Treating complicated grief and posttraumatic stress in homicidally bereaved individuals: A randomized controlled trial

Denderen, Mariëtte van; Keijser, Jos de; Stewart, Roy E.; Boelen, Paul A.

doi:10.1002/cpp.2183

Cited by 28 publications

(62 citation statements)

References 43 publications

(58 reference statements)

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“…Eight sessions have shown to be sufficient to yield clinically relevant effects in prior research. 40 Following Dutch guidelines for grief-specific CBT, 42 central components of the treatment are exposure, cognitive restructuring and behavioural activation. In the first session, psychoeducation is offered, including information about possible emotional reactions to the death of a loved one in a traffic accident and processes that might foster or hamper recovery.…”

Section: Interventionmentioning

confidence: 99%

Online cognitive–behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial

et al. 2020

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IntroductionThe traumatic death of a loved one, such as death due to a traffic accident, can precipitate persistent complex bereavement disorder (PCBD) and comorbid post-traumatic stress disorder (PTSD) and depression. Waitlist-controlled trials have shown that grief-specific cognitive–behavioural therapy (CBT) is an effective treatment for such mental health problems. This is the first study that will examine the effectiveness of online CBT (vs waitlist controls) in a sample exclusively comprised of people bereaved by a traumatic death. Our primary hypothesis is that people allocated to the online CBT condition will show larger reductions in PCBD, PTSD and depression symptom levels at post-treatment than people allocated to a waitlist. We further expect that reductions in symptom levels during treatment are associated with reductions of negative cognitions and avoidance behaviours and the experience of fewer accident-related stressors. Moreover, the effect of the quality of the therapeutic alliance on treatment effects and drop-out rates will be explored.Methods and analysisA two-arm (online CBT vs waiting list) open-label parallel randomised controlled trial will be conducted. Participants will complete questionnaires at pretreatment and 12 and 20 weeks after study enrolment. Eligible for participation are Dutch adults who lost a loved one at least 1 year earlier due to a traffic accident and report clinically relevant levels of PCBD, PTSD and/or depression. Multilevel modelling will be used.Ethics and disseminationEthics approval has been received by the Medical Ethics Review Board of the University Medical Center Groningen (METc UMCG: M20.252121). This study will provide new insights in the effectiveness of online CBT for traumatically bereaved people. If the treatment is demonstrated to be effective, it will be made publicly accessible. Findings will be disseminated among lay people (eg, through newsletters and media performances), our collaborators (eg, through presentations at support organisations), and clinicians and researchers (eg, through conference presentations and scientific journal articles).Trial registration numberNL7497.

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Section: Interventionmentioning

confidence: 99%

Online cognitive–behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial

et al. 2020

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“…This self-report questionnaire includes 15 items rated on 4-point scales ranging from 0 (not at all), 1 (rarely experienced), 3 (sometimes experienced), to 5 (often experienced), the summation of which provides an index of traumatic stress. A score of 26 was used as a cut-off for clinically relevant scores (23,34). The scale has sound psychometric properties (34).…”

Section: Impact Of Event Scale (Ies)mentioning

confidence: 99%

“…Although the emotional consequences of homicidal loss evidently merit clinical attention, options for preventive and curative treatments are scarce. In existing literature on the treatment of traumatic loss, grief-and trauma-focused interventions are described, as well as interventions integrating working mechanisms of both (23,24). For the treatment of PTSD, trauma-focused cognitive behavioral therapy (CBT) and Eye Movement Desensitization and Reprocessing (EMDR) are implemented in treatment guidelines (25).…”

Section: Introductionmentioning

confidence: 99%

The UK National Homicide Therapeutic Service: A Retrospective Naturalistic Study Among 929 Bereaved Individuals

Soydas

Smid

Goodfellow³

et al. 2020

Front. Psychiatry

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Homicidal bereavement puts survivors at risk of developing a broad range of lasting and severe mental health problems. Previous research has often relied on relatively small and homogenous samples. Still, little is known about what factors influence the expression of symptoms following homicidal bereavement. Preventive and curative treatments often do not consider the complex coherence between the emotional, judicial, financial, and societal challenges that likely arise following a homicide. Despite the severity of its consequences on mental health, no gold standard for the preventative and curative treatment of mental health issues in homicide survivors exists. We aimed to introduce a time-limited, traumatic grief-focused outreaching model of care designed specifically for homicide survivors, and to examine its potential effectiveness. Furthermore, we aimed to investigate what factors influence the severity of mental health problems and response to treatment. In the current study, self-reported data on five different outcome measures, namely, symptoms of posttraumatic stress, prolonged grief, depression, anxiety, and functional impairment were available from 929 homicidally bereaved treatment receiving adults. We used Latent Growth Modeling to analyze our repeated measures data and to classify individuals into distinct groups based on individual response patterns. Results showed that the current model of care is likely to be effective in reducing mental health complaints following homicidal bereavement. Having a history of mental illness, being younger of age and female, and having lost either a child or spouse consistently predicted greater symptom severity and functional impairment at baseline. For change in symptom severity and functional impairment during treatment, having a history of mental illness was the only consistent predictor across all outcomes. This study was limited by its reliance on self-reported data and cross-sectional design without a control group. Future prospective, longitudinal research across different cultures is needed in order to

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“…Post‐treatment responses appeared to be influenced by high distress, female gender, positive relationship with the deceased, and type of relationship (e.g., loss of a child), but were not influenced by the time since loss, and type of death (homicide vs. nonhomicide). In contrast, van Denderen, de Keijser, Stewart, and Boelen () found that both eye movement desensitization and reprocessing and cognitive behaviour therapy (CBT) seem promising treatments for homicidally bereaved individuals, regardless of their gender and the passage of time since the loss. These contradictory findings prompted us to examine the relevant factors predicting the treatment outcomes targeted at specific groups (e.g., widowed older adults).…”

Section: Introductionmentioning

confidence: 99%

Predictive factors for differential changes in grief symptoms following group bereavement intervention for Chinese widowed older adults

Xiu

Chow

Tang

2020

Clin Psychology and Psychoth

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This study aimed to delineate changes in the patterns of prolonged grief severity in widowed adults following group bereavement interventions and to identify the predictive factors impacting these patterns. We performed a secondary analysis of data from a randomized trial of 125 Chinese widowed older adults who participated in either LOGBI or DPGBI. Self-ratings of prolonged grief symptoms via Inventory of Complicated Grief (ICG) were subjected to latent class growth analysis to identify subgroups according to symptomatic changes among baseline, posttreatment, and 8-week follow-up. Multinomial regression analysis examined whether participant classification could be predicted by demographics, loss-related characteristics, and the relationship with the deceased and baseline symptom severity. In the results, intervention sample comprised 96 completers with an attendance greater than 60%. A three-class categorization yielded the best model fit for changes in prolonged grief severity for both randomized and intervention samples:improved class (41.6% in the randomized sample, 42.8% in the intervention sample), partial responded class (48.1%/45.5%), and relapse class (10.3%/11.8%). Older widowed adults experiencing a high level of grief at baseline and bereavement following chronic illness had an elevated risk of symptomatic relapse after the completion of intervention. These findings indicated that Chinese widowed adults experienced different changing patterns of prolonged grief severity following group bereavement interventions. Practically, widowed adults with a higher risk of symptomatic relapse might need more intensive or longer term intervention or follow-up support.

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Treating complicated grief and posttraumatic stress in homicidally bereaved individuals: A randomized controlled trial

Cited by 28 publications

References 43 publications

Online cognitive–behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial

Online cognitive–behavioural therapy for traumatically bereaved people: study protocol for a randomised waitlist-controlled trial

The UK National Homicide Therapeutic Service: A Retrospective Naturalistic Study Among 929 Bereaved Individuals

Predictive factors for differential changes in grief symptoms following group bereavement intervention for Chinese widowed older adults

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