Psychological consequences of homicidal loss

Individuals who lost a family member or partner due to homicide often deal with both separation distress (e.g., yearning) related to the loss (Burke, Neimeyer & McDevitt-Murphy, 2010) and traumatic distress (e.g., intrusive images, hyper arousal) (Armour, 2003; Asaro, 2001; Hatton, 2003; Rynearson, 1994), associated with the circumstances surrounding the death. The preceding reactions are related to Complicated Grief (CG) and Posttraumatic Stress Disorder (PTSD), respectively (Rynearson & Sinnema, 1999). An estimated 20%-70% of homicidally bereaved individuals develop PTSD (Van Denderen, De Keijser, Kleen, & Boelen, 2013).



There is growing evidence that cognitive-behavioural therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are effective in the treatment of PTSD and CG (Asaro, 2001; Boelen, De Keijser, Van den Hout, & Van den Bout, 2011; De Groot et al., 2007; Resnick, 2001; Shear, Frank, Houck, & Reynolds, 2005). No studies have yet examined the effects of both interventions for individuals bereaved by homicide. The present study therefore evaluated the effectiveness of a brief, 8-session, treatment, encompassing CBT and EMDR to reduce CG and PTSD, using a randomized control trial across 88 homicidally bereaved individuals in the Netherlands.

People confronted with homidical loss are randomly allocated to (i) an 8 session, individual therapy, consisting of 4 sessions of Eye Movement Desensitization and Reprocessng (EMDR) and 4 sessions of cognitive behavioural therapy (CBT) or (ii) a wait list control group.
The central hypothesis is that allocation to the active treatment condition leads to greater reductions in symptom levels of Complicated Grief and Posttraumatic Stress Disorder.

All variables will be measured at baseline (pre-intervention), half way the intervention (after 5 sessions), post-intervention (after 8 sessions), and at follow-up, 6 month later. The waitlist group will complete measures at enrolment into the study and 4 months later.

The present study evaluates the effectiveness of a brief, 8-session, treatment, encompassing Cognitive Behavioural Therapy (CBT) and Eye Movement Desentizitation and Reprocessing (EMDR) to reduce Complicated Grief and Post Traumatic Stress Disorder (PTSD), using a randomized control trial in homicidally bereaved individuals in the Netherlands.
Because homicidally bereaved individuals have to cope with the traumatic circumstances surrounding the loss, and the loss itself, it seems reasonable to assume that these individuals can benefit from a combined therapy with both treatment forms. While both treatment forms are often applied to individuals with complicated grief and PTSD, with successful results, no study have yet investigated the effect of a combined therapy with both treatment forms. In the literature, it has been assumed that PTSD symptoms must be relieved first, before treating grief complaints (Murphy, Johnson, Chung & Beaton, 2003; Rando, 1996; Rynearson & Geoffery, 1999); This treatment trial seeks to examine (1) whether the treatment decreases symptoms of CG and PTSD. It also examines(2) whether the sequence of CBT and EMDR – as two treatment interventions – exert an influence on outcome measures, by comparing two treatment conditions: one in which 3 sessions of EMDR are followed by 3 sessions of CBT (Condition 1: EMDR+CBT), and one in which 3 sessions of CBT are followed by 3 sessions of EMDR (Condition 2: CBT+EMDR). We further examine (3) whether revenge, avoidance and resilience mediate the effect of the treatment conditions.



A schematic presentation of the therapy:
Condition 1

Session 1: Introduction and psycho-education

Session 2: A family member is invited to discuss different coping mechanism in one family

Session 3-5: EMDR

Session 6-8 CGT




Condition 2

Session 1: Introduction and psycho-education

Session 2: A family member is invited to discuss different coping mechanism in one family

Session 3-5: CGT

Session 6-8 EMDR

The duration of the CGT sessions is 45 minutes. The duration of the EMDR sessions is minimally 45 minutes and maximally 90 minutes.


Participants are randomized to one of four groups: (i) Intervention group: EMDR + CGT, (ii) Intervention group: CBT + EMDR, (iii) waitlist control group: EMDR + CGT, or (iiii) waitlist controlgroup: CGT + EMDR. Participants in the IG receive the intervention immediately. Participants in the WG receive the intervention after four months.