Brief behavioural activation for prolonged grief disorder: a case series

Objective: Prolonged grief disorder (PGD) is a debilitating disorder that affects seven percent of the bereaved. The search for effective and efficient treatments is ongoing. This study tested the feasibility of an adapted version of brief behavioural activation (BA) for depression revised (BATD-R). Method: After a three-week baseline, two bereaved individuals who met criteria for PGD were provided with 6 weekly sessions of BATD-R. Measures of PGD, BA, and grief rumination were collected at each session in addition to other measures pre- and 3- and 6-months post-treatment. Results: For the first participant BATD-R was associated with rapid and reliable reductions in PGD, grief-related rumination, and post-traumatic stress such that she no longer met criteria for PGD at post-intervention. These results were largely maintained at 3 and 6-month follow-up. The second participant demonstrated a less dramatic trajectory of improvement although his PGD symptoms decreased from the clinical to the elevated range post-treatment. These results were maintained at 3- and 6-month follow-up. Conclusions: The results support an association between BA and reductions in PGD symptoms and provide partial support for the use of BATD-R to target PGD symptoms including grief-related rumination. Further study of BATD-R in larger randomised trials is warranted. KEY POINTS What is already known about this topic: (1) Prolonged grief disorder is experienced by approximately 7 percent of the bereaved. (2) It is not clear whether all the components of existing treatments are necessary. (3) Investigating alternative treatments may inform briefer, more efficient, interventions. What this topic adds: (1) Brief behavioural activation is a feasible treatment for prolonged grief disorder. (2) There is an inverse relationship between activation and prolonged grief symptoms. (3) For some individuals, behavioural activation is a minimally sufficient intervention.