title: Treating prolonged grief disorder: a randomized clinical trial.
abstract: OBJECTIVE
  Prolonged grief disorder (PGD) is a potentially disabling condition that affects approximately 10% of bereaved people. Grief-focused cognitive behavior therapy (CBT) has been shown to be effective in treating PGD. Although treatments for PGD have focused on exposure therapy, much debate remains about whether exposure therapy is optimal for PGD.
  
  
  OBJECTIVE
  To determine the relative efficacies of CBT with exposure therapy (CBT/exposure) or CBT alone for PGD.
  
  
  METHODS
  A randomized clinical trial of 80 patients with PGD attending the outpatient University of New South Wales Traumatic Stress Clinic from September 17, 2007, through June 7, 2010.
  
  
  METHODS
  All patients received 10 weekly 2-hour group therapy sessions that consisted of CBT techniques. Patients also received 4 individual sessions, in which they were randomized to receive exposure therapy for memories of the death or supportive counseling.
  
  
  METHODS
  Measures of PGD by clinical interview and self-reported measures of depression, cognitive appraisals, and functioning at the 6-month follow-up.
  
  
  RESULTS
  Intention-to-treat analyses at follow-up indicated a significant quadratic time×treatment condition interaction effect (B [SE], 0.49 [0.16]; t120.16=3.08 [95% CI, 0.18-0.81]; P=.003), indicating that CBT/exposure led to greater PGD reductions than CBT alone. At follow-up, CBT/exposure led to greater reductions in depression (B [SE], 0.35 [0.12]; t112.65=2.83 [95% CI, 0.11-0.60]; P=.005), negative appraisals (B [SE], 0.68 [0.25]; t109.98=2.66 [95% CI, 0.17-1.18]; P=.009), and functional impairment (B [SE], 0.24 [0.08]; t111.40=3.01 [95% CI, 0.08-0.40]; P=.003) than CBT alone. In terms of treatment completers, fewer patients in the CBT/exposure condition at follow-up (14.8%) met criteria for PGD than those in the CBT condition (37.9%) (odds ratio, 3.51; 95% CI, 0.96-12.89; χ2=3.81; P=.04).
  
  
  CONCLUSIONS
  Including exposure therapy that promotes emotional processing of memories of the death is an important component to achieve optimal reductions in PGD severity. Facilitating emotional responses to the death may promote greater changes in appraisals about the loss, which are associated with symptom reduction. Promotion of emotional processing techniques in therapies to treat patients with PGD is needed.
  
  
  BACKGROUND
  anzctr.org.au Identifier: ACTRN12609000229279.
authors.affiliation: School of Psychology, University of New South Wales, Sydney, Australia.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Bryant
authors.affiliation: School of Psychology, University of New South Wales, Sydney, Australia.
authors.forename: Lucy
authors.initials: L
authors.lastname: Kenny
authors.affiliation: School of Psychology, University of New South Wales, Sydney, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Joscelyne
authors.affiliation: School of Psychology, University of New South Wales, Sydney, Australia.
authors.forename: Natasha
authors.initials: N
authors.lastname: Rawson
authors.affiliation: School of Psychology, University of New South Wales, Sydney, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Maccallum
authors.affiliation: School of Psychology, University of New South Wales, Sydney, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cahill
authors.affiliation: School of Psychology, University of New South Wales, Sydney, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Hopwood
authors.affiliation: Department of Psychology, University of Haifa, Haifa, Israel.
authors.forename: Idan
authors.initials: I
authors.lastname: Aderka
authors.affiliation: School of Psychology, University of New South Wales, Sydney, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Nickerson
mesh_terms: D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000150:complications / Q000628:therapy*; D000368:Aged; D015928:Cognitive Behavioral Therapy; D005260:Female; D006117:Grief; D006801:Humans; D007171:Implosive Therapy; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000628:therapy*; D055815:Young Adult