Cognitive behavioral therapy for prolonged grief in children and adolescents: A randomized clinical trial

P.A. Boelen*, Lonneke Lenferink, Mariken Spuij

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Objective: Prolonged Grief Disorder (PGD) was newly included in ICD-11 and resembles Persistent Complex Bereavement Disorder (PCBD) newly included in DSM-5. In adults, PGD can be successfully treated using cognitive behavioral therapy (CBT). There is no evidence yet that CBT interventions can successfully alleviate PGD in children and adolescents. The goal of this randomized clinical trial was to examine the effects of CBT for PGD in children and adolescents (named “CBT Grief-Help”) in comparison with the effects of non-directive supportive counselling.
Methods: One hundred and thirty four children and adolescents with PGD (aged M=13.10 (SD=2.84, range 8-18) years, bereaved M=37.79 (SD=36.23, range 4-188) months earlier) were randomized to receive either CBT Grief-Help (n=74) or supportive counselling (n=60). Both treatment conditions encompassed nine individual sessions with children/adolescents paralleled by five sessions counselling with parents/caretakers. Children/adolescents completed measures of PGD, depression, and posttraumatic stress disorder (PTSD), and their parents/caretakers completed measures of their children’s problem behavior, before treatment, immediately after treatment, and three-, six-, and twelve-months following treatment.
Results: Both treatments yielded moderate to large effect sizes across PGD and most other outcome measures. Compared to supportive counseling, CBT Grief-Help resulted in significantly greater reductions PGD-symptoms at all post-treatment assessments, and more successfully alleviated depression, PTSD, and internalizing problems six- and twelve-months following treatment.
Conclusions: PGD and accompanying symptoms in bereaved children and adolescents can be effectively treated using CBT interventions. The superior long-term effects of CBT Grief-Help relative to supportive counselling suggest that this treatment successfully harnesses children and adolescents to the challenges faced after loss.
Original languageEnglish
Pages (from-to)294-304
Number of pages11
JournalAmerican Journal of Psychiatry
Issue number4
Early online date21-Jan-2021
Publication statusPublished - 1-Apr-2021


  • prolonged grief disorder
  • bereavement
  • children
  • adolescents
  • cognitive-behavioral treatment

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