title: Internet-Based Exposure and Behavioral Activation for Complicated Grief and Rumination: A Randomized Controlled Trial.
abstract: This study examined the effectiveness and feasibility of therapist-guided Internet-delivered exposure (EX) and behavioral activation (BA) for complicated grief and rumination. Forty-seven bereaved individuals with elevated levels of complicated grief and grief rumination were randomly assigned to three conditions: EX (N=18), BA (N=17), or a waiting-list (N=12). Treatment groups received 6 homework assignments over 6 to 8weeks. Intention-to-treat analyses showed that EX reduced complicated grief, posttraumatic stress, depression, grief rumination, and brooding levels relative to the control group at posttreatment (d=0.7-1.2). BA lowered complicated grief, posttraumatic stress, and grief rumination levels at posttreatment (d=0.8-0.9). At 3-month follow-up, effects of EX were maintained on complicated grief and grief rumination (d=0.6-1.2), and for BA on complicated grief, posttraumatic stress, and grief rumination (d=0.8-0.9). EX reduced depression more strongly than BA (d=0.6). Completers analyses corroborated results for EX, and partially those for BA, but no group differences were detected. BA suffered from high dropout (59%), relative to EX (33%) and the waiting-list (17%). Feasibility appeared higher for EX than BA. Results supported potential applicability of online exposure but not behavioral activation to decrease complicated grief and rumination.
authors.affiliation: Utrecht University. Electronic address: m.c.eisma@uu.nl.
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Eisma
authors.affiliation: Utrecht University.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Boelen
authors.affiliation: Utrecht University.
authors.forename: Jan
authors.initials: J
authors.lastname: van den Bout
authors.affiliation: Utrecht University; University of Groningen.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stroebe
authors.affiliation: Utrecht University.
authors.forename: Henk A W
authors.initials: HA
authors.lastname: Schut
authors.affiliation: University of Amsterdam.
authors.forename: Jaap
authors.initials: J
authors.lastname: Lancee
authors.affiliation: Utrecht University; University of Groningen.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Stroebe
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000592:standards; D005260:Female; D006117:Grief; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D000074222:Rumination, Cognitive; D013813:Therapy, Computer-Assisted / Q000592:standards*; D016896:Treatment Outcome
keywords: behavioral activation; exposure; grief therapy; prolonged grief; rumination