A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder
Open accessAbstract
This trial assessed the feasibility, acceptability, tolerability, and efficacy of an Internet-based therapist-assisted cognitive-behavioral indicated prevention intervention for prolonged grief disorder (PGD) called Healthy Experiences After Loss (HEAL). Eighty-four bereaved individuals at risk for PGD were randomized to either an immediate treatment group (n = 41) or a waitlist control group (n = 43). Assessments were conducted at four time-points: prior to the wait-interval (for the waitlist group), pre-intervention, post-intervention, 6 weeks later, and 3 months later (for the immediate group only). Intent-to-treat analyses indicated that HEAL was associated with large reductions in prolonged grief (d = 1.10), depression (d = .71), anxiety (d = .51), and posttraumatic stress (d = .91). Also, significantly fewer participants in the immediate group met PGD criteria post-intervention than in the waitlist group. Pooled data from both groups also yielded significant reductions and large effect sizes in PGD symptom severity at each follow-up assessment. The intervention required minimal professional oversight and ratings of satisfaction with treatment and usability of the Internet interface were high. HEAL has the potential to be an effective, well-tolerated tool to reduce the burden of significant pre-clinical PGD. Further research is needed to refine HEAL and to assess its efficacy and mechanisms of action in a large-scale trial.
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A PG-13 threshold of 34 was similarly used to recruit participants for a preventive intervention trial.
“A threshold of 34 was similarly used to recruit participants for a preventive intervention trial.20”
From Mental health services for parents who lost a child to cancer: if we build them, Will they come? (2015) · cites this paper as [20]
The Method > Participants passage says the trial screened participants with the PG-13 but required a score of 23 or higher, plus functional impairment, for inclusion. It does not give 34 as the recruitment threshold; page numbers are not provided in our copy. (LLM, conf=0.90)
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Experimental — accuracy not yet measuredThe EMPOWER intervention seeks to act on peritraumatic stress and anticipatory grief through the reduction of experiential avoidance and teaching of coping skills, empirically supported techniques from cognitive-behavioral therapy and acceptance and commitment therapy, applicable during the ICU stay and its immediate aftermath.
“The EMPOWER intervention seeks to act on these symptoms through the reduction of “experiential avoidance” [16, 17] and teaching of coping skills, empirically supported techniques from cognitive-behavioral therapy [18–20], and acceptance and commitment therapy [21–23] that can be applied during the ICU stay and in the immediate aftermath of the ICU stay.”
From Enhancing & Mobilizing the POtential for Wellness & Emotional Resilience (EMPOWER) among Surrogate Decision-Makers of ICU Patients: study protocol for a randomized controlled trial (2019) · cites this paper as [18]
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Experimental — accuracy not yet measuredIt is possible to prevent complicated grief by intervening in the early stages for people who present significant preclinical symptoms after loss, reducing the possibility of developing considerable deterioration.
“In this sense, Litz et al. (2014), suggest that it is possible to prevent complicated grief by intervening in the early stages for people who present significant preclinical symptoms after the loss, reducing the possibility of developing a considerable deterioration in their loss during the following months, functioning on the daily basis and allowing to alleviate emotional suffering gradually.”
CBT proposes that the way we think affects the way we feel and behave.
“The CBT proposes that the way we think affects the way we feel and behave (Litz et al., 2014).”
From A Self-Applied Multi-Component Psychological Online Intervention Based on UX, for the Prevention of Complicated Grief Disorder in the Mexican Population During the COVID-19 Outbreak: Protocol of a Randomized Clinical Trial (2021) · cites this paper as Litz et al., 2014
The Method > HEAL Intervention section describes HEAL as cognitive-behavioral and lists its activities, but does not explain CBT as proposing that thoughts affect feelings and behavior. Searches for that formulation and for related terms about thoughts, emotions, and behavior found no passage addressing the proposed relationship; page numbers were not available in our copy. (LLM, conf=0.73)
Experimental — accuracy not yet measured
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On the Classification and Reporting of Prolonged Grief: Assessment and Research Guidelines
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“…incorporates evidence-based cognitive-behavioral approaches (Bryant et al., 2003, 2008, 2014; Boelen et al., 2007; Gartlehner et al., 2013; Litz et al., 2014; Birur et al., 2016), acceptance-based principles to build distress tolerance (Orsillo and Batten, 2005; Walser and Westrup, 2007;…”
Self-citationvan Velsen, L., Cabrita, M., den Akker, H. O., Brandl, L., Isaac, J., Suárez-Gómez, M., Gouveia, A., de Sousa, R. D., Rodrigues, A. M., Canhão, H. M., et al. (2020) · JMIR Research Protocols · doi:10.2196/19344 · Cited by 21 · see citing works
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Developing a practice-based research agenda for grief and bereavement care
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“In order to respond to the needs of the Mexican population, the objective of this study is to prevent complicated grief through a self-applied online intervention to influence the early stages of the grief process (Litz et al., 2014).”
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EMPOWER: A Multi-Site Pilot Trial to Reduce Distress in Surrogate Decision-Makers in the ICU
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Traumatic grief research and care in the aftermath of the COVID-19 pandemic
Djelantik, A. A. M., Bui, E., O'Connor, M., Rosner, R., Robinaugh, D., Simon, N. M., & Boelen, P. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1957272 · Cited by 16 · see citing works
A Systematic Review of Treatment Options for Grieving Older Adults
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Digital Interventions for PTSD Symptoms in the General Population: a Review
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Addressing Grief and Bereavement in Covid-19 Pandemic
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Differences in meanings made according to prolonged grief symptomatology
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Yasın Aile Üzerine Etkilerini Azaltmak İçin Uygulanan Yas Destek Programları
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Litz, B. T. (2024) · Journal of Traumatic Stress · doi:10.1002/jts.23063 · Cited by 11 · see citing works
Self-citationBereavement care for family caregivers of neuro-oncology patients
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Self-citationAn Open Trial of Skills for Psychological Recovery for Sudden Loss Survivors
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State of the Science: Psychotherapeutic Interventions for Prolonged Grief Disorder
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Self-citationFeasibility of Present-Centered Therapy for Prolonged Grief Disorder: Results of a Pilot Study
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ICD-11 and DSM -5-TR prolonged grief symptoms and quality of life: A criterion validity test
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Treating War-Related Moral Injury and Loss with Adaptive Disclosure: A Case Study
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Research into services and needs for people experiencing complicated grief: Final report
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Yas Sürecinde Uygulanan Psikolojik Müdahale Yaklaşımlarının Doküman Analizi İle İncelenmesi
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- Authors
- Litz, B. T., Schorr, Y., Delaney, E., Au, T., Papa, A., Fox, A. B., Morris, S., Nickerson, A., Block, S., & Prigerson, H. G.
- Affiliations
- Boston University (US)
- VA Boston Healthcare System (US)
- Bureau of Medicine and Surgery (US)
- University of Nevada, Reno (US)
- Dana-Farber Cancer Institute (US)
- UNSW Sydney (AU)
- Harvard University (US)
- Weill Cornell Medicine (US)
- Corresponding author
- Litz, Brett T.
- ORCID
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 61
- Pages
- 23-34
- ISSN
- 0005-7967 (ISSN-L)
- PMC
- PMC4172488
- OpenAlex
- W2093168957
- Cited by
- 139
- References
- 77
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 16 · 2023: 24 · 2022: 6 · 2021: 18 · 2020: 11 · 2019: 11 · 2018: 5 · 2017: 11 · 2016: 5 · 2015: 10
- FWCI
- 10.26
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34MH079884, MH079884)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- prolonged grief disorder, online intervention, bereavement, depression, anxiety, post-traumatic stress, treatment feasibility and acceptability
- MeSH terms
- Adult, Aged, Female, Grief, Humans, Male, Middle Aged, Stress Disorders, Post-Traumatic, Cognitive Behavioral Therapy, Treatment Outcome, Remote Consultation, Internet
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