Current estimates suggest that death rates from Covid-19 will continue to rise and, at the very least, will lead to tens of thousands of deaths. Sadly, the circumstances of these deaths will likely increase the rates of prolonged grief disorder (PGD) well over the estimated 7% of the overall bereaved population. The DSM5 has now joined the ICD-11 in proposing similar diagnostic criteria and in using the name Prolonged Grief Disorder to designate a syndrome characterized by persistent, pervasive and impairing grief. Sudden unexpected death, the need for physical distancing, the high contagiousness of the virus, the widespread unemployment and the ongoing highly stressful context in which these deaths occur are unique characteristics of covid-19 deaths that increase the risk of developing PGD. We developed a short-term, manualized Complicated Grief Treatment (CGT) for this condition and found it efficacious in three large NIMH sponsored randomized controlled trials. In the parent grant, we develop an on-line therapist training in CGT to help disseminate CGT training, a skill now greatly in demand and one not widely possessed. In this administrative supplement we plan add two major features to our parent study in response to the COVID epidemic: 1) development of a patient- facing therapist-assisted web-based form of CGT developed specifically to deal with COVID- related grieving and 2) development of three supplementary therapist training modules: a) special considerations when delivering CGT for covid-related loss, b) how to administer CGT remotely via videoconference and c) how to integrate the patient-facing form of CGT into clinician-guided treatment. A hybrid model using both self-guided therapeutic activities augmented with a therapist guide has been successfully demonstrated in the UK, and has been adopted as best practice for the treatment of depression. Such a model will both 1) enhance the efficacy of treatment, as studies have shown that the more a patient understands the concepts of treatment, the better the treatment outcomes, and 2) will enable the reduction in the number of clinician sessions, both reducing patient costs and freeing clinician time to treat more patients in order to meet the overwhelming demand due to this crisis.
Complicated Grief (CG) is a prevalent and debilitating disorder associated with significant distress and impairment. The supplemental study will build upon the on line therapist training for CG with a patient-facing web-based tutorial for patients, as well as COVID specific modules for therapist CGT training. 1
