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

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.

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