A pilot randomised controlled trial of metacognitive therapy for prolonged grief

Abstract

ObjectivesProlonged grief disorder is associated with significant distress and impairment and thus efforts to improve treatments are essential. The present pilot study tested the efficacy and feasibility of group Metacognitive Grief Therapy (MCGT) designed specifically for prolonged grief symptomatology to reduce the psychological distress and impaired function resulting from bereavement.Design/participantsTwenty-two bereaved adult participants with prolonged grief symptomatology were randomised to a wait-list control (n=10) or an intervention condition (n=12) with a 3-month and 6-month follow-up. The wait-list control group was offered treatment after the post-test assessment.InterventionParticipants attended six group MCGT sessions that ran for 2 hours per week.Outcome measuresA primary outcome measure of prolonged grief symptomatology and secondary outcome measures of depression, anxiety, rumination, metacognitive beliefs and quality of life were taken pretreatment and post-treatment for both groups and at the 3-month and 6-month follow-up for the intervention group. A Generalised Linear Mixed Model was used to assess treatment efficacy.ResultsPost-treatment intent-to-treat analyses showed MCGT reduced prolonged grief symptomatology (Cohen’s d=1.7), depression (d=1.3), anxiety (d=0.8), stress (d=1.0), rumination (d=0.9) and increased quality of life (d=0.6), and these effects were maintained at the 3-month and 6-month follow-ups. No prepost between-group differences were found in metacognitive beliefs. However, a large significant effect was identified at the 3-month and 6-month follow-ups (d=1.0).ConclusionThe results show promise for the utility of group MCGT for reducing psychological distress and promoting quality of life. Additionally, the results underscore the need for a full randomised controlled trial of group MCGT, which may be an important addition to the treatment armamentarium available to support people with prolonged grief.Trial registration numberACTRN12613001270707; Results.Original protocol BMJ Open 2015;5:e007221. doi:10.1136/bmjopen-2014-007221

Effects of bereavement groups–a systematic review and meta-analysis

“…Interrater reliability was excellent for the full text screening (j ¼ 1.00). This review included 14 data sets (Chow et al, 2019;Constantino & Bricker, 1996;Foster & Holden, 2014;Goodkin et al, 1999;Johnson et al, 2016;MacKinnon et al, 2015;McGuinness et al, 2015;Murphy et al, 1998;Piper et al, 2001Piper et al, , 2007Rosner et al, 2011;Sikkema et al, 2004;Supiano & Luptak, 2014;Wenn et al, 2019).…”

“…Of the 14 studies included in the review, five (36%; Chow et al, 2019;Johnson et al, 2016;MacKinnon et al, 2015;Supiano & Luptak, 2014;Wenn et al, 2019) were judged to be of good quality with a score of nine or more (Supplement 2). It is noteworthy that only few studies provided unambiguous information on their randomization procedures.…”

“…Three studies (21%) did not describe in which way treatment adherence or compliance with the intervention was addressed (Foster & Holden, 2014;McGuinness et al, 2015;Rosner et al, 2011). Seven studies (50%) used intention-to-treat analyses (ITT; i.e., last observation carried forward method, expectation-maximization algorithms, hierarchical linear models), whereby one study did not describe the ITT method (Wenn et al, 2019).…”

“…Half of the bereavement groups were heterogenous with respect to the kinship of the deceased (Foster & Holden, 2014;Goodkin et al, 1999;McGuinness et al, 2015;Piper et al, 2001Piper et al, , 2007Supiano & Luptak, 2014;Wenn et al, 2019), and four (29%) concentrated solely on partners or parents (Chow et al, 2019;Constantino & Bricker, 1996;Johnson et al, 2016;Murphy et al, 1998). Five studies (36%) included heterogenous causes of death (Chow et al, 2019;Johnson et al, 2016;Murphy et al, 1998;Supiano & Luptak, 2014;Wenn et al, 2019), whereas three studies (21%) focused on bereavement by suicide or AIDS (Constantino & Bricker, 1996;Goodkin et al, 1999;Sikkema et al, 2004). Six studies (43%) did not indicate the cause of death (Foster & Holden, 2014;MacKinnon et al, 2015;McGuinness et al, 2015;Piper et al, 2001Piper et al, , 2007Rosner et al, 2011).…”

“…Supplement 4 summarizes the concepts of the treatment and control groups. Eleven studies (79%) labeled their groups "therapy" or "intervention" (Chow et al, 2019;Foster & Holden, 2014;Goodkin et al, 1999;Johnson et al, 2016;Murphy et al, 1998;Piper et al, 2001Piper et al, , 2007Rosner et al, 2011;Sikkema et al, 2004;Supiano & Luptak, 2014;Wenn et al, 2019), although only six of them were addressed at prolonged grief; further terms were "nursing postvention" (Constantino & Bricker, 1996), "group counseling" (MacKinnon et al, 2015), or "bereavement support group" (McGuinness et al, 2015). Five (36%) studies described their concepts to be based on support group principles (Constantino & Bricker, 1996;Foster & Holden, 2014;Goodkin et al, 1999;McGuinness et al, 2015;Murphy et al, 1998), three studies (21%) described their treatment concepts as being based on CBT principles (Rosner et al, 2011;Sikkema et al, 2004;Supiano & Luptak, 2014), two studies (14%) applied interpretive therapy (IT; Piper et al, 2001Piper et al, , 2007, and one study (7%) each offered metacognitive grief therapy (MCGT; Wenn et al, 2019), interpersonal psychotherapy (IPT; Johnson et al, 2016), meaning-based group counseling (MBGC; MacKinnon et al, 2015), or a dual-process bereavement group intervention (DPBGI; Chow et al, 2019).…”