The efficacy of psychotherapeutic interventions for prolonged grief disorder: A systematic review

Abstract

Prolonged Grief Disorder (PGD), newly recognized in the ICD-11 and DSM-5-TR, represents a severe and persistent bereavement response that disrupts adaptive functioning. Characterized by intense yearning, preoccupation with the deceased, and profound social and emotional disturbances, PGD is associated with adverse physical and mental health outcomes. While most individuals progress from acute to integrated grief, those with PGD remain entrenched in maladaptive grief patterns. With prevalence estimates ranging from 9.8 % to 34.3 % in bereaved populations, especially following traumatic or sudden losses, the need for effective interventions is urgent.

This systematic review examines the efficacy of psychotherapeutic interventions for PGD across 30 randomized controlled trials published between 2011 and 2024. Cognitive Behavioral Therapy (CBT) emerged as the predominant and most effective approach, demonstrating versatility across individual, group, and internet-based formats. Innovations such as combining CBT with mindfulness, exposure therapy, or EMDR showed promise, particularly in addressing trauma-related grief. Alternative interventions, including music therapy and Accelerated Resolution Therapy, revealed potential benefits but require further investigation. Mindfulness-based therapies, while less prevalent, showed modest efficacy when integrated with CBT frameworks.

Findings emphasize the need for personalized, culturally sensitive treatments tailored to the diverse circumstances of grief. The success of internet-delivered interventions highlights opportunities to expand access, particularly in resource-limited settings. Despite progress, gaps remain in understanding the role of pharmacological adjuncts, long-term outcomes, and underrepresented populations.

This review underscores the importance of advancing therapeutic approaches to mitigate PGD's profound impact on individuals and communities, proposing directions for future research and clinical practice.