Accelerated Resolution Therapy for Early Maladaptive Grief: A Clinical Trial

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PROJECT SUMMARY/ABSTRACT Maladaptive grief negatively impacts 25-40% of older adult family caregivers of persons with a serious chronic illness, with adverse health outcomes including increased morbidity and mortality, reduced independence, and diminished immune function.1-4 Losses associated with aging, such as the death of multiple close family and friends, are highly traumatic and contribute to the devastating impact of maladaptive grief among older adults.8,10 Brief, effective interventions that address maladaptive grief early in the grief trajectory are urgently needed. Accelerated Resolution Therapy (ART) is an evidence-based treatment for post-traumatic distress in civilians and veterans14-17 that may be useful in alleviating maladaptive grief prior to bereavement and could prevent prolonged, complicated grief following bereavement. We are proposing to test the efficacy of ART, a low-risk, brief therapy with a strong theoretical rationale for treatment success in maladaptive grief and supported by the promising results of our recently completed preliminary trial (R21AG056584). Additional aims of the study are to examine changes in cognitive appraisal and integration of loss following ART using a mixed methods approach and to evaluate personal, social, and psychological factors predictors of response. During the proposed double blinded, randomized, controlled two arm clinical trial, 472 older adult family caregivers from two different geographic locations will receive either ART or an educational program that is matched for time and attention. Each participant will receive four sessions of either the ART intervention or the control intervention. Data collection will occur at screening/enrollment (T1), at the end of the 4-session intervention period (T2) and at 6-months (T3) and 12-months post bereavement (T4). A subgroup of 20 participants randomly assigned to ART will participate in semi-structured interviews to enhance understanding of cognitive appraisal and integration of loss. This trial will provide critical information on the efficacy of the ART intervention as a potential first-line treatment option for pre-loss grief and preventative option for complicated grief and contribute new information about characteristics of individuals most likely to benefit from ART.