A Case Series Evaluation of a Pilot Brief Behavioural Activation Intervention for Pathological Grief

This study was approved by the Curtin University Human Research Ethics Committee (approval number: HR2017-0241). This study is also registered as a clinical trial with the Australian New Zealand Clinical Trials Registry (registration number: ACTRN12617000494336p). Research Design: In line with goals for feasibility testing of novel treatments, a case series design was employed with two participants to measure symptoms of PGD before, during, and after BATD-R. Participants completed a three-week baseline until stability was established before beginning the intervention. The participants completed an initial phone screening interview to determine eligibility based on the inclusion/exclusion criteria. Next, participants completed a pre-assessment at the Curtin University Psychology Clinic and then completed week one baseline measures. Week two and three baseline measures were completed remotely and participants received SMS reminders each week. Participants completed the PG-13, BADS-SF, and UGRS at all baseline points, at each weekly treatment session, and at 1-week post-treatment. All other self-report measures were completed at pre-baseline and at 1-week post-treatment. The treatment protocol and session checklists were based on the BATD revised treatment manual (BATD-R; Lejuez et al. 2011). The protocol was adapted to tailor the treatment rationale for the unique responses in pathological grief and to ensure key elements of the sessions were covered within 6 sessions rather than 10 sessions as outlined in in the BATD-R manual. The treatment comprised six 1.5 hour weekly sessions over six weeks. Although previous studies have shown that one hour BA sessions per week have been effective (e.g. Lejuez et al., 2011; Daughters et al., 2008; Eisma et al., 2015), 1.5 hour sessions were assessed as more feasible to allow time for rapport building, grief story-telling, and completion of weekly measures. The intervention details are outlined below: Session 1 Psychoeducation about grief, rationale for BATD-R, introduction of daily monitoring forms Session 2 Life areas, values, and activities, and daily monitoring Session 3 Activity selection and ranking and monitoring with activity planning Session 4 Monitoring with activity planning Session 5 Contracts and monitoring with activity planning Session 6 Concept review of key elements, feedback on progress and monitoring with activity planning The therapist was a master of clinical psychology student with two years of clinical experience. To assess the integrity of treatment delivery, an adapted version of the BATD-R Adherence Checklists (Lejuez et al., 2011) was completed by the primary researcher at the completion of each treatment session. An independent rater who was familiar with the BATD-R viewed a random sample of 20 percent of video-recorded sessions and rated session adherence. Rater assessment indicated100 percent agreement with the therapist ratings. The therapist also had weekly team meetings with the research team to monitor adherence and obtain feedback on upcoming participant sessions.