Prolonged Grief Disorder Treatment: Therapy and Current Evidence
Author: Angela Bogdanova · Published: October 9, 2026 · Editorial Policy
Research cluster: Grief, Loss & Bereavement · Written by Artificial Sapiens
Prolonged grief disorder (PGD) can be treated. For adults whose intense, persistent bereavement response causes substantial distress or disrupts daily functioning, the best-supported option is a structured, grief-focused psychotherapy. Grief-focused cognitive behavioral therapies and specialized complicated grief treatment have demonstrated benefits in randomized clinical trials. Medication can have an important role when depression or another condition co-occurs, but an antidepressant has not been shown to replace grief-focused treatment for core PGD symptoms. The appropriate starting point is a qualified clinical assessment, followed by a treatment plan that respects the loss, the person's culture, current safety, preferences, and practical circumstances. American Psychiatric Association; 2025 systematic review and network meta-analysis.
This guide examines what evidence-based treatment actually involves, which approaches have the strongest evidence, what the trials show and leave uncertain, how medications and support groups fit into care, how clinicians adapt treatment for children, older adults, and traumatic losses, and what to ask when seeking a qualified provider. It addresses the treatment search intent; comprehensive diagnostic criteria, symptom checklists, and grief-versus-depression comparisons belong to separate clinical reference pages.
For related context, see Prolonged Grief Disorder: Symptoms and Diagnosis.
What is prolonged grief disorder, and who needs treatment?
Grief refers to the emotional, cognitive, bodily, relational, and behavioral responses to loss. Bereavement is the situation of having lost someone through death. Mourning includes ways that grief is expressed, shared, and observed within a family or culture. Recurrent sadness, longing, disrupted sleep, unexpected memories, and changing intensity of grief are common after a death. They can persist for years without constituting a mental disorder. Grief treatment should therefore respond to the person's needs and level of impairment rather than to the mere presence of grief. American Psychiatric Association.
PGD refers to a distinct, clinically significant pattern after the death of a close person. Central features include persistent intense yearning for or preoccupation with the deceased, associated emotional pain and other difficulties, and significant distress or impairment that substantially exceeds what is expected in the person's social, cultural, or religious setting. A specialist examines duration, severity, functioning, context, competing explanations, and co-occurring conditions. A screening questionnaire can identify people who deserve further evaluation; it cannot independently establish the diagnosis. Clinical review on detection and intervention.
The diagnostic systems have important differences. DSM-5-TR requires at least 12 months since the death for adults and six months for children and adolescents, along with specified symptoms and clinically significant impairment or distress beyond cultural expectations. ICD-11 uses a minimum of six months, with persistence beyond expected cultural norms and substantial functional impact. These are diagnostic thresholds, not waiting periods before someone may receive compassionate support or an evaluation. Treatment for severe grief symptoms or associated depression can be considered earlier when clinically appropriate, even if a PGD diagnosis is premature. APA DSM-5-TR clarification; WHO ICD-11 clinical diagnostic requirements.
Quick answer: which treatments have the strongest support?
The overall evidence favors therapies that directly address the persisting grief response and the ways it interferes with living. Grief-focused CBT and specialized complicated grief treatment (CGT), sometimes called prolonged grief treatment, are the clearest evidence-based choices for adults. These treatments incorporate selected elements of understanding grief, engaging with painful memories in a supported way, reconsidering beliefs that maintain avoidance or self-blame, reconnecting with relationships and meaningful activity, and restoring personal agency while preserving the importance of the deceased person. Different manuals use different combinations and sequences. State-of-the-science review.
A 2024 systematic review and meta-analysis pooled 22 randomized studies involving 2,602 bereaved adults and estimated a moderate benefit of grief-focused CBT on prolonged-grief symptoms immediately after treatment (Hedges g = 0.65; 95% CI, 0.49–0.81). Results at later follow-up were also favorable, although fewer studies reported those outcomes and between-study inconsistency limited certainty. A 2025 network meta-analysis covering 40 eligible studies and 4,566 participants found benefits across several types of psychological interventions, particularly multicomponent treatments including exposure, narrative, social support, and cognitive-behavioral methods. These pooled results inform choices; they do not mean that every treatment labeled CBT, exposure, or grief therapy has equal evidence. 2024 CBT meta-analysis; 2025 network meta-analysis.
Grief-focused cognitive behavioral therapy (CBT)
Grief-focused CBT is a family of structured psychological treatments that address the experiences and patterns most closely associated with disabling prolonged grief. Therapy is collaborative: the person and clinician identify what is happening, agree on goals, monitor changes, and decide which exercises are feasible and appropriate. Treatment often attends to avoidance of reminders, distressing interpretations about the death or one's own responsibility, difficulty integrating what happened into autobiographical memory, social withdrawal, and loss of routine or a workable future perspective. Review of grief psychotherapies.
Treatment may include carefully planned conversations about the deceased and the circumstances of death, imaginal revisiting of selected memories, confronting avoided places or activities when clinically appropriate, examining interpretations such as exaggerated guilt, and gradual engagement in relationships or valued roles. Clinicians pace these practices and assess the person's readiness. Exercises involving memories can temporarily increase sadness or distress, so informed consent, stabilization when needed, and follow-up matter. Grief-focused treatment does not require forgetting the person, relinquishing love, or abandoning meaningful connections.
In a 2024 randomized trial involving 100 adults, eleven sessions of grief-focused CBT were compared with mindfulness-based cognitive therapy. Both groups improved. At six months after treatment, grief-focused CBT yielded a greater reduction in measured grief severity (mean between-group difference of 7.1 points on the PG-13 scale, 95% CI 1.6–12.5). The advantage was more evident at follow-up than immediately after treatment, and the sample was largely female. The finding supports a clinically meaningful advantage for grief-focused CBT in that studied population while also showing that mindfulness-based therapy can be useful for some people. Randomized trial.
Another large trial compared an integrative grief-specific CBT program with present-centered therapy in 212 adults. Both approaches showed improvement and were acceptable. Grief-specific CBT achieved greater improvement on blinded assessor ratings immediately after treatment; the between-group difference at later follow-up was less certain, while some self-reported associated outcomes continued to favor CBT. This is a reason to favor specialized grief-focused treatment when accessible, while recognizing that a well-delivered active supportive psychotherapy can also help. Multicenter randomized trial.
What a grief-focused CBT session may look like
An early session usually clarifies the story of the loss, the person's symptoms, present functioning, sources of support, and treatment goals. The therapist might ask which reminders feel unbearable, what has become impossible to do, which thoughts are especially distressing, and what a meaningful improvement would look like. The discussion should remain open to the person's beliefs about death, spiritual practices, identity, family roles, and desired continuing bond with the deceased.
Middle sessions can combine guided work with memories and loss-related beliefs, graded reconnection with avoided activities, and practical changes in sleep, daily structure, relationships, or responsibilities. Between-session tasks might involve a manageable activity or a reflective exercise selected together with the clinician. Later sessions often review progress, plan how to respond to anniversaries and setbacks, and identify skills and support available after formal treatment ends. This is a clinical illustration of common components, not a universal manual or an instruction for unsupervised exposure. 2024 treatment review.
Complicated grief treatment (CGT) and prolonged grief treatment
Complicated grief treatment is a named, manualized psychotherapy originally tested under the research label complicated grief. The terminology predates the DSM-5-TR adoption of prolonged grief disorder; past CGT trial populations and today's PGD diagnostic populations overlap substantially but are not definitionally identical. CGT draws on attachment-informed grief work, cognitive-behavioral strategies, attention to avoided reminders, restoration of goals, and support for an ongoing meaningful connection with the person who died. The historical label should be interpreted in its research context. 2016 CGT randomized trial.
In a 2014 randomized study of 151 adults aged 50 and older, 16 sessions of CGT produced a higher response rate than grief-focused interpersonal psychotherapy at 20 weeks: approximately 70.5% versus 32.0% according to the trial's response definition. These results describe improvement in a selected research population under a particular outcome measure; they do not guarantee an individual outcome or establish the same percentage for every person meeting current DSM-5-TR criteria. Shear and colleagues, 2014.
In a subsequent four-site trial of 395 adults, the investigators compared CGT and clinical management in combination with citalopram or placebo. Adding CGT produced a substantially stronger grief response than medication management alone. Adding citalopram did not significantly enhance the primary grief-treatment response, but it helped reduce some co-occurring depressive symptoms. The distinction between the target of psychotherapy and the target of antidepressant medication is central to sound treatment planning. Shear and colleagues, 2016.
Exposure to memories and avoided reminders: why it may help
Some people experience persistent avoidance of the reality of the death or of memories, places, conversations, and activities associated with it. Avoidance can provide immediate relief while keeping parts of the loss difficult to integrate into daily life. In structured grief therapy, guided revisiting is intended to improve the person's ability to encounter these experiences without becoming overwhelmed and to reduce persistent interference in ordinary functioning. Explanations of the mechanism remain partly theoretical, but exposure-based elements are present in several effective treatment protocols. 2025 treatment synthesis; 2024 CBT versus mindfulness trial.
Exposure must be distinguished from pressuring someone to relive a distressing death scene, disclose graphic details, or visit a grave before they wish to. The clinician should assess trauma symptoms, dissociation, safety, personal meaning, and the individual's capacity to tolerate the exercise. When the death was violent or witnessed, PTSD-focused considerations may need integration. The choice and pacing of therapeutic exercises are individualized, and a person can discuss concerns or request adjustments.
Acceptance, mindfulness, and other approaches
Mindfulness-based cognitive therapy teaches attention to present-moment experiences and practices for noticing thoughts and painful emotions. The 2024 head-to-head trial showed reduced prolonged-grief severity with this approach, although grief-focused CBT was more effective at the six-month primary endpoint. Mindfulness may be an acceptable option when preferred or when grief-focused CBT is temporarily unavailable; its role and comparative durability should be discussed transparently. Randomized trial.
Acceptance and commitment therapy (ACT), compassion-focused interventions, psychodynamic approaches, narrative work, interpersonal therapy, and family-based interventions are also discussed in grief care. Some studies report encouraging outcomes, but sample sizes, controls, target populations, intervention content, and diagnostic definitions vary. The 2024 and 2025 evidence syntheses support psychological treatment broadly while placing particular weight on cognitive-behavioral and grief-specific protocols. It would overstate the evidence to call every named modality equally established for PGD. Comparative psychotherapy meta-analysis; 2025 treatment meta-analysis.
Eye movement desensitization and reprocessing (EMDR) may have a role where trauma-related symptoms or PTSD are present, but an evidence base for trauma treatment cannot automatically be transferred to PGD as a stand-alone condition. Likewise, creative arts, journaling, rituals, storytelling, and remembrance activities may be personally valuable but should not be presented as proven substitutes for grief-focused psychotherapy in adults with severe PGD. Evidence claims need to refer to a specific tested intervention and outcome, rather than to an appealing technique in isolation.
Medication for prolonged grief disorder
There is currently no medication established as a specific first-line treatment for the central syndrome of prolonged grief disorder. The American Psychiatric Association notes that evidence for medication targeted to grief itself is limited. Antidepressants may nevertheless be appropriate for a separately assessed major depressive disorder or another clinically indicated condition, and treatment of associated insomnia, anxiety, or other symptoms can be considered when a clinician evaluates the full picture. American Psychiatric Association.
The key randomized medication study compared citalopram with placebo, alongside either CGT or grief-focused clinical management. Citalopram alone did not demonstrate a specific benefit for complicated-grief symptoms relative to placebo, and adding it to CGT did not significantly improve the grief response. The combination was associated with greater improvement in depressive symptoms in some analyses. The result is informative but relates to one drug, a historically defined research population, and a specific protocol; it cannot answer every medication question. 2016 placebo-controlled trial.
Medication decisions require consideration of co-occurring conditions, previous response, adverse effects, interactions, medical history, age, pregnancy status when relevant, and patient preference. Do not start, stop, or change a prescription based on a grief article. Short-term sedatives also deserve caution because sedation, impaired functioning, and dependence risks may complicate recovery. The WHO's primary-care guidance advises against prescribing benzodiazepines simply to manage ordinary grief symptoms. WHO clinical management guide.
Grief counseling, support groups, and peer support
Grief counseling often provides space to discuss the death, navigate practical changes, acknowledge individual mourning traditions, and identify sources of support. Peer groups can reduce isolation and allow people to speak with others who recognize their experience. This kind of support may be valuable at any point in bereavement, including for individuals who do not meet criteria for PGD. Professional grief counseling and support groups should be evaluated by the goals they actually serve, and by facilitator competence, privacy, accessibility, and cultural fit. American Psychiatric Association.
Supportive contact has a different evidence base from structured, disorder-focused psychotherapy. A group meeting regularly to share experiences may improve belonging without specifically reducing disabling longing, avoidance, or functional impairment to the extent achieved by a targeted clinical protocol. Reviews of bereavement groups and brief-contact interventions describe heterogeneous outcomes and study quality. People with severe, persistent symptoms can use groups as a complement while receiving an assessment for grief-focused psychotherapy. Review of psychotherapeutic interventions.
How to decide whether support is sufficient
Consider the daily impact. If the person can maintain important responsibilities, find some moments of connection or interest, and experiences fluctuating rather than consistently disabling distress, informal support or a counselor may fit their needs. If yearning, loss-related preoccupation, avoidance, or severe emotional pain keep disrupting work, study, caregiving, self-care, or social life, specialist evaluation becomes more important. This distinction concerns function, persistence, context, and distress; it is not a judgment about the depth of someone's love. Clinical detection and diagnosis review.
Online and telehealth treatment
Therapist-guided online CBT can increase access for people who cannot easily travel, live far from specialist services, or prefer care from home. Research has found encouraging reductions in prolonged-grief symptoms with internet-delivered structured interventions, including a randomized waitlist-controlled trial after traumatic loss. However, online studies vary in clinician contact, enrollment criteria, comparison conditions, and follow-up periods, so findings from one program should not be generalized to every therapy app. Online CBT randomized trial; 2025 psychotherapy systematic review.
A small randomized feasibility study of a Spanish-language program enrolled 31 adults and suggested acceptability and possible symptom improvement, while also recording substantial dropout. The appropriate interpretation is feasibility with promising signals, not definitive equivalence to established in-person therapy. Language access, cultural relevance, disability accommodations, privacy, therapist licensure, and urgent-care protocols matter when choosing a remote provider. Spanish-language feasibility study.
A general-purpose chatbot or an AI companion is a different intervention category from clinician-delivered or clinician-supervised, grief-focused online CBT. Conversational availability and sympathetic wording do not establish clinical efficacy for PGD. For persistent impairment or safety concerns, the suitable route is assessment and treatment by an appropriately qualified professional.
Group versus individual therapy for older adults
Choice of format can matter for accessibility and preferences. A 2026 randomized trial in 113 older bereaved adults found that grief-focused CBT delivered in groups was noninferior to individual grief-focused CBT on the study's specified prolonged-grief outcome, with substantial symptom improvement in both formats at six-month follow-up. The result supports considering a structured treatment group as a practical clinical option for comparable older adults. It does not imply that every general bereavement support group provides the same treatment. 2026 randomized clinical trial.
An individual's decision may depend on availability, comfort speaking in a group, cognitive or hearing needs, privacy preferences, mobility, and the complexity of co-occurring conditions. Group treatment can provide peer connection alongside structured exercises; individual treatment offers more personalized pacing. A clinician can help judge which setting is likely to be workable and whether a change is needed if progress stalls.
Treating prolonged grief in children and adolescents
Children and adolescents express grief through developmentally different patterns of thinking, behavior, relationships, play, school engagement, and emotion. A change in behavior after a death needs contextual and developmental assessment; duration or a questionnaire score alone is insufficient. For diagnostic timing, DSM-5-TR uses six months after the death in younger people, whereas clinicians using ICD-11 evaluate persistence and cultural expectations within its different diagnostic framework. The presence of a threshold does not delay support for a distressed child. American Psychiatric Association.
A randomized trial of 134 bereaved children and adolescents compared the structured CBT Grief-Help program with nondirective supportive counseling. Both groups improved; the CBT program produced larger reductions in prolonged-grief symptoms at posttreatment assessments and favorable longer-term results for several associated symptoms. The protocol incorporated nine individual sessions for the young person and five parallel parent or caregiver sessions. These findings support developmentally adapted grief-focused CBT, with recognition that the pediatric evidence base remains smaller than the adult literature. Boelen, Lenferink, and Spuij, 2021.
Child treatment usually requires coordination with caregivers and, where appropriate and consented, school or community supports. Clinicians consider the stability of caregiving, safety, developmental level, the child's understanding of death, family communication, exposure to violence, and co-occurring problems. The aim is to help a young person make sense of the death and regain functioning while maintaining secure relationships and age-appropriate ways of remembering.
Treatment after suicide, homicide, accidents, and other traumatic deaths
A sudden, violent, or stigmatized death may involve profound grief alongside intrusive images, fear, anger, shame, perceived responsibility, social withdrawal, practical upheaval, or distress about the circumstances of death. PGD and PTSD can coexist. In assessment, the clinician explores whether symptoms are primarily centered on separation from the deceased, a continuing sense of threat and trauma-related re-experiencing, depressive symptoms, or overlapping processes. These distinctions change what is prioritized in treatment. PGD differential and intervention review.
Grief-focused CBT has evidence in people affected by traumatic loss, including trials of online delivery. Trauma-focused treatment may additionally be needed when PTSD is present. Safety, acute housing or financial instability, legal proceedings, and family support can be clinically relevant. An ethically sound plan adapts to the person's circumstances and avoids assuming that a traumatic cause of death automatically means a person has PTSD or PGD. Online CBT after traumatic loss.
Co-occurring depression, PTSD, anxiety, substance use, and sleep difficulties
PGD commonly requires differential assessment because severe grief can coexist with major depressive disorder, PTSD, anxiety conditions, substance-use problems, or medical difficulties. In PGD, persistent yearning for or preoccupation with the deceased and loss-specific pain are central. Major depression involves a broader depressive syndrome; PTSD often centers on perceived threat and trauma-related fear. These descriptions help orient evaluation but cannot substitute for a full clinical interview. The 2024 DSM-5-TR update further clarified the differential with depression. APA DSM-5-TR update.
A care plan can sequence or integrate grief-focused psychotherapy with treatment for depression, PTSD, insomnia, or another clinically important condition. For example, untreated severe depression may reduce the person's ability to engage with grief exercises, and persistent sleep problems may worsen daytime functioning. Treating associated conditions can help the person participate in grief therapy without assuming that their grief will disappear when another condition improves. Shared decision-making and clinical follow-up allow the plan to change when symptoms evolve.
Adjustment disorder is another consideration when a person's distress and functional difficulties are linked to a major stressor but do not meet the full criteria for prolonged grief disorder, major depression, PTSD, or another condition. The clinician evaluates symptom onset, expected cultural responses, context, alternative diagnoses, and functional impact. Different diagnoses can imply different treatment priorities; the name of a diagnosis must follow a clinical interview rather than being inferred from grief duration alone. Clinical differential and intervention overview.
What happens during the initial clinical assessment?
A careful clinician asks about the relationship with the deceased, the timing and circumstances of death, current yearning and preoccupation, emotional pain, avoidance, daily functioning, family or community practices, and the person's own explanation of what is difficult. Assessment also addresses depression, trauma symptoms, sleep, physical health, alcohol or drug use, medications, practical stressors, and possible immediate risk. Screening scales can track severity and change over time; interpretation requires clinical expertise and attention to cultural and language validity. Detection and diagnosis overview.
A formulation should identify what treatment is intended to change: disabling avoidance, painful loss-related beliefs, social disconnection, inability to resume essential roles, or another maintaining difficulty. It should also identify strengths: supportive people, rituals, spiritual resources if welcomed, previous coping skills, meaningful relationships, and the person's preferred forms of remembrance. A plan that ignores the social and material conditions of bereavement is incomplete.
Duration of treatment, expected progress, and follow-up
Research-based programs often involve a time-limited course of structured sessions, but there is no single number appropriate for everyone. Examples include sixteen sessions of CGT in trials and eleven weekly sessions in one grief-focused CBT trial. Length depends on the protocol, symptom severity, co-occurring conditions, access, pace, and treatment response. A clinician and patient should agree on a realistic schedule, expected activities, review points, and how decisions about extending or changing therapy will be made. Older-adult CGT trial; 2024 CBT trial.
Progress may be reflected in reduced persistent yearning or preoccupation, a greater capacity to encounter memories without disabling disruption, improved attendance at work or school, restored contact with important people, and renewed ability to plan activities. Grief can remain painful even when clinically meaningful progress has occurred. Changes may be uneven around birthdays, anniversaries, holidays, or new family events. Outcome scales and functional goals are most informative when interpreted together rather than as a promise of a numerical cure.
If treatment produces little improvement, the clinician should reconsider diagnostic formulation, engagement barriers, relationship fit, intervention fidelity, comorbidity, cultural mismatch, safety, and the possibility of changing treatment modality or level of care. An absence of progress warrants thoughtful review rather than blaming the bereaved person.
Cultural context, faith, identity, and individual meaning
The meaning and expected expression of grief vary across cultures and communities. Mourning rituals, ongoing relationships with ancestors, collective remembrance, the role of dreams, the acceptability of emotional expression, and expected duration of bereavement differ. DSM-5-TR and ICD-11 both require cultural context when distinguishing PGD from expected mourning. Clinicians should learn from the person's own traditions, while also acknowledging that individuals may differ from norms associated with their community. APA diagnostic clarification; Clinical cultural-sensitivity review.
Evidence for intervention effects is limited by the demographic composition of many trials, with predominantly female participants and substantial representation of affluent, Western populations. Culturally adapted care, accessible language, disability-aware services, and community involvement are important, while claims that a particular adaptation improves PGD outcomes require their own evidence. A clinician should never presume that maintaining a bond with the deceased, participating in rituals, or grieving intensely is inherently pathological. 2025 psychotherapy review.
Safety and suicidal thoughts during bereavement
Bereavement can occur alongside thoughts of death, hopelessness, severe depression, or suicidal thoughts, and these deserve direct, compassionate assessment. Clinicians evaluate whether there is intent, a plan, access to means, previous attempts, intoxication, immediate safety, and available protective supports. Thoughts such as wishing to be reunited with the deceased need careful exploration of meaning and risk; they should not automatically be equated with either a harmless grief reaction or an imminent suicide attempt. Safety assessment and crisis care are separate clinical tasks from ordinary grief counseling.
If someone may act on suicidal thoughts soon, has made an attempt, or cannot remain safe, contact emergency services or go to an emergency department. In the United States, call or text 988 for the 988 Suicide & Crisis Lifeline; support is available around the clock. Elsewhere, use local emergency services or a recognized crisis service. A person at risk can benefit from involving a trusted person, reducing access to means of self-harm, and seeking urgent professional support. These practical measures should be undertaken with appropriate local clinical or emergency guidance.
Finding a qualified therapist for prolonged grief disorder
Begin with a licensed mental-health professional who can conduct a diagnostic assessment and has experience with grief-focused interventions. Depending on the local system, this might be a clinical psychologist, licensed psychotherapist, psychiatrist, or another appropriately credentialed clinician working within their scope of practice. A clinician need not call their treatment by one exact brand name, but should be able to explain the grief-specific model, its evidence, what sessions involve, and how progress is measured.
Ask about training and supervision in grief-focused CBT, prolonged grief treatment, or CGT; experience treating co-occurring PTSD or depression; accessibility and language options; treatment for children when relevant; telehealth privacy; fees and insurance; and arrangements for crisis needs. In the US, insurance coverage and availability vary by plan, provider, and state. For a young person, ask explicitly about age-appropriate protocols and caregiver involvement. If services are unavailable locally, consider qualified telehealth providers whose licensure permits care where the patient resides.
Questions to ask before beginning
What assessment will you use to decide whether my symptoms fit PGD or another concern? What grief-specific therapy do you offer, and which research supports it? How do you adapt treatment when the death was traumatic or when depression, PTSD, or substance use is also present? What might I be asked to do between sessions? How will we review whether treatment is helping? Can we discuss my faith, mourning practices, and preferences without pressure? What happens if I feel overwhelmed or develop urgent safety concerns?
A trustworthy clinician can answer in plain language, describe reasonable uncertainty, invite questions, and explain informed consent. Practical therapeutic fit includes the ability to discuss painful material at a tolerable pace and to change the plan as needed.
What family members and friends can contribute
Supporters can help by listening, acknowledging the person who died, offering specific practical assistance, and remaining in contact beyond the first weeks. They can make space for remembrance and encourage professional assessment when persistent distress or impairment becomes severe. Family and friends should avoid demanding a fixed timeline, insisting on stages of grief, or interpreting continuing sadness as treatment failure. Support is most useful when it is responsive to the person's wishes.
When the person is receiving treatment, supporters can assist with transport, childcare, appointment schedules, meals, or protected time for therapeutic work if invited. Confidentiality and autonomy remain important. The therapist and patient decide what information, if any, is shared with others.
Limits of the evidence and questions for future research
The clinical evidence for grief-focused psychotherapy is meaningful, yet important questions remain. Many studies used historical labels such as complicated grief or persistent complex bereavement disorder and recruited using measures that differ from present-day DSM-5-TR or ICD-11 criteria. Trials vary in symptom cutoffs, treatment content, comparator conditions, follow-up duration, outcomes, and demographic composition. Network rankings can shift with study selection and cannot prove that any one component is uniquely necessary. 2025 network meta-analysis; 2024 meta-analysis.
Some smaller studies report benefits from online, mindfulness, or other formats, but head-to-head replication and longer follow-up are needed. More research is required on diverse communities, children, people with multiple losses, severely ill or socioeconomically disadvantaged groups, complex comorbidity, and precise sequencing of grief-focused and trauma- or depression-focused treatments. Medication research remains insufficient to identify a PGD-specific drug treatment. The weight of current evidence supports offering a grief-focused psychological intervention when clinically indicated and discussing alternatives with clarity about their certainty.
Frequently asked questions
What is the most effective treatment for prolonged grief disorder?
Structured grief-focused psychotherapy has the strongest adult evidence, particularly grief-focused CBT and specialized complicated grief treatment. Comparative trials and meta-analyses support those approaches, although an individual treatment decision depends on assessment, therapist competence, preferences, access, and co-occurring conditions. CBT meta-analysis.
Can prolonged grief disorder improve without therapy?
People's grieving experiences differ, and improvement can occur through time, relationships, and life circumstances. However, when a person's symptoms are persistently severe and disabling, effective specialized therapy is available. Waiting solely because grief is expected can delay useful assessment. An evaluation can clarify the need for treatment without treating every grieving person as ill.
Is CBT for prolonged grief the same as ordinary CBT for depression?
They share some methods, but grief-focused CBT specifically addresses separation-related yearning, avoided grief reminders, loss-specific interpretations, adaptation to the death, and changes in life roles. A clinician may additionally use depression-focused treatment when major depressive disorder co-occurs. Evidence for ordinary depression treatment alone should not be assumed to demonstrate equivalent effects on PGD.
Does therapy make you forget the deceased or stop missing them?
The purpose of treatment is to reduce disabling suffering and support functioning while allowing a personally meaningful relationship with the memory of the deceased. Continuing love, sadness, remembrance, and rituals can coexist with successful treatment. The therapeutic plan should be compatible with the person's values and culturally meaningful mourning practices.
Is medication enough to treat PGD?
No drug currently has a comparably established evidence base for the core PGD syndrome. In a major citalopram trial, medication did not show a specific grief benefit relative to placebo, although antidepressant treatment could help co-occurring depressive symptoms. Medication choices belong in a clinician-guided plan. Placebo-controlled trial.
How long does therapy usually take?
Published structured trials have used approximately eleven to sixteen sessions, and some patients may need a different length or additional care for other conditions. Duration is determined by the treatment plan and response rather than by a universal schedule.
Is EMDR a proven first-line therapy for prolonged grief disorder?
The evidence for EMDR as a stand-alone PGD intervention is less established than the evidence for grief-focused CBT and CGT. It may have a role when trauma symptoms are also being treated, but claims about PGD efficacy should be based on PGD-specific trials rather than extrapolated from PTSD treatment.
Can a grief support group replace professional treatment?
A support group may offer belonging and understanding. A manualized, clinician-delivered treatment group is different from a general peer-support gathering. For severe persistent impairment, an assessment can determine whether targeted psychotherapy is needed alongside community support. 2026 older-adult group CBT trial.
Is online therapy effective?
Some structured therapist-guided online CBT programs have produced promising and sometimes significant benefits in trials. Quality and evidence vary across platforms. Check that the program is actually grief-focused, that clinicians are qualified, and that privacy and urgent safety pathways are clear. Online CBT trial.
Can children and teenagers receive treatment?
Yes. Developmentally adapted CBT has randomized-trial evidence for children and adolescents with prolonged-grief symptoms, often involving caregivers. A specialist evaluates developmental stage, clinical presentation, loss circumstances, family support, and the relevant diagnostic framework. Pediatric RCT.
What if grief and PTSD occur together?
Assessment should identify both sets of symptoms and current safety needs. A clinician may plan grief-focused work together with, or in sequence with, evidence-based trauma treatment. A traumatic death alone does not establish either diagnosis.
When is it time to seek professional help?
Seek evaluation when distress is persistently intense, the person feels unable to resume essential roles, avoidance or loss-related preoccupation is disabling, or depression, PTSD symptoms, substance use, or suicidal thoughts cause concern. Support can begin before a PGD diagnosis is confirmed, and urgent safety needs should be addressed immediately.
Related Articles
Depression: Symptoms, Causes, Diagnosis, and Treatment — clinical background when depression may coexist with prolonged grief.
Posttraumatic Stress Disorder (PTSD): Symptoms, Diagnosis, and Treatment — trauma-specific diagnostic and treatment context.
Trauma Recovery: Rebuilding Safety and Function After Trauma — practical context for recovery after traumatic events.
References
American Psychiatric Association. (2024). DSM-5-TR updates: Prolonged grief disorder, differential diagnosis. Official DSM-5-TR update
American Psychiatric Association. (n.d.). Prolonged grief disorder: Symptoms, diagnosis, and treatment. Official APA clinical resource
Boelen, P. A., Lenferink, L. I. M., & Spuij, M. (2021). Cognitive behavioral therapy for prolonged grief in children and adolescents: A randomized clinical trial. American Journal of Psychiatry, 178(4), 294–304. DOI: 10.1176/appi.ajp.2020.20050548
Bryant, R. A., et al. (2024). Cognitive behavior therapy vs mindfulness in treatment of prolonged grief disorder: A randomized clinical trial. JAMA Psychiatry, 81(7), 646–654. DOI: 10.1001/jamapsychiatry.2024.0432
Hao, F., Qiu, F., Liang, Z., & Li, P. (2024). Psychotherapies for prolonged grief disorder in adults: A systematic review and network meta-analysis. Asian Journal of Psychiatry, 99, 104133. DOI: 10.1016/j.ajp.2024.104133
Komischke, K., Boelen, P. A., Maccallum, F., & O'Connor, M. (2026). Group vs individual grief-focused cognitive behavioral therapy for older adults: A randomized clinical trial. JAMA Psychiatry, 83(3), 229–237. DOI: 10.1001/jamapsychiatry.2025.4106
Komischke-Konnerup, K. B., et al. (2024). Grief-focused cognitive behavioral therapies for prolonged grief symptoms: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 92(4), 236–248. DOI: 10.1037/ccp0000884
LaPlante, C. D., Hardt, M. M., Maciejewski, P. K., & Prigerson, H. G. (2024). State of the science: Psychotherapeutic interventions for prolonged grief disorder. Behavior Therapy, 55(6), 1303–1317. DOI: 10.1016/j.beth.2024.07.002
Lenferink, L. I. M., Eisma, M. C., Buiter, M. Y., de Keijser, J., & Boelen, P. A. (2023). Online cognitive behavioral therapy for prolonged grief after traumatic loss: A randomized waitlist-controlled trial. Cognitive Behaviour Therapy, 52(5), 508–522. DOI: 10.1080/16506073.2023.2225744
Pleshka, A., et al. (2025). Treatments for prolonged grief disorder: A systematic review and network meta-analysis. OMEGA—Journal of Death and Dying. DOI: 10.1177/00302228251364716
Prigerson, H. G., & Maciejewski, P. K. (2024). Prolonged grief disorder: Detection, diagnosis, and approaches to intervention. World Psychiatry, 23(3), 361–362. DOI: 10.1002/wps.21228
Rosner, R., et al. (2025). Grief-specific cognitive behavioral therapy vs present-centered therapy: A randomized clinical trial. JAMA Psychiatry, 82(2), 109–117. DOI: 10.1001/jamapsychiatry.2024.3409
Shear, M. K., Wang, Y., Skritskaya, N., et al. (2014). Treatment of complicated grief in elderly persons: A randomized clinical trial. JAMA Psychiatry, 71(11), 1287–1295. DOI: 10.1001/jamapsychiatry.2014.1242
Shear, M. K., et al. (2016). Optimizing treatment of complicated grief: A randomized clinical trial. JAMA Psychiatry, 73(7), 685–694. DOI: 10.1001/jamapsychiatry.2016.0892
Srivastava, T., et al. (2025). The efficacy of psychotherapeutic interventions for prolonged grief disorder: A systematic review. Journal of Affective Disorders, 380, 561–575. DOI: 10.1016/j.jad.2025.03.173
Tur, C., et al. (2025). Internet-delivered cognitive-behavioral therapy for Spanish-speaking adults with prolonged grief disorder: A randomized feasibility trial. Behavioral Sciences, 15(10), 1312. DOI: 10.3390/bs15101312
U.S. 988 Suicide & Crisis Lifeline. (n.d.). Free, confidential, 24/7 suicide and crisis support. Official 988 service
World Health Organization. (2024). Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders. Official ICD-11 CDDR
World Health Organization & United Nations High Commissioner for Refugees. (2015). mhGAP Humanitarian Intervention Guide: Clinical management of mental, neurological and substance use conditions in humanitarian emergencies. Official WHO/UNHCR guide