A new JAMA Psychiatry noninferiority trial by Komischke and colleagues involved researchers in Denmark, the Netherlands, and Australia. The study randomized 113 bereaved adults ages 65 and older to 12 weekly sessions of grief-focused CBT delivered either individually or in a group. Both formats followed the same sequence of active interventions: exposure, cognitive restructuring, and behavioural activation. Group sessions lasted two hours, while individual sessions lasted one hour.
Both formats produced large reductions in prolonged-grief symptoms, and group treatment was noninferior to individual CBT at six-month follow-up. Group treatment was also noninferior for secondary PTSD, depression, and anxiety outcomes. Dropout was 23% in the group condition and 19% in individual treatment. Important qualifications are that eligibility was based on clinically significant questionnaire scores rather than requiring every participant to have a formal prolonged-grief-disorder diagnosis, 81% of the sample were women, and there was no untreated control group. The trial therefore speaks most directly to delivery format, rather than independently establishing efficacy against no treatment.
Clinical Takeaway: Group delivery may extend the reach of grief-focused CBT without sacrificing clinical benefit, provided the group remains a structured treatment rather than becoming only a supportive discussion group. Preserve exposure to memories and reminders of the loss, cognitive work on guilt and catastrophic meanings, and behavioural re-engagement. For older adults, also assess hearing, mobility, cognitive, transportation, and technology barriers, as well as whether trauma complexity or difficulty disclosing in a group makes individual treatment more appropriate.