Cognitive behavioral therapy with exposure therapy (CBT/exposure), where patients relive the experience of a death of a loved one, resulted in greater reductions in measures of prolonged grief disorder (PGD) than CBT alone.
PGD involves persistent yearning for the deceased and the associated emotional pain, difficulty in accepting the death, a sense of meaninglessness, bitterness about the death and difficulty in engaging in new activities. To diagnose PGD, the symptoms need to last at least six months. PGD is distinct from depression because of a person's preoccupation with yearning for the deceased.
: A randomized clinical trial of 80 patients with PGD was conducted to determine the effectiveness of CBT/exposure (n=41) or CBT alone (n=39). All patients received 10 weekly two-hour group therapy sessions of CBT techniques. Patients also had four individual sessions where they received exposure therapy (reliving the time they experienced the death of their loved one) or patients receiving CBT alone could discuss whatever they liked. Outcome measures were depression, cognitive appraisals and functioning at the six-month follow-up.
The analyses indicate that CBT/exposure resulted in greater PGD reductions than CBT alone: there were greater reductions in depression, negative appraisals and functional impairment at follow-up. Fewer patients in the CBT/exposure group at follow-up (14.8 percent) met the criteria for PGD than those in the group who received CBT alone (37.9 percent).
"In the most valuable lesson from this study, optimal gains with PGD patients are achieved when the emotions associated with the memories of the death and the sequelae of the loss are fully accessed. ... Despite the distress elicited by engaging with memories of the death, this strategy does not lead to aversive responses. In light of evidence that many interventions provided to grieving people are not empirically supported, the challenge is to foster better education of clinicians through evidence-supported interventions to optimize adaptation to the loss as effectively as possible."
Authors: Richard A. Bryant, Ph.D., of the University of New South Wales, Sydney, Australia, and colleagues.
(JAMA Psychiatry. Published online October 22, 2014. doi:10.1001/jamapsychiatry.2014.1600. Available pre-embargo to the media at http://media.
Editor's Note: This study was supported by a grant from the National Health and Medical Research Council Program and a grant from the National Health and Medical Research Council Project. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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