Online cognitive behavioral therapy for prolonged grief after traumatic loss: a randomized waitlist-controlled trial.

Prolonged grief disorder, a condition characterized by severe, persistent, and disabling grief, is newly included in ICD-11 and DSM-5-TR. Prolonged grief symptoms can be effectively treated with face-to-face or internet-delivered cognitive behavioral therapy. Traumatic losses may elicit higher prevalence of severe grief reactions. While face-to-face cognitive behavioral therapy appears efficacious in treating prolonged grief symptoms in traumatically bereaved individuals, it is not yet clear if internet-based cognitive behavioral therapy is efficacious for this population. Therefore, we investigated the efficacy of a 12-week internet-delivered cognitive behavioral therapy for people bereaved through traffic accidents in a randomized waitlist-controlled trial (registration number: NL7497, Dutch Trial Register). Forty adults bereaved though a traffic accident were randomized to internet-based cognitive behavioral therapy (n = 19) or a waitlist control condition (n = 21). Prolonged grief, post-traumatic stress, and depression symptoms were assessed at baseline, post-treatment, and 8-week follow-up. Dropout in the treatment condition was relatively high (42%) compared to the control condition (19%). Nevertheless, multilevel analyses showed that internet-based cognitive behavioral therapy strongly reduced prolonged grief, post-traumatic stress, and depression symptoms relative to the control condition at post-treatment and follow-up. We conclude that internet-based cognitive behavioral therapy appears a promising treatment for traumatically bereaved adults.

The mediating role of state anger in the associations between intentions to participate in the criminal trial and psychopathology in traumatically bereaved people.

Victims of crimes have been granted increasing procedural rights to participate in the juridical process since the mid 1990s. However, knowledge about the (anti)-therapeutic effect of participation is limited. We examined the associations between symptom levels of persistent complex bereavement disorder (PCBD), posttraumatic stress disorder (PTSD), and depression and the intention to participate in a criminal trial. Furthermore, we investigated the mediating role of state anger in these associations. People who lost loved ones after a plane disaster with flight MH17 (N = 203) completed questionnaires within three weeks before the start of the criminal trial. Mediation analyses indicated that people, who did not intend to actively participate in the trial by delivering a written or oral victim statement, were less likely to experience anger, which is, in turn, associated with attenuated psychopathology levels. State anger explains 68% of the effect of the intention to exercise the right to speak on PCBD levels. An important limitation is the cross-sectional study design, which precludes conclusions about temporal associations. More research is needed to improve preparation and support of bereaved people when they intend to exercise their victim rights during a criminal trial.