A group of researchers evaluated whether integrative cognitive behavioral therapy for prolonged grief (PG-CBT) is more effective than present-centered therapy (PCT) in reducing prolonged grief disorder (PGD) symptoms.

Study

The present trial was conducted across four university outpatient clinics in Germany. Ethical approval was obtained from each center’s review board, and participants provided written informed consent before randomization.

Participants were aged 18 to 75, had primary PGD based on the Prolonged Grief Disorder 13 (PG-13) interview, demonstrated sufficient cognitive ability, and could read and answer questions in German. Exclusion criteria included severe mental health disorders, concurrent therapy, acute suicidality, or recent changes in psychotropic medication.

The trial aimed to assess the efficacy of integrative PG-CBT compared to PCT by analyzing changes in PGD severity scores after 12 months. PG-CBT, combining exposure, psychoeducation, and cognitive restructuring, was compared to PCT, which provided support for daily stressors without core cognitive restructuring.

Randomization was managed by an independent center using block randomization. Treatment included 20 weekly sessions with up to 4 optional sessions, conducted face-to-face or via video during the coronavirus disease 2019 (COVID-19) pandemic.

Blinded raters conducted assessments at multiple points, and statistical analyses used a linear mixed-effects model for continuous outcomes. This study followed Consolidated Standards of Reporting Trials (CONSORT) reporting guidelines and was registered with the German Clinical Trials Register.

Findings

Between April 2017 and May 2022, 544 individuals were screened for eligibility, with 213 enrolled and randomly assigned to PCT or PG-CBT. After one participant withdrew consent, 212 participants (mean age 51.8, ranging from 19 to 75 years; 82% female) remained.

Baseline characteristics were balanced between the groups, including the time since loss, which averaged 26.5 months. Among participants, 47% had at least one comorbid mental disorder, with depressive disorder being the most common (57%).

In the intention-to-treat (ITT) analysis, both therapies led to substantial reductions in PGD severity at follow-up. PG-CBT was initially more effective than PCT on the PG-13 severity score after treatment, with a mean change difference of -3.15 (Cohen’s d = 0.31), though this advantage diminished by the 12-month follow-up, showing only a trend-level difference (Cohen’s d = 0.28).

Secondary outcomes revealed PG-CBT’s significant superiority over PCT in reducing overall psychopathology at six and twelve months and depressive symptoms at twelve months. Both therapies were comparable in improving somatic symptoms.

Within each group, improvements from baseline to follow-up in PGD severity were significant and large (PG-CBT: Cohen’s d = 1.64; PCT: Cohen’s d = 1.38). Suicide risk reductions, measured by the Columbia-Suicide Severity Rating Scale (C-SSRS) severity score, were significant post-treatment for both therapies, though only PG-CBT maintained significance through follow-up.

Diagnostic assessments indicated no significant difference in PGD remission rates between the groups, with PGD persisting post-treatment for 10 in PG-CBT and 17 in PCT and at follow-up for 8 in PG-CBT and 15 in PCT.

The study had a lower-than-expected dropout rate, with 18% of participants discontinuing treatment. The main reasons for dropout were external stressors and lack of motivation.

Treatment adherence and safety were high across both groups, with no serious treatment-related adverse events. Sensitivity analyses confirmed the treatment responses, showing consistency across various methods.

The study also evaluated the potential impact of the COVID-19 pandemic, categorizing participants based on their participation timing relative to the pandemic. There was no differential treatment response among these groups, with effect sizes suggesting stability across pre-, during, and post-pandemic periods.

Conclusion

To summarize, PG-CBT showed superior short-term effects on PGD symptoms, but this advantage lessened at follow-up. Both therapies effectively reduced PGD and comorbid depressive symptoms, with similar remission and dropout rates to other trials.

Unlike previous studies using non-specific controls, PCT focused on addressing daily grief-related stressors, potentially enhancing its effectiveness.

Source:

https://www.news-medical.net/news/20241115/Cognitive-behavioral-therapy-shows-promise-for-prolonged-grief-disorder.aspx

A group of researchers evaluated whether integrative cognitive behavioral therapy for prolonged grief (PG-CBT) is more effective than present-centered therapy (PCT) in reducing prolonged grief disorder (PGD) symptoms.

Study

The present trial was conducted across four university outpatient clinics in Germany. Ethical approval was obtained from each center’s review board, and participants provided written informed consent before randomization.

Participants were aged 18 to 75, had primary PGD based on the Prolonged Grief Disorder 13 (PG-13) interview, demonstrated sufficient cognitive ability, and could read and answer questions in German. Exclusion criteria included severe mental health disorders, concurrent therapy, acute suicidality, or recent changes in psychotropic medication.

The trial aimed to assess the efficacy of integrative PG-CBT compared to PCT by analyzing changes in PGD severity scores after 12 months. PG-CBT, combining exposure, psychoeducation, and cognitive restructuring, was compared to PCT, which provided support for daily stressors without core cognitive restructuring.

Randomization was managed by an independent center using block randomization. Treatment included 20 weekly sessions with up to 4 optional sessions, conducted face-to-face or via video during the coronavirus disease 2019 (COVID-19) pandemic.

Blinded raters conducted assessments at multiple points, and statistical analyses used a linear mixed-effects model for continuous outcomes. This study followed Consolidated Standards of Reporting Trials (CONSORT) reporting guidelines and was registered with the German Clinical Trials Register.

Findings

Between April 2017 and May 2022, 544 individuals were screened for eligibility, with 213 enrolled and randomly assigned to PCT or PG-CBT. After one participant withdrew consent, 212 participants (mean age 51.8, ranging from 19 to 75 years; 82% female) remained.

Baseline characteristics were balanced between the groups, including the time since loss, which averaged 26.5 months. Among participants, 47% had at least one comorbid mental disorder, with depressive disorder being the most common (57%).

In the intention-to-treat (ITT) analysis, both therapies led to substantial reductions in PGD severity at follow-up. PG-CBT was initially more effective than PCT on the PG-13 severity score after treatment, with a mean change difference of -3.15 (Cohen’s d = 0.31), though this advantage diminished by the 12-month follow-up, showing only a trend-level difference (Cohen’s d = 0.28).

Secondary outcomes revealed PG-CBT’s significant superiority over PCT in reducing overall psychopathology at six and twelve months and depressive symptoms at twelve months. Both therapies were comparable in improving somatic symptoms.

Within each group, improvements from baseline to follow-up in PGD severity were significant and large (PG-CBT: Cohen’s d = 1.64; PCT: Cohen’s d = 1.38). Suicide risk reductions, measured by the Columbia-Suicide Severity Rating Scale (C-SSRS) severity score, were significant post-treatment for both therapies, though only PG-CBT maintained significance through follow-up.

Diagnostic assessments indicated no significant difference in PGD remission rates between the groups, with PGD persisting post-treatment for 10 in PG-CBT and 17 in PCT and at follow-up for 8 in PG-CBT and 15 in PCT.

The study had a lower-than-expected dropout rate, with 18% of participants discontinuing treatment. The main reasons for dropout were external stressors and lack of motivation.

Treatment adherence and safety were high across both groups, with no serious treatment-related adverse events. Sensitivity analyses confirmed the treatment responses, showing consistency across various methods.

The study also evaluated the potential impact of the COVID-19 pandemic, categorizing participants based on their participation timing relative to the pandemic. There was no differential treatment response among these groups, with effect sizes suggesting stability across pre-, during, and post-pandemic periods.

Conclusion

To summarize, PG-CBT showed superior short-term effects on PGD symptoms, but this advantage lessened at follow-up. Both therapies effectively reduced PGD and comorbid depressive symptoms, with similar remission and dropout rates to other trials.

Unlike previous studies using non-specific controls, PCT focused on addressing daily grief-related stressors, potentially enhancing its effectiveness.

Source:

https://www.news-medical.net/news/20241115/Cognitive-behavioral-therapy-shows-promise-for-prolonged-grief-disorder.aspx