ImportanceAlthough grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy.ObjectiveTo examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity.Design, Setting, and ParticipantsA single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief−13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months.InterventionsBoth groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress.Main Outcomes and MeasuresThe primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life.ResultsThe trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events.Conclusions and RelevanceIn this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration.Trial Registrationanzctr.org.au Identifier: ACTRN12612000307808

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认知行为疗法与正念治疗长期悲伤障碍的比较

重要性虽然以悲伤为中心的认知行为疗法是针对长期悲伤障碍最有经验支持的治疗方法，但许多人发现这种治疗很困难。一种可行的治疗替代方案是基于正念的认知疗法。目的检查以悲伤为中心的认知行为疗法和基于正念的认知疗法在降低长期悲伤障碍严重程度方面的相对功效。设计、设置和参与者单盲、平行、随机临床试验在 18 至 70 岁患有长期悲伤障碍的成年人中进行，定义见国际疾病分类,第11次修订，并根据长期悲伤−13 (PG-13) 量表通过临床访谈进行评估。那些有严重自杀风险、存在精神病或物质依赖的人被排除在外。 2012 年 11 月至 2022 年 11 月期间，符合条件的参与者按照 1:1 的比例在澳大利亚悉尼的创伤应激诊所随机分配至 11 次 90 分钟的以悲伤为中心的认知行为疗法或基于正念的认知疗法，并随访 6 个月干预措施 两组患者每周接受一次 90 分钟的单独治疗，持续 11 周。以悲伤为中心的认知行为疗法包括 5 次回忆死者记忆的疗程，以及认知重建和规划未来的社交和积极活动。基于正念的认知治疗包括适合耐受悲伤相关痛苦的正念练习。主要结果和测量主要结果是通过在基线、治疗后 1 周和治疗后 6 个月评估的 PG-13 量表测量的长期悲伤障碍严重程度的变化（主要结果时间点），以及抑郁、焦虑、悲伤相关认知和生活质量的次要结果指标。结果该试验包括 100 名参与者（平均 [SD] 年龄，47.3 [13.4] 岁；87 [87.0%]女性），50 名处于以悲伤为中心的认知行为治疗条件下，50 名处于基于正念的认知行为治疗条件下。线性混合模型表明，在 6 个月的评估中，与基于正念的认知治疗组相比，以悲伤为中心的认知行为治疗组的参与者在 PG-13 量表评分上表现出更大的降低（平均差为 7.1；95%）置信指数，1.6-12.5；磷= .01），组间效应值较大（0.8；95% CI，0.2-1.3）。根据贝克抑郁量表的测量，以悲伤为中心的认知行为治疗组的参与者比基于正念的认知治疗组的参与者也表现出更大的抑郁减少（平均差，6.6；95% CI，0.5-12.9；磷= .04）和悲伤相关认知（平均差，14.4；95% CI，2.8-25.9；磷= .02)。治疗组之间没有其他显着差异，也没有报告不良事件。结论和相关性在这项研究中，与基于正念的认知疗法相比，以悲伤为中心的认知行为疗法在治疗后 6 个月对核心长期悲伤障碍症状和相关问题带来更多益处。虽然这两种治疗方法都可以考虑治疗长期悲伤障碍，但考虑到所有因素，以悲伤为中心的认知行为疗法可能是更有效的选择。试验注册anzctr.org.au标识符：ACTRN12612000307808