• Complicated Grief;
  • Cognitive–Behavioural Therapy;
  • Predictors of Outcome;
  • Cognitions;
  • Avoidance Behaviour


Complicated grief (CG), also called prolonged grief disorder, is a debilitating condition that can develop following a loss. There is growing evidence that cognitive–behavioural interventions are efficacious in the treatment of CG. The present preliminary study used data from 43 patients with CG who were randomly assigned to cognitive–behavioural therapy in an earlier treatment trial to explore (a) predictors of outcome of cognitive–behavioural therapy for CG and (b) the relationship between symptom improvement and changes in loss-related negative cognitions and avoidance behaviours. Analyses showed that worse treatment outcome was associated with lower education attainment, loss of a partner/child (instead of some other relative), early treatment discontinuation, less patient motivation and more severe CG symptoms at pre-treatment. As predicted, stronger reduction in CG severity was significantly associated with stronger reductions in negative cognitions and avoidance. Implications of these findings are discussed. Copyright © 2010 John Wiley & Sons, Ltd.

Key Practitioner Message:

• Greater effectiveness of cognitive–behavioural therapy (CGT) for complicated grief (CG) seems to be associated with higher educational level, being confronted with losses other than the loss of a partner or child, completion (and not early discontinuation) of treatment and stronger motivation.

• Longer CBT treatment may be needed for CG patients bereaved by the loss of a partner or child and mourners with more severe levels of CG.

• Seeking ways to enhance patient motivation and adherence to treatment seems important to improve the effectiveness of CBT for CG.

• Reduction in CG severity during CGT is associated with reduction in negative cognitions and avoidance behaviours.