Brief Eclectic Psychotherapy for Traumatic Grief (BEP-TG): toward integrated treatment of symptoms related to traumatic loss

Figures & data

Fig. 1 A cognitive stress model of traumatic grief.

Fig. 2 BEP-TG overview. Numbers indicate session numbers.

Table 1 Examples of therapist explanations and questions

BEP-TG component	Aim	Example
Information and motivation	Explaining traumatic grief symptoms	When we lose a loved person in a traumatic situation, we are often forced to remain active and not to dwell on our feelings. Painful feelings about the loss can be so severe that one may become afraid of them. Therefore, people may try to control their feelings or to avoid them. This costs a lot of energy: people become exhausted and forgetful. Therefore, one needs to allow one's feelings of grief and sadness, in order to accept finally that the death has occurred.
Grief-focused exposure	Explaining different types of avoidance	Some people: …suppress thoughts and feelings about the loss, because they find it just too painful to realize what the loss means to them, and sometimes because they are afraid that allowing these feelings will turn them crazy; …tuck away or suppress memories of certain events, because they are intensely painful; …avoid certain places, such as the tomb of the deceased or objects, such as photos of the deceased; …keep trying to be with the deceased and stick to various rituals surrounding the lost person.
	Evoking memories and feelings	What do you miss most now that he is dead? At what times do you miss him? What do you feel when it comes to your mind that you will never will be able to do your favorite activities with him anymore? Remember when you have spoken for the last time with the deceased. Describe what you see. How do you feel when you recall that memory?
Finding meaning and activation	Explaining activation	The traumatic loss of a loved one often puts a brake on all sorts of activities. Life is “on hold.” To process a loss, it is important that we once again undertake activities that provide pleasure and meaning. You then gradually can get back to undertaking activities that are important to you. When you continue to do things that you always did, you will have a chance that positive experiences will be a counterweight to all the sadness and help you through the process. How would you like your life to be in the near future, taking into account this loss? Imagine that it is now a year later, you have come to terms with the loss and you are able to undertake enjoyable and satisfying activities. What would your life be like? What would you do?

Table 2 Writing assignments

Writing assignment	In patients who …	Description
Ongoing farewell letter	Have difficulty allowing feelings of sadness	A letter to the deceased in which the patient writes what he has always wanted to say to the deceased, what he misses most, expressing his longing for the deceased
Three letters task	Are very ambivalent about the deceased	In a first letter, negative feelings toward the deceased are verbalized (anger, discontent); in a second letter, positive feelings are expressed(love, things that are missed); in a third and final letter positive and negative feelings are integrated
Letter to an imaginative companion in misfortune	Have strong maladaptive cognitions	A letter to a non-existing person who has been through exactly the same loss, trying to help this imaginary companion to re-evaluate maladaptive cognitions about the loss
Angry letter	Have difficulty dealing with feelings of anger	A letter to a perpetrator of murder, negligent bystanders, government, or other agency that is held responsible, in which uncensored anger, including insults and diatribes can be expressed. The letter is not sent. Sometimes, burning the angry letter is part of the farewell ritual.