Changes in typical beliefs in response to complicated grief treatment
Open accessAbstract
BACKGROUND: Prolonged grief disorder (PGD) is a new diagnosis in the 11th edition of the International Classification of Diseases, estimated to affect 1 in 10 bereaved people and causing significant distress and impairment. Maladaptive thoughts play an important role in PGD. We have previously validated the typical beliefs questionnaire (TBQ), which contains five kinds of thinking commonly seen in PGD: protesting the death, negative thoughts about the world, needing the person, less grief is wrong, and grieving too much. The current paper examines the role of maladaptive cognition as measured by the TBQ in PGD and its change with treatment. METHODS: Among participants in a multisite clinical trial including 394 adults, we examined (a) the relationship between maladaptive thoughts at baseline and treatment outcomes, (b) the relationship between maladaptive thoughts and suicidality at baseline and posttreatment, and (c) the effect of treatment with and without complicated grief therapy (CGT) on maladaptive thinking. RESULTS: TBQ scores were associated with treatment outcomes and were strongly related to suicidal thinking before and after treatment. TBQ scores showed significantly greater reduction in participants who received CGT with citalopram versus citalopram alone (adjusted mean standard error [SE] difference, -2.45 [0.85]; p = .004) and those who received CGT with placebo versus placebo alone (adjusted mean [SE] difference, -3.44 [0.90]; p < .001). CONCLUSIONS: Maladaptive thoughts, as measured by the TBQ, have clinical and research significance for PGD and its treatment.
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In a multicenter clinical trial of 394 adults, typical belief questionnaire scores decreased significantly in subjects who received complicated grief therapy with citalopram compared with those who were only given citalopram.
“An analysis of the scores of the typical belief questionnaire revealed a significant decrease in these symptoms in subjects who received complicated grief therapy with citalopram compared with those who were only given citalopram (Skritskaya et al., 2020).”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Skritskaya et al., 2020
The efficacy of purely pharmacological treatment for PGD management is limited.
“The efficacy of purely pharmacological treatment for PGD management is limited, and better results have been reported if it is used in conjunction with psychotherapeutic treatment (Skritskaya et al., 2020).”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Skritskaya et al., 2020
Better results have been reported if pharmacological treatment is used in conjunction with psychotherapeutic treatment for PGD.
“The efficacy of purely pharmacological treatment for PGD management is limited, and better results have been reported if it is used in conjunction with psychotherapeutic treatment (Skritskaya et al., 2020).”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Skritskaya et al., 2020
The use of SSRIs (citalopram) enhances the efficacy of psychotherapy for co-occurring depressive symptoms.
“The use of SSRIs (citalopram) was found to enhance the efficacy of psychotherapy for co-occurring depressive symptoms.”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Skritskaya et al., 2020
The Results section compares citalopram and placebo alongside complicated grief treatment, but reports changes in maladaptive beliefs, not co-occurring depressive symptoms. A search for depression and depressive symptoms found no passage establishing that citalopram enhanced psychotherapy’s effect on those symptoms. (LLM, conf=0.74)
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- Authors
- Skritskaya, N. A., Mauro, C., Garcia de la Garza, A., Meichsner, F., Lebowitz, B., Reynolds, C. F., Simon, N. M., Zisook, S., & Shear, M. K.
- Affiliations
- Columbia University (US)
- Department of Biostatistics, Mailman School of Public HealthColumbia University New York New York
- Department of Clinical Psychology and Psychotherapy, Institute of PsychologyGoethe University Frankfurt Germany
- University of California San Diego (US)
- University of Pittsburgh (US)
- NYU Langone Health (US)
- Corresponding author
- Skritskaya, Natalia A.
- ORCID
- Venue
- Depression and Anxiety
- Publisher
- Wiley
- Published
- 2019-12-05
- Volume
- 37
- Issue
- 1
- Pages
- 81-89
- ISSN
- 1091-4269 (ISSN-L)
- 1520-6394
- PMC
- PMC6952544
- OpenAlex
- W2992265622
- Cited by
- 24
- References
- 44
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 8 · 2021: 2 · 2020: 3
- FWCI
- 3.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- American Foundation for Suicide Prevention (LSRG‐S‐172‐12)
- National Institute of Mental Health (R01MH060783, R01MH085288, R01MH085297, R01MH085308)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- prolonged grief disorder, complicated grief, maladaptive cognitions, citalopram, suicidality, bereavement, treatment outcomes, cognitive change
- MeSH terms
- Bereavement, Depression, Female, Grief, Humans, Male, Middle Aged, Psychotherapy, Surveys and Questionnaires, Citalopram, Treatment Outcome, International Classification of Diseases, Suicidal Ideation
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