Treatment For Prolonged Grief Disorder Research Articles

Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder

Although grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy. To examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity. A single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief-13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months. Both groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress. The primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life. The trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events. In this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration. anzctr.org.au Identifier: ACTRN12612000307808.

Understanding laypersons’ perceptions of pathological grief and their support recommendations in a German sample

BackgroundKnowledge about mental disorders (mental health literacy, MHL) among laypeople facilitates adequate help-seeking. Prolonged grief disorder (PGD) is a relatively new diagnosis and little is known about MHL regarding PGD. Since grief is a normal phenomenon, it may be difficult for laypeople to recognise the presence of this mental disorder and their decision could be influenced by circumstantial factors determining the expression and intensity of grief.We examined whether the gender of the bereaved person and the person's relationship to the deceased affected laypeople's recognition of PGD as a mental disorder and what treatment laypeople would recommend for PGD. MethodsA German convenience sample (n = 369) was randomly presented one of four vignettes. Vignettes varied the gender of the bereaved person (male vs female) and the relationship to the deceased (child vs parent). Participants indicated whether in their view the depicted person suffered from a mental disorder and what treatment they would recommend. Additionally, participants rated their agreement with positive and negative statements about PGD. ResultsNeither gender nor the relationship to the deceased influenced laypeople's diagnostic ratings and treatment recommendations. If participants considered a mental disorder to be present, they recommended most strongly grief counselling, followed by psychotherapy and self-help groups. Attitudes towards PGD were overwhelmingly positive. LimitationsResults need to be replicated in representative samples. ConclusionLaypeople mostly recognised PGD as a mental disorder and recommended seeking help. As only psychotherapy is an evidence-based treatment for PGD, knowledge about different treatment options must be disseminated among the public.

Associations of dimensions of anger with distress following traumatic bereavement.

A prior study with people exposed to a traumatic event indicated that posttraumatic anger is a multidimensional construct that consists of five factors comprising anger at (a) the criminal justice system, (b) other people, (c) the self, and (d) a perpetrator and (e) a desire for revenge. Preliminary evidence shows that anger at the self and perpetrators is related to posttraumatic stress disorder (PTSD) symptoms. Expanding the focus from trauma victims to people exposed to a traumatic loss of a significant other, for example, due to road traffic accidents, may enhance our knowledge on factors that are amenable to change in the treatment of prolonged grief disorder (PGD) and PTSD. We examined the (a) factor structure of the 20-item Posttraumatic Anger Questionnaire in 209 Dutch people bereaved by road traffic accidents using confirmatory factor analysis and (b) associations between the posttraumatic anger factors and PGD and PTSD using structural equation models. The expected five-factor structure of the Posttraumatic Anger Questionnaire was supported. Anger at the self was related to greater PGD (β = .35) and PTSD (β = .50) symptoms over and above known risk factors of distress. A desire for revenge (β = .20) was uniquely and positively associated with PTSD symptoms. Pending replication of our findings in longitudinal studies, we conclude that anger subtypes relate differently to distress after traumatic loss. Anger toward the self seems the most detrimental type of anger and may therefore be an important target in treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Prolonged grief disorder symptomology in three African countries: A network analysis and comparison.

Bereavement is a globally prevalent life stressor, but in some instances, it may be followed by a persistent condition of grief and distress, codified within the 11th edition of the International Classification of Diseases (ICD-11) as prolonged grief disorder (PGD). Network analysis provides a valuable framework for understanding psychological disorders at a nuanced symptom-based level. This study novelly explores the network structure of ICD-11 PGD symptomology in a non-Western sample and assesses the replication of this across three African country sub-samples in these data. Network models were estimated using the "Inventory of Complicated Grief-Revised" in a sample of trauma-exposed individuals who experienced bereavement throughout life (N=1,554) from three African countries (Ghana, n=290; Kenya, n=619; Nigeria, n=645). These networks were statistically evaluated using the network comparison test. It was found that "Feelings of Loss" and "Difficulty moving on" were the most central symptoms in the combined sample network. These findings were largely consistent for the Ghana and Nigeria sub-samples, however, network structure differences were noted in the Kenya sub-sample. The identified PGD network highlights particular indicators and associations across three African samples. Implications for the assessment and treatment of PGD in these cultural contexts warrant consideration.

Trajectories of insomnia following bereavement

BackgroundInsomnia symptoms are common following bereavement and may exacerbate severe and protracted grief reactions, such as prolonged grief disorder (PGD). However, typical trajectories of insomnia symptoms and risk factors for having a more chronic insomnia trajectory following bereavement are yet unknown. MethodIn the current investigation, 220 recently bereaved (≤6 months post-loss) participants, completed questionnaires assessing sociodemographic and loss-related characteristics, rumination, experiential avoidance and symptoms of (prolonged) grief and depression, on three time-points (6 months apart). We applied growth mixture models to investigate the typical trajectories of insomnia symptoms following bereavement. ResultsThree insomnia trajectory classes emerged, characterized by a resilient (47 %), recovering (43 %), and a chronic trajectory (10 %). Baseline depression symptoms best predicted the type of insomnia trajectory. At one-year follow-up, 9 %, 27 %, and 60 % of participants met the criteria for probable PGD within the resilient, recovering and chronic trajectory, respectively. A parallel process model showed that temporal changes in insomnia symptoms were strongly related to changes in prolonged grief symptoms. ConclusionThe results suggest, that targeting insomnia symptoms in the treatment of PGD, particularly with comorbid depression, may be a viable option.

GRIEF SYMPTOM PROFILES OF OLDER SPOUSES BEREAVED BY COVID-19

Abstract Many older adults lost their spouse or life partner to COVID-19. Despite the anticipated rise in the prevalence of prolonged grief disorder, the association between COVID-19 bereavement and symptoms of complicated (or pathological) grief in community-dwelling older adults remains unclear. This study compared six clinically meaningful complicated grief symptom profiles between older spouses who were and were not bereaved by COVID-19. Participants included 80 adults aged 60+ years (20% men, 10% Black/minority status) who lost their spouse or life partner within the previous 12 months (M time since loss=6.6 months [SD=3.4 months]) and were enrolled in a randomized controlled trial for depression prevention. Grief symptom profiles were assessed with the Inventory of Complicated Grief. At the time of enrollment, older spouses bereaved by COVID-19 (n=18) reported more shock and disbelief (M = 7.11 [SD=3.16] versus M=3.83 [SD3.30], F=13.84, p<.001) and more hallucinations (M=1.56 [SD=1.29] versus M=0.45 [SD=0.88], F=17.12, p<.001) compared to older spouses bereaved by other causes of death (n=62). The two groups were similar in terms of yearning, anger and bitterness, estrangement from others, and avoidance behaviors. In addition, older spouses bereaved by COVID-19 had over 3 and a half times the odds of screening positive for probable prolonged grief disorder (OR=3.84 (95% CI = 1.28 -11.53, p = 0.016). These symptom clusters, particularly hallucinations, map to the highest level of prolonged grief disorder severity. These findings suggest that clinical treatment for prolonged grief disorder may be warranted for surviving spouses who lost their loved one to COVID-19.

Pertinent Studies on Treatments for Prolonged Grief Disorder

Prolonged grief disorder (PGD) is a distinctive disorder and leads to severe impairments in people’s life. Treatments specific to PGD are urgently needed. However, there have not been enough studies on this topic and universally effective treatments have not been validated. As a result, the current paper aims to summarize some studies about pertinent treatments and list what may be their shortcomings, in order to give future direction for investigation on treatment for PGD. Results show that study of pharmacology for PGD may just start. There has not been effective medicine yet. Complicated grief treatment can be an effective way to treat PGD, but its response rate can be better, if future studies can confirm its real working factors and examine the treatment in a larger and more diverse sample group. Cognitive behavioral therapy (CBT) targeted at CG shows promising outcomes. However, its response rate should also be improved in the future. Meanwhile, as different CBT plans always have different intervention procedure, it may be hard to figure out what really works on PGD and helps to improve. Future study can try to confirm its true therapeutic factors. In all, there is much work need to be done in the future.

A quasi-experimental trial of narrative reconstruction for prolonged grief disorder: Symptomatic improvement and enhanced memory integration.

Prolonged grief disorder (PGD) was recently approved as a formal diagnosis in the DSM-5-TR. The implementation of bereavement interventions is frequently requested, but their effectiveness has been controversial. Narrative reconstruction (NR) is a time-limited integrative therapy, originally developed for the treatment of post-traumatic stress disorder (PTSD) and adapted for the treatment of PGD. NR consists of exposure to the loss memory, a detailed written reconstruction of the loss memory narrative, and an elaboration of the personal significance of that memory for the bereaved. In this study we evaluated the efficacy of NR for PGD. In this study, 33 participants with PGD were quasi-randomized-that is, assigned to an immediate (n = 20) or delayed (n = 13) 16-session NR intervention. PGD, intrusion, avoidance and depression symptoms, as well as levels of the loss memory integration, were assessed at pretreatment, post-treatment, and at a 3-month follow-up. Mixed linear models showed significant intervention effects for PGD and intrusive symptomatology. Results also showed an increase in integration of the loss memory, and improvements remained stable for all outcomes at follow-up. In this study we established NR as an effective intervention for PGD and call for further validation in future studies. Integrating this intervention into the routine care of people with PGD seems important and beneficial.

Understanding Black and African American Grief Following Inclusion of Prolonged Grief Disorder in the DSM-5-TR.

Black and African Americans experience bereavement more frequently and earlier in life than White Americans and thus may be more impacted by prolonged grief disorder (PGD). With the revision of the DSM-5 and the inclusion of PGD as a recognized psychiatric syndrome, researchers have an opportunity to further the understanding, diagnosis, and treatment of PGD in Black grievers residing in the United States. Relatively little research has been devoted to the specific risks and resiliencies impacting bereavement-related mental health outcomes among these individuals. Participants in our study were invited to participate in a Qualtrics-based survey disseminated through Centiment. A total of 259 participants were included in the final sample. Overall findings suggest demographic factors such as educational attainment and gender were not significantly associated with PGD. Factors such as younger age, prior trauma exposure, and violent circumstances of the death were associated with PGD, though only PTSD and anxiety symptoms were associated with PGD after adjusting for co-occurring mental health symptoms. These findings point to identifiable risk factors and resilience factors that may contribute to grief trajectories among Black grievers.

Living with loss: a cognitive approach to prolonged grief disorder - incorporating complicated, enduring and traumatic grief - ADDENDUM.

The subject of prolonged, complicated and traumatic grief has become more topical as a consequence of the Covid-19 pandemic. CBT practitioners have been asked to provide effective therapeutic responses for clients with enduring distressing grief reactions. These enduring grief conditions have now been categorised as Prolonged Grief Disorder in the two main mental health classification systems: in the ICD -11 in November 2020 and as a revision to the DSM-5 in 2021. In this paper we draw on our research and clinical experience in applying cognitive therapy for PTSD (CT-PTSD) to traumatic bereavement to derive lessons for the treatment of prolonged grief. During the pandemic the authors of this paper delivered several workshops on prolonged grief disorder (PGD) during which clinicians raised several thought-provoking questions; how do we differentiate between normal and abnormal or pathological grief; how do we categorise pathological grief; how effective are existing therapies and is there a role for CBT; and how do our experiences with Cognitive Therapy for PTSD help with conceptualisation and treatment of PGD. The purpose of this paper is to answer these important questions and in so doing, consider the historical and theoretical concepts relating to complex and traumatic grief, factors that differentiate normal grief from abnormal grief, maintenance factors for PGD and implications for CBT treatments.

Grief is a family affair: examining longitudinal associations between prolonged grief in parents and their adult children using four-wave cross-lagged panel models.

Losing a parent or spouse in adulthood may result in prolonged grief disorder (PGD) symptoms. PGD levels in parents may affect PGD levels in their adult offspring and the other way around. However, research on transmission of PGD in parent-child dyads is lacking. Consequently, we aimed to examine temporal associations between PGD levels in parent and adult children. In doing so, we analyzed longitudinal self-report data on PGD levels (using the PG-13) assessed at 2, 11, 18, and 26 months after loss in 257 adult parent-child dyads from Denmark. Cross-lagged panel modeling was used for data-analyses. Changes in PGD levels in parents significantly predicted PGD levels in adult children, but not vice versa. Small through moderate cross-lagged effects (β = 0.05 through 0.07) were found for PGD levels in parents predicting PGD levels in adult children at a subsequent time-point. These cross-lagged effects were found while taking into account the association between PGD levels in parents and adult children at the same time-point as well as the associations between the same construct over time and relevant covariates. Pending replication of these findings in clinical samples and younger families, our findings offer tentative support for expanding our focus in research and treatment of PGD from the individual to the family level.

Habituation of distress during exposure and its relationship to treatment outcome in post-traumatic stress disorder and prolonged grief disorder

ABSTRACT Background: Reliving distressing memories is a core component of treatments for post-traumatic stress disorder (PTSD) and prolonged grief disorder (PGD). There is little understanding of how reliving these memories functions in the treatment of these disorders. Objective: This study investigated whether reliving functions comparably in the treatment of PTSD and PGD, and whether it is comparably related to treatment outcome. Method: This study conducted a reanalysis of patients with either PTSD (n = 55) or PGD (n = 45) who underwent treatments that comprised at least four sessions of reliving memories of either their traumatic experience or the loss of the deceased person. Results: PTSD participants displayed greater habituation of distress across sessions during reliving than PGD participants. Between-session reduction in distress during reliving was associated with symptom remission in PTSD, but this pattern was not observed in PGD. Conclusion: This pattern of findings indicates that although reliving appears to be a useful strategy for treating both PTSD and PGD, this strategy does not function comparably in the two conditions and may involve distinct mechanisms.

Prolonged grief disorder: Nature, risk-factors, assessment, and cognitive-behavioural treatment

Most people who are confronted with the death of a loved adjust without needing professional help. A significant minority of people confronted with loss develops symptoms of prolonged grief disorder (PGD), sometimes accompanied by bereavement-related post-traumatic stress disorder (PTSD) and depression. PGD is newly included in the psychiatric classification systems of the ICD-11 and DSM-5-TR. In Ukraine, many people are currently facing losses, in circumstances that may render them vulnerable to develop PGD and associated symptoms. In this article, we address “healthy” grief and discuss the nature, assessment, risk factors, and treatment of “unhealthy” grief, now referred to PGD. We also introduce a cognitive behavioural theory that helps to understand problematic psychological processes involved in the persistence and maintenance of PGD and that offers a clear framework for the application of all kinds of cognitive behavioural interventions and other treatment interventions that can be used to alleviate the pain of people with PGD. Examples of these interventions are described. Attention is paid to how the situation of war affects the development and treatment of PGD.

Narrative reconstruction therapy for prolonged grief disorder: Basic interventions and mechanisms of change

Narrative reconstruction is a time-limited integrative therapy, originally developed in the context of post-traumatic stress disorder and adjusted for the treatment of prolonged grief disorder (PGD). It consists of exposure to the loss memory and narrating a detailed written reconstruction of it. In this paper, we describe narrative reconstruction interventions and modifications for the treatment of PGD as well as the underlying mechanisms of change including integration of the loss episode into the life narrative. A case demonstration of narrative reconstruction with a patient with PGD presented for illustration and the integrative nature of narrative reconstruction for PGD is discussed.

Factors Associated With Treatment Response in an Internet-Based Intervention for Prolonged Grief Disorder After Cancer Bereavement

Internet-based psychological interventions have proven effective in the treatment of prolonged grief disorder (PGD). Yet, some patients do not benefit from treatment in a clinically significant way. We aimed to examine predictors of symptom reduction in an Internet-based intervention for PGD after cancer bereavement, in order to identify possible treatment mechanisms and discern directions for future intervention design. A secondary analysis of data from a randomized wait-list controlled trial on an Internet-based intervention for PGD after cancer bereavement was conducted. Multiple regression models were used (1) to test for the influence of pretreatment PGD, working alliance, avoidance and gender on PGD symptom reduction; and (2) to explore further predictors of treatment success with a best subset selection protocol. The regression models explained 18% (Model 1) and 34% (Model 2) of variance in symptom reduction. Participants with more favorable symptom change had more severe pretreatment PGD scores and better working alliance. Those with lower social support and less posttraumatic growth experienced more PGD symptom change. In conclusion, therapeutic alliance is an important factor that should be monitored and fostered. Findings regarding social support and posttraumatic growth need further replication and clarification.

Introduction and evaluation of a therapeutic adherence and competence scale for grief-focused cognitive behavioural therapy

ABSTRACT Background: There is no therapeutic competence and adherence scale for grief-focused cognitive behavioural therapy (grief-focused CBT). However, given the growing body of evidence for the efficacy of grief-focused CBT, such a scale is needed both to ensure the internal validity of clinical trials and to facilitate psychotherapy process research. Objective: To develop and undertake a psychometric evaluation of a therapeutic adherence and competence scale for grief-focused CBT. Method: The scale was developed in two steps. (I) Five experts on the treatment of prolonged grief disorder provided feedback on the relevance and appropriateness of the items. The scale was revised to reflect their feedback. The final therapeutic adherence and competence scale for grief (TACs-G) consisted of 15 adherence and 16 competence items. (II) Psychometric evaluation of the TACs-G was based on the rating of 48 randomly selected PG-CBT sessions by two independent raters. The videos were recorded in the context of a randomized controlled trial (RCT; DRKS00012317.) ICC was used to calculate inter-rater reliability and TACs-G stability over time (re-evaluation of 10 sessions after 12 months). Results: The five experts confirmed the relevance and appropriateness of the items. Interrater reliability was found to be high for the total adherence and competence scores (ICC = 0.889 and 0.782, respectively) and moderate to excellent for individual items (ICC = 0.509–1.00). The TACs-G stability over time was found to be strong for both adherence (ICC = 0.970) and competence total scores (ICC = 0.965). Conclusions: The TACs-G for CBT is a reliable instrument that can be used not only to ensure internal validity but is also suited for psychotherapy process studies. Additionally, it provides a valuable database for targeted feedback in training settings. HIGHLIGHTS This is the first study to report on the development and psychometrical evaluation of a grief-focused adherence and competence scale. Although an increasing number of clinical trials do report the efficacy of grief-focused cognitive–behavioural therapy, none of these studies used a standardized adherence and competence scale to control internal validity. In the present study, we introduced a therapeutic adherence and competence scale for grief (TACs-G) that can be applied efficiently across different research settings (e.g. manipulation check, dissemination), and report results of good to excellent psychometric properties. The scale itself could prove useful beyond the research setting as it could possibly serve as a basis for feedback in training settings.

Beliefs About Causes and Cures of Prolonged Grief Disorder Among Arab and Sub-Saharan African Refugees.

BackgroundMany refugees have experienced the death of a loved one under traumatic circumstances. Accordingly, the prevalence of Prolonged Grief Disorder (PGD) among refugees is high. Culture-specific symptoms of PGD have been described previously, but beliefs about causes and cures of PGD among refugees remain unknown. We therefore aimed at identifying illness beliefs and treatment expectations regarding PGD among refugees.MethodWe focused on refugees from Arab countries (n = 14) and from Sub-Sahara Africa (n = 9) and applied qualitative and quantitative methods. In a semi-structured interview, participants first answered questions about assumed causes and potential cures for prototypical PGD symptoms according to ICD-11 that were presented in a vignette as representatives of their own culture. In the quantitative part, they completed the Cause Subscale of the Illness Perception Questionnaire (IPQ-R) that included additional culture-specific items. Interviews were analyzed with Qualitative Content Analysis.ResultsIn both groups of refugees, PGD symptoms were predominantly attributed to a close relationship to the deceased, lack of social support, personal vulnerabilities, and circumstances of the death. Participants also named a number of flight-related causes (e.g., inability to perform or participate in rituals, feeling isolated in the host country). None of the participants attributed PGD symptoms to supernatural causes. Descriptive analyses of responses on the IPQ-R indicated that participants predominantly attributed PGD symptoms to psychological causes. Participants believed that PGD can be cured and predominantly mentioned social and religious support. Psychological help was only mentioned by a minority of participants. In both groups, participants emphasized that a therapist must be familiar with the patient's culture and rituals. Participants also mentioned stigma associated with seeking psychological help.ConclusionResults suggest specific beliefs of refugees regarding causes and cures of PGD as well as similarities with Western conceptualizations. A culture-sensitive approach to the treatment of PGD in refugees that can include knowledge of culture-specific rituals and incorporating religious beliefs as well as decreasing stigma and increasing mental health literacy seem important. The study is limited by its focus on only two groups of refugees and its small sample size.

Multimedia Psychotherapy: brief report of a pilot study.

Multimedia Psychotherapy is a new form of brief psychotherapy based on narrative medicine and ethnopsychoanalytic theories, developed to help patients affected by prolonged grief disorder (ICD-11). It consists of eight sessions, during which an 'audio-video memory object' is produced by using pictures, video clips, and music chosen by the bereaved patient. The audio-video montage is focused on remembering the deceased relative and help the patient to move on. Considering initial positive results, we ran a first controlled pilot study comparing experimental and control group. We enrolled a sample of bereaved patients who were referred for prolonged grief disorder (ICD-11) by their general practitioners or psychiatrists. Patients were randomly assigned to the experimental group (n=18) or to the control group (n=18). Patients in the experimental group received psycho-pharmacological therapy and multimedia psychotherapy, while patients in the control group received psycho-pharmacological therapy and psycho-oncological support. All patients were assessed with Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and Prolonged Grief-13 (PG-13) prior to beginning treatment (pre-treatment), and with PG-13 after six months from the end of the treatment (post-treatment). Patients in the experimental group (i.e., Multimedia Psychotherapy treatment) after six months performed better than patients in the control group in Criteria B, D, and E of PG-13 (i.e.: Separation Distress, Cognitive, Emotional, and Behavioral Symptoms, Functional Impairment). We will discuss our results, issues related to the screening of patients (due to possible contraindications of Multimedia Psychotherapy), and methodological limitations. Finally, we will discuss new future applications in other clinical situations. These findings suggest that multimedia psychotherapy may hold promise for the treatment of prolonged grief disorder (ICD-11).

Feasibility of Present-Centered Therapy for Prolonged Grief Disorder: Results of a Pilot Study.

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.

Change in avoidance and negative grief-related cognitions mediates treatment outcome in older adults with prolonged grief disorder

ABSTRACT 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 Interpersonal Therapy (IPT). Method: We performed secondary analyses with assessment completers (n = 131) from a randomized-controlled trial with older adults with PGD. Patients received 16 sessions of CGT or IPT. Outcomes were treatment response and reductions in grief symptoms and grief-related related impairment. Results: Reductions in avoidance between baseline and week 16 mediated reductions in grief symptoms and grief-related impairment. Reductions in maladaptive grief-related cognitions over the same period mediated treatment response, reductions in grief symptoms and grief-related impairment. There were no significant treatment-mediator interactions. We could not establish that mediators changed before the outcomes. Conclusion: Results are consistent with theoretical models of PGD, including the CGT treatment model. Despite different therapeutic procedures, we found no significant interaction effect, but CGT produced larger effects. Future research needs to establish a timeline of change through the use of multiple measurements of mediators and outcomes. Trial registration: ClinicalTrials.gov identifier: NCT01244295.