Brief Internet-Based Intervention Reduces Posttraumatic Stress and Prolonged Grief in Parents after the Loss of a Child during Pregnancy: A Randomized Controlled Trial

Abstract

Background: The loss of a child during pregnancy causes significant psychological distress for many women and their partners, and may lead to long-lasting psychiatric disorders. Internet-based interventions using exposure techniques and cognitive restructuring have proved effective for posttraumatic stress disorder (PTSD) and prolonged grief. This study compared the effects of an Internet-based intervention for parents after prenatal loss with a waiting list condition (WLC). Methods: The Impact of Event Scale - Revised assessed symptoms of PTSD; the Inventory of Complicated Grief and the Brief Symptom Inventory assessed depression, anxiety, and general mental health. The 228 participants (92% female) were randomly allocated to a treatment group (TG; n = 115) or a WLC group (n = 113). The TG received a 5-week cognitive behavioral intervention including (1) self-confrontation, (2) cognitive restructuring, and (3) social sharing. Results: The TG showed significantly reduced symptoms of posttraumatic stress, prolonged grief, depression, and anxiety relative to the WLC control group. Intention-to-treat analysis revealed treatment effects of between d = 0.84 and d = 1.02 for posttraumatic stress and prolonged grief from pre- to posttreatment time points. Further significant improvement in all symptoms of PTSD and prolonged grief was found from the posttreatment evaluation to the 12-month follow-up. The attrition rate of 14% was relatively low. Conclusions: The Internet-based intervention proved to be a feasible and cost-effective treatment, reducing symptoms of posttraumatic stress, grief, depression, anxiety, and general mental health after pregnancy loss. Low-threshold e-health interventions should be further evaluated and implemented routinely to improve psychological support after pregnancy loss.

Prolonged grief disorder for ICD-11: the primacy of clinical utility and international applicability

“…Its guidelines can be used for assessment and treatment, particularly the recommendations that the management of grief symptoms should include the discussion of culturally appropriate adjustment and mourning rituals. In addition, there have been several successful randomized controlled trials of treatments for CG (Shear, Frank, Houck, & Reynolds, 2005; Shear et al, 2016, 2014) and PGD (Bryant et al, 2014; Kersting et al, 2013; Litz et al, 2014; Rosner, Pfoh, Kotoučová, & Hagl, 2014). These treatments pull valuable techniques from PTSD interventions, narrative therapy and cognitive behavioural therapy, and could be incorporated into the WHO mhGAP guidelines (Rosner, Bartl, Pfoh, Kotoučová, & Hagl, 2015; Shear, 2015).…”

Impact of Cognitive Behavioral-Based Counseling on Grief Symptoms Severity in Mothers After Stillbirth

“…If there is doubt or ambivalence about the pregnancy, or the woman feels she has done something wrong during pregnancy that may have caused the stillbirth (such as exercise, poor diet or smoking), this may prolong the grief process. Difficulty in coping with negative emotions and ongoing avoidance leads to social isolation (9). Stillbirth is associated with a more than threefold greater risk of depression than healthy live birth, and 44% of mothers suffer from signs and symptoms of posttraumatic stress disorder after stillbirth (10).…”

“…Despite the known psychological vulnerability of women after a stillbirth, and the evidence that perinatal loss causes mental illness, few of these mothers receive adequate psychological support (9). In some institutions, educational pamphlets and care guides are given to grieving mothers, but their efficacy is rarely evaluated (13).…”

“…In some institutions, educational pamphlets and care guides are given to grieving mothers, but their efficacy is rarely evaluated (13). A few clinical trials have addressed depression in women after perinatal loss, but studies of grief and its severity in such cases are lacking (9). Regarding intervention, some studies have investigated the impact of physical activity (14), online short-term intervention (4), individual counseling by telephone (6), and couple-based intervention (14) on the symptoms of depression, anxiety, and grief in a largely unfocused manner.…”

Elektronisches Routine-Outcome-Monitoring (eROM) in Psychiatrie und klinischer Psychologie

“…Im Bereich der wissenschaftlichen Forschung werden PROs zur Evaluation von Behandlungsmodalitäten, Psychopharmakatherapien [7][8][9] oder psychologischen und psychotherapeutischen Interventionen eingesetzt [10,11].…”