Group Vs Individual Grief-Focused Cognitive Behavioral Therapy for Older Adults: A Randomized Clinical Trial

Importance Grief-focused cognitive behavioral therapies (GF-CBTs) are found effective in treating prolonged grief disorder (PGD), but the relative efficacy of different delivery formats is unknown. While evidence for individual GF-CBT (GF-CBT individual) is well established, evidence for group GF-CBT (GF-CBT group) is scarce. However, the group format holds possible advantages in a bereavement context. Objective To examine whether GF-CBT group is noninferior to GF-CBT individual in reducing PGD symptoms in older adults. Design, Setting, and Participants Enrollment and data collection for this noninferiority randomized clinical trial took place from April 2021 to May 2025. Participants were randomized 1:1 to GF-CBT group and GF-CBT individual and followed up with until 6 months posttreatment. Recruitment and treatment were done in a naturalistic clinical practice. Participants included older bereaved adults (65 years or older) with clinically relevant levels of PGD, posttraumatic stress disorder (PTSD), depression, and/or anxiety based on established cutoffs on self-report questionnaires. These data were analyzed from June 2025 through August 2025. Interventions GF-CBT group and GF-CBT individual consisted of 12 weekly sessions (duration: 2 hours vs 1 hour), including the same intervention techniques in the same order (exposure, cognitive restructuring, and behavioral activation). Main outcomes and measures Outcomes were measured at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up as the primary end point. The primary outcome was PGD symptoms measured with the Prolonged Grief-13 questionnaire. Secondary outcomes included symptoms of PTSD, depression, anxiety, loneliness, social support, functional impairment, quality of life, and well-being. Results Participants (N = 113; mean [SD] age, 71.58 [5.86] years; 92 female [81.4%], 20 male [17.7%], and 1 person [.09%] had missing information on gender) were randomized to GF-CBT group (n = 56) or GF-CBT individual (n = 57). Mixed linear models on the intention-to-treat sample showed that both formats yielded statistically significant large reductions in PGD symptoms over time (GF-CBT group: d = 1.74; GF-CBT individual: d = 1.46). GF-CBT group was noninferior compared with GF-CBT individual (d = 0.09; 95% CI, −0.06 to 0.25) at 6-month follow-up. The noninferiority of GF-CBT group was evidenced for all secondary outcomes. Dropout rates were 23% (GF-CBT group) vs 19% (GF-CBT individual). Conclusions and relevance In this study, GF-CBT group was noninferior to GF-CBT individual at 6-month follow-up in reducing PGD symptoms, but also symptoms of PTSD, depression, and anxiety. Both formats had large effects on symptoms over time and appear to be relevant treatment formats for older adults with symptoms of PGD and other disorders post loss.