What’s New in Psychology

Exploring the Best Treatment for Prolonged Grief Disorder      

Jim Windell

             Alice, a woman I know, lost her son in a motorcycle accident. When talking with friends, she brings up the death of her son and her eyes fill with tears. She tells the same stories about her son over and over, never remembering who she has told about getting the phone call from the police and how she couldn’t accept his death.

           When she meets someone new, it isn’t long before she brings up her son and describes the accident and how it has affected her. She admits that she still maintains her son’s bedroom and cannot bear to get rid of anything that belonged to him.

           Although Alice’s son died 15 years ago, for her, it’s as if his death happened just last week. The grief Alice experienced is inevitable for anyone who has lost a meaningful relationship. But her grief can be classified as Prolonged Grief Disorder (PGD), which is also known as “complicated grief” or “prolonged complex bereavement disorder.” This disorder has been added to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR).

           A defining characteristic of PGD is severe bereavement that persists for more than a year after a loss in adults and 6 months in children and adolescents. Key diagnostic criteria include intense yearning and longing for the deceased person, along with persistent preoccupation with thoughts or memories of them. Limited acceptance of the loss, social disconnection, isolation, diminished sense of self, inability to find meaning in life, and persistent preoccupation with the deceased are additional diagnostic criteria that people experiencing PGD may exhibit.

           While most individuals who experience a loss progress from acute to integrated grief, those with PGD remain entrenched in maladaptive grief patterns. With prevalence estimates ranging from 9.8 % to 34.3 % in bereaved populations, especially following traumatic or sudden losses, the need for effective interventions is urgent.

           So, what is the best treatment for PGD?

            This is what the authors of a systematic review which was recently published in the Journal of Affective Disorders wanted to find out.

            This systematic review examined research literature published between January, 2011 and May, 2024 to investigate psychological interventions for PGD. Included were studies conducted before PGD was added to diagnostic manuals because these earlier studies used the same assessment scales and similar cutoff points to identify prolonged grief. 

            A total of 962 articles were initially identified. After removing duplicates, 458 articles remained and underwent screening based on title and abstract. Subsequently, the full texts of 135 articles were retrieved for detailed assessment, resulting in 30 articles that met the outlined inclusion criteria for this systematic review.

           And the results?

           First, several important patterns in the treatment of PGD were found. One important pattern was that CBT was found to be the predominant approach, and that approach was found to be effective. In effect, CBT across multiple delivery formats suggested its versatility and robustness as a treatment approach to PGD.

           Second, innovations such as combining CBT with mindfulness, exposure therapy, or EMDR showed promise, particularly in addressing trauma-related grief. Although alternative interventions, including music therapy and Accelerated Resolution Therapy, revealed potential benefits, they require further investigation. Mindfulness-based therapies, while less prevalent, showed modest efficacy when integrated with CBT frameworks.

           Findings emphasize the need for personalized, culturally sensitive treatments tailored to the diverse circumstances of grief. The success of internet-delivered interventions highlights opportunities to expand access, particularly in resource-limited settings. Despite progress, gaps remain in understanding the role of pharmacological adjuncts, long-term outcomes, and underrepresented populations.

           Finally, this review underscores the importance of advancing therapeutic approaches to mitigate PGD's profound impact on individuals and communities, proposing directions for future research and clinical practice.

           To read the original article, find it with this reference:

Srivastava, T., Lee, K., Ehrenkranz, R., Cozzolino, P., Wise, F. A., Burns, M., ... & Penberthy, J. K. (2025). The efficacy of psychotherapeutic interventions for prolonged grief disorder: A systematic review. Journal of Affective Disorders.