CBT beats mindfulness at treating severe grief

Patients are less likely to relapse if they have cognitive behaviour therapy, research suggests.

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Cognitive behaviour therapy has a more sustained effect than mindfulness for patients with prolonged grief disorder, research suggests.

The Australian research in JAMA Psychiatry found that both interventions reduced the severity of participants’ grief after six months, but CBT showed greater reduction in prolonged grief symptoms compared to mindfulness-based cognitive therapy.

The 100 adult participants had prolonged grief disorder, “characterised by persistent yearning for the deceased, along with associated emotional pain and impairment”. The condition is estimated to affect up to 10% of bereaved people.

Participants were randomised to have either cognitive behaviour therapy focusing on grief, or mindfulness-based cognitive therapy with clinical psychologists.

The grief-focused CBT prompted participants to recall memories of the deceased, writing a letter to them and focusing on positive memories, and planning future positive activities, while the mindfulness-based cognitive therapy involved mindfulness exercises and meditation.

After six months of treatment, both groups showed significant reductions in anxiety and improvements in quality of life, the study showed.

“Grief-focused cognitive behaviour therapy afforded greater benefit in reducing prolonged grief disorder severity, mindfulness-based cognitive therapy achieved comparable gains in reducing anxiety and improving quality of life,” the researchers said.

However, a difference between the effectiveness of therapies appeared at later follow-up.

Lead researcher Scientia Professor Richard Bryant said while both therapies were effective at the end of treatment, the CBT group showed lasting benefits when participants were contacted at the six-month follow-up.

“Relapse tended to occur following mindfulness, whereas treatment gains continued to occur in the grief-focused cognitive behaviour therapy group,” Professor Bryant, from the University of NSW school of psychology, said in a statement.

Participants in the CBT group also showed greater reductions in depression and grief-related cognition compared to the mindfulness group, he said.

“All trials to date have highlighted that CBT is the treatment of choice when dealing with prolonged grief disorder,” he said.

But Professor Bryant said mindfulness still had benefits for patients.

“Our research shows that symptom relief can also be achieved by an alternate approach such as mindfulness,” he said.

“This mean that if clinicians or patients are reluctant to engage in the recommended treatment of cognitive behaviour therapy, one can use mindfulness as an alternative that has been shown to have a positive effect.”

JAMA Psychiatry 2024, online 24 April