Internet-based exposure and behavioral activation for complicated grief and rumination: A randomized controlled trial

Maarten Eisma, Paul Boelen, Jan van den Bout, Wolfgang Stroebe, Henk Schut, Jaap Lancee, Margaret Stroebe

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Abstract

This study examined the effectiveness and feasibility of therapist-guided Internet-delivered exposure (EX) and behavioral activation (BA) for complicated grief and rumination. Forty-seven bereaved individuals with elevated levels of complicated grief and grief rumination were randomly assigned to three conditions: EX (N = 18), BA (N = 17), or a waiting-list (N = 12). Treatment groups received 6 homework assignments over 6 to 8 weeks. Intention-to-treat analyses showed that EX reduced complicated grief, posttraumatic stress, depression, grief rumination, and brooding levels relative to the control group at posttreatment (d = 0.7–1.2). BA lowered complicated grief, posttraumatic stress, and grief rumination levels at posttreatment (d = 0.8–0.9). At 3-month follow-up, effects of EX were maintained on complicated grief and grief rumination (d = 0.6–1.2), and for BA on complicated grief, posttraumatic stress, and grief rumination (d = 0.8–0.9). EX reduced depression more strongly than BA (d = 0.6). Completers analyses corroborated results for EX, and partially those for BA, but no group differences were detected. BA suffered from high dropout (59%), relative to EX (33%) and the waiting-list (17%). Feasibility appeared higher for EX than BA. Results supported potential applicability of online exposure but not behavioral activation to decrease complicated grief and rumination.
Original languageEnglish
Pages (from-to)729-748
Number of pages20
JournalBehavior Therapy
Volume46
Issue number6
Early online date28 May 2015
DOIs
Publication statusPublished - Nov 2015

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Keywords

  • prolonged grief
  • grief therapy
  • rumination
  • exposure
  • behavioral activation

Cite this

Eisma, M., Boelen, P., van den Bout, J., Stroebe, W., Schut, H., Lancee, J., & Stroebe, M. (2015). Internet-based exposure and behavioral activation for complicated grief and rumination: A randomized controlled trial. Behavior Therapy, 46(6), 729-748. https://doi.org/10.1016/j.beth.2015.05.007