Psychotherapy identified as most effective treatment for grief

1. In this systematic review and meta-analysis, psychotherapy was the most effective intervention, improving grief disorder symptoms, general grief, and depression compared with no treatment.

2. Expert-facilitated support groups reduced depression symptoms, though effects were inconsistent across studies.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Various interventions exist to manage bereavement and grief, but evidence on their benefits and harms for individuals at risk of or diagnosed with prolonged grief disorder (PGD) is limited. This systematic review synthesized current literature on interventions for individuals at risk of grief disorders or with PGD. Psychotherapy was found to improve grief disorder symptoms, with an average 11-point reduction on the Inventory of Complicated Grief (range 0–76), and also benefited general grief, grieving symptoms, and depression compared with no treatment. Expert-facilitated support groups reduced depression symptoms, but effects on grief disorder symptoms were unclear due to limited reporting. One study reported that pharmacotherapy combined with complicated grief therapy improved grief symptoms and suicidal ideation, though it was unclear which component was responsible. Peer support showed no clinical improvement, and evidence for self-help interventions was insufficient. Writing, music, and art therapy did not significantly affect grief or depression symptoms. Comprehensive support or enhanced provider contact did not improve grief disorder symptoms but reduced depression compared with usual care. The generalizability of these findings is limited by a lack of culturally specific data and insufficient understanding of how cultural considerations influence diagnosis and treatment. Overall, this review suggests that psychotherapy may be effective in improving grief disorder symptoms, general grief, and depression in bereaved individuals, whereas evidence for support groups, pharmacotherapy, peer support, self-help, and creative therapies remains limited or inconclusive.

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Relevant Reading: Interventions To Improve Care of Bereaved Persons

In-Depth [systematic review and meta-analysis]: This systematic review synthesized evidence on interventions for bereaved individuals, including those at risk for grief disorders and those with prolonged grief disorder (PGD). Articles were identified in PubMed, Embase, CINAHL, PsycINFO, Social Work Abstracts, Dimensions, and clinical trial registries through September 11, 2025. Randomized controlled trials (RCTs) comparing interventions for bereaved children or adults with no intervention, usual care, or another intervention were included. Outcomes were grief disorder symptoms, general grief/grieving symptoms, and depression. Of 5,773 full-text publications, 169 RCTs (303 publications) were included; 57 were conducted in the US and 66 in Europe. Populations included suicide survivors, hospital staff, bereaved mothers, teenaged refugees, and incarcerated adolescents; fewer than 10% of studies included children. Almost half (n = 73) were rated high risk of bias. Psychotherapy (76 studies) improved grief disorder symptoms (standardized mean difference [SMD], -1.01; 95% confidence interval [CI], -1.35 to -0.66; 20 RCTs), corresponding to an ~11-point reduction on the Inventory of Complicated Grief. CBT-based approaches (11 studies) also reduced symptoms (SMD, -0.86; 95% CI, -1.30 to -0.43). Psychotherapy improved general grief (SMD, -0.55; 95% CI -0.93 to -0.16; 14 RCTs; ~8-point reduction on Texas Revised Inventory of Grief) and depressive symptoms (SMD, -0.71; 95% CI, -0.98 to -0.44; 29 RCTs; ~7-point reduction on BDI-II). Effects remained after excluding high-risk-of-bias studies. Expert-facilitated support groups (38 RCTs) reduced depression (SMD, -0.39; 12 RCTs; ~3-point BDI-II reduction) but had no clear effect on grief disorder symptoms (SMD, -0.14; 4 RCTs). Pharmacotherapy plus grief therapy (1 study) improved grief symptoms (risk ratio [RR], 0.65) and suicidal ideation (RR, 0.21). Peer support, self-help, creative therapies, and comprehensive support had limited or inconsistent effects. Overall, psychotherapy provides the strongest evidence for improving grief disorder, general grief, and depression among bereaved individuals, while evidence for other interventions remains limited or inconclusive.

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