Feasibility and efficacy of cognitive behavioural therapy for youths with parental support: a pilotstudy with a multiple baseline design.

In the Netherlands, every year thousands of children lose a family member in
the first degree (parent, brother or sister). Research has shown that these
children run a greater risk of subsequent psychological problems. Therefore,
early identification and treatment of children that are likely to get stuck in
processing their grief is desirable. Studies in children and adults show that
problematic grief can be distinguished from depression and anxiety. Also, in
adults it has been demonstrated that problematic grief calls for specific
(grief-oriented) interventions. Similar research has not yet been performed in
children. As a consequence it is likely that their problematic grief will not
be detected and treated timely and adequately. The present proposed research
project is aimed at bridging this gap.

The prime objective of this research project is to assess the feasibility of a
low-threshold, accessible, preventive cognitive-behavioural therapeutic
intervention with parental support for grieving children and their parents, and
to get a first impression of its efficacy.

A multiple baseline will be used. The study will start with a pre-measurement,
followed by baseline measurements, measurements at the end of every session and
a final post-measurement. Baseline measurements are done to determine the
baseline level of grief reactions and to exclude any changes in these reactions
before the intervention starts. Children will be randomly assigned to one of
three different baseline conditions with a duration of either 3,5 or 7 weeks,
during which they are asked to complete a short Grief Checklist assessing the
intensity of certain grief reactions. These grief reactions correspond to the
proposed (DSM V-) criteria for Complicated Grief (Prigerson et al, 2007)
Because the start of the intervention is not dependent on the baseline period,
alternative explanations for changes in experienced grief (like cyclic
influences and regression towards the mean) are less likely. The intervention
starts after the baseline period. During the intervention the child will
complete the Grief Checklist after each session. Also, at the end of every
session clients (i.e., child and parent(s)) and the therapist will complete a
number of questions regarding the feasibility of the session. The therapist
will complete this for both the sessions with the child and those with the
parent(s), whereas the child and parent will only complete these questions
after each of their own sessions. At the end of the complete intervention there
is one post-measurement (measurement 3).

The children will receive 8 sessions of individual cognitive behavioural
therapy; parents will receive 5 sessions of parental support.

The questionnaires ask only little time and effort from the participants and do
not pose any risk to them. Many of the instruments are used routinely in
everyday practice. Other instruments have been used extensively in research.
Moreover, the completion of questionnaires will be guided by specially trained
research assistants and special attention will be given to specific needs of
the participants. The named burdens and risks do not outweigh the benefits of
researching and developing an intervention aimed specifically at youths that
run a heightened risk of developing severe psychopathologies.