A recent clinical trial has found that integrative cognitive behavioral therapy for prolonged grief (PG-CBT) is more effective than present-centered therapy (PCT) in alleviating symptoms of prolonged grief disorder (PGD). The study offers hope for individuals struggling with this condition, which is characterized by intense and persistent yearning for a deceased loved one.
Published in JAMA Psychiatry, the research aimed to compare the effectiveness of PG-CBT and PCT in reducing the severity of PGD symptoms. PGD is recognized as a distinct diagnosis in both the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). It affects approximately 5% of the population, with higher prevalence among older adults and those who have experienced traumatic losses. PGD is associated with significant risks, including suicidality and co-occurring mental health disorders, particularly depression.
The study was conducted across four university outpatient clinics in Germany, with ethical approval from each center’s review board. Participants, aged 18 to 75, were required to have primary PGD diagnosed through the Prolonged Grief Disorder 13 (PG-13) interview. Exclusion criteria included severe mental health disorders, concurrent therapies, acute suicidality, and recent changes in medication.
Over the course of the trial, researchers assessed the efficacy of PG-CBT—which combines exposure therapy, psychoeducation, and cognitive restructuring—against PCT, which focuses on providing support for daily stressors without core cognitive restructuring. Participants underwent 20 weekly sessions, with additional optional sessions available, delivered either in-person or via video conferencing during the COVID-19 pandemic.
A total of 544 individuals were screened for eligibility between April 2017 and May 2022, with 213 enrolled in the study. Following one withdrawal, 212 participants (average age 51.8, 82% female) completed the trial. Baseline characteristics were well-balanced between the two groups, with an average time since loss of 26.5 months.
Results indicated that both therapies significantly reduced PGD severity at follow-up. Initially, PG-CBT demonstrated greater effectiveness than PCT, with a mean change difference of -3.15 in PG-13 severity scores. However, this difference diminished by the 12-month follow-up, indicating only a trend-level advantage for PG-CBT.
Secondary outcomes revealed that PG-CBT significantly outperformed PCT in reducing overall psychopathology and depressive symptoms at both six and twelve months. Both therapies were similarly effective in improving somatic symptoms. Notably, PG-CBT maintained a significant reduction in suicide risk, as measured by the Columbia-Suicide Severity Rating Scale (C-SSRS), through follow-up assessments.
Despite no significant differences in PGD remission rates between the two groups, treatment adherence was high, with only 18% of participants discontinuing treatment, primarily due to external stressors and lack of motivation. No serious treatment-related adverse events were reported.
The study also considered the impact of the COVID-19 pandemic, finding no significant differences in treatment responses among participants based on their timing of participation relative to the pandemic.
In conclusion, while PG-CBT showed superior short-term effects on PGD symptoms, both therapies effectively reduced symptoms and comorbid depressive conditions. The study highlights the potential of PCT, which addresses daily grief-related stressors, to enhance therapeutic outcomes. These findings contribute valuable insights into effective treatment options for those suffering from prolonged grief disorder.
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