ImportanceProlonged grief disorder (PGD) is included as a new diagnosis in international classification systems. Treatments following a cognitive behavioral model are most effective, but comparisons with active control treatments are scarce.ObjectiveTo examine whether integrative cognitive behavioral therapy for prolonged grief (PG-CBT) is superior to present-centered therapy (PCT).Design, Setting, and ParticipantsThis was a rater-blinded, multicenter, randomized clinical trial (stratified by center and relationship to the deceased) with enrollment from April 2017 to May 2022. The setting included 4 university outpatient clinics in Germany. Eligible participants were aged 18 to 75 years and had PGD based on the Prolonged Grief Disorder 13 (PG-13) interview. Participants were randomized 1:1 to PG-CBT and PCT.InterventionsPG-CBT focused on the exposure to the worst moment of the loss and cognitive restructuring of grief-related cognitions in combination with solution-focused and experiential methods (eg, walk to the grave exercise). PCT was adapted in session length and number to PG-CBT and focused on a supportive relationship and coping with daily problems that may have arisen from the loss or grief symptoms.Main Outcomes and MeasuresAll outcomes were assessed at baseline, after treatment, and 12 months after randomization at follow-up. The primary outcome was a blinded assessment of the PG-13 severity score at follow-up. Secondary outcomes were self-reported depressive, somatic, and overall psychopathological symptoms.ResultsOf 544 treatment-seeking individuals experiencing bereavement, 212 eligible participants (mean [SD] age, 51.8 [13.3] years; 173 female [82%]) with PGD based on the PG-13 interview were randomized to PG-CBT and PCT (n = 106 in each condition). In the intention-to-treat analysis, both treatments yielded high reductions in PGD severity at follow-up (PG-CBT: Cohen d = 1.64; 95% CI, 1.31-1.97; PCT: Cohen d = 1.38; 95% CI, 1.09-1.66). After treatment, participants receiving PG-CBT demonstrated significantly greater reductions in PGD severity than those receiving PCT (Cohen d = 0.31; 95% CI, 0.03-0.57). At follow-up, this effect was only visible on a trend level (Cohen d = 0.28; 95% CI, −0.02 to 0.57), whereas participants in the PG-CBT group had significantly less depressive and general psychopathological symptoms. Twenty-three participants (20%) discontinued PG-CBT treatment, and 17 participants (16%) discontinued PCT.Conclusion and RelevanceThis randomized clinical trial demonstrates that PG-CBT was superior to PCT after treatment and at follow-up with regard to comorbid symptoms. Both treatments were shown to be effective and acceptable, showing the potential for dissemination and increasing patient choice.Trial registrationGerman Clinical Trials Register (DRKS) identifier: DRKS00012317

中文翻译：

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悲伤特异性认知行为疗法与以当下为中心的疗法


重要性延长哀伤障碍 （PGD） 被纳入国际分类系统的新诊断。遵循认知行为模型的治疗最有效，但与主动对照治疗的比较很少。目的检查长期悲伤的综合认知行为疗法 （PG-CBT） 是否优于以当下为中心的疗法 （PCT）。设计、设置和参与者这是一项评分者盲法、多中心、随机临床试验（按中心和与死者的关系分层），于 2017 年 4 月至 2022 年 5 月入组。该机构包括德国的 4 所大学门诊诊所。符合条件的参与者年龄在 18 至 75 岁之间，根据延长悲伤障碍 13 （PG-13） 访谈患有 PGD。参与者以 1：1 的比例随机分配到 PG-CBT 和 PCT 组。干预措施PG-CBT 侧重于暴露于失去的最糟糕时刻和悲伤相关认知的认知重构，并结合以解决方案为中心的体验式方法（例如，步行到坟墓练习）。PCT 在会话时长和数量上适应了 PG-CBT，并侧重于支持关系和应对可能由损失或悲伤症状引起的日常问题。主要结局和指标在基线、治疗后和随机分组后 12 个月的随访中评估所有结局。主要结局是随访时 PG-13 严重程度评分的盲法评估。次要结局是自我报告的抑郁、躯体和总体精神病理学症状。结果在 544 名寻求治疗的丧亲个体中，212 名符合条件的参与者 （平均 [SD] 年龄，51.8 [13.3] 岁;173 名女性 [82%]）根据 PG-13 访谈被随机分配到 PG-CBT 和 PCT 组 （每种情况下 n = 106）。 在意向治疗分析中，两种治疗在随访时 PGD 严重程度均显著降低（PG-CBT：Cohen d = 1.64;95% CI，1.31-1.97;PCT： 科恩 d = 1.38;95% CI，1.09-1.66）。治疗后，接受 PG-CBT 的参与者的 PGD 严重程度降低幅度显著大于接受 PCT 的参与者 （Cohen d = 0.31;95% CI，0.03-0.57）。在随访中，这种影响仅在趋势水平上可见（Cohen d = 0.28;95% CI，-0.02 至 0.57），而 PG-CBT 组的参与者的抑郁和一般精神病理学症状显着减少。23 名参与者 （20%） 停止 PG-CBT 治疗，17 名参与者 （16%） 停止 PCT。结论和相关性这项随机临床试验表明，PG-CBT 在治疗后和随访时在合并症状方面优于 PCT。两种治疗都被证明是有效和可接受的，显示出传播和增加患者选择的潜力。试验注册German Clinical Trials Register （DRKS） 标识符：DRKS00012317