title: Mediators of Outcome in Complicated Grief Treatment.
abstract: OBJECTIVE
  In this study, we examined the mechanisms of action of complicated grief treatment (CGT), an efficacious psychotherapy for complicated grief.
  
  
  METHODS
  We explored 3 putative mediators (guilt/self-blame related to the deceased, negative thoughts about the future, and avoidance) among treatment completers assigned to either CGT (n = 35) or interpersonal psychotherapy (n = 34) in a previously reported randomized controlled trial. Antidepressant use was examined as a moderator of mediation effects.
  
  
  RESULTS
  A reduction in guilt/self-blame, negative thoughts about the future, and avoidance behavior each mediated the relationship between treatment group and complicated grief outcomes. Reduction in avoidance emerged as an independent mediator after controlling for all mediators.
  
  
  CONCLUSIONS
  Reducing avoidance of situations and emotions connected to the loss seems to be a key mechanism of change in CGT. Revising counterfactual thinking around troubling aspects of the death may also play a role in facilitating effective adaptation to loss.
authors.affiliation: York College of the City University of New York.
authors.forename: Kim
authors.initials: K
authors.lastname: Glickman
authors.affiliation: Columbia University.
authors.forename: M Katherine
authors.initials: MK
authors.lastname: Shear
authors.affiliation: Columbia University.
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Wall
mesh_terms: D001362:Avoidance Learning; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067073:Psychological Trauma / Q000523:psychology / Q000628:therapy*
keywords: avoidance behavior; complicated grief; complicated grief treatment; grief-related guilt; mediation of treatment outcome