Complicated grief group therapy for community-residing persons diagnosed with serious mental illness

Figures & data

Table 1. Summary of efficacy results from three pilot complicated grief group therapy studies

Study Population	N			BGQ						PG-13
					Control Mean (sd)		Treatment Mean (sd)	Effect Size	Control Mean (sd)			Treatment Mean (sd)	Effect Size
Older Adults	34		Pretest Posttest		7.29 (1.40) 6.53 (1.37)		7.06 (1.29) 3.3 (1.30)*	d = 2.42	38.79 (9.46) 30.29 (9.37)			41.5 (5.42) 23.00 (9.02)*	d = 1.34
						BGQ			ICG-r
Suicide Survivors	46		Pretest Posttest		6.73 (2.10) 7.29 (2.78)		7.29(1.90) 4.03 (2.17)*	d = 1.376	42.93 (12.82) 44.52 (16.48)		44.52 (10.17) 28.55 (11.73)*		d = 1.306
Dementia Caregivers	37		Pretest Posttest		5.58 (0.38) 6.29 (0.49)		6.29 (0.32) 3.00 (0.37)	d = 1.324	28.48 (2.10) 31.73 (2.67)		31.73 (1.39) 19.21 (1.60)*		d = 1.351

* indicates p-value for difference between treatment group pre and end of treatment time points is < 0.001.

BGQ = Brief Grief Questionnaire; PG-13 = Prolonged Grief Disorder Scale (used instead of ICG-r); ICG-r = Inventory of Complicated Grief-revised.

Table 2. Outline of CGGT Intervention Sessions

Session 1	Session 7
Psychoeducation Death story #1 & group feedback Explanation homework, distress scoring	Supportive Other visit #2 (half of session) Difficult-memories worksheet & pictures Grief & self-care goals for next session
Session 2	Session 8
Mindfulness education & practice Developing grief goals & self-care goals	Imaginal conversation for half of group & group feedback Working with emotions/thoughts/body sensations Grief & self-care goals for next session
Session 3	Session 9
Supportive Other visit #1 (10 minutes in group) Working with emotions/thoughts/body sensations Integrated grief check Grief & self-care goals for next session	Imaginal conversation for 2nd half of group & group feedback Working with emotions/thoughts/body sensations Grief & self-care goals for next session
Session 4	Session 10
Death story #2 & group feedback Working with emotions/thoughts/body sensations Grief & self-care goals for next session	Death story #4 & group feedback Education on integrated memory Grief & self-care goals for next session
Session 5	Session 11
Pleasant-memory worksheet & pictures Working with emotions/thoughts/body sensations Grief & self-care goals for next session	Integrated-memories worksheet & pictures Grief & self-care goals for next session
Session 6	Session 12
Death story #3 & group feedback Working with emotions/thoughts/body sensations Grief & self-care goals for next session	Bringing the memory of the deceased forward in one’s life Participant accomplishments Grief & self-care goals for the future

Table 3. Recruitment

Category	N	Notes
Total potential participants	188 (%)
Not interested	12 (6.4%)	Was directly told that they weren’t interested
Contacted by lost to follow up after initial contact	33 (17.6%)	Would ask to call back at a different time, would call but then not answer; would tell me they would call back, but wouldn’t – I would call back and no answer
Could never contact	75 (39.9%)	Left VM’s, busy signal, mailbox full, sent e-mails, etc. never had any kind of response
Number not in service, clinic didn’t have a phone number, or wrong number	16 (8.5%)
Scheduled (came)	18 (9.6%)	1 was not eligible 1 had school and couldn’t make the group time
Scheduled (never came)	14 (7.4%)	They would sometimes keep rescheduling but never come, scheduled once, no-showed, and wouldn’t answer follow up calls.
Work/school conflicted with group time	9 (4.8%)
No longer with Polizzi Clinic	2 (1.1%)
Moved	4 (2.1%)	Some of these were people who gave the number of a residential home or treatment center they were staying at and had since left the facility
Didn’t speak English	3 (1.6%)
Too young	2 (1.1%)

Table 4. Participant enrollment and retention

Category	N	Notes
Individuals eligible	16/17	All but 1 who were assessed were eligible
Never showed up	3	We were able to continue to get data from 2, but never heard from a third after she said she couldn’t make the first session.
Lost to follow up	3	No phone or e-mail, no response to contact by text or call
Completers	10

Table 5. Demographics and participant characteristics

Variables		N	%
Age in years
N (Nmiss)		16 (0)
Mean±SD			34.75 ± 11.95
Min-Max			[19– 58]
Gender
Female		11	68.8
Male		3	18.8
Other/Non-binary		2	12.5
Race
White		12	75
Black		1	6.3
Hispanic		3	18.8
Relationship to primary decedent
Sibling		1	6.25
Spouse		2	12.5
Parent		6	37.5
Child		1	6.25
Grandparent		3	18.75
Other		3	18.75
Death unexpected
Yes		14	87.5
No		2	12.5
Family living at home
Yes		11	68.8
No		5	31.3
Health rate compared to others
Excellent		1	6.25
Very good		2	12.5
Good		5	31.25
Fair		3	18.75
Poor		5	31.25

Table 6. Descriptives and Wilcoxon Sign rank tests for questionnaire outcomes

	BGQ PRE	BGQ POST	ICG PRE	ICG POST	PHQ-2 PRE	PHQ-2 POST	GAD2 PRE	GAD2 POST	ISLES PRE	ISLES POST	INQ PRE	INQ POST
N	16	10	16	10	16	10	16	10	16	10	15	10
Mean	7.38	3.90	38.56	27.80	3.50	2.50	4.00	3.70	15.63	19.70	59.21	49.18
Std. Deviation	1.78	1.85	9.77	8.31	1.97	1.90	1.86	1.83	5.06	3.92	8.74	7.47
Minimum	4	1	24	13	0	0	1	0	7	13	45.00	34.29
Maximum	10	6	55	39	6	6	6	6	25	25	75.00	56.79
Median	7	4.5	38.5	28.5	3	2	4	4	14.5	20	57.86	50.89
N (post-pre)		10		10		10		10		10		10
Z value		−2.687		−1.99		−0.923		−0.566		−1.939		−2.68
p statistic		0.007		0.047		0.356		0.571		0.052		0.01

Figure 1. Change in grief severity as measured on clinician global impressions scale

Figure 2. Change in grief improvement as measured on clinician global impressions scale