Department of Psychology, Ludwig Maximilian University of Munich, Germany.
Psychiatric Hospital, kbo-Inn-Salzach-Klinikum, Wasserburg/Inn, Germany.
Psychol Psychother. 2018 Mar;91(1):27-41. doi: 10.1111/papt.12140. Epub 2017 Jul 24.
Prolonged grief disorder (PGD) is a persistent and disabling kind of grief reaction that can be treated effectively with psychotherapeutic interventions. There has been limited investigation of whether these interventions can also enhance positive outcomes of bereavement, such as posttraumatic growth or benefit finding.
As part of secondary analyses in a randomized controlled trial evaluating integrative cognitive-behavioural therapy for PGD (PG-CBT), the posttraumatic growth trajectories in 51 outpatients with clinically relevant prolonged grief symptoms were followed up from baseline up to 1.5 years.
Immediate treatment effects on posttraumatic growth in comparison with a waiting list control group were evaluated with univariate ANCOVA. Using mediation analysis, we examined the relation between symptom reduction and the short-term treatment effect on posttraumatic growth. For evaluating long-term outcome stability, the immediately treated group and the delayed treatment group were pooled.
PG-CBT significantly fostered growth in patients suffering from PGD, with a controlled medium effect size of Cohen's d = 0.60 (completer analysis). This effect remained stable up to the 1.5-year follow-up. Grief symptom reduction mediated short-term treatment effects on posttraumatic growth. However, growth also partially mediated treatment effects on prolonged grief symptoms.
Taken together, PG-CBT was effective in enhancing the participants' perception of posttraumatic growth, but the definite interaction between symptom reduction and posttraumatic growth remains unclear, as both seemed to influence each other's trajectory in the course of treatment.
Integrative CBT for prolonged grief disorder also fostered posttraumatic growth. Post-treatment and 1.5-year follow-up effect sizes for posttraumatic growth were moderate. Whether growth-enhancing techniques are useful in grief treatment needs further research.
持续性创伤后应激障碍（PGD）是一种持续且使人丧失能力的悲伤反应，可通过心理治疗干预进行有效治疗。这些干预措施是否也能增强丧亲之痛的积极结果，如创伤后成长或获益发现，这方面的研究还很有限。
作为评估针对 PGD 的综合认知行为疗法（PG-CBT）的随机对照试验的二次分析的一部分，对 51 名有临床相关持续性悲伤症状的门诊患者的创伤后成长轨迹进行了随访，从基线到 1.5 年。
使用单变量协方差分析评估与等待名单对照组相比，即时治疗对创伤后成长的影响。使用中介分析，我们检查了症状减轻与短期治疗对创伤后成长的影响之间的关系。为了评估长期结果的稳定性，将立即治疗组和延迟治疗组合并。
PG-CBT 显著促进了患有 PGD 的患者的成长，控制后的中等效应大小为 Cohen 的 d = 0.60（完成分析）。这种效果在 1.5 年的随访中保持稳定。悲伤症状的减轻介导了短期治疗对创伤后成长的影响。然而，成长也部分介导了治疗对持续性悲伤症状的影响。
综上所述，PG-CBT 有效地增强了参与者对创伤后成长的感知，但症状减轻和创伤后成长之间的确切相互作用仍不清楚，因为两者似乎在治疗过程中相互影响。
针对持续性创伤后应激障碍的综合认知行为疗法也促进了创伤后成长。创伤后成长的治疗后和 1.5 年随访的效应大小为中等。增强成长的技术在悲伤治疗中的有效性需要进一步研究。
