ABSTRACT

Objective: The present study investigated the role of the two theoretically derived mediators in the treatment of Prolonged Grief Disorder (PGD). Mediators were changes in avoidance and maladaptive cognitions. An additional hypothesis tested whether these candidate mediators are specific to CBT-based Complicated Grief Treatment (CGT) compared to Interpersonal Therapy (IPT). Method: We performed secondary analyses with assessment completers (n = 131) from a randomized-controlled trial with older adults with PGD. Patients received 16 sessions of CGT or IPT. Outcomes were treatment response and reductions in grief symptoms and grief-related related impairment. Results: Reductions in avoidance between baseline and week 16 mediated reductions in grief symptoms and grief-related impairment. Reductions in maladaptive grief-related cognitions over the same period mediated treatment response, reductions in grief symptoms and grief-related impairment. There were no significant treatment-mediator interactions. We could not establish that mediators changed before the outcomes. Conclusion: Results are consistent with theoretical models of PGD, including the CGT treatment model. Despite different therapeutic procedures, we found no significant interaction effect, but CGT produced larger effects. Future research needs to establish a timeline of change through the use of multiple measurements of mediators and outcomes.

Trial registration: ClinicalTrials.gov identifier: NCT01244295.

摘要

目标：本研究调查了两种理论推导的介质在延长悲伤障碍 (PGD) 治疗中的作用。中介是回避和适应不良认知的变化。另一个假设测试了与人际关系治疗 (IPT) 相比，这些候选调解员是否特定于基于 CBT 的复杂悲伤治疗 (CGT)。方法：我们对 来自患有 PGD 的老年人的随机对照试验的评估完成者 ( n = 131) 进行了二次分析。患者接受了 16 次 CGT 或 IPT。结果是治疗反应以及悲伤症状和悲伤相关损伤的减少。结果：基线和第 16 周之间回避行为的减少介导了悲伤症状和悲伤相关损伤的减少。在同一时期内，不适应性悲伤相关认知的减少介导了治疗反应、悲伤症状和悲伤相关损伤的减少。没有显着的治疗-中介相互作用。我们无法确定调解员在结果出现之前就发生了变化。结论：结果与 PGD 的理论模型一致，包括 CGT 治疗模型。尽管治疗程序不同，我们没有发现明显的交互作用，但 CGT 产生了更大的影响。未来的研究需要通过对中介和结果的多种测量来建立变化的时间表。

试验注册： ClinicalTrials.gov 标识符：NCT01244295。