Online CBT for bereaved youth due to a traffic accident

Children and adolescents who lose a loved one are at risk of developing
symptoms of Prolonged Grief Disorder (PGD), posttraumatic stress disorder
(PTSD), and depression. Deaths due to a traffic accident involve unique
features that might impose more traumatic stress on bereaved youths next to the
experience of the death itself, such as attention from the media and dealing
with authorities. Consequently, detection and adequate intervention of
psychological symptoms for this at-risk group of bereaved youths is important.
An intervention that has shown to be effective in reducing symptom-levels of
PGD, PTSD, and depression for bereaved children is Grief-Help; a face-to-face
grief-specific cognitive-behavioral therapy (CBT). CBT aims to change three
core processes considered to be crucial in the development and persistence of
PGD: 1) the insufficient integration of the separation in the autobiographical
memory, 2) maladaptive beliefs and misinterpretations of grief, and 3)
avoidance behavior. For non-grief related psychological symptoms, there is
evidence that online formats of CBT can be effective for youth, which have
important benefits compared to face-to-face formats, such as lower costs and
higher accessibility. In the current study, the potential effectiveness of
online grief-specific CBT (i.e., an online format of Grief-Help) will be
studied in children and adolescents bereaved due to a traffic accident. The
primary hypothesis is that undergoing the online CBT co-occurs with stronger
changes in symptom-levels of PGD when compared to a baseline-period with no
treatment. Furthermore, we expect that the children and adolescents will have
similar symptom-levels of PTSD and depression before and after the
baseline-period, and lower symptom-levels of PTSD and depression after
treatment than before treatment (i.e., after the baseline-period).

The primary aim of the current study is to evaluate the potential effectiveness
of online grief-specific CBT, in terms of reductions in symptom-levels of PGD,
PTSD, and depression, for children and adolescents who lost a loved one due to
a traffic accident.

A sequential replicated and randomized A-B-phase design will be conducted. This
design will consist of a baseline and a treatment phase. The baseline phase
will consist of at minimum three and at maximum seven weekly measurement
occasions. The treatment phase, in which the online CBT will be followed, will
include nine weekly measurement occasions. During the weekly measurements in
the baseline and treatment phase, PGD symptoms will be assessed. Before the
baseline phase, after the baseline phase and after treatment, PGD, PTSD and
depressive symptoms will be measured in an online interview.

The intervention consists of online individual grief-specific CBT.

Completing the instruments could evoke painful thoughts or feelings related to
the loss. The treatment could lead to a temporary increase in grief. However,
previous research gives no indication that CBT or participation in bereavement
research results in an unacceptable risk of exacerbation of complaints for
bereaved children and adolescents.