For the millions of people who experience the loss of a loved one every year, grief can take many forms.

Some mourners become stoic. Others are angry, or in denial. And some are like Elizabeth Carbone of Greensburg, who was plagued by feelings of guilt long after her adult son's suicide and haunted by her memories of his death.

About 10 to 20 percent of survivors suffer from this debilitating condition, called complicated grief, which can leave mourners unable to cope with the world around them for a half year or more after a death.

Doctors at the University of Pittsburgh Medical Center may have found a way to help patients suffering from this type of grief. In a study published today in the Journal of the American Medical Association, they outline a two-pronged therapy, which involves the patient both "revisiting" the death and resuming pleasurable activities and social contacts.

"Some of the lore in grief is that you have to resolve your grief and then move on with your life," said Dr. Katherine Shear, lead author and a Pitt psychiatry professor. "This newer research says you have to do both things at once."

The study, which followed 95 patients who were suffering from complicated grief over the course of three years, found that more than half of those who go through complicated grief treatment significantly improved. By contrast, only 28 percent improved when treated with interpersonal psychotherapy, which encourages patients to resume interpersonal relationships, improved.

Those treated by complicated grief therapy also responded to the treatment faster.

In the new therapy, patients are urged to retell the story of the death, produce an audio recording of their story, and listen to it repeatedly to reduce their aversion to talking or thinking about it. Patients also participate in an imagined conversation with the person they have lost, speaking openly about their shared experiences.

During the therapy, doctors also urge patients to resume activities that satisfy them, re-engaging with the world.

These findings are important because those suffering from complicated grief sometimes have difficulty finding help for their problems, because they look physiologically sound.

"Often bereaved family members are kind of neglected by the medical profession," said Shear. "Doctors are really trained to treat ill patients and get them better."

For Carbone, it wasn't that doctors were neglecting her grief, but that their efforts weren't helping.

Prior to participating in the study, she felt only guilt and devastation when thinking about her son Natale's suicide five years ago.

Searing memories of his death would strike her at moments, crystal clear: finding his suicide note on the landing of her home, rushing downstairs to find her son in the barn with a gunshot wound to his head, arriving at the hospital and grasping the hand of a priest who read her son his last rites.

Carbone, a nurse, was plagued by feelings of guilt because she hadn't been able to diagnose or interfere with her son's plans to end his life. She would wander downstairs and open the front door of her home in the middle of the night, hoping that her son would return home.

She visited a psychologist and a support group, and was prescribed medicine by a psychiatrist, but she still wasn't able to handle Natale's personal belongings without crying.

During the complicated grief therapy, she talked to Natale as if he were still alive, and recorded the conversation on tape, playing it back over and over again. As she talked about his death, she began to realize that it was his choice to end his life, and that there was really no one to blame.

Her 39-year-old son had suffered from a rare blood disorder that made his life very uncomfortable. Although she did not know his reasons at the time, he came home to Greensburg from Virginia determined to sort out his affairs and end his life.

She now talks about his life and death calmly, and without guilt.

"Even though you don't think you need it, you're strong -- and I've always been a very strong person -- you do need it," Carbone said about the therapy. Shear "made me feel that there is a ray of hope at the end of a very dark tunnel."

Carbone has moved on. She plays bridge and does some traveling, and volunteers as a nurse.

"It's not that you're ever going to forget what happened because he was a part of our life," she said. "But it's imperative to talk to someone. . . It saved my life."

The grief and bereavement program at UPMC provides assessments for people who may have complicated grief; call 412-246-5800 for information. For local grieving resources, call the Good Grief Center at 1-888-GRIEF88.