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. METHOD: 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. CONCLUSION: 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.
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Pre-to-post treatment changes in loss-related behavioral avoidance was an independent mediator of pre-post treatment changes in complicated grief in CBT versus interpersonal psychotherapy, while controlling for guilt, self-blame, and negative cognitions.
“Similarly, pre-to-post treatment changes in loss-related behavioral avoidance was an independent mediator (while controlling for mediators guilt, selfblame, and negative cognitions) of the pre-post treatment changes in CG in CBT (vs. interpersonal psychotherapy; Glickman et al., 2017).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Glickman et al., 2017
Secondary pre-post change analyses of RCTs supported the importance of behavioral loss avoidance in the treatment of complicated grief.
“Secondary pre-post change analyses of RCTs also supported the importance of behavioral loss avoidance in the treatment of CG (e.g., Glickman et al., 2017).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Glickman et al., 2017
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- Authors
- Glickman, K., Shear, M. K., & Wall, M. M.
- Affiliations
- York College, City University of New York (US)
- Columbia University (US)
- Corresponding author
- Glickman, Kim
- Shear, M. Katherine
- Wall, Melanie M.
- Venue
- Journal of Clinical Psychology
- Publisher
- Wiley
- Published
- 2016-10-18
- Volume
- 73
- Issue
- 7
- Pages
- 817-828
- ISSN
- 0021-9762 (ISSN-L)
- 1097-4679
- OpenAlex
- W2544150030
- Cited by
- 34
- References
- 38
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 1 · 2022: 5 · 2021: 4 · 2020: 5 · 2019: 2 · 2018: 4 · 2017: 2
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Anthropology › Death, Funerary Practices, and Mourning
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- complicated grief, mechanisms of change, guilt and self-blame, avoidance, interpersonal psychotherapy, antidepressant use, adaptation to loss, bereavement
- MeSH terms
- Psychological Trauma, Avoidance Learning, Female, Grief, Humans, Male, Middle Aged, Cognitive Behavioral Therapy
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