Both grief-focused cognitive-behavioral therapy (CBT) and mindfulness-based cognitive therapy improved patients’ symptoms of prolonged grief disorder immediately after 11 weeks of treatment, according to a study published yesterday in JAMA Psychiatry. Grief-focused CBT, however, was more effective in reducing patients’ symptom severity six months after treatment ended.
“[B]etween 15% and 25% of patients with prolonged grief disorder offered grief-focused cognitive behavior therapy decline to participate in treatment, and between 17% and 50% may not respond to treatment,” wrote Richard A. Bryant, Ph.D., of the University of New South Wales in Australia and colleagues. “A viable means to advance treatment of prolonged grief disorder is to evaluate therapeutic options that do not explicitly evoke distress through loss-focused strategies.”
Bryant and colleagues recruited 100 adults (87% female) aged 18 to 70 with prolonged grief disorder; diagnoses were made using ICD-11 criteria as this study was conducted prior to DSM-5-TR. Participants were evenly randomized to receive either grief-focused CBT or mindfulness-based cognitive therapy. Both interventions consisted of 11 weekly, 90-minute individual sessions. Grief-focused CBT included psychoeducation about prolonged grief disorder, cognitive reframing of maladaptive grief-related thoughts, and activities that promoted positive memories of the deceased. Mindfulness-based cognitive therapy included meditation, descriptions of how mindfulness could be used to tolerate aversive emotions and thoughts, and how to use mindfulness practices to manage grief reactions or to focus on positive memories.
Grief symptoms were assessed at baseline, one week after treatment, and six months later with the Prolonged Grief–13 (PG-13) scale, with possible scores ranging from 11 to 55. The authors also assessed depressive symptoms and grief-related cognition.
At baseline, the grief-focused CBT group had an average score of 43.6 on the PG-13 scale compared with 40.6 in the mindfulness group. Both interventions were associated with symptom improvement immediately after treatment, with PG-13 scores falling to 31.2 in the grief-focused CBT group and 29.5 in the mindfulness group. At six months, the average score in the grief-focused CBT group was 28.7, suggesting sustained improvement, compared with 32.8 in the mindfulness group. Similarly, though participants in both groups showed improvements in depressive symptoms and grief-related cognition one week after treatment, those in the grief-focused CBT group showed greater reductions in both measures six months later.
“Despite the superior gains made by participants in the grief-focused cognitive behavior therapy group, it is noteworthy that across both treatment groups there was a significant reduction in prolonged grief disorder symptoms,” the authors wrote. “It is possible that while mindfulness-based cognitive therapy afforded symptom relief for the duration of the trial, this emotion regulatory approach did not lead to longer-term gains because memories of the death and core beliefs about the loss were not directly targeted.”
For related information, see the Psychiatric News article “Special Report: Prolonged Grief Disorder—What You Need to Know.”
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