An evaluation of a pilot high-intensity treatment pathway for prolonged grief reactions in a Devon NHS Talking Therapies service

Abstract

Effective, evidence-based psychological therapies for prolonged grief reactions exist but are not routinely available in United Kingdom National Health Service (NHS) services. This audit evaluated the feasibility and clinical effectiveness of a high intensity Prolonged Grief Disorder Therapy (PGDT) treatment pathway in an NHS Talking Therapies (NHS-TT) context for clients with a prolonged grief reaction alongside depression, anxiety and/or post-traumatic stress disorder. Seventeen experienced high intensity therapists were trained to deliver PGDT. Ninety-one clients were treated between April 2022 and April 2024, 80 of whom met criteria and were included in this audit. 83% of clients completed at least four treatment sessions (a liberal estimate of minimum adequate dose), the mean number of sessions attended was 10.29 (SD=5.81) and rates of dropout were low (16%). Data completeness rates were 100% depression, anxiety and functioning measures and 61% for the grief outcome (Brief Grief Questionnaire; BGQ). There was no evidence of treatment-related harms. There were statistically significant, large pre-post treatment effect size improvements across outcomes from intake to last treatment session (ps<.001; Cohen’s ds>1.05). According to NHS-TT outcome metrics for combined changes in anxiety and depression, 82% of clients exhibited reliable improvement, 72% showed recovery, and 68% of clients achieved reliable recovery. On the BGQ, rates of reliable improvement were 77% and rates of recovery were 63%. Effects held when focusing on the subgroup with more severe grief symptoms (intake BGQ>8; N=40). These findings suggest it is feasible and likely effective to implement a PGDT pathway in an NHS-TT context.