A systematic review of internet-based cognitive behavioral therapy studies for prolonged grief disorder: Insights

Prolonged Grief Disorder, a multidimensional novel disorder, is creating an increased risk of suicide and lower functional status among caregivers. Retention is a significant issue in patient engagement and participation in grief intervention studies. Therefore, we examined the retention strategies based on the effectiveness of Internet-based Cognitive Behavioral Therapy (ICBT) for caregivers with Prolonged Grief Disorder.

We followed the PRISMA (2020) systematic review guidelines to search databases from 2000 to October 14, 2022. The three main concepts searched were grief, web-based, and familial caregivers. The included studies were conducted by the interventionists and had Prolonged Grief Disorder as a primary outcome. We matched the effectiveness of the studies with retention strategies to come to our conclusions.

In the six identified studies, female participation (70-96 %) was highest, with effect sizes ranging from 0.33 to 1.10. One study probed trust as a predictor for retention. The authors of all six studies experienced challenges regarding the inclusion and retention of male participants. Tailoring the feedback during therapy was a retention strategy followed by most researchers; however, it did not limit female participants from dropping out of studies. All six studies found it challenging to include and retain males in their studies.

These findings underscore the need for intervention studies based on effective retention strategies. This review demonstrates that ICBT studies should be task-oriented with trust-building strategies to address the gender-specific role differences among people. The suggestions will enable researchers to overcome the drawbacks seen in the reviewed studies and help uplift the ethnoracial equity and gender-specific disparities in PGD prevention studies.