Posttraumatic Stress Symptoms in People Who Have Lost a Loved One During the COVID-19 Pandemic: Risk Factors and the Effectiveness of Unsupervised Online Cognitive Behavioral Therapy

Abstract

This randomized-waitlist controlled trial investigates the association between saying goodbye to a deceased loved one and baseline posttraumatic stress disorder (PTSD) symptoms in Dutch people bereaved during the COVID-19 pandemic. Additionally, it assesses the effectiveness of unsupervised grief-specific online cognitive-behavioral therapy (CBT) on PTSD symptoms in this population. The study utilizes an existing dataset, with 65 participants randomly allocated to the online CBT group (N = 32) or the waitlist group (N = 33). Participants lost a loved one at least three months earlier during the pandemic and experienced clinically relevant levels of Prolonged Grief Disorder (PGD), PTSD and/or depression. Telephone interviews measured PGD, PTSD and depression symptoms at baseline (T1) and post-treatment/waiting (T2). PTSD symptoms were evaluated using the PTSD Checklist for DSM-5 (PCL-5), while the degree of saying goodbye was assessed with a single item at T1. Despite the expectation, no significant association was found between saying goodbye and baseline PTSD symptoms. In accordance with the expectation, the online CBT group exhibited significantly lower PTSD symptoms post-treatment than the waitlist group post- waiting, demonstrating a moderate/large effect size (η2 = .128). The study concludes that, contrary to expectations, saying goodbye may not significantly correlate with baseline PTSD symptoms in COVID-19-bereaved people. Unsupervised online CBT effectively reduces PTSD symptoms, offering clinical promise. Despite limitations, the study pioneers comprehensive CBT for pandemic-induced PTSD, advocating for replications to explore long-term effects and to compare unsupervised with supervised online CBT for enhanced clinical implementation.