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Exposure, CBT improved outcomes vs. CBT alone in prolonged grief

Patients with prolonged grief disorder after the death of a loved one treated with exposure and cognitive-behavioral therapies had better outcomes 6 months after treatment than those who only received cognitive-behavioral therapy, according to study results.

Eighty patients were assessed for prolonged grief disorder using the Complicated Grief Assessment, Clinician-Administered PTSD Scale-1 and other self-report measures such as the Beck Depression Inventory. Patients with psychosis, substance dependence, borderline personality disorder, high risk for suicide and other criteria were excluded.

Eligible participants were randomly assigned to two treatment groups stratified by sex and grief severity. One group received CBT combined with exposure therapy (n=41), which included reliving the time they experienced the person’s death for 40 minutes, writing letters to the deceased to express unresolved issues and management of rumination. The other group received CBT alone (n=39) in a group setting. Ten weekly 2-hour sessions were conducted, along with four additional individual 1-hour sessions.

Two clinical psychologists, each with a master’s degree, conducted group therapy; trained clinical psychologists, under the researchers’ supervision, managed the individual sessions. Seventy-six percent of patients completed treatment, and 70% participated in the 6-month follow-up.

Treatment fidelity was assessed by providing audiotapes of 20% of the 240 individual sessions, and 20 of the 100 group sessions to three independent clinicians experienced with CBT. On a 7-point scale, the mean score was 5.3.

Researchers compared complex statistical analyses of outcomes in relation to severity of prolonged grief, symptoms of depression and psychological function. Patients treated with exposure in addition to CBT had better outcomes.

“Patients who received exposure therapy enjoyed better psychological and social functioning than those receiving CBT alone,” the researchers wrote. “In the most valuable lesson from this study, optimal gains with prolonged grief disorder patients are achieved when the emotions associated with the memories of the death and the sequelae of the loss are fully accessed.”