Katherine Shear

Katherine Shear
Columbia University | CU

M.D.

About

440
Publications
137,725
Reads
How we measure 'reads'
A 'read' is counted each time someone views a publication summary (such as the title, abstract, and list of authors), clicks on a figure, or views or downloads the full-text. Learn more
33,544
Citations
Citations since 2017
35 Research Items
11488 Citations
201720182019202020212022202305001,0001,5002,000
201720182019202020212022202305001,0001,5002,000
201720182019202020212022202305001,0001,5002,000
201720182019202020212022202305001,0001,5002,000
Additional affiliations
June 2013 - present
Stanford University
January 2006 - December 2012
Columbia University
January 1992 - December 2005
University of Pittsburgh
Education
September 1968 - June 1972
Tufts University
Field of study
  • Medicine
September 1965 - May 1967
University of Chicago
Field of study
  • Biology

Publications

Publications (440)
Preprint
BACKGROUND : Prolonged Grief Disorder(PGD) is a newly recognized mental disorder characterized by pervasive intense grief that persists longer than cultural/social expectations and interferes with functioning . The COVID epidemic has resulted in increased rates of PGD, and yet few clinicians feel confident in treating this condition. Prolonged grie...
Article
Full-text available
Objective The therapeutic alliance is related to treatment outcome but less is known about the agreement on alliance between patients and therapists and its relationship to outcomes. We examined the association of patient-therapist congruence of alliance perceptions, early and late in cognitive behavioral therapy for panic disorder in relation to s...
Chapter
Prolonged grief disorder (PGD) is now an official diagnosis in both ICD-11 and DSM 5-TR. This condition is characterized by persistent pervasive yearning, longing, and/or preoccupation with the person who died for a period of at least 6 (ICD11) or 12 months (DSM 5) and longer than expected by their social, cultural, or religious groups (Prigerson e...
Article
Full-text available
The Typical Beliefs Questionnaire (TBQ) assesses common grief‐related cognitions, which demonstrated satisfactory psychometric properties in a treatment‐seeking sample with prolonged grief disorder (PGD). Chinese shidu parents (bereaved parents over the age of 49 who have lost their only child) are at a high risk of PGD. The current study aimed to...
Article
Objective: Posttraumatic stress disorder and prolonged grief disorder (PGD) arise following major life stressors and may share some overlapping symptomatology. This study aimed to examine the presence and response to treatment of posttraumatic stress symptoms (PTSS) in bereaved adults with a primary diagnosis of PGD. Methods: A randomized contro...
Article
Objective: The present study investigated the role of the two theoretically derived mediators in the treatment of Prolonged Grief Disorder (PGD). Mediators were changes in avoidance and maladaptive cognitions. An additional hypothesis tested whether these candidate mediators are specific to CBT-based Complicated Grief Treatment (CGT) compared to In...
Article
In few periods in human history have bereavement and grief been on so many people's minds as they are today. As the coronavirus disease 2019 (COVID-19) ravages the world, we have seen many perish in a short time. Many have died alone because of requirements for physical distancing. Even more will succumb as COVID-19 continues to spread. Moreover, d...
Article
Full-text available
Bereavement is the state of loss, determined in most of the cases by the death of a close person. It is probably the greatest sorrow that can occur in an individual life. Grief is a normal, healthy response to loss, evolving through stages in the process of mourning. In some cases, bereavement may lead to the outburst of manic episode: despite lite...
Article
Grief is the natural response to the death of a loved one and is encountered frequently in clinical practice with the elderly; it can also precede the death. Knowledge about four distinct forms of grief can aid clinicians with the conceptualization of grief, and the assessment and care of grievers. First, predeath grief is experienced by many careg...
Article
Full-text available
Background: Complicated grief (CG) is characterized by persistent, impairing grief after losing a loved one. Little is known about sleep disturbance in CG. Baseline prevalence of subjective sleep disturbance, impact of treatment on sleep, and impact of mid-treatment sleep on CG and quality of life outcomes were examined in adults with CG in second...
Article
Full-text available
The death of a loved one is one of life's greatest stressors. Most bereaved individuals experience a period of acute grief that diminishes in intensity as they adapt to the changes brought about by their loss. Over the past four decades, a growing body of research has focused on a form of prolonged grief that is painful and impairing. There is a su...
Article
Full-text available
In the United States alone, about 10 million persons are newly bereaved each year. Most do not require professional intervention or treatment, but many can benefit from targeted support. However, a significant minority of bereaved persons experience intense, prolonged and disabling grief symptoms associated with considerable morbidity and mortality...
Article
Full-text available
Background/objectives: Bereavement is associated with increases in prevalence of mental health conditions and in healthcare utilization. Due to younger age and bereavement by sudden and violent deaths, military widows may be vulnerable to poorer outcomes. No systematic research has examined these effects. Method: Using outpatient medical records...
Article
Full-text available
Background: Prolonged grief disorder (PGD) is a new diagnosis in the 11th edition of the International Classification of Diseases, estimated to affect 1 in 10 bereaved people and causing significant distress and impairment. Maladaptive thoughts play an important role in PGD. We have previously validated the typical beliefs questionnaire (TBQ), whi...
Article
In psychiatry, clinicians use criteria sets from the Diagnostic and Statistical Manual of Mental Disorders to diagnose mental disorders. Most criteria sets have several symptom domains, and in order to be diagnosed, an individual must meet the minimum number of symptoms required by each domain. Some efforts are now focused on adding biomarkers to t...
Article
Full-text available
Background Distinguishing a disorder of persistent and impairing grief from normative grief allows clinicians to identify this often undetected and disabling condition. As four diagnostic criteria sets for a grief disorder have been proposed, their similarities and differences need to be elucidated. Methods Participants were family members bereave...
Chapter
The death of a loved one is a stressful experience that can lead to the onset of a range of mental disorders, including major depressive disorder (MDD) and complicated grief (CG). CG is a disorder characterized by persistent and impairing grief symptoms (e.g., yearning, preoccupation with the deceased). Though MDD and CG frequently co-occur, factor...
Article
Background The World Health Organization (WHO) International Classification of Disease (ICD-11) is expected to include a new diagnosis for prolonged grief disorder (ICD-11 PGD ). This study examines the validity and clinical utility of the ICD-11 PGD guideline by testing its performance in a well-characterized clinical sample and contrasting it wit...
Article
In this study, we examined the role of the therapeutic alliance in complicated grief treatment (CGT), an efficacious psychotherapy for complicated grief. Using data from a previously reported randomized controlled trial, we explored whether the alliance–outcome relationship differs by treatment group among treatment completers assigned to either CG...
Article
Full-text available
Background: Complicated grief, a syndrome of persistent grief diagnosed >6 months following the loss of someone close is expected to be included in the 11th revision of the International Classification of Diseases as a new diagnosis called prolonged grief disorder. Complicated grief is associated with impaired functioning and health comorbidity an...
Article
Full-text available
There is a dearth of research investigating youths’ experience of grief and mourning after the death of close friends or family. Even less research has explored the question of how youth use social media sites to engage in the grieving process. This study employs qualitative analysis and natural language processing to examine tweets that follow 2 d...
Article
Full-text available
There is a dearth of research investigating youths’ experience of grief and mourning after the death of close friends or family. Even less research has explored the question of how youth use social media sites to engage in the grieving process. This study employs qualitative analysis and natural language processing to examine tweets that follow 2 d...
Article
Objective: Nonspecific factors, such as treatment outcome expectancy and working alliance, can influence treatment outcome. No studies to date have examined the role of expectancy and alliance on pharmacotherapy outcomes in individuals with complicated grief (CG). Method: This secondary analysis of a larger randomized, control trial (RCT) examin...
Article
Objective: Suffering associated with complicated grief (CG) is profound. Because suicide loss survivors are susceptible to developing CG, identifying effective treatments for suicide loss survivors with CG is a high priority. This report provides data on the acceptability and effectiveness of antidepressant medication and complicated grief therapy...
Article
Objective: To describe medical comorbidity in persons with Complicated Grief (CG) and to test whether medical comorbidity in individuals with CG is associated with the severity and duration of CG, after adjusting for age, sex, race, and current depressive symptoms. Methods: In exploratory analyses, we compared data from participants in an NIMH-s...
Article
Knowledge about the effect of a US service member's death on surviving family members is limited. In order to identify their grief-related health care needs, a first step is to identify the characteristics of persistent and elevated grief in a military family sample. The present study identified military family members (n = 232) bereaved more than...
Article
Background: Complicated Grief (CG) is a recently recognized bereavement-related mental health disorder. Social support is commonly measured with the Interpersonal Support Evaluation List (ISEL), a 40-item, 4-factor, self-report measure. Though the ISEL has been well-studied, no identified research has examined its psychometric properties or perfor...
Article
Are complicated grief criteria better for diagnosing grief disorder than prolonged grief disorder criteria?—Yes.
Article
Importance: Bereavement after spousal suicide has been linked to mental disorders; however, a comprehensive assessment of the effect of spousal suicide is needed. Objective: To determine whether bereavement after spousal suicide was linked to an excessive risk of mental, physical, and social health outcomes when compared with the general populat...
Article
Full-text available
Complicated grief is a condition that occurs when something impedes the process of adapting to a loss. The core symptoms include intense and prolonged yearning, longing and sorrow, frequent insistent thoughts of the deceased and difficulty accepting the painful reality of the death or imagining a future with purpose and meaning. Complicated grief c...
Article
We compared baseline demographic characteristics, clinical features, and grief-related thoughts, feelings and behaviors of individuals bereaved by suicide, accident/homicide and natural causes participating in a complicated grief (CG) treatment clinical trial. Severity of CG and depression and current depression diagnosis did not vary by loss type....
Article
Background: Persistent complex bereavement disorder (PCBD) is a protracted form of grief included in DSM Section 3 indicating a need for more research. Two other criteria sets [prolonged grief disorder (PGD) and complicated grief (CG) disorder] are also currently in use by researchers. This study evaluates rates of diagnosis of each proposed crite...
Article
Full-text available
TO THE EDITOR: Smid and Boelen rightfully highlight the importance of identifying standards for diagnosing clinically impairing grief. This issue has been of clinical interest within the United States and internationally, leading to the proposed DSM-5 persistent complex bereavement disorder criteria, as well as newly defined ICD-11 criteria for a s...
Article
Objective: In this study, we examined the mechanisms of action of complicated grief treatment (CGT), an efficacious psychotherapy for complicated grief. Method: We explored 3 putative mediators (guilt/self-blame related to the deceased, negative thoughts about the future, and avoidance) among treatment completers assigned to either CGT (n = 35)...
Article
Objectives: Maladaptive cognitions related to loss are thought to contribute to development of complicated grief and are crucial to address in treatment, but tools available to assess them are limited. This paper introduces the Typical Beliefs Questionnaire (TBQ), a 25-item self-report instrument to assess cognitions that interfere with adaptation...
Article
Introduction: Complicated grief (CG) has been the subject of increasing attention in the past decades but its relationship with separation anxiety disorder (SEPAD) is still controversial. The aim of the current study was to explore the prevalence and clinical significance of adult SEPAD in a sample of help-seeking individuals with CG. Methods: 1...
Article
Importance To our knowledge, this is the first placebo-controlled randomized clinical trial to evaluate the efficacy of antidepressant pharmacotherapy, with and without complicated grief psychotherapy, in the treatment of complicated grief. Objective To confirm the efficacy of a targeted complicated grief treatment (CGT), determine whether citalopr...
Article
Objective: The purpose of this article was to examine the accuracy of DSM-5 proposed criteria for persistent complex bereavement disorder in identifying putative cases of clinically impairing grief and in excluding nonclinical cases. Performance of criteria sets for prolonged grief disorder and complicated grief were similarly assessed. Method:...
Article
Individuals with complicated grief are at elevated risk of suicidal thoughts. Anxiety sensitivity has recently emerged as a risk factor of suicide. This study aimed to investigate a possible association between anxiety sensitivity and a wish to die in individuals with complicated grief. Participants were evaluated for participation in a treatment s...
Article
Grief-related avoidance is a significant component of complicated grief, yet has rarely been formally measured in a validated fashion. Further, more work is needed to understand the impact of grief-related avoidance on symptom severity and functional impairment among individuals with complicated grief (CG). The Grief-Related Avoidance Questionnaire...
Article
Objectives: This study evaluates the validity and reliability of a new self-report instrument that assess GAD spectrum symptoms: the WORRY-SR. Methods: Participants included 120 patients with mood and anxiety disorders recruited at the Department of Psychiatry of the University of Pisa and two comparison groups included 47 participants recruited at...
Article
Full-text available
Persistent intense yearning for the deceased is a core clinical feature of complicated grief (CG) that distinguishes it from other mental disorders that develop following loss. The Yearning in Situations of Loss Scale (YSL) is a recently developed assessment of yearning. To assess the psychometric properties of the YSL in those with CG, we administ...
Article
Background: Cognitive behavioral therapy (CBT) and pharmacotherapy are efficacious for the short-term treatment of panic disorder. Less is known about the efficacy of these therapies for individuals who do not respond fully to short-term CBT. Method: The current trial is a second-step stratified randomized design comparing two treatment conditio...
Chapter
The common mantra for bereaved people these days is “Everyone grieves in their own way.” This is incontrovertibly true, yet it is not the whole truth. It is similarly true to say that grief is universal. This chapter provides a way of working with bereaved clients that honors both realities and focuses on work with complicated grief. We begin with...
Article
Complicated grief (CG) has been recently included in the DSM-5, under the term "persistent complex bereavement disorder," as a condition requiring further study. To our knowledge, no psychometric data on any structured clinical interview for CG (SCI-CG) is available to date. In this manuscript, we introduce the SCI-CG, a 31-item "SCID-like" clinici...
Chapter
Psychiatrists may be called upon to assist in providing support, solace, and clinical interventions to dying patients and their caregivers, and to bereaved people following the death of a loved one. This chapter provides a discussion of death, including its rates and causes, current thinking about management of terminally ill patients, and an overv...
Chapter
Complicated grief (CG) also called prolonged grief disorder (PGD) is a recently described syndrome characterized by intense and persistent acute grief with yearning, longing, and sadness; preoccupation with thoughts and memories of the deceased; and complicating thoughts, feelings, and behaviors that impede successful mourning. This chapter describ...
Article
Separation Anxiety Disorder has been recently classified into the DSM-5 section of Anxiety Disorders, acknowledging its role not only in childhood and adolescence but also across the whole lifespan. In the DSM-IV-TR, in fact, this condition was typically considered to begin in childhood. Clinical data report prevalence rates from 20 to 40%, showing...
Article
Epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. It is unclear whether the presence of adult separation anxiety disorder (ASAD) is a manifestation of anxious attachment, or a form of agoraphobia, or a specific condition with clinically significant consequences. We conducted a study to...
Article
The present study examines a more fine-grained analysis of anxiety-related and depression-related outcomes amongst a sample of treatment completers who were assigned to complicated grief treatment (CGT) (n = 35) or interpersonal psychotherapy (IPT) (n = 34) in a previously reported randomized controlled trial. We examined effects of antidepressant...
Article
Increasing literature is focused on complicated grief (CG) and its distinctiveness from other potentially loss related mental disorders such as major depression (MD). In this regard, symptoms of separation distress seem to play a key role. The aim of this study was to compare the clinical features of CG to those of MD and of CG + MD, with particula...
Article
Full-text available
Complicated grief (CG) is increasingly recognized as a debilitating outcome of bereavement. Given the intensity of the stressor, its chronicity, and its association with depression, it is important to know the impact CG may have on cognitive functioning. This exploratory and descriptive study examined global and domain-specific cognitive functionin...
Article
This paper discusses each of several potential consequences of bereavement. First, we describe ordinary grief, followed by a discussion of grief gone awry, or complicated grief (CG). Then, we cover other potential adverse outcomes of bereavement, each of which may contribute to, but are not identical with, CG: general medical comorbidity, mood diso...
Article
Importance Complicated grief (CG) is a debilitating condition, most prevalent in elderly persons. However, to our knowledge, no full-scale randomized clinical trial has studied CG in this population.Objective To determine whether complicated grief treatment (CGT) produces greater improvement in CG and depressive symptoms than grief-focused interp...
Article
Background: It is unclear whether bereaved parents with Complicated Grief (CG) struggle with their grief differently than others with CG. This study addressed this question by comparing CG severity, CG-related symptoms, thoughts and behaviors, and comorbid psychiatric diagnoses of bereaved parents with CG to the diagnoses and symptoms of others wi...
Article
Full-text available
We examine a test of a nonparametric regression function based on penalized spline smoothing. We show that, similarly to a penalized spline estimator, the asymptotic power of the penalized spline test falls into a small- K or a large-K scenarios characterized by the number of knots K and the smoothing parameter. However, the optimal rate of K and t...
Article
Young adults experience problematic responses to loss more often than is commonly recognized. Few empirical studies have examined the contribution of intrapersonal and interpersonal characteristics to grief and depression in bereaved young adults. This study investigated the association of dependency and quality of the relationship with the decease...
Article
Objective: Unexpected death of a loved one is common and associated with subsequent elevations in symptoms of multiple forms of psychopathology. Determining whether this experience predicts novel onset of psychiatric disorders and whether these associations vary across the life course has important clinical implications. The authors examined assoc...
Article
Full-text available
Although spirituality often has been associated with better outcomes following bereavement, it can be significantly challenged by loss as well. Studies have shown that some bereaved individuals suffer profoundly not only in relation to the death of their loved one but also in their relationship with God and their faith community, a condition known...
Article
Full-text available
Objective: Recently, innovative statistical tools have been used to model patterns of change in psychological treatments. These tools can detect patterns of change in patient progress early in treatment and allow for the prediction of treatment outcomes and treatment length. Method: We used growth mixture modeling to identify different latent cl...
Article
Although the alliance-outcome correlation is well established, no published studies to date have separated between therapists' and patients' contributions while controlling for early symptom change. In this study, we examined therapist effects in two trials of CBT for panic disorder with agoraphobia (PDA) and the impact of therapists' and patients'...
Article
Bereavement is a common experience in adults aged 60 and older. Loss of a loved one usually leads to acute grief characterized by yearning and longing, decreased interest in ongoing activities, and frequent thoughts of the deceased. For most, acute grief naturally evolves into a state of integrated grief, where the bereaved is able to reengage with...
Article
The present study examined temporal dependencies of change of panic symptoms and two promising mechanisms of change (self-efficacy and anxiety sensitivity) during an 11-session course of cognitive-behavior therapy (CBT) for Panic Disorder (PD). 361 individuals with a principal diagnosis of PD completed measures of self-efficacy, anxiety sensitivity...
Article
Based on the recommendations of the sub-workgroup on trauma and dissociative disorders, the American Psychiatric Association (APA) removed the "bereavement exclusion" from the criteria for major depression in DSM-5. In addition, proposed DSM-5 research criteria for persistent complex bereavement disorder (PCBD) were included in the new manual in a...
Article
Full-text available
Constructing classification rules for accurate diagnosis of a disorder is an important goal in medical practice. In many clinical applications, there is no clinically significant anatomical or physiological deviation exists to identify the gold standard disease status to inform development of classification algorithms. Despite absence of perfect di...
Article
Little is known about the presence and role of subclinical anxiety symptoms and traits in complicated grief (CG). Data from adults with CG (n=28) suggest that they experience more panic-spectrum symptoms (PSS) than bereaved controls (n=44), and that the presence of greater PSS is independently associated with poorer quality of life.
Article
Bereavement is common among older adults and may result in major depression or complicated grief (CG). Little is known about the effectiveness of physician care for these conditions. We examined whether, among older adults with CG and/or major depression, using physician support was associated with reductions in grief, depression, or anxiety severi...
Article
Bereavement and its accompanying psychological response (grief) constitute potent experiences that necessitate the reorganization of cognitive-affective representations of lost significant attachment figures during both wakefulness and dreaming. The goals of this preliminary study were to explore whether the dream content of 77 adults with complica...
Article
Background: Complicated grief (CG) is a bereavement-specific syndrome characterized by traumatic and separation distress lasting over 6 months. Little is known about the role of dissociation experienced during or immediately after the loss of a loved one (i.e., periloss dissociation [PLD]) in CG. The present study aimed to examine the psychometric...
Article
Unlabelled: Although associations with outcome have been inconsistent, therapist adherence and competence continues to garner attention, particularly within the context of increasing interest in the dissemination, implementation, and sustainability of evidence-based treatments. To date, research on therapist adherence and competence has focused on...
Article
Full-text available
Context Suicide bereavement remains understudied and poorly understood. Objectives To examine outcomes of parents bereaved by the suicide death of their offspring and to compare these with both nonbereaved parent controls and parents who had offspring die in a motor vehicle crash (MVC). Design Population-based case-control study. Suicide-bereaved p...
Article
Objective: We examined the possibility that maintenance cognitive behavior therapy (M-CBT) may improve the likelihood of sustained improvement and reduced relapse in a multi-site randomized controlled clinical trial of patients who met criteria for panic disorder with or without agoraphobia. Method: Participants were all patients (N = 379) who f...