This feature story uses powerful anecdotes to examine whether “complicated” grief can be remedied by special therapy. The story references a review article in the New England Journal of Medicine, but appears to rest mainly on a single small clinical trial. We thought the quality of this evidence deserved a bit more scrutiny than the story provided. We were pleased, however, that the story quoted a skeptic and provided some context for the controversy of re-labeling grief in a way that could produce over-treatment. The story rightly noted the professional disagreement about whether and when to distinguish pathological or “complicated” grief from depression.
Labels matter in how patients seek help. This story’s empathetic description of two women’s suffering risks unbalancing the discussion over “complicated grief” — a label that scientist-committees of the American Psychiatric Association have determined needs further study before it can be accepted. The story’s nod to this debate is essential to signal for readers that the risks and benefits of a relabeling aren’t fully established.
The story does not tell us what it costs to get 16 weeks of complicated grief therapy. The insurance issues for medical care are thorny enough, but mental health coverage often lags behind other categories. The story would have been more useful had it mentioned that most therapy costs upwards of $150 an hour, and that a 16-week set might be more than $2,400 and might not be covered.
The story explains how the participants in one small study were randomly assigned to different kinds of psychotherapy. The group receiving what is called “complicated” therapy showed more than 70 percent “much improved” or “very much improved” in the severity of their symptoms and impairment, compared with 32 percent in the standard psychotherapy group. That’s a useful and user-friendly way to characterize the results. Much better than saying something like, “More than twice the number of patients receiving complicated therapy saw significant improvement,” which is how many stories might have put it.
The story does not come out and discuss the general topic of harms vs. benefits of “complex” therapy. But it does manage to clear our bar by quoting skeptic Jerome Wakefield, who says that labeling of people might result in over-treatment.
“By diagnosing complicated grief just six months after a death, he said, “you’ll get a lot of normal people receiving treatment they don’t need,” including drugs.
We’ll give the benefit of the doubt here, although it’s debatable whether a single quote about the controversy of labeling covers enough ground on this issue.
There are a couple of concerns here. One is that the vivid portrayal of two women who personally benefited from complicated grief therapy risks overshadowing the evidence — which is not as clear-cut as these positive stories might suggest to the reader. We think that the story needed to tell the reader explicitly that the evidence is preliminary and based largely on a single small study. We are glad the story outlined the evidence, and we are glad it included the statement that “a larger, four-site study” was completed but not published. But we think it’s a stretch to talk about that unpublished study showing “similar effectiveness” to the first study without some clearer acknowledgment that this evidence hasn’t been reviewed or scrutinized by other experts.
The story correctly shows the controversy over the labeling of one sort of grief as “abnormal.” Professionals are still arguing over that.
But the story is on shakier ground when discussing the percentage of grieving people who might be affected by such “abnormal” grief. It references a study putting the proportion at around 7 to nine percent, then quotes an expert who says the “real” figure might be closer to 10 to 15 percent. We thought the story should have provided some justification for why the bigger figure was the “real” one. However, we don’t think that omission is enough to affect our rating of Satisfactory.
The story includes several sources whose affiliations are well described, including a skeptical voice. There is no obvious conflict of interest, beyond the professional investment that some of these researchers might have in advancing the notion of “complicated” grief.
The story spends time talking about ordinary vs. complicated grief, but it doesn’t describe what might be the alternative ways of a person coping with dysfunction years after a loss. Is treatment for depression sometimes effective? What are the alternatives to the label of “complicated grief?”
We also found the description of the special therapy too brief. These few words were all we could find to define this new form: “focuses specifically on bereavement symptoms, and incorporates memories, photographs and recordings.” We hoped for more detail about how this therapy might differ from more traditional forms of psychotherapy.
A consumer cannot tell from this story whether complicated grief therapy is widely available outside of research centers in urban areas.
The story establishes the novelty of complicated grief therapy.
The story goes beyond any news release to include independent reporting.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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