Cognitive Behavioral Therapy for Prolonged Grief Disorder: Research Brief of Integrative CBT for Prolonged Grief Disorder

Journal of Affective Disorders, 2015 

Coping after the death of a loved one is a universal, but unique and personal journey often filled with pain and despair. Most usually have the natural capacity to adjust to their new lives in the absence of loved ones. However, some experience more difficulty or prolonged grieving than others.

One of the factors identified as significant in the coping process is cognitions that the mourner holds about the loved one. Specifically, thoughts about the person who died, reflections on their relationship, and assessment of one’s own ability to survive (whether in a practical or literal sense) without the deceased are important cognitions to consider. Additionally, rumination is a cognitive distortion often linked with grief. 

This study looks at prolonged grief disorder (PGD), often termed “complicated grief,” which is defined as continuing to experience the following symptoms for more than six months after the death of a loved one: intense yearning and preoccupation of the deceased, feeling stunned or shocked by the loss, avoiding reminders of the reality of the loss, emotional numbing, and social or identity disruptions. PGD has been found to be associated with deteriorated health, increased depression, and suicidality. PGD prevalence rates range from 3.7% to 25.4% depending on the study. 

The study concluded that CBT for prolonged grief is effective after a 20-session treatment and at 1.5 years follow-up, for both grief symptoms and overall mental health. 

Highlights from the Study

The study looked at 51 individuals about 1.5 years after they participated in a randomized controlled trial for Cognitive Behavioral Therapy (CBT) for PGD. The CBT intervention was composed of 20 sessions divided into three parts, including a part on stabilizing and motivating the patient, confronting and reinterpreting cognitions and perceptions related to the patients and their deceased loved one, and examining future prospects while maintaining a healthy bond to the deceased. The patients were also offered five optional sessions for addressing special situations or occasions, like anniversaries and holidays. 

Prior studies have demonstrated that CBT for PGD is effective in comparison to wait list control groups, and this study added to the literature by showing that these therapy gains are maintained, on average, for 1.5 years post treatment. According to Rosner et al., regarding overall mental health (based on the SCL-90-R), initial therapy gains were maintained from post treatment to follow-up for overall psychopathology (Global Severity Index) and the subscales of somatization, depression, anxiety, and phobic anxiety. 

At Feeling Good Institute, we use a variety of evidence-based treatment models, which can be applied to prolonged grief as demonstrated in this study. Our therapists are trained in creating a strong, authentic therapeutic relationship with clients, and treatment includes a focus on motivation and an examination of cognitions, all of which were a vital part of the CBT therapy used in this study. 

Learn about the essential skills for effective cognitive behavior therapy and how we set therapists up for success.

Citation: Rosner, R., Bartle, H., Pfoh, G., Kotoučová, M., & Hagl, M (2015). Efficacy of an integrative CBT for prolonged grief disorder: A long-term follow-up. Journal of Affective Disorders, 183 (2015), 106-112. Doi: 10.1016/j.jad.2015.04.051

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