereaved adults (PGD/PCBD = 12, NoPGD/PCBD = 16) were analysed using thematic analysis. Results: Three superordinate themes were identified: (1) intrusive imagery, (2) qualities of memory, and (3) triggers. Results showed that individuals suffering from probable PGD/PCBD reported a predominance of negative and upsetting memories, happy memories triggering pain and more negative intrusive imagery than those without PGD/PCBD. Conclusions: Bereavement by cancer can result in troubling intrusive memories that overshadow positive memories. Sufferers of PGD/PCBD are more likely to experience loss-related memories as negative and upsetting. Clinical approaches that utilise memory processing may be of particular relevance in this group.

Objetivo: El estudio tuvo como objetivo explorar el contenido y las características de los recuerdos relacionados con la pérdida en una muestra de personas viviendo un duelo por cáncer con y sin un diagnóstico probable de trastorno de duelo prolongado/trastorno de duelo complejo persistente (PGD/PCBD).Métodos: Se analizaron entrevistas semiestructuradas con 28 adultos dolientes (PGD/PCBD = 12, NoPGD/PCBD = 16) mediante análisis temático.Resultados: Se identificaron tres temas supraordinados: (1) imágenes intrusivas, (2) cualidades de la memoria y (3) gatillantes. Los resultados mostraron que las personas que padecen un probable PGD/PCBD informaron un predominio de recuerdos negativos y molestos, recuerdos felices que desencadenan dolour y más imágenes intrusivas negativas que aquellos sin PGD/PCBD.Conclusiones: El duelo por cáncer puede provocar recuerdos intrusivos problemáticos que eclipsan los recuerdos positivos. Las víctimas de PGD/PCBD tienen más probabilidades de experimentar los recuerdos relacionados con la pérdida como negativos y molestos. Los enfoques clínicos que utilizan el procesamiento de memoria pueden ser de particular relevancia en este grupo.

Internet-delivered cognitive therapy for PTSD: a development pilot series.

BACKGROUND: Randomised controlled trials have established that face-to-face cognitive therapy for posttraumatic stress disorder (CT-PTSD) based on Ehlers and Clark's cognitive model of PTSD is highly effective and feasible with low rates of dropout. Access to evidence-based psychological treatments for PTSD is insufficient. Several studies have shown that therapist-assisted treatment delivery over the Internet is a promising way of improving access to cognitive behavioural therapy interventions. OBJECTIVE: To develop an Internet version of CT-PTSD that significantly reduces therapist contact time without compromising treatment integrity or retention rates. METHODS: We describe the development of an Internet version of CT-PTSD. It implements all the key procedures of face-to-face CT-PTSD, including techniques that focus on the trauma memory, such as memory updating, stimulus discrimination and revisiting the trauma site, as well as restructuring individually relevant appraisals relating to overgeneralisation of danger, guilt, shame or anger, behavioural experiments and planning activities to reclaim quality of life. A cohort of 10 patients meeting DSM-IV criteria for PTSD worked through the programme, with remote guidance from a therapist, and they were assessed at pre- and post-treatment on PTSD outcome, mood, work and social adjustment and process measures. RESULTS: No patients dropped out. Therapists facilitated the treatment with 192 min of contact time per patient, plus 57 min for reviewing the patient's progress and messages. Internet-delivered CT-PTSD was associated with very large improvements on all outcome and process measures, with 80% of patients achieving clinically significant change and remission from PTSD. CONCLUSIONS: Internet-delivered cognitive therapy for PTSD (iCT-PTSD) appears to be an acceptable and efficacious treatment. Therapist time was reduced to less than 25% of time in face-to-face CT-PTSD. Randomised controlled trials are required to evaluate systematically the acceptability and efficacy of iCT-PTSD.