A large systematic review in Annals of Internal Medicine found psychotherapy to be the only bereavement intervention supported by moderate-quality evidence for improving grief-related outcomes in adults. Evidence for most other commonly used approaches—including peer support, self-help interventions, and integrative therapies—was limited, inconsistent, or insufficient.
The review synthesized data from 169 randomized controlled trials reported across 303 publications, evaluating a wide range of interventions for bereaved pediatric and adult patients. Most studies focused on adults experiencing general grief or prolonged grief symptoms rather than formally diagnosed prolonged grief disorder.
Across pooled analyses, individual psychotherapy was associated with improvements in grief disorder symptoms, general grief, and depressive symptoms. These benefits were observed across diverse psychotherapeutic approaches, including cognitive behavioral therapy and counseling-based interventions—although heterogeneity across studies was substantial. The researchers rated the strength of evidence for psychotherapy as moderate, reflecting consistent benefit despite methodological limitations in the underlying literature.
By contrast, evidence supporting other interventions was weaker. Expert-facilitated support groups and enhanced contact with health care providers were associated with modest improvements in depressive symptoms, but the strength of evidence was rated low. Peer support interventions, self-help programs, and expressive therapies such as writing, music, or art therapy showed no consistent benefit for grief or depression outcomes, or lacked sufficient data to support firm conclusions.
Notably, fewer than 10% of included trials enrolled pediatric patients, limiting conclusions about bereavement care in this population. The review also identified gaps in evidence for outcomes beyond grief and depression, including loneliness, quality of life, substance use, and unintended consequences of intervention.
In an accompanying editorial, Joanne Cacciatore, PhD, of Arizona State University, and Joyal Mulheron, MS, of EVERMORE, cautioned against medicalizing normal grief, emphasizing that distress alone should not be treated as pathology. "While psychotherapy benefits those with intense grief," they wrote, "physicians must resist interpreting distress itself as pathology."
The editorialists also emphasized the importance of identifying patients with persistent, impairing symptoms. Prolonged grief disorder—now formally recognized in diagnostic classifications—was presented as a framework for more targeted care rather than broader treatment.
The researchers conclude that future research should prioritize higher-quality trials, greater inclusion of pediatric patients and diverse populations, and outcomes that better reflect patient-centered recovery.
Disclosures: The study was funded by the Agency for Healthcare Research and Quality under contract from the Patient-Centered Outcomes Research Institute. Disclosure forms are available with the article online.
