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Lenferink LIM, Eisma MC, Buiter MY, de Keijser J, Boelen PA. Online cognitive behavioral therapy for prolonged grief after traumatic loss: a randomized waitlist-controlled trial. Cogn Behav Ther 2023; 52:508-522. [PMID: 37341432 DOI: 10.1080/16506073.2023.2225744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/07/2023] [Indexed: 06/22/2023]
Abstract
Prolonged grief disorder, a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Prolonged grief symptoms can be effectively treated with face-to-face or internet-delivered cognitive behavioral therapy. Traumatic losses may elicit higher prevalence of severe grief reactions. While face-to-face cognitive behavioral therapy appears efficacious in treating prolonged grief symptoms in traumatically bereaved individuals, it is not yet clear if internet-based cognitive behavioral therapy is efficacious for this population. Therefore, we investigated the efficacy of a 12-week internet-delivered cognitive behavioral therapy for people bereaved through traffic accidents in a randomized waitlist-controlled trial (registration number: NL7497, Dutch Trial Register). Forty adults bereaved though a traffic accident were randomized to internet-based cognitive behavioral therapy (n = 19) or a waitlist control condition (n = 21). Prolonged grief, post-traumatic stress, and depression symptoms were assessed at baseline, post-treatment, and 8-week follow-up. Dropout in the treatment condition was relatively high (42%) compared to the control condition (19%). Nevertheless, multilevel analyses showed that internet-based cognitive behavioral therapy strongly reduced prolonged grief, post-traumatic stress, and depression symptoms relative to the control condition at post-treatment and follow-up. We conclude that internet-based cognitive behavioral therapy appears a promising treatment for traumatically bereaved adults.
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Affiliation(s)
- L I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, Utrecht 3508, The Netherlands
- Department of Psychology, Health, & Technology, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Drienerlolaan 5, Enschede 7522, The Netherlands
| | - M C Eisma
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
| | - M Y Buiter
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
| | - J de Keijser
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, Groningen 9712, The Netherlands
| | - P A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, Utrecht 3508, The Netherlands
- ARQ National Psychotrauma Centre, Nienoord 5, Diemen 1112, The Netherlands
- Foundation Centrum '45, Nienoord 5, Diemen 1112, The Netherlands
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Schmidt V, Kaiser J, Treml J, Linde K, Nagl M, Kersting A. Linguistic predictors of symptom change in an internet-based cognitive behavioural intervention for prolonged grief symptoms. Clin Psychol Psychother 2023; 30:898-906. [PMID: 36882969 DOI: 10.1002/cpp.2849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023]
Abstract
This study investigates linguistic predictors of reduction in prolonged grief symptoms following a writing intervention in an internet-based cognitive behavioural therapy for people bereaved by cancer. Data stem from a randomized control clinical trial with 70 people. The Linguistic Inquiry and Word Count program was used to analyse patient language. Absolute change scores and reliable change index were used to calculate reduction in grief symptoms and clinical significant change. Best subset regression and Mann-Whitney U tests were conducted. A higher reduction of prolonged grief symptoms was correlated with more social words in the first module (β = -.22, p = .042), less risk (β = .33, p = .002) and body words (β = .22, p = .048) in the second module and more time words in the third module (β = -.26, p = .018). Patients with clinically significant change showed a higher median in function words in the first module (p = .019), a lower median in risk words in the second module (p = .019) and a higher median in assent words in the last module (p = .014) compared to patients without clinically significant change. Findings suggest that it may be beneficial for therapists to encourage a more detailed description of patients' relationship with their deceased relative during the first module, a change in perspective during the second module and a summary of past, present and future aspects at the end of therapy. Future studies should include mediation analyses to allow causal attribution of the studied effects.
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Affiliation(s)
- Viktoria Schmidt
- Department of psychosomatic medicine and psychotherapy, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Julia Kaiser
- Department of psychosomatic medicine and psychotherapy, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Julia Treml
- Department of psychosomatic medicine and psychotherapy, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Katja Linde
- Department of psychosomatic medicine and psychotherapy, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Michaela Nagl
- Department of psychosomatic medicine and psychotherapy, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
| | - Anette Kersting
- Department of psychosomatic medicine and psychotherapy, Medical Faculty, University of Leipzig, Semmelweisstraße 10, 04103, Leipzig, Germany
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Factors Associated With Treatment Response in an Internet-Based Intervention for Prolonged Grief Disorder After Cancer Bereavement. Behav Ther 2023; 54:119-131. [PMID: 36608969 DOI: 10.1016/j.beth.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 06/01/2022] [Accepted: 07/24/2022] [Indexed: 01/11/2023]
Abstract
Internet-based psychological interventions have proven effective in the treatment of prolonged grief disorder (PGD). Yet, some patients do not benefit from treatment in a clinically significant way. We aimed to examine predictors of symptom reduction in an Internet-based intervention for PGD after cancer bereavement, in order to identify possible treatment mechanisms and discern directions for future intervention design. A secondary analysis of data from a randomized wait-list controlled trial on an Internet-based intervention for PGD after cancer bereavement was conducted. Multiple regression models were used (1) to test for the influence of pretreatment PGD, working alliance, avoidance and gender on PGD symptom reduction; and (2) to explore further predictors of treatment success with a best subset selection protocol. The regression models explained 18% (Model 1) and 34% (Model 2) of variance in symptom reduction. Participants with more favorable symptom change had more severe pretreatment PGD scores and better working alliance. Those with lower social support and less posttraumatic growth experienced more PGD symptom change. In conclusion, therapeutic alliance is an important factor that should be monitored and fostered. Findings regarding social support and posttraumatic growth need further replication and clarification.
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