Which therapy works best to treat prolonged grief disorder?

Cognitive behaviour therapy appeared to have more long-lasting effects when treating prolonged grief disorder, while mindfulness therapy also showed some benefits.

Researchers from UNSW Sydney have compared the effectiveness of two different therapies that deal with prolonged grief disorder where people experience persistent yearning for the bereaved, thought to affect between 4 and 10 per cent of bereaved people.

Grief is a complex blend of emotions, thoughts and behaviours following the loss of a loved one. Healthy grieving involves a gradual adjustment to the new reality of life where the loss is integrated into one’s sense of self and identity.

But sometimes the intensity of the grieving remains just as strong, without diminishing over time. Known as prolonged grief disorder (PGD), the condition leaves the griever in a type of limbo where their ability to function normally in everyday life is impaired.

Two leading therapeutic approaches to treating it have had some success – cognitive behaviour therapy (CBT) and mindfulness therapy. But up until now, a comparison had never been made that measured their lasting efficacy.  

Researchers from the School of Psychology at UNSW Sydney conducted a randomised clinical trial that tested each therapy among 100 participants (50 doing CBT, 50 in the mindfulness group) between the ages of 18 and 70 who had been diagnosed with PGD.

In research published recently in JAMA Psychiatry, the researchers described how participants received weekly sessions with a therapist for 11 weeks.

The grief-focused cognitive behaviour therapy consisted of deliberately focusing on the bereaved person such as recalling memories of the deceased and reframing the way the person thought about them, as well as planning future social and positive activities. The mindfulness-based therapy focused more on what was being felt by the grieving individuals, designed to enable the person to better tolerate grief-related distress.

The results

Lead researcher Scientia Professor Richard Bryant says that while both therapies had beneficial outcomes at the completion of the therapy, it was the cognitive behavioural therapy group that showed lasting benefits when participants were contacted again six months after therapy ended.

“While both treatments offered relief during the course of the therapy, relapse tended to occur following mindfulness, whereas treatment gains continued to occur in the grief-focused cognitive behaviour therapy group,” Prof. Bryant says.

Participants in the CBT group also demonstrated greater reductions in depression and grief-related cognition compared to the mindfulness group.

However, Prof. Bryant says that while CBT showed more lasting benefits at the six-month mark, this was not to say that the mindfulness approach was not beneficial as a tool to break the pattern of prolonged grief.

“It’s true that all trials to date have highlighted that CBT is the treatment of choice when dealing with prolonged grief disorder,” he says.

“But our research does show that symptom relief can also be achieved by an alternate approach such as mindfulness.

“This mean that if clinicians or patients are reluctant to engage in the recommended treatment of cognitive behaviour therapy, one can use mindfulness as an alternative that has shown to have a positive effect.”

Looking ahead

Despite the success of these treatments, a proportion of patients were not responsive and still experienced problematic grief after treatment.

“The challenge ahead is to determine how we can deliver better treatments,” says Prof. Bryant.

“The UNSW Traumatic Stress Clinic is currently conducting further trials to determine how CBT can help more people reduce their persistent grief.”