Emotional anaesthesia: a cognitive-behavioural treatment of prolonged grief in a client with complex comorbidities-the importance of reintegrating attachment, memory, and self-identity

Objective: This case-report presents the formulation and treatment of a patient with a primary diagnosis of schizophrenia, and significant complex comorbidities. It was hypothesised that much of the presentation was secondary to unresolved grief. This raises issues regarding treatment and diagnosis of unresolved grief in psychiatric inpatient units, as the DSM-5 does not currently recognise Prolonged Grief Disorder (PGD). We argue that failing to recognise PGD as a distinct syndrome has implications for research into effective psychotherapeutic interventions for patients with unresolved, prolonged, or complicated grief.

Method: A case-report of a patient diagnosed with schizophrenia and multiple comorbidities who received 31 sessions of psychotherapy (i.e. integrative cognitive behaviour therapy for prolonged grief disorder) as part of a rehabilitation programme. The following measures were administered pre- and post-treatment: (i) The Depression Anxiety Stress Scale, to measure levels of depression, anxiety, and stress; (ii) The Beck Depression Inventory-II to assess more specifically levels of depression; and (iii) the Prolonged Grief Disorder (PG 13) to assess symptoms of prolonged grief disorder.

Results: Upon completion of therapy, reductions were observed in PG-13 scores, stress on The Depression Anxiety Stress Scale, and depression on The Beck Depression Inventory-II.

Conclusions: This case report demonstrates the utility of going beyond the DSM-5 when formulating complex patients. It also highlights the importance of identifying precursory and perpetuating factors driving complex presentations, and implementing a flexible and evidence-based treatment that sensitively addresses the presentation.