A Swedish Internet CBT for Prolonged Grief Disorder: a Three-armed RCT

The death of a loved one can lead to various mental and physical health problems. Previous research has shown that Cognitive Behavioral Therapy (CBT) can be effective in recuding symptoms of prolonged grief. However, most previous studies have had small sample sizes and lacked follow-up assessments over time.

The purpose of this project is to conduct a large randomized controlled trial (RCT) to evaluate the effectiveness of internet-delivered cognitive-behavioral therapy (iCBT) in reducing symptoms of prolonged grief, depression, and posttraumatic stress in adults who have lost a loved one. The iCBT treatment will be compared against both an active control condition and a waitlist condition. Participants in the active control condition will receive a simplified version of the iCBT treatment, which is also therapist-led but lacks active CBT components. The waitlist control group will receive the iCBT treatment after 10 weeks. Follow-up assessments will be conducted at 6 and 12 months after treatment completion.

The study will also examine potential moderators (such as baseline symptom levels and loss characteristics) and mediators (such as belief in treatment efficacy, changes in negative cognitions and level of avoidance) on treatment effects. This may provide insights into the effectiveness of prolonged grief treatment and factors that influence treatment outcomes.

Participants will be recruited through advertisements on social media platforms, and organisations and clinical contacts. Individuals interested in participating in the study register their interest on a website linked to the research project, and complete an initial screening form. Potential participants are contacted by phone to schedule an assessment interview over video, which includes the structured diagnostic interview Mini International Neuropsychiatric Interview (M.I.N.I.). Subsequently, eligible participants are randomized to iCBT, active control, or waitlist control. The participants will be informed that they have been randomly assigned to either a waitlist or one of two grief treatment programs but will not know which of the treatments they are in, and are thus blind at the beginning of the study. The treatment is accessed on a digital platfom.

This study is the first of its kind in Sweden to examine the effectiveness of internet-delivered treatment for prolonged grief. Additionally, it is the first trial to assess both short- and long-term effects of iCBT for prolonged grief compared to an active control group.

• Change (from baseline) in Posttraumatic stress disorder checklist for DSM-5, PCL-5 [Срок оценки: 0, 5 and 10 weeks. Follow-up at 6 and 12 months post-treatment.]
• Change (from baseline) in Patient Health Questionnaire, PHQ-9 [Срок оценки: 0, 5 and 10 weeks. Follow-up at 6 and 12 months post-treatment.]
• Change (from baseline) in Depressive and Anxious Avoidance in Prolonged Grief questionnaire, DAAPGQ [Срок оценки: 0, 5 and 10 weeks. Follow-up at 6 and 12 months post-treatment.]
• Change (from baseline) in Grief Cognitions Questionniare, GCQ [Срок оценки: 0, 5 and 10 weeks. Follow-up at 6 and 12 months post-treatment.]
• Change (from baseline) in the short version of Traumatic Grief Inventory Self Report Plus, Short version TGI-SR+ [Срок оценки: Weekly assessments between week 0 and week 10, excluding week 5.]
• Change (from baseline) in Short Form Posttraumatic stress disorder checklist for DSM-5, Short form PCL-5 [Срок оценки: Weekly assessments between week 0 and week 10, excluding week 5.]
• Change (from baseline) in Patient Health Questionnaire, PHQ-2 [Срок оценки: Weekly assessments between week 0 and week 10, excluding week 5.]