Cognitive behavioral therapy may improve outcomes in children and adolescents with prolonged grief disorder

1. In this randomized control trial, individualized cognitive behavioral therapy (CBT) for prolonged grief disorder was superior to supportive therapy in reducing symptoms at both 6- and 12-month follow-up.

2. Participants in the CBT Grief-Help group also demonstrated decreased symptoms of depression, post-traumatic stress disorder (PTSD), and lower levels of internalizing problems compared to the supportive therapy group.

Evidence Rating Level: 2 (Good)

Prolonged grief disorder occurs following bereavement and is typically treated with CBT in adults. Treatment practices for children and adolescents commonly include supportive counselling; the current literature does not address whether CBT is effective for prolonged grief disorder in this population.

This randomized control trial compared an individualized CBT program, CBT Grief-Help, with supportive therapy in children and youths in prolonged grief disorder. The primary outcome was participant Inventory of Prolonged Grief for Children (IPG-C) score at 3-, 6-, and 12-month follow-up. Secondary outcomes included Children’s Depression Inventory (CDI), Child PTSD Symptom Scale (CPSS), and Child Behavior Checklist (CBCL) scores. Participants included were between 8 and 18 years old, had lost a close relative, and were experiencing distressing/disabling prolonged grief disorder symptoms. Participants with a history of concurrent psychological or psychopharmacological treatment as well as those with a previous diagnosis of intellectual disabilities, developmental disorders, or severe conduct disorders were excluded.

134 participants were randomly allocated to either the supportive counselling group (n=60) or the CBT group (n=74). Participants in the CBT and supportive group showed 78.6% and 60% improvement of IPG-C scores, respectively, at 12-month follow-up as compared to pre-treatment measurements. Additionally, there was a greater reduction in CDI, CPSS, and CBCL scores in the CBT group. However, this study had several limitations. For instance, multiple therapists were used to administer the therapies and no independent ratings of treatment integrity occurred. Additionally, the home environment and level of caretaker support for participants were not accounted for. The results of this study suggested that CBT may be superior to supportive therapy in treating prolonged grief disorder in children and adolescents.

Click to read the study in The American Journal of Psychiatry 

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