A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder

Abstract

This trial assessed the feasibility, acceptability, tolerability, and efficacy of an Internet-based therapist-assisted cognitive-behavioral indicated prevention intervention for prolonged grief disorder (PGD) called Healthy Experiences After Loss (HEAL). Eighty-four bereaved individuals at risk for PGD were randomized to either an immediate treatment group (n = 41) or a waitlist control group (n=43). Assessments were conducted at four time-points: prior to the wait-interval (for the waitlist group), pre-intervention, post-intervention, 6 weeks later, and 3 months later (for the immediate group only). Intent-to-treat analyses indicated that HEAL was associated with large reductions in prolonged grief (d=1.10), depression (d=.71), anxiety (d=.51), and posttraumatic stress (d=.91). Also, significantly fewer participants in the immediate group met PGD criteria post-intervention than in the waitlist group. Pooled data from both groups also yielded significant reductions and large effect sizes in PGD symptom severity at each follow-up assessment. The intervention required minimal professional oversight and ratings of satisfaction with treatment and usability of the Internet interface were high. HEAL has the potential to be an effective, well-tolerated tool to reduce the burden of significant pre-clinical PGD. Further research is needed to refine HEAL and to assess its efficacy and mechanisms of action in a large-scale trial.

Disturbed grief: prolonged grief disorder and persistent complex bereavement disorder

“…50 Another recent study evaluated an online therapist assisted intervention for bereaved care givers of recently deceased cancer patients who reported clinically significant and disabling PGD symptoms at three to six months after loss. 51 This intervention yielded lower dropout (17.3%) and led to statistically and clinically significant reductions in PGD, post-traumatic stress disorder, depression, and anxiety that were maintained over time.…”

Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability

“…Its guidelines can be used for assessment and treatment, particularly the recommendations that the management of grief symptoms should include the discussion of culturally appropriate adjustment and mourning rituals. In addition, there have been several successful randomized controlled trials of treatments for CG (Shear, Frank, Houck, & Reynolds, 2005; Shear et al, 2016, 2014) and PGD (Bryant et al, 2014; Kersting et al, 2013; Litz et al, 2014; Rosner, Pfoh, Kotoučová, & Hagl, 2014). These treatments pull valuable techniques from PTSD interventions, narrative therapy and cognitive behavioural therapy, and could be incorporated into the WHO mhGAP guidelines (Rosner, Bartl, Pfoh, Kotoučová, & Hagl, 2015; Shear, 2015).…”

Internet-Based Exposure and Behavioral Activation for Complicated Grief and Rumination: A Randomized Controlled Trial

“…Moreover, there is accumulating evidence that cognitive behavioral therapy (CBT) is a promising therapeutic intervention for complicated grief (Boelen, de Keijser, van den Hout, & van den Bout, 2007;Bryant et al, 2014;Litz et al, 2014;Papa, Sewell, GarrisonDiehn, & Rummel, 2013;Rosner, Pfoh, Kotoučová, & Hagl, 2014;Shear, Frank, Houck, & Reynolds, 2005;Wagner, Knaevelsrud, & Maercker, 2006). CBT for complicated grief typically consists of multiple components, including, but not limited to: (a) exposure to avoided bereavement-related cues; (b) cognitive restructuring of loss-related negative cognitions; and/or (c) behavioral activation to counter inactivity and behavioral withdrawal.…”