title: A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder.
abstract: This trial assessed the feasibility, acceptability, tolerability, and efficacy of an Internet-based therapist-assisted cognitive-behavioral indicated prevention intervention for prolonged grief disorder (PGD) called Healthy Experiences After Loss (HEAL). Eighty-four bereaved individuals at risk for PGD were randomized to either an immediate treatment group (n = 41) or a waitlist control group (n = 43). Assessments were conducted at four time-points: prior to the wait-interval (for the waitlist group), pre-intervention, post-intervention, 6 weeks later, and 3 months later (for the immediate group only). Intent-to-treat analyses indicated that HEAL was associated with large reductions in prolonged grief (d = 1.10), depression (d = .71), anxiety (d = .51), and posttraumatic stress (d = .91). Also, significantly fewer participants in the immediate group met PGD criteria post-intervention than in the waitlist group. Pooled data from both groups also yielded significant reductions and large effect sizes in PGD symptom severity at each follow-up assessment. The intervention required minimal professional oversight and ratings of satisfaction with treatment and usability of the Internet interface were high. HEAL has the potential to be an effective, well-tolerated tool to reduce the burden of significant pre-clinical PGD. Further research is needed to refine HEAL and to assess its efficacy and mechanisms of action in a large-scale trial.
authors.affiliation: VA Boston Healthcare System, Massachusetts Veterans Epidemiological Research and Information Center, USA; Boston University School of Medicine, USA. Electronic address: litzb@bu.edu.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Litz
authors.affiliation: VA Boston Healthcare System, Massachusetts Veterans Epidemiological Research and Information Center, USA.
authors.forename: Yonit
authors.initials: Y
authors.lastname: Schorr
authors.affiliation: Naval Center for Combat & Operational Stress Control, Bureau of Medicine and Surgery, USA.
authors.forename: Eileen
authors.initials: E
authors.lastname: Delaney
authors.affiliation: Boston University, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: Au
authors.affiliation: University of Nevada at Reno, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Papa
authors.affiliation: VA Boston Healthcare System, USA.
authors.forename: Annie B
authors.initials: AB
authors.lastname: Fox
authors.affiliation: Dana Farber Cancer Institute, USA.
authors.forename: Sue
authors.initials: S
authors.lastname: Morris
authors.affiliation: University of New South Wales, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Nickerson
authors.affiliation: Dana Farber Cancer Institute, USA; Harvard University School of Medicine, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Block
authors.affiliation: Weill Cornell Medical College, USA.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006117:Grief; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D019114:Remote Consultation; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control* / Q000523:psychology; D016896:Treatment Outcome
keywords: Cognitive behavior therapy; Internet-based intervention; Prevention; Prolonged grief
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