GROw, an Internet-delivered Cognitive-Behavioral Therapy (iCBT) for Adults with Prolonged Grief Disorder (PGD)

Resumen

Losing a loved one is a painful process with physical, psychological, and social consequences characterized by feelings of longing and regret that usually diminish over time. However, between 9.8 and 21.5% of bereaved adults are at risk of developing Prolonged Grief Disorder (PGD), and the SARS-CoV-2 coronavirus (COVID-19) has made disturbed grief a major public health concern worldwide. There are effective treatments for PGD, but this does not ensure that the treatments reach the people who need them. Internet-delivered cognitive-behavioral therapies (iCBTs) make it possible to reach people who need therapy, and they are cost-effective and clinically effective. The main aim of this thesis was to explore the feasibility of GROw, a novel iCBT developed in the Spanish language for adults with prolonged grief disorder (PGD). The secondary aim of this thesis was to explore the potential effectiveness of GROw in treating grief-related symptoms. Based on these aims, the present doctoral thesis is divided into four chapters: Chapter one presents a literature review of all the published studies that have tested an Internet-based treatment for PGD using randomized clinical trial study designs. This chapter provides a synthesis of the characteristics and effects of each intervention, and it concludes that Internet-based treatments have promising results in improving grief-related symptomatology. Chapter two presents a multiple-baseline single-case experimental study with six participants that explored the feasibility (usability and satisfaction) and potential effectiveness of GROw, concluding that participants reported high usability and satisfaction with GROw, which showed strong potential in treating grief-related symptomatology. Chapters three and four present the study protocol and results of a randomized feasibility trial study that compared the GROw program and the same intervention delivered face-to-face through videoconference. The results showed that GROw was feasible and well-accepted in terms of adherence, preferences, expectations, satisfaction, and qualitative opinions about the usefulness of the intervention. In addition, GROw showed strong potential in treating grief-related symptomatology, compared to the same intervention delivered face-to-face through videoconference. The results obtained in both the multiple-baseline single-case experimental study and the randomized feasibility trial study recommend continuing to investigate GROw by scaling up the treatment with larger samples and more complex designs such as randomized controlled trials.