Effectiveness of an Internet-Based Self-Management Program in Treating Prolonged Grief Disorder

This study will evaluate the effectiveness of an Internet-based self-help program in treating people who are at risk for developing prolonged grief disorder following a recent loss.

Prolonged grief disorder (PGD) is a severe psychiatric condition that occurs in about 10% of people who experience a recent loss. PGD does not just go away with time and is associated with considerable functional impairment, physical and mental health problems, lost productivity, lack of interest in previously enjoyed activities, suicide, and depression. Because the majority of people with PGD are elderly and less capable of pursuing outside care, making readily available treatments for PGD is very important. Current treatments for PGD include psychotherapy and antidepressant medications, but there is very little solid research on the effectiveness of these treatments. Previous studies have shown that Internet-based mental health treatments are an effective and cost-efficient way to provide self-help to people who otherwise would not seek care. Using strategies from the psychotherapy known as cognitive behavioral therapy (CBT), this study will evaluate the effectiveness of an Internet-based self-help program in treating people who are at risk for developing prolonged grief disorder following a recent loss.

Participation in this study will last 6 weeks. Participants will be asked to log-on to the study's self-help Web site three times per week for the 6 weeks of treatment. During these 30-minute Internet sessions, participants will read or listen to information about grief and coping with grief and will complete computer exercises that involve identifying self-care needs, support systems, and short-term goals. Participants will also be asked to perform off-line activities that are designed to increase self-care and social activities and that may take anywhere from a few minutes to 30 minutes per day. Participants will be randomly assigned to begin the treatment program 12, 18, or 24 weeks after their loss. For all participants, there will be four assessments, occurring 12, 18, 24, and 30 weeks after the loss, regardless of when the participants start the program. These assessments will include questions about mental and physical health adjustment, beliefs about the loss, and coping status.

• Grief
• Mental Health

• Experimental: 6-week delay start
  This group begins treatment 6 weeks after recruitment and baseline.
  Intervention: Behavioral: Internet-Based Self-Management for Prolonged Grief Symptoms
• Experimental: 12-week delay start
  This group begins treatment 12 weeks after recruitment and baseline.
  Intervention: Behavioral: Internet-Based Self-Management for Prolonged Grief Symptoms
• Experimental: No delay start
  This group begins treatment immediately after recruitment and baseline.
  Intervention: Behavioral: Internet-Based Self-Management for Prolonged Grief Symptoms

Inclusion criteria:

• Meets criteria for a diagnosis of prolonged grief (with the exception of the requirement for 6-month duration of symptoms) using the Prolonged Grief -13
• Access to the Internet

Exclusion Criteria:

• Lifetime history of bipolar disorder, schizophrenia, psychosis, or delusional disorders
• History of substance or alcohol dependence other than nicotine in the year prior to study entry
• Significant suicidal ideation
• Concurrent psychotherapy initiated within 3 months prior to study entry, or ongoing psychotherapy specifically targeting loss; general supportive therapy initiated more than 3 months prior to study entry is acceptable