CBT interventions may effectively treat prolonged grief disorder in children, adolescents

Cognitive behavioral therapy interventions may effectively treat prolonged grief disorder among bereaved children and adolescents, according to results of a randomized clinical trial published in American Journal of Psychiatry.

“Notwithstanding the importance of the treatments that have been developed so far, they are limited in their focus on prevention (eg, [Family Bereavement Program] (FBP)), their reliance on group-based formats (eg, FBP, trauma and grief component therapy) and their focus on specific groups (parentally [eg, FBP] or traumatically [eg, trauma and grief component therapy, cognitive behavioral therapy for childhood traumatic grief ] bereaved children and adolescents),” Paul A. Boelen, PhD, of the department of clinical psychology at Utrecht University in the Netherlands, and colleagues wrote. “In adults, CBT is a promising treatment for reducing prolonged grief disorder and associated psychopathology. An understanding of whether CBT is effective in treating childhood prolonged grief disorder is needed.”

The researchers sought to compare the effects of the CBT program CBT Grief-Help for prolonged grief disorder among 134 children and adolescents with those of nondirective supportive counseling. Participants had a mean age of 13.1 years and had been bereaved for a mean of 37.79 months. Boelen and colleagues randomly assigned 74 participants to receive CBT Grief-Help and 60 to receive supportive counseling. Each treatment condition involved nine individual sessions with children and adolescents paralleled by five counseling session with parents or caretakers. The researchers assessed measures of prolonged grief disorder, depression and PTSD among the children and adolescents and received responses from their parents or caretakers regarding children’s problem behavior before treatment, immediately after treatment and 3, 6 and 12 months after treatment.

Results showed moderate to large effect sizes across prolonged grief disorder and most other outcome measures for both treatments. CBT Grief-Help was linked to significantly greater reductions in prolonged grief disorder symptoms at all posttreatment assessments and more successfully alleviated depression, PTSD symptoms and internalizing problems 6 and 12 months after treatment vs. supportive counseling.

“Considering that many bereaved children and adolescents who need help likely receive no treatment, or no evidence-based treatment, disseminating CBT Grief-Help is a key challenge for bereavement care,” Boelen and colleagues wrote. “There is recent evidence that similar interventions for children and adolescents who experienced parental death can be successfully delivered by lay counselors in lower-resource areas. The specifically described protocol of CBT Grief-Help potentially allows a similar delivery by a variety of caretakers.”