Changes in typical beliefs in response to complicated grief treatment

Natalia A. Skritskaya, Christine Mauro, Angel Garcia de la Garza, Franziska Meichsner, Barry Lebowitz, Charles F. Reynolds, Naomi M. Simon, Sidney Zisook, M. Katherine Shear

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background: Prolonged grief disorder (PGD) is a new diagnosis in the 11th edition of the International Classification of Diseases, estimated to affect 1 in 10 bereaved people and causing significant distress and impairment. Maladaptive thoughts play an important role in PGD. We have previously validated the typical beliefs questionnaire (TBQ), which contains five kinds of thinking commonly seen in PGD: protesting the death, negative thoughts about the world, needing the person, less grief is wrong, and grieving too much. The current paper examines the role of maladaptive cognition as measured by the TBQ in PGD and its change with treatment. Methods: Among participants in a multisite clinical trial including 394 adults, we examined (a) the relationship between maladaptive thoughts at baseline and treatment outcomes, (b) the relationship between maladaptive thoughts and suicidality at baseline and posttreatment, and (c) the effect of treatment with and without complicated grief therapy (CGT) on maladaptive thinking. Results: TBQ scores were associated with treatment outcomes and were strongly related to suicidal thinking before and after treatment. TBQ scores showed significantly greater reduction in participants who received CGT with citalopram versus citalopram alone (adjusted mean standard error [SE] difference, −2.45 [0.85]; p =.004) and those who received CGT with placebo versus placebo alone (adjusted mean [SE] difference, −3.44 [0.90]; p <.001). Conclusions: Maladaptive thoughts, as measured by the TBQ, have clinical and research significance for PGD and its treatment.

Original languageEnglish (US)
Pages (from-to)81-89
Number of pages9
JournalDepression and Anxiety
Issue number1
StatePublished - Jan 1 2020
Externally publishedYes


  • assessment/diagnosis
  • cognition
  • grief/bereavement/complicated grief
  • suicide/self harm
  • treatment

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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