Caregivers are a special breed. They feel a deep sense of commitment when it comes to caring for those they love, even despite the incredible challenges they face daily. Unfortunately, the flip side of this dedication is a profound sense of loss once a care recipient passes away. These feelings loom beforehand, are often overwhelming around the time of death, and can linger with varying intensity long after caregiving ends.
Countless members of the Caregiver Forum have experienced these emotions firsthand and helped others through them. The most common advice is to embrace one’s feelings, lose the guilt, seek grief counseling, and rely on the passage of time to provide solace and clarity. While this is sound guidance, caregivers and seniors alike who are struggling with mourning the loss of a beloved family member may also benefit from a method of psychotherapy that is growing in popularity: accelerated resolution therapy.
Understanding the Complexities of Grief
The commonly accepted model of bereavement was introduced by psychiatrist Elisabeth Kübler-Ross in her 1969 book On Death and Dying. Her model posited that there are five stages of grief: denial, anger, bargaining, depression and acceptance. However, family caregivers are keenly aware of the misconception that grief occurs in neat or predictable stages. In fact, this population goes through a unique grieving process that is often prolonged and intense.
Many caregivers spend years bearing responsibility for the health and happiness of chronically ill parents and spouses. Once this journey comes to an end, caregivers not only mourn the loss of their loved ones, but they also struggle to accept this absence and resume their own lives. For many, caregiving was their life; it took the place of their career, their family, their hobbies and their friends.
Conflicting feelings arise when the prospect of one’s caregiving role ending is viewed as the light at the end of the tunnel. For caregivers, it is the end of feeling powerless to help someone they love, and for seniors, it is an end to suffering and dependence on others. When death occurs, caregivers are often caught off-guard by the complex emotions that descend upon them.
This is where complicated grief, also known as prolonged grief disorder or persistent complex bereavement disorder, deviates from “healthy” bereavement. While each person mourns differently, feelings of anger, sorrow, bitterness, numbness and guilt tend to lessen in intensity over time. With complicated grief, these emotions are deep and persistent even a year or more after a beloved’s passing. Such feelings become almost obsessive and prevent individuals from forming new relationships, resuming old or forming new routines, enjoying life, and accepting the loss. Untreated complicated grief can trigger or exacerbate mental health issues, including depression, anxiety, suicidal thoughts, substance use disorders, and post-traumatic stress disorder (PTSD), and negatively impact one’s physical health.
The Connection Between Caregiving, Complicated Grief and PTSD
While the connection between post-traumatic stress disorder and caregiving remains woefully under-researched, there is some evidence that the act of providing care can cause psychological trauma. Watching an ill or aging loved one lose their independence and endure painful medical conditions, testing and treatments has a lasting impact on a caregiver.
In truth, the experience of providing care can leave these selfless individuals with a unique kind of PTSD. According to the National Institute of Mental Health, characteristics of this disorder include:
- Re-experiencing symptoms (flashbacks or nightmares about the traumatic event)
- Avoidance symptoms (changes in behavior to avoid people, places or things that trigger memories of the traumatic event)
- Arousal and reactivity symptoms (relatively constant feelings of stress and tension that can cause jumpiness, irritability, outbursts, sleeplessness and problems concentrating)
- Cognitive and mood symptoms (poor memory of the traumatic event, distorted feelings of guilt, depression, negativity)
Some of these feelings and behaviors are normal following a dangerous or emotionally taxing event, but when a combination of these symptoms occurs consistently for at least one month and interferes with a person’s daily functioning and relationships, the resulting impairment may qualify as a diagnosable level of trauma. Many caregivers who have lost care recipients will be familiar with these signs of PTSD, and many adult children have likely observed them in aging parents who have lost their spouses.
Trauma can be very disruptive to the grieving process. When traumatic feelings underlying a recent loss become intricately tied to the grief experience, complicated grief ensues. Traditional grief counselling is certainly beneficial for the bereaved, but if someone is having a particularly difficult time coping with a traumatic loss, incorporating additional therapeutic methods may be necessary to assist in the healing process.
Accelerated Resolution Therapy Can Be a Valuable Tool
Complicated grief and PTSD share a few similarities, which may be a promising link for researchers and mental health professionals who are trying to help those struggling with loss. Conventional grief is typically treated with talk therapy, but this approach can take a long time to yield results for individuals who are experiencing complicated grief and/or symptoms of PTSD.
Accelerated Resolution Therapy (also known as ART or ARTherapy) is a little-known treatment method designed to address PTSD and other mental disorders more successfully and in fewer sessions. Developed by Laney Rosenzweig, LMFT, in 2008, ART borrows several different techniques from other psychotherapies to desensitize patients to the signs of physical distress that emerge when thoughts of a loved one’s death arise and to help patients re-frame the past with the deceased in a more positive way.
During sessions, a trained therapist induces eye movements (similar to those that occur during deep sleep) by having a patient follow their hand movements. These eye movements tax the patient’s working memory and allow them to essentially rewrite how the traumatic experience is stored in the brain so that all relevant information is still present and capable of being recalled, but without the distressing reactions that these memories used to elicit. This aspect of ART is based upon a technique called eye movement desensitization and reprocessing (EMDR), which has been conditionally recommended by the American Psychological Association for treatment of PTSD. Although this technique may sound similar, ART is not hypnotherapy.
ART is an evidence-based technique that can be used in conjunction with medications and other types of therapy to reduce the severity of certain emotional triggers. This technique has been recognized by the Substance Abuse and Mental Health Services Association (SAMHSA) as an effective psychotherapy for PTSD, depression and stress, and as a promising therapy for symptoms of phobia, panic, anxiety, sleep and wake disorders, and antisocial behaviors. In fact, most patients experience relief from symptoms in one to five sessions. This is a huge draw for individuals who are wary of the long-term personal and financial commitments that are usually associated with other types of therapy.
How to Seek Treatment for Complicated Grief
While ART has been proven effective for PTSD and many other mental health disorders, research is still ongoing regarding its efficacy in those with complicated grief. Health researchers at the University of South Florida have received funding from the National Institute on Aging to conduct a two-year study of ART’s effectiveness in treating complicated grief in seniors.
If you or someone you know is interested in finding a certified ART therapist or learning more about this type of grief therapy, visit the non-profit ART International website. Even if ART does not sound like a good fit, it is still important to seek help throughout the grieving process. Hospice providers, therapists, religious organizations and support groups can provide valuable assistance in processing difficult emotions, resuming daily routines, accepting loss and connecting with peers who understand these unique challenges.
Sources: Kübler-Ross model (https://en.wikipedia.org/wiki/K%C3%BCbler-Ross_model); The Center for Complicated Grief (https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/); Post-Traumatic Stress Disorder (https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorder-ptsd/index.shtml); What Is ART? (https://acceleratedresolutiontherapy.com/what-is-art/); Eye Movement Desensitization and Reprocessing (EMDR) Therapy (https://www.apa.org/ptsd-guideline/treatments/eye-movement-reprocessing); Ethical Reflections on Offering Patients Accelerated Resolution Therapy (ART) (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145606/); USF Health Researchers Team Up to Study Effectiveness of Novel Therapy for Prolonged Grief (https://hscweb3.hsc.usf.edu/nursingnews/usf-health-researchers-team-up-to-study-effectiveness-of-novel-therapy-for-prolonged-grief/)