Department of Clinical Psychology (Boelen, Lenferink) and Department of Child and Adolescent Studies (Spuij), Utrecht University, Utrecht, the Netherlands; ARQ National Psychotrauma Centre, Diemen, the Netherlands (Boelen); Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands (Lenferink); TOPP-zorg, Driebergen-Rijsenburg, the Netherlands (Spuij).
Am J Psychiatry. 2021 Apr 1;178(4):294-304. doi: 10.1176/appi.ajp.2020.20050548. Epub 2021 Jan 21.
Prolonged grief disorder was newly included in ICD-11 and resembles persistent complex bereavement disorder, newly included in DSM-5. Although prolonged grief disorder in adults can be successfully treated by cognitive-behavioral therapy (CBT), there is no evidence yet that CBT interventions can successfully alleviate the disorder in children and adolescents. The goal of this randomized clinical trial was to examine the effects of a CBT program, CBT Grief-Help, for prolonged grief disorder in children and adolescents in comparison with the effects of nondirective supportive counseling.
A total of 134 children and adolescents with prolonged grief disorder (mean age, 13.10 years [SD=2.84], bereaved a mean of 37.79 months [SD=36.23] earlier) were randomly assigned to receive either CBT Grief-Help (N=74) or supportive counseling (N=60). Both treatment conditions encompassed nine individual sessions with children and adolescents paralleled by five counseling sessions with parents or caretakers. Children and adolescents completed measures of prolonged grief disorder, depression, and posttraumatic stress disorder (PTSD), and their parents or caretakers completed measures of their children's problem behavior before treatment, immediately after treatment, and 3, 6, and 12 months after treatment.
Both treatments yielded moderate to large effect sizes across prolonged grief disorder and most other outcome measures. Compared with supportive counseling, CBT Grief-Help resulted in significantly greater reductions in prolonged grief disorder symptoms at all posttreatment assessments, and it was more successful in alleviating depression, PTSD symptoms, and internalizing problems 6 and 12 months after treatment.
Prolonged grief disorder and its symptoms in bereaved children and adolescents can be effectively treated by CBT interventions. The superior long-term effects of CBT Grief-Help relative to supportive counseling suggest that this treatment successfully strengthens children and adolescents in facing challenges brought about by bereavement.
延长哀伤障碍于《国际疾病分类》第 11 版中被新收录，类似于在《精神疾病诊断与统计手册》第 5 版中被新收录的持续性复杂丧亲障碍。虽然成人的延长哀伤障碍可以通过认知行为疗法（CBT）成功治疗，但目前尚无证据表明 CBT 干预可以成功缓解儿童和青少年的障碍。本随机临床试验的目的是检验 CBT 计划（CBT 悲伤援助）对儿童和青少年延长哀伤障碍的效果，与非指导性支持性咨询的效果进行比较。
共有 134 名患有延长哀伤障碍的儿童和青少年（平均年龄为 13.10 岁[标准差=2.84]，丧亲时间平均为 37.79 个月[标准差=36.23]）被随机分配接受 CBT 悲伤援助（N=74）或支持性咨询（N=60）。两种治疗方法均包括 9 次与儿童和青少年的个体会议，同时进行 5 次与父母或照顾者的咨询会议。儿童和青少年在治疗前、治疗后立即以及治疗后 3、6 和 12 个月完成延长哀伤障碍、抑郁和创伤后应激障碍（PTSD）的测量，他们的父母或照顾者完成他们孩子治疗前、治疗后立即、治疗后 3、6 和 12 个月的问题行为的测量。
两种治疗方法在延长哀伤障碍和大多数其他结果测量上均产生了中度至较大的效果。与支持性咨询相比，CBT 悲伤援助在所有治疗后评估中均导致延长哀伤障碍症状的显著减少，并且在治疗后 6 和 12 个月时更成功地缓解了抑郁、PTSD 症状和内化问题。
丧亲的儿童和青少年的延长哀伤障碍及其症状可以通过 CBT 干预有效治疗。CBT 悲伤援助相对于支持性咨询的优越长期效果表明，这种治疗成功地增强了儿童和青少年面对丧亲带来的挑战的能力。
