Efficacy of an outpatient treatment for prolonged grief disorder: A randomized controlled clinical trial
Abstract
Background Abnormal forms of grief, currently referred to as complicated grief or prolonged grief disorder, have been discussed extensively in recent years. While the diagnostic criteria are still debated, there is no doubt that prolonged grief is disabling and may require treatment. To date, few interventions have demonstrated efficacy. Methods We investigated whether outpatients suffering from prolonged grief disorder (PGD) benefit from a newly developed integrative cognitive behavioural therapy for prolonged grief (PG-CBT). A total of 51 patients were randomized into two groups, stratified by the type of death and their relationship to the deceased; 24 patients composed the treatment group and 27 patients composed the wait list control group (WG). Treatment consisted of 20-25 sessions. Main outcome was change in grief severity; secondary outcomes were reductions in general psychological distress and in comorbidity. Results Patients on average had 2.5 comorbid diagnoses in addition to PGD. Between group effect sizes were large for the improvement of grief symptoms in treatment completers (Cohen׳s d=1.61) and in the intent-to-treat analysis (d=1.32). Comorbid depressive symptoms also improved in PG-CBT compared to WG. The completion rate was 79% in PG-CBT and 89% in WG. Limitations The major limitations of this study were a small sample size and that PG-CBT took longer than the waiting time. Conclusions PG-CBT was found to be effective with an acceptable dropout rate. Given the number of bereaved people who suffer from PGD, the results are of high clinical relevance.
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Cognitive-behavioral therapy is highly efficacious in reducing the severity of grief.
“cognitive-behavioral therapy is highly efficacious in reducing the severity of grief”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Rosner et al., 2014
A CBT treatment for prolonged mourning was found to be highly effective in reducing the severity of grief, with a controlled effect size d = 1.61.
“This treatment was found to be highly effective in terms of reducing the severity of grief.The controlled effect size for the improvement of grief symptoms in people who completed CBT treatment was d = 1.61 (Rosner, Pfoh, Kotoučová, & Hagl, 2014).”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Rosner et al., 2014
CBT applied to Prolonged Grief is highly effective in reducing the severity of grief in individuals who complete treatment.
“The review identified various techniques used for the management of PGD, with CBT applied to Prolonged Grief being found to be highly effective in terms of reducing the severity of grief in individuals who complete treatment (Rosner et al., 2014).”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Rosner et al., 2014
CBT for PGT is highly effective in reducing grief severity.
“-Highly effective in terms of reducing grief severity (Rosner et al., 2014).”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Rosner et al., 2014
The effect size for symptom improvement with CBT for PGT is d = 1.61.
“-Effect size for symptom improvement: d = 1.61 (Rosner et al., 2014).”
From Prolonged grief disorder treatment: An approach to COVID-19 grief (2023) · cites this paper as Rosner et al., 2014
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Differences in meanings made according to prolonged grief symptomatology
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Prolonged grief disorder in bereaved parents: Exploring impacts and treatment pathways
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State of the Science: Psychotherapeutic Interventions for Prolonged Grief Disorder
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“ir 428 30), qualitative studies (31-36), correlational study(37-39) or case study (40) and some studies didn’t evaluate the post-abortion grief (41-51).”
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On the concept, taxonomy, and transculturality of disordered grief
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Effectiveness of Psychotherapy-Based Interventions for Complicated Grief: A Systematic Review
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“Fifty one patients, who had participated in a RCT conducted by Rosner et al. (2014), were followed up, 1.5- year after PG-CBT for PGD. Findings of this follow-up study proved that the initial therapy gains could be maintained, 1.5- year after post-assessment.”
BackgroundMethodResultInfluentialFeasibility of Present-Centered Therapy for Prolonged Grief Disorder: Results of a Pilot Study
Vogel, A., Comtesse, H., Nocon, A., Kersting, A., Rief, W., Steil, R., & Rosner, R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.534664 · Cited by 7 · see citing works
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“…treatment) (Shear et al., 2005, 2014, 2016; Shear & Gribbin Bloom, 2017), cognitive-behavioral therapy for complicated grief (Boelen et al., 2007) or prolonged grief disorder (Bryant et al., 2014; Rosner et al., 2014), and recently metacognitive therapy for prolonged grief (Wenn et al., 2019).”
Argyriou, E., Grös, D. F., Hernandez‐Tejada, M. A., Muzzy, W. A., & Acierno, R. E. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.05.028 · Cited by 8 · see citing works
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Palliative Care in Pediatric Oncology
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Prolonged grief disorder treatment: An approach to COVID-19 grief
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“Highly effective in terms of reducing grief severity (Rosner et al., 2014).”
InfluentialTreatments for Prolonged Grief Disorder: A Systematic Review and Network Meta-Analysis
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Exploring Prolonged Grief Disorder and Its Relationship to Suicidal Ideation Among Veterans
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Mindfulness in Adaptation to Bereavement: A Systematic Review
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“CBT is the first-choice treatment for loss-related psychopathology (Boelen et al. 2007; Bryant et al. 2014; Lenferink et al. 2023; Rosner et al. 2014).”
Family Bereavement Care in Pediatric Oncology
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“Complicating factors are that PGD is more often than not co-morbid with other psychiatric disorders, with PGD associated with on average 2.5 other psychiatric disorders (Rosner et al., 2014).”
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Self-citationPsychological therapies for major depressive disorder and prolonged grief in bereaved adults
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“Results suggest that PG-CBT is highly effective in reducing grief severity and compares well to other treatments for PGD (Rosner 2014).”
InfluentialRosner, R., Pfoh, G., Kotoučová, M., & Comtesse, H. (2018) · Verhaltenstherapie (Basel) · doi:10.1159/000489509 · Cited by 3 · see citing works
“Wirksamkeit der KVT-PG Die Wirksamkeit der KVT-PG wurde sowohl ambulant [Rosner et al., 2014, 2015] als auch stationär [Rosner et al., 2011] überprüft.”
BackgroundInfluentialSelf-citationPsychological Effects of Natural Disaster: Traumatic Events and Losses at Different Disaster Stages
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Two Psychosocial Interventions for Complicated Grief: Review of Principles and Evidence Base
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Prolonged Grief Disorder: Treatment Approaches and the Spiritual Dimensions of Healing
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“Integrative Cognitive Behavioral Therapy for Prolonged Grief (PG-CBT): This newly developed approach has demonstrated efficacy in randomized controlled trials, showing large pre-to post-treatment effect sizes [48].”
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“Removing the duration and cultural requirements could be advantageous because it would simplify the diagnosis by focusing on the symptoms, and the impairments they cause, which are the key targets for therapeutic interventions (Bryant et al., 2014; Rosner et al., 2014; Szuhany et al., 2021).”
Haneveld, J., Rosner, R., Vogel, A., Mäkitalo, S., Treml, J., Steil, R., Rief, W., & Comtesse, H. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2022.2079873 · Cited by 2 · see citing works
“Compared with a waiting list, between group effect sizes were large for the improvement of grief symptoms in the intent-to-treat analysis (d = 1.32; Rosner et al., 2014).”
BackgroundInfluentialSelf-citationJoplin, S., & Vrklevski, L. P. (2017) · Bereavement Care · doi:10.1080/02682621.2017.1305048 · Cited by 2 · see citing works
- Authors
- Rosner, R., Pfoh, G., Kotoučová, M., & Hagl, M.
- Affiliations
- Catholic University of Eichstätt-Ingolstadt (DE)
- Ludwig-Maximilians-Universität München (DE)
- Corresponding author
- Rosner, Rita
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2014-10
- Volume
- 167
- Pages
- 56-63
- ISSN
- 0165-0327 (ISSN-L)
- OpenAlex
- W2115507862
- Cited by
- 133
- References
- 0
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 16 · 2023: 14 · 2022: 6 · 2021: 16 · 2020: 12 · 2019: 7 · 2018: 9 · 2017: 18 · 2016: 6 · 2015: 8 · 2014: 1
- FWCI
- 13.02
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Affective Disorders (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 › Posttraumatic Stress Disorder Research
- Keywords
- prolonged grief disorder, complicated grief, outpatient psychotherapy, grief severity, depressive symptoms, comorbidities, bereavement, treatment discontinuation, waitlist control
- MeSH terms
- Adult, Ambulatory Care, Depression, Female, Grief, Humans, Male, Middle Aged, Outpatients, Risk Factors, Severity of Illness Index, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome, Young Adult
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