CBT vs Present Centered Therapy in Prolonged Grief Equally Effective

Cognitive behavioral therapy for prolonged grief (PG-CBT) vs present-centered therapy (PCT) in prolonged grief disorder (PGD) may show greater improvement immediately following treatment, although only a trend-level effect remains after 1 year, according to study findings published in JAMA Psychiatry.

The ICD-11 includes prolonged grief disorder as a new diagnosis. CBT has proven effective in treatment of PGD, although with a paucity of comparisons with active control treatments. Researchers, therefore, sought to compare integrative PG-CBT vs PCT for superiority in treatment of PGD.

The researchers conducted a multicenter, randomized, rater-blinded clinical trial at 4 university outpatient clinics in Germany. Eligibility included those 18 to 75 years of age with PGD assessed on the Prolonged Grief Disorder 13 (PG-13) interview. A blinded evaluation of the PG-13 severity score was the primary outcome, assessed at baseline, after treatment, and at 1 year in follow-up. Self-reported comorbidities of somatic, depressive, and overall psychopathological symptoms were secondary outcomes.

Treatment with PG-CBT centered on solution-focused and experiential methods in combination with cognitive restructuring of grief-related cognitions and exposure to the worst moment of the loss. PCT focused on coping with daily problems related to grief through a supportive relationship, adapted in session length and number to PG-CBT.

In total, 212 participants were selected from 544 individuals experiencing grief and seeking treatment. Participants (mean [SD] age, 51.8 [13.3] years; 82% women) were randomly assigned 1:1 to PG-CBT (n=106) and PCT (n=106). Between-group baseline characteristics were similar. Overall, mean time since loss was 26.5 months, and 57% of participants experienced comorbid depressive disorder.

High reductions in PGD severity at follow-up were noted with both treatments in the intention-to-treat analysis (PG-CBT Cohen d=1.64; 95% CI, 1.31-1.97; PCT Cohen d=1.38; 95% CI, 1.09-1.66). Participants receiving PG-CBT vs those receiving PCT experienced significantly greater reductions in PGD severity after treatment (Cohen d=0.31; 95% CI, 0.03-0.57). Only a trend level of this effect was found at follow-up (Cohen d=0.28; 95% CI, -0.02 to 0.57).

At follow-up, significantly fewer depressive symptoms and general psychopathological symptoms were noted among participants in the PG-CBT group, though there were no differences in somatic symptoms. The two groups also did not differ significantly in PGD remission rates after treatment and at follow-up.

Over the course of the study, 23 participants discontinued PG-CBT treatment and 17 discontinued PCT.

Study limitations include a preponderance of White participants limiting generalizability (although race/ethnicity data not collected) and the COVID-19 pandemic affected treatments and assessments.

The study authors concluded, “Both treatments were shown to be effective and acceptable, showing the potential for dissemination and increasing patient choice.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor