Abstract
Present-centered therapy (PCT) was originally developed as a strong comparator for the non-specific effects of psychotherapy in the treatment of posttraumatic stress disorder. PCT qualifies as a not strictly supportive treatment as it is structured and homework is assigned between sessions. It does not focus on cognitive restructuring or exposure. A growing body of literature supports its beneficial effects. For example, it demonstrated only slightly inferior effect sizes and lower dropout rates compared to that of trauma-focused cognitive behavioral therapy in several trials with patients suffering from posttraumatic stress disorder. The current study is the first to evaluate the feasibility and the treatment effects of PCT in adults with prolonged grief disorder (PGD). Meta-analyses on psychotherapy for PGD have yielded moderate effect sizes. N = 20 individuals suffering from PGD were treated with PCT by novice therapists as part of a preparation phase for an upcoming RCT in an outpatient setting. Treatment consisted of 20–24 sessions á 50 min. All outcomes were assessed before treatment, at post-treatment, and at the 3-month follow-up. The primary outcome, PGD symptom severity, was assessed using the Interview for Prolonged Grief-13. Secondary outcomes were self-reported PGD severity, depression, general psychological distress, and somatic symptom severity. Furthermore, therapists evaluated their experiences with their first PCT patient and the treatment manual. In intent-to-treat analyses of all patients we found a significant decrease in interview-based PGD symptom severity at post-treatment (d = 1.26). Decreases were maintained up to the 3-month follow-up assessment (d = 1.25). There were also significant decreases in self-reported PGD symptoms, depression, and general psychological distress. No changes were observed for somatic symptoms. The completion rate was 85%. Therapists deemed PCT to be a learnable treatment program that can be adapted to the patient's individual needs. The preliminary results of PCT as a treatment for PGD demonstrate large effects and indicate good feasibility in outpatient settings. The treatment effects were larger than those reported in meta-analyses. Thus, PCT is a promising treatment for PGD. Possible future research directions are discussed.
Highlights
Prolonged grief disorder (PGD) has emerged as a well-defined mental disorder, distinguishable from major depression and posttraumatic stress disorder (PTSD) or other stress-related disorders [1]
To meet the criteria for PGD in the current study, it was necessary for participants to report at least (a) one separation distress symptom, (b) four out of nine cognitive, emotional, and behavioral symptoms, and (c) significant impairment in social, occupational or other important domains, for 6 months or longer, after the loss according to the PG-13, see below
This study is the first to investigate the feasibility of Present-centered therapy (PCT) in patients suffering from PGD
Summary
Prolonged grief disorder (PGD) has emerged as a well-defined mental disorder, distinguishable from major depression and posttraumatic stress disorder (PTSD) or other stress-related disorders [1]. PCT can be deemed to be what is known as a bona fide therapy, namely a therapy based on psychological principles containing specific factors (i.e., specific techniques like fostering of problem-solving skills and homework exercises, or promoting a theory of the therapeutic change, namely by clientcentered principles of offering empathy, unconditional positive regard and congruence) and delivered by trained professionals [cf [29, 30]] It is, a credible intervention for both patients and therapists. On a theoretical basis, by focusing on the active mastery of daily problems and functional coping, one might speculate that PCT resembles restoration-orientation according to the Dual Process Model of coping with bereavement [31] This is why we decided to adapt PCT to the needs of patients suffering from PGD. The aim of this study was to evaluate the feasibility and the treatment effects of PCT in adults with PGD, and to explore therapists’ and supervisor’s experiences with this new treatment
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