Tofthagen, Cindy

Abstract Complicated grief (CG), severe, prolonged (>12 months) grieving, disproportionately affects older adults. A prospective two-group, waitlisted RCT examined whether four sessions of Accelerated Resolution Therapy (ART) was effective in informal caregivers by comparing pre-to-post ART changes and investigating variation in treatment response by baseline CG levels. Inclusion: ≥60 years, Inventory of Complicated Grief >25. Paired t-tests of mean (SD) differences compared pre- to post-ART; pre-ART to 8-week follow-up, and post-ART to 8-week follow-up; then stratified by median baseline level of CG. Mean (SD) age of 54 participants was 68.7 (7.2) years, 85% female, and 93% white. Significantly greater CG reduction (-22.8 (10.3)) vs. waitlist (-4.3 (6.0)) was found. Within-participant effect sizes from baseline to 8-weeks post treatment were 1.96 (95% CI: 1.45, 2.47; p<0.0001). Treatment effects did not substantially differ by baseline levels. Lesson learned was that it was possible to successfully recruit and treat CG in the community.

Biomarkers may serve as objective measures in complicated grief (CG) potentially capturing responses to stress reduction treatment. This paper reports challenges in obtaining and assessing salivary cortisol and α-amylase (sAA) for a recent randomized clinical trial. Within-session changes in salivary cortisol and sAA for 54 older adults with CG who received Accelerated Resolution Therapy were compared with perceived stress measured by Subjective Units of Distress Scale. Bivariate correlations and multiple regressions examined changes in biomarkers. Protocols, study logs, and audit reports identified challenges. Challenges included obtaining unstimulated passive drool salivary samples and their analyses. Our sample of older females on multiple medications may have resulted in a perfect storm of moderating and intervening variables which affected the stress response. This paper contributes to the discussion on designing clinical trials for older adults which must account for physiologic changes, multimorbidity, and polypharmacy common in this population and makes recommendations moving forward.

Complicated grief is a significant health concern for older adults, resulting in significant psychological and physical morbidity. Elements of post traumatic stress disorder (PTSD) are often present in individuals with complicated grief. Accelerated Resolution Therapy (ART) is a brief form of psychotherapy that utilizes the techniques of imaginal exposure, rescripting of events, and lateral eye movements that may be useful in complicated grief with PTSD symptoms. Two cases where ART was used for complicated grief with PTSD are presented. Both individuals had attempted to come to terms with their loss through traditional grief therapy with an inadequate response and substantial residual grief symptoms. These cases illustrate how ART can be used to address CG and PTSD and describe situations where it may be appropriate. Clinical and research implications are also discussed.

Background and Objectives: Complicated grief (CG) is severe, prolonged (>12 months) grieving. Complicated grief disproportionately affects older adults and is associated with negative physical/psychological effects. Although treatment options exist, those which do are time-intensive. We report on a randomized clinical trial (RCT) which examined whether accelerated resolution therapy (ART), a novel mind-body therapy, is effective in treating CG, post-traumatic stress disorder (PTSD), and depression among hospice informal caregivers. Research Design and Methods: Prospective 2 group, wait-listed RCT. All participants were scheduled to receive 4 ART sessions. Inclusion: ≥60 years, inventory of CG >25, and PTSD checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition >33 or Psychiatric Diagnostic Screen Questionnaire PTSD subscale >5. Exclusion: Major psychiatric disorder, other current psychotherapy treatment. Depression was measured by the Center for Epidemiologic Studies Depression. Results: Mean (standard deviation [SD]) age of 54 participants was 68.7 (7.2) years, 85% female, and 93% white. Participants assigned to ART reported significantly greater mean (SD) CG reduction (−22.8 [10.3]) versus Wait-list participants (−4.3 [6.0]). Within-participant effect sizes (ESs) for change from baseline to 8-week post-treatment were CG (ES = 1.96 (95% confidence interval [CI]: 1.45-2.47; P < .0001), PTSD (ES = 2.40 [95% CI: 1.79-3.00]; P < .0001), depression (ES = 1.63 [95% CI: 1.18-2.08; P < .0001). Treatment effects did not substantially differ by baseline symptom levels. Discussion and Implications: Results suggests that ART presents an effective and less time-intensive intervention for CG in older adults. However, it should undergo further effectiveness testing in a larger, more diverse clinical trial with a focus on determining physiological or behavioral mechanisms of action.

Abstract Complicated grief (CG) is characterized by lengthy, intense, and functionally impairing grief which disproportionately affects older adults. Accelerated Resolution Therapy (ART) is a brief, protocol driven, exposure/imagery rescripting therapy which uses lateral left-right eye movements. ART, unlike traditional psychotherapy, directs the person to perform two tasks simultaneously (e.g. re-experiencing the grief experience and performing eye movements), taxing limited working memory capacity. Importantly, this may force memory traces representing events, emotions, and sensations to compete for permanence, as well as reduce the vividness and emotional intensity of the original grief. Two CG case studies are presented (expected; unexpected death) with their response to ART. Stake’s instrumental case study methodology was used to identify and study cases which reflect a range of CG. Additionally, CG was measured by the Inventory of Complicated Grief (ICF). ICF’s range is 0-76 with scores &gt; 24 indicating CG. Case 1 was a spousal caregiver with a single, expected death where helplessness, guilt, shame, and a life alone had resulted in CG (baseline ICF 33). Her ICF at 8 weeks post-ART was 10. Case 2 was an adult child caregiver with multiple (parent, sibling), unexpected deaths in quick succession where loss, guilt, anger, and helplessness had resulted in CG (baseline ICF 25). Her ICF at 8 weeks post-ART was 9. Both participants were able to process the distressing sensations that emerged during the imaginal exposure component facilitated with the use of eye movements. This suggests that ART may be a powerful new mind-body treatment for CG.

AbstractBackgroundRegenerative technologies aim to restore organ form and function. Technological advances in regenerative treatments have led to patients increasingly seeking these therapies. The readiness of nursing to fully contribute to this emerging healthcare field is uncertain.PurposeThe goal of this discipline‐oriented overview is to enhance awareness in the nursing community regarding regenerative science, and to provide suggestions for nursing research contributions and practice implications.MethodsEvolving and applied cutting‐edge therapies, such as regenerative immunotherapies with chimeric antigen receptor expressing T lymphocytes, are highlighted in the context of emerging opportunities for nurses in practice and research.DiscussionNext generation nurses will increasingly be at the forefront of new therapies poised to make chronic illnesses curable, thus restoring health and function to diverse groups of individuals.Clinical RelevanceThe regenerative care model imposes on the nursing community the imperative to (a) increase research awareness; (a) educate, develop, and deploy a skilled nursing workforce; (c) integrate regenerative technologies into nursing practice; and (d) embrace the regenerative technologies horizon as a future in health care.