An Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Prolonged Grief Disorder (PGD) in adults: A multiple-baseline single-case experimental design study

Cintia Tur; Daniel Campos; Carlos Suso-Ribera; Evaldas Kazlauskas; Diana Castilla; Irene Zaragoza; Azucena García-Palacios; Soledad Quero

doi:10.1016/j.invent.2022.100558

An Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Prolonged Grief Disorder (PGD) in adults: A multiple-baseline single-case experimental design study

Internet Interv. 2022 Jul 7:29:100558. doi: 10.1016/j.invent.2022.100558. eCollection 2022 Sep.

Authors

Cintia Tur¹, Daniel Campos^{2

3}, Carlos Suso-Ribera^{1

4}, Evaldas Kazlauskas⁵, Diana Castilla^{4

6}, Irene Zaragoza⁴, Azucena García-Palacios^{1

4}, Soledad Quero^{1

4}

Affiliations

¹ Departmento de Psicología Básica, Clínica y Psicobiología. Universitat Jaume I, Castellón de la Plana, Spain.
² Departmento de Psicología y Sociología, Universidad de Zaragoza, Zaragoza, Spain.
³ Instituto de Investigación Sanitaria Aragón (IISAragon), Zaragoza, Spain.
⁴ CIBER de Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Madrid, Spain.
⁵ Center for Psychotraumatology, Institute of Psychology, Vilnius University, Lithuania.
⁶ Universitat de València, València, Spain.

Abstract

The death of a loved one has physical, psychological, and social consequences. Between 9.8 and 21.5 % of people who lose a loved one develop Prolonged Grief Disorder (PGD). Internet- and computer-based interventions (i.e., Internet-delivered Cognitive-Behavioral Therapy, iCBT) are cost-effective and scalable alternatives that make it possible to reach more people with PGD. The main goal of the present investigation was to examine the effect and feasibility (usability and satisfaction) of an iCBT (GROw program) for adults with PGD. A secondary objective was to detect adherence to the app (Emotional Monitor) used to measure daily grief symptoms. The study had a single-case multiple-baseline AB design with six participants. The GROw program is organized sequentially in eight modules, and it is based on the dual-process model of coping with bereavement. Evaluations included a pre-to-post treatment assessment of depression, grief symptoms, and typical grief beliefs, along with daily measures of symptom frequency and intensity on the Emotional Monitor App. Treatment opinions and adherence to the App were also collected. Efficacy data were calculated using a Nonoverlap of All Pairs (NAP) analysis and Reliable Change Index (RCI). The mean age of the sample was 29.5 years (SD = 8.19). Two participants dropped out of the study. Adherence to the App varied across patients (4.8 % -77.8 %). Most participants (75 %) showed a clinically significant change (recovered) in depression, and 50 % obtained a clinically significant improvement (recovered) in symptoms of loss and typical beliefs in complicated grief. The participants reported high usability and satisfaction with the treatment content and format. In sum, the GROw program was very well accepted and generally feasible, and it has strong potential for treating PGD. The results support scaling up the treatment by using more complex designs with larger samples (i.e., randomized controlled trials comparing GROw with active conditions).

Keywords: App; Internet-delivered Cognitive-Behavioral Therapy; Multiple-baseline single-case design; Prolonged Grief Disorder; iCBT.