Accelerated Resolution Therapy for Early Maladaptive Grief Study Protocol.

The objective of this manuscript is to present the protocol of a study aiming to test the effects of Accelerated Resolution Therapy® (ART) on pre-loss grief and prolonged grief among older adult family caregivers. This study also aims to better understand predictors of response to ART®, and cognitive processes that occur among grieving individuals following ART®.

Design: The study is a double-blinded, randomized clinical trial.

Setting: This study takes place at both inpatient and outpatient palliative care and hospice programs at two Mayo Clinic sites.

Participants: Participants include older adult ($\ge$ 60 years) immediate family members who are primary caregivers of someone with an advanced illness and life expectancy of less than 12 months.

Intervention: Participants are randomized to either the ART® intervention group or the attention control group. In the ART® intervention, caregivers engage in imaginal exposure, lateral eye movements, and imagery rescripting via 4 sessions lasting 1-1.5 hours each. The attention control group receives a standard social work intervention, including education, resources, and active listening, which is matched for time and attention. Both interventions will longitudinally follow caregivers from active caregiving into bereavement.

Outcomes measured: The primary outcomes of pre-loss grief and prolonged grief will be measured with the Pre-Loss Grief 12 item (PG-12-R) before the care recipient's death, and with the Prolonged Grief-13 (PG-13-R) afterwards.