Multidimensional Grief Therapy: Pilot Open Trial of a Novel Intervention for Bereaved Children and Adolescents

Abstract

Objectives This study describes a pilot open trial of Multidimensional Grief Therapy, an assessment-driven, phasic individual therapy for bereaved youth. This study provides a preliminary outcome evaluation with respect to maladaptive grief reactions, post-traumatic stress symptoms, and depressive symptoms in bereaved youth. Methods The sample consisted of 65 bereaved youth (ages 6-17 years, M = 11.62, SD = 2.76; 53% female; 33.3% Hispanic, 31.8% African American/Black, 27.3% Caucasian, 6.1% mixed/biracial, 1.5% Native American). The study utilized a single-group open trial design. Youth referred to the study due to the death of a loved one completed measures of grief reactions, posttraumatic stress symptoms, and depressive symptoms. Measures were also completed following Phases I and II of the treatment. Results Youth who completed Phase I (n = 42) reported significant reductions from baseline, with large to very large effect sizes (Cohen's D range = 0.77−1.35) for all three domains of maladaptive grief, post-traumatic stress symptoms, and depressive symptoms. Youth who completed Phase II (n = 22) exhibited significant reductions from the end of Phase I, with medium to large effect sizes (range = 0.57-0.90) for two domains of maladaptive grief as well as for posttraumatic stress symptoms and depressive symptoms. Conclusions Although further evaluations using a wider array of outcomes are needed to evaluate MGT and the maintenance of treatment gains over time, the present study provides preliminary evidence supporting MGT as an individual treatment for bereaved youth experiencing maladaptive grief reactions, post-traumatic stress, and depressive symptoms.

Initial Validation and Measurement Invariance of the Active Inhibition Scale Among Traumatized and Grieving Youth

“…In the DSM‐5 , PCBD is a provisional diagnosis included in the appendix as an invitation for further research. Items on the PCBD Checklist are rated using a 5‐point scale ranging from 0 ( not at all ) to 4 ( all the time ) and have shown good convergent and discriminant validity with symptoms of posttraumatic stress and depression (Kaplow et al., 2018) as well as good sensitivity to therapeutic change (Hill et al., 2019). In the current study, summative subscale scores corresponding to the primary grief symptom clusters described in PCBD Criterion B and C were used.…”

A Systematic Review and Meta-Analysis of the Efficacy of Grief Interventions for Anxiety and Depression in Young People

“…There were not enough studies with between-group comparisons or follow-up to include in calculation of effect sizes in the meta-analysis, we synthesize these here. Only 3 of the 27 studies included an active treatment comparison (i.e., between-groups comparison) in an RCT design [26,29,30]. Similarly, few studies (n = 8; 30%) included a follow-up, ranging from 6 weeks [31] to 12 months [26,32].…”

“…Considering that some studies did not measure grief, and a wide variety of grief measures were used across studies, we were unable to test-baseline grief symptoms as a moderator in the meta-regression. However, among CBT interventions, groups where the participants had clinically significant grief or PTSD symptoms typically reported larger reductions in grief, anxiety, and depression [26,29,30,32,[35][36][37][38][39], compared to non-clinical samples (e.g., inclusion was "has experienced a loss"; [40][41][42][43][44]. Sandler et al [46] was the one outlier, with no clinical inclusion criteria but showing a large decrease in depression at posttest.…”

CBT for Prolonged Grief in Children and Adolescents: A Randomized Clinical Trial

“…Third, uncontrolled studies (14,15) have indicated that cognitive-behavioral therapy for childhood traumatic grief, targeting both traumatic stress and grief following unnatural deaths, successfully alleviates disabling grief. More recently, an uncontrolled pilot study showed that multidimensional grief therapy yielded promising effects (16).…”