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Randomized Controlled Trial
. 2021 Jun 17;12(1):1926650.
doi: 10.1080/20008198.2021.1926650. eCollection 2021.

Efficacy of an Internet-based cognitive-behavioural grief therapy for people bereaved by suicide: a randomized controlled trial

Julia Treml  1 , Michaela Nagl  1 , Katja Linde  1 , Christine Kündiger  1 , Carolin Peterhänsel  1 , Anette Kersting  1
Affiliations
Randomized Controlled Trial

Efficacy of an Internet-based cognitive-behavioural grief therapy for people bereaved by suicide: a randomized controlled trial

Julia Treml et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: The loss of a loved one due to suicide can be a traumatic event associated with prolonged grief and psychological distress. Objective: This study examined the efficacy of an Internet-based cognitive-behavioural grief therapy (ICBGT) specifically for people bereaved by suicide. Methods: In a randomized controlled trial, 58 participants with prolonged grief disorder (PGD) symptoms who had lost a close person to suicide were randomly allocated either to the intervention group (IG) or waitlist-control group (WCG). The 5-week intervention comprised ten writing assignments in three phases: self-confrontation, cognitive restructuring, and social sharing. Symptoms of PGD, common grief reactions after suicide, depression, and general psychopathology were assessed at pre-, post-test and follow-up. Results: Between-group effect sizes were large for the improvement of PGD symptoms in treatment completers (dppc2 = 1.03) and the intent-to-treat analysis (dppc2 = 0.97). Common grief reactions after suicide and depressive symptoms also decreased in the IG compared to the WCG (moderate to large effects). The results are stable over time. Only for general psychopathology, there was no significant time by group interaction effect found. Conclusions: The ICBGT represents an effective treatment approach for people suffering from PGD symptoms after bereavement by suicide. Considering the effect sizes, the small treatment dose, duration, and the stability of the results, the ICBGT constitutes an appropriate alternative to face-to-face grief interventions.

Antecedentes: La pérdida de un ser querido por suicidio puede ser un evento traumático asociado con el duelo prolongado y el malestar psicológico.Objetivo: Este estudio examinó la eficacia de una terapia cognitivo conductual de duelo basada en el internet (ICBGT en su sigla en inglés), específicamente para las personas en duelo por suicidio.Métodos: En un ensayo controlado aleatorizado, 58 participantes con síntomas de trastorno de duelo prolongado (PGD en su sigla en inglés) que han perdido una persona cercana por suicidio fueron asignados al grupo de intervención (IG en su sigla en inglés) o grupo de control de lista de espera (WCG en su sigla en inglés). La intervención de 5 semanas incluye diez tareas escritas en tres etapas: auto-confrontación, reestructuración cognitiva, y compartir social. Fueron evaluados antes y después de la intervención y al seguimiento, los síntomas de PGD, reacciones de duelo comunes luego de un suicidio, depresión, y psicopatología general.Resultados: Los tamaños de los efectos entre los grupos fueron grandes para la mejoría de los síntomas de PGD en quienes completaron el tratamiento (dppc2=1.03) y el análisis del intento-de-tratar (dppc2=0.97). Las reacciones de duelo comunes luego de suicidio y los síntomas depresivos también disminuyeron en IG en comparación con WCG (efectos moderados a grandes). Los resultados fueron estables a lo largo del tiempo. Solo en psicopatología general no se encontró un efecto significativo de tiempo por grupo.Conclusiones: ICBGT representa una forma de tratamiento efectiva para las personas que sufren de síntomas PGD luego de una pérdida por suicidio. Considerando los tamaños de los efectos, la dosis pequeña de tratamiento, la duración, y la estabilidad de los resultados, ICBGT constituye una alternativa apropiada para las intervenciones en duelo presenciales.

背景:因自杀而失去亲人可能是与延长哀伤和心理困扰相关的创伤事件。目的:本研究考查了针对因自杀丧亲者的网络认知行为哀伤疗法 (ICBGT) 的效果。方法:在一项随机对照试验中, 将因自杀失去亲密伴侣的58名有延长哀伤障碍 (PGD) 症状的参与者随机分配到干预组 (IG) 或候补对照组 (WCG) 。为期五周的干预包括三个阶段的十个写作作业:自我对抗, 认知重构和社交共享。在测试前, 后和随访中评估了PGD症状, 自杀后的常见哀伤反应, 抑郁和一般精神病。结果:对于治疗完成者PGD症状的改善 (dppc2 = 1.03) 和意向治疗分析 (dppc2 = 0.97) 的组间效应量较大。与WCG相比, IG中自杀后常见悲伤反应和抑郁症状也有所降低 (中到大的效应) 。结果跨时间稳定。仅对于一般精神病, 没有发现显著的时间与组别的交互效应。结论:ICBGT表现出是一种对于因自杀丧亲而患有PGD症状者的有效治疗方法。考虑到效果量, 小治疗剂量, 持续时间以及结果的稳定性, ICBGT构成了一个面对面哀伤干预的适当替代方案。.

Keywords: CBT; Internet-based therapy; bereavement; prolonged grief; randomized controlled trial; suicide.

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Conflict of interest statement

The authors have no competing interests to declare in relation to this article.

Figures

Figure 1.
Figure 1.
Study enrolment flow
Figure 2.
Figure 2.
Time by group interaction effect for PGD symptoms measured with the ICG (means and 95% CI, ICG cut-off =25, possible range: 0-76)
Figure 3.
Figure 3.
Time by group interaction effect for grief symptoms (GEQtotal) (means and 95% CI, possible range: 55-275)
Figure 4.
Figure 4.
Percentage of participants above the ICG cut-off score
See this image and copyright information in PMC

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References

    1. Aboujaoude, E., Salame, W., & Naim, L. (2015). Telemental health: A status update. World Psychiatry, 14(2), 223–14. doi:10.1002/wps.20218 - DOI - PMC - PubMed
    1. Agerbo, E. (2005). Midlife suicide risk, partner’s psychiatric illness, spouse and child bereavement by suicide or other modes of death: A gender specific study. Journal of Epidemiology and Community Health, 59(5), 407–412. doi:10.1136/jech.2004.024950 - DOI - PMC - PubMed
    1. Andriessen, K. (2009). Can postvention be prevention? Crisis, 30(1), 43–47. doi:10.1027/0227-5910.30.1.43 - DOI - PubMed
    1. Andriessen, K., Krysinska, K., Hill, N. T. M., Reifels, L., Robinson, J., Reavley, N., & Pirkis, J. (2019). Effectiveness of interventions for people bereaved through suicide: A systematic review of controlled studies of grief, psychosocial and suicide-related outcomes. BMC Psychiatry, 19(1), 49. doi:10.1186/s12888-019-2020-z - DOI - PMC - PubMed
    1. Andriessen, K., Krysinska, K., & Tekavčič-Grad, O. (2017). Postvention in action: The international handbook of suicide bereavement support. Göttingen, Germany: Hogrefe Publishing.

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Grants and funding

This work was supported by research grants from the Roland Ernst Stiftung, which had no role in the design of this study, its execution, analysis and interpretation of data, or publication of results.