The DOI matches its Crossref record; 15 of the 15 references it cites were found in a registry or an index.
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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In the citing paper
“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
In the citing paper
“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
In the citing paper
“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
In the citing paper
“-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
In the citing paper
“-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
Citations
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“PG-CBT had been shown to be effective in the treatment of PGD in relation to a wait list control group (Rosner et al., 2014).”
MethodSelf-citationTherapeutic potential of ayahuasca in grief: a prospective, observational study
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“…as well as several studies using a closely related treatment (Boelen et al. 2007; Wagner and Maercker 2007; Wagner et al. 2006; Asukai et al. 2011; Rosner et al. 2011; Acierno et al. 2012; Kersting et al. 2013; Barbosa et al. 2014; Bryant et al. 2014; Rosner et al. 2014; Supiano and Luptak 2014).”
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“Rosner et al. (2014) showed how integrative cognitive behavioral therapy for prolonged grief could be useful in these patients with clinical relevance; however, in this study, no long term follow-up was performed.”
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van Denderen, M., de Keijser, J., Stewart, R., & Boelen, P. (2018) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.2183 · Cited by 36
“This is comparable with the 40% to 60% of participants found in studies in which CBT based interventions or CG treatment were examined in a mixed population of bereaved individuals (Papa, Sewell, Garrison‐Diehn, & Rummel, 2013; Rosner et al., 2014).”
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“The major goal of this trial on PROlonged GRIef Disorder – PROGRID – is to substantiate the positive results of our pilot-tested intervention [12] while remedying the methodological shortcomings of the pilot trial: (1) PGD symptoms are assessed in a structured interview by independent blind raters, (2) additional atte…”
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Mediators of outcome in complicated grief treatment
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Prolonged grief: setting the research agenda
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“However, current randomised clinical studies on PGD patients do not report clinically significant deterioration in patients (Papa et al., 2013; Rosner et al., 2014).”
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“supportive counselling) support the superior effect of CBT on reducing prolonged grief and related mental health problems among individuals bereaved due to natural and unnatural deaths (Boelen, Lenferink, et al., 2021; Boelen et al., 2007; Rosner et al., 2014; Shear et al., 2005; Shear et al., 2014).”
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Peri, T., Hasson‐Ohayon, I., Garber, S., Tuval‐Mashiach, R., & Boelen, P. A. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.30687 · Cited by 36
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“So far, only a few interventions for bereaved persons in general have been evaluated, mostly including cognitive behavioral therapy (e.g., Boelen et al., 2011; Bryant et al., 2017; Papa et al., 2013; Rosner et al., 2014).”
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Simon, N. M., Shear, M. K., Reynolds, C. F., Cozza, S. J., Mauro, C., Zisook, S., Skritskaya, N. A., Robinaugh, D. J., Malgaroli, M., Spandorfer, J., et al. (2020) · Depression and Anxiety · doi:10.1002/da.22985 · Cited by 40
Prevalence of prolonged grief disorder in a sample of female refugees
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“This is supported by evidence showing that all other treatments to date that successfully reduce PGD symptoms include elements that focus on changing avoidance and maladaptive grief-related cognitions (e.g., Boelen et al., 2007; Bryant et al., 2014; Rosner et al., 2014; Wagner et al., 2006).”
Prolonged grief disorder in Chinese Shidu parents who have lost their only child
Zhang, H., Shang, Z., Wu, L., Sun, Z., Zhang, F., Sun, L., Zhou, Y., Wang, Y., & Liu, W. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1726071 · Cited by 34
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“This specific effect has not been demonstrated in previous psychotherapy research for CG (e.g., Boelen et al., 2007; Rosner et al., 2014), so it is important to consider additional reasons for the delayed effect on CG. Differences in study design between the present and previous investigations…”
ResultCo-occurrence of approach and avoidance in prolonged grief: a latent class analysis
Eisma, M. C., & Lenferink, L. I. M. (2023) · European Journal of Psychotraumatology · doi:10.1080/20008066.2023.2190544 · Cited by 24
“(e.g. Boelen et al., 2007, 2021; Bryant et al., 2014; Rosner et al., 2014; Shear et al., 2005, 2016), average effect sizes are modest (for a meta-analysis: Johannsen et al.”
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“Although there is some evidence in support of the efficacy of cognitive behavioral interventions in treating complicated bereavement in nonrefugee populations (Rosner et al., 2014; Bryant et al., 2017), no culturally adapted interventions of this type have been systematically trialled amongst refugees (Murray et al.”
BackgroundProlonged Grief Symptoms Predict Social and Emotional Loneliness and Depression Symptoms
Eisma, M. C., & Büyükcan-Tetik, A. (2024) · Behavior Therapy · doi:10.1016/j.beth.2024.04.014 · Cited by 26
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“A number of interventions targeting Persistent Complex Bereavement Disorder exist.(28-41) While some intervention components (e.”
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Rosner, R., Rau, J., Kersting, A., Rief, W., Steil, R., Rummel, A.-M., Vogel, A., & Comtesse, H. (2024) · JAMA psychiatry · doi:10.1001/jamapsychiatry.2024.3409 · Cited by 17
Self-citationThe self-help app My Grief: Bereaved parents' experiences of helpfulness, satisfaction and usability
Eklund, R., Eisma, M. C., Boelen, P. A., Arnberg, F. K., & Sveen, J. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100712 · Cited by 16
“…effective in reducing symptoms of prolonged grief, depression, and posttraumatic stress both face-to-face (Boelen et al., 2007; Bryant et al., 2014; Rosner et al., 2014; Shear et al., 2005) as well as in internet-based formats, with the latter yielding moderate to large effects (Eisma et al.,…”
BackgroundSomatic symptom distress and ICD-11 prolonged grief in a large intercultural sample
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“(CBT) for prolonged grief, 54% of outpatients were diagnosedwith a comorbid somatoform disorder (Rosner et al., 2014).”
BackgroundClinical Handbook of Bereavement and Grief Reactions
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The efficacy of psychotherapeutic interventions for prolonged grief disorder: A systematic review.
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Challenges in Grief-Focused Cognitive Behavior Therapy for Prolonged Grief Disorder
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“While different treatment interventions, including CBT (CBT: Bryant et al., 2014; Boelen et al., 2007, Rosner et al., 2014) and complicated grief treatment (Shear et al., 2005) have proved their efficacy in treating PGD, these treatments are not yet widely available.”
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Cross-Lagged Analyses of Prolonged Grief and Depression Symptoms With Insomnia Symptoms.
de Lang, T. A., Buyukcan-Tetik, A., de Jong, P., Lancel, M., & Eisma, M. (2022) · The Behavior Therapist · doi:10.1016/j.beth.2022.12.004 · Cited by 13
Mintz, E. H., Toner, E. R., Skolnik, A. M., Pan, A., Frumkin, M., Baker, A. W., Simon, N. M., & Robinaugh, D. (2024) · Death Studies · doi:10.1080/07481187.2024.2433109 · Cited by 12
“An estimated 3–10% of bereaved individuals experience this syndrome (Lundorff et al., 2017; Rosner et al., 2014; Treml et al., 2022), placing them at heightened risk for a wide range of adverse physical and mental health outcomes (Clayton, 1973; Jacobs & Ostfeld, 1977; Keyes et al., 2014; Zinzow et…”
Trucco, A., Backhouse, T., Mioshi, E., & Kishita, N. (2023) · Death Studies · doi:10.1080/07481187.2023.2191351 · Cited by 12
“Moreover, studies focusing on interventions targeting PGD, such as group psychotherapy (Rosner et al., 2011) and cognitive behavior therapy, have proved to be effective in the general bereaved population (Rosner et al., 2014, 2015), which may also work for informal carers of people living with MND.”
BackgroundMy Grief App for Prolonged Grief in Bereaved Parents: A Pilot Study
Eklund, R., Eisma, M. C., Boelen, P. A., Arnberg, F. K., & Sveen, J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.872314 · Cited by 13
Management of Grief, Depression, and Suicidal Thoughts in Serious Illness.
McKee, K. Y., & Kelly, A. (2020) · The Medical clinics of North America · doi:10.1016/j.mcna.2020.01.003 · Cited by 12
Tay, A., Mohsin, M., Rees, S., Tam, N., Kareth, M., & Silove, D. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01666-1 · Cited by 12
Differences in meanings made according to prolonged grief symptomatology
Breen, L., Karangoda, M. D., Kane, R., Howting, D. A., & Aoun, S. (2018) · Death Studies · doi:10.1080/07481187.2017.1328467 · Cited by 12
Lechner-Meichsner, F., Boelen, P., & Hagenaars, M. A. (2024) · European Journal of Trauma & Dissociation · doi:10.1016/j.ejtd.2024.100435 · Cited by 11
Lacasta, M., & Cruzado, J. A. (2023) · Palliative & Supportive Care · doi:10.1017/s147895152300010x · Cited by 11
Effectiveness of a Cancer Bereavement Therapeutic Group
Jerome, H., Smith, K. V., Shaw, E. J., Szydlowski, S., Barker, C., Pistrang, N., & Thompson, E. H. (2018) · Journal of Loss and Trauma · doi:10.1080/15325024.2018.1518772 · Cited by 11
Bartl, H., Hagl, M., Kotoučová, M., Pfoh, G., & Rosner, R. (2017) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12140 · Cited by 10
Self-citationTur, C., Campos, D., Herrero, R., Mor, S., López-Montoyo, A., Castilla, D., & Quero, S. (2021) · BMJ Open · doi:10.1136/bmjopen-2020-046477 · Cited by 9
Prolonged grief disorder in bereaved parents: Exploring impacts and treatment pathways
Yaffe, Y., & Levkovich, I. (2025) · World Journal of Psychiatry · doi:10.5498/wjp.v15.i5.104711 · Cited by 9
State of the Science: Psychotherapeutic Interventions for Prolonged Grief Disorder
LaPlante, C. D., Hardt, M. M., Maciejewski, P. K., & Prigerson, H. G. (2024) · Behavior Therapy · doi:10.1016/j.beth.2024.07.002 · Cited by 14
Treml, J., Nagl, M., Brähler, E., Boelen, P. A., & Kersting, A. (2021) · PLoS ONE · doi:10.1371/journal.pone.0254959 · Cited by 10
Bagheri, L., Nazari, A., Chaman, R., Ghiasi, A., & Motaghi, Z. (2020) · Iranian Journal of Public Health · doi:10.18502/ijph.v49i3.3123 · Cited by 9
“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).”
BackgroundGoveas, J. S., Hwang, G., Blair, N. P., Stein, E. A., & Reynolds, C. F. (2026) · Neuropsychopharmacology · doi:10.1038/s41386-026-02329-x · Cited by 8
Rueger, M. S., Steil, R., Lubik, S., Roll, S. C., & Lechner-Meichsner, F. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.07.014 · Cited by 8
On the concept, taxonomy, and transculturality of disordered grief
Gouveia, A. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1165421 · Cited by 8
Effectiveness of Psychotherapy-Based Interventions for Complicated Grief: A Systematic Review
Enez, Ö. (2017) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.295017 · Cited by 8
“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
Self-citationXu, X. Y., Skritskaya, N. A., Zhou, N., Wen, J., Shi, G., & Shear, M. K. (2024) · Death Studies · doi:10.1080/07481187.2024.2355228 · Cited by 7
“…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
Elinger, G., Hasson-Ohayon, I., Bar-Shachar, Y., & Peri, T. (2023) · Journal of Clinical Psychology · doi:10.1002/jclp.23583 · Cited by 6
Palliative Care in Pediatric Oncology
Wolfe, J., Jones, B. L., Kreicbergs, U., & Jankovic, M. (2017) · Pediatric oncology · doi:10.1007/978-3-319-61391-8 · Cited by 20
Prolonged grief disorder treatment: An approach to COVID-19 grief
Martínez-Medina, C. B., & Rodríguez-Orozco, A. R. (2023) · Salud Mental · doi:10.17711/sm.0185-3325.2023.021 · Cited by 5
“Highly effective in terms of reducing grief severity (Rosner et al., 2014).”
InfluentialTreatments for Prolonged Grief Disorder: A Systematic Review and Network Meta-Analysis.
Pleshka, A., Crawford, S., Wellsby, M., Bahji, A., O'Connor, C., Trieu, J. P., Beck, A., Faqiri, M., & Devoe, D. (2025) · Omega · doi:10.1177/00302228251364716 · Cited by 5
Eklund, R., Eisma, M. C., Boelen, P. A., Arnberg, F. K., & Sveen, J. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-052763 · Cited by 20
Exploring Prolonged Grief Disorder and Its Relationship to Suicidal Ideation Among Veterans
Rings, J. A., Gutierrez, P. M., & Forster, J. E. (2014) · Military Behavioral Health · doi:10.1080/21635781.2014.963758 · Cited by 5
Mindfulness in Adaptation to Bereavement: A Systematic Review
Sun, X., Schroevers, M. J., Lessing, M., Karsten, J., & Eisma, M. (2025) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.70198 · Cited by 4
“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
Lövgren, M., & Sveen, J. (2017) · Pediatric oncology · doi:10.1007/978-3-319-61391-8_12 · Cited by 3
Kim, Y., Ghimire, A., Lasater, M., Kohrt, B., Surkan, P., & Luitel, N. (2021) · Global Mental Health · doi:10.1017/gmh.2021.29 · Cited by 3
“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).”
BackgroundMethodInfluentialHarrison, O., Wiedenmann, C., Rosner, R., & Steil, R. (2021) · Psychiatric Quarterly · doi:10.1007/s11126-021-09914-x · Cited by 6
Self-citationPsychological therapies for major depressive disorder and prolonged grief in bereaved adults
Roulston, A., Clarke, M. J., Donnelly, M., Candy, B., McGaughey, J., Keegan, O., & Duffy, M. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013237 · Cited by 4
“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
“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
Kozu, S., & Gibson, A. (2020) · Springer eBooks · doi:10.1007/978-3-030-51525-6_6 · Cited by 3
Two Psychosocial Interventions for Complicated Grief: Review of Principles and Evidence Base
O’Day, E. B., & Goetter, E. M. (2017) · Springer eBooks · doi:10.1007/978-3-319-65241-2_12 · Cited by 3
Lee, C. E., Prigerson, H. G., Falzarano, F. B., Rogers, M., Osso, F., Korian, S., LaPlante, C. D., Pavao, M., Pyon, J., She, W. J., et al. (2025) · BJPsych Open · doi:10.1192/bjo.2025.10882 · Cited by 1
Prolonged Grief Disorder: Treatment Approaches and the Spiritual Dimensions of Healing
Ungar-Sargon, J. (2025) · Addiction Research · doi:10.33425/2639-8451.1052 · Cited by 2
“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].”
Redican, E., Shevlin, M., Ben-Ezra, M., Karatzias, T., & Hyland, P. (2025) · Death Studies · doi:10.1080/07481187.2025.2468822 · Cited by 2
“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
“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 1
Metadata
- 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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