Franziska Lechner-Meichsner

Introduction: Prolonged Grief Disorder (PGD) was newly included in the 11th edition of the International Classification of Diseases (ICD-11) and the text revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). There is a need to increase our understanding of the prevalence, nature, and risk factors of this condition. Research in this area can be advanced by pooling existing datasets.Objective: The MARBLES (Multi-region Archive of Research data on Bereavement and Loss from Empirical Studies) project was initiated to create a consortium of researchers conducting studies on PGD. Its goal is to harmonize and combine data from separate studies into a unified, individual participant data-archive, boosting bereavement research.Methods: To date, data from 16,666 bereaved individuals have been compiled from 32 datasets across nine countries. All datasets include data on PGD symptoms and sociodemographic and loss characteristics; most also include data on emotion regulation and concurrent symptoms. For preliminary analyses presented in this paper, data on sociodemographic and loss-related characteristics and on PGD, posttraumatic stress, and depression symptoms were harmonized.Results: Regarding the preliminary analyses, participants' mean age was in their mid-40s, about 70% of the participants were female, one in four participants had lost a partner, and one in four participants experienced an unnatural loss. Analyses (with multiple imputation) indicated that 18.3% met criteria for probable PGD (ICD-11).Conclusion: The MARBLES archive demonstrates that it is feasible to build a FAIR archive of PGD symptom data. Although the archive can already be used to study the prevalence, pathogenesis, and predictors of PGD symptoms and associated emotional problems, it is intended as an evolving resource. Its potential will expand as additional datasets are added and use of the archive grows. Future extensions should prioritize the inclusion of underrepresented groups (e.g. migrants) and currently missing social, cognitive, and neurobiological variables.

Aversive mental images occur across psychological disorders. Images related to the deceased and the loss can also develop after the death of a close person and seem related to prolonged grief. The present study investigated the content and characteristics of grief-related mental images and tested hypotheses regarding their associations with prolonged grief symptoms (PGS) and negative grief cognitions. Bereaved participants (N = 261) completed an online mental images questionnaire and measures of PGS and negative grief cognitions. Data were analyzed using hierarchical regression analyses and group comparisons, alongside a thematic analysis of image descriptions. More frequent and more uncontrollable mental images were associated with higher levels of PGS and higher endorsement of different domains of negative grief cognitions. Image specificity was unrelated to PGS levels. The qualitative analysis resulted in 12 distinct image themes that differed in frequency, uncontrollability, fantasy content, and emotional responses. Associations with PGS and endorsement of negative grief cognitions related to life and the future also differed for the distinct themes. Because the design precludes conclusions about causality, longitudinal studies need to clarify how such images relate to PGS development and maintenance. Imagery-focused interventions may be a promising treatment approach for PGS.

Refugees often experience grief related to traumatic death that occurs in combination with other traumatic events. Migration-related stressors and cultural incongruities can additionally influence grief reactions and help-seeking behavior in migrants and refugees. This chapter first describes prolonged grief disorder in migrants and refugees, including culture-specific symptoms and potential influencing factors, and introduces instruments for culturally sensitive assessment. Effective psychotherapy for prolonged and traumatic grief involves deepening understanding of cultural identity in relation to bereavement and grief. The second part therefore introduces cultural sensitivity in psychotherapy, and outlines how treatment elements can be adapted. Special attention is given to conducting exposure, implementing culturally appropriate rituals in therapy, and using symbolic interactions.

Exposure-based interventions are central to effective treatments for prolonged grief disorder (PGD) and prolonged and traumatic grief (PTG). These interventions typically involve gradual confrontation with internal (e.g., memories, thoughts, images) and external cues (e.g., places, people), to promote emotional processing of the loss and its circumstances. This chapter introduces an associative memory perspective, offering a basis for broader application of exposure techniques to alleviate different symptoms that may occur in PGD and PTG. A key premise is that these symptoms are partly maintained by associative memory networks containing representational information of pivotal, emotional events—and responses to them—that threaten fundamental needs (e.g., for safety, attachment, moral integrity, social status) or shatter preexisting schematic knowledge. Exposure interventions that include gradual review and articulation of such information may substantially reduce symptoms, especially when combined with efforts to reduce maladaptive avoidance and control strategies.

Refugees often experience traumatic events and the loss of loved ones, leading to post‐traumatic stress disorder (PTSD), complex PTSD (cPTSD) and prolonged grief disorder (PGD). It has been repeatedly shown that comorbidity between PGD and PTSD is frequent especially after violent losses, but only few studies have investigated the relationship between PGD and cPTSD. The network approach to psychopathology is well suited to investigate associations between different symptoms. We therefore combined a traditional investigation of the probable prevalence of PGD and its comorbidity with PTSD and cPTSD in refugees and used network analysis to identify central symptoms and bridge symptoms. A total N of 92 treatment‐seeking refugees who had experienced both loss and traumatic events completed a self‐report measure of PGD and clinical interviews for PTSD and cPTSD. We determined the probable prevalence of PGD _ICD‐11 and rates of comorbidity. Network centrality and associations between symptoms of PGD and cPTSD were examined using network analysis. The probable prevalence of PGD _ICD‐11 was 28.04%. Of those with probable PGD _ICD‐11 , 65.38% also met criteria for comorbid PTSD _ICD‐11 and 19.23% for comorbid cPTSD. The most central PGD symptom in the network was difficulties engaging in social or other activities , and the most central cPTSD symptom was negative self‐concept . The most important PGD bridge symptom was emotional numbness . Results underscore the importance of screening for PGD in treatment‐seeking traumatized refugees in order to consider it in treatment planning. The relatively small sample size and the stability indices call for cautious interpretation of the results. Trial Registration: DRKS‐ID: DRKS00019876. Summary: This is the first prolonged grief and post‐traumatic stress symptom network analysis in refugees. Prolonged grief disorder is an important mental health problem in refugees. Emotional numbness and avoidance were the most important bridge symptoms. Screening for PGD is important in traumatized treatment‐seeking refugees. Culturally sensitive grief‐focused interventions should be offered to refugees.

Sudden gains describe large and stable reductions in symptoms between two consecutive treatment sessions and have not yet been investigated in prolonged grief disorder (PGD), a new disorder in the 11th edition of the International Classification of Diseases and text revision of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders characterized by separation distress and accompanying symptoms beyond 6 months of bereavement. The study aimed to examine the occurrence of sudden gains and their relation to treatment outcome and content during cognitive behavioral therapy (CBT) and supportive counseling for children and adolescents with PGD symptoms. We used data from 118 patients (50% female; age: M = 12.93, SD = 2.81) who were randomized to receive either nine individual sessions of CBT or nondirective supportive counseling. Session-by-session PGD symptoms were assessed using the Grief Checklist. We identified sudden gains using the original criteria by Tang and DeRubeis (1999) and compared treatment outcomes between sudden gainers and nonsudden gainers using linear mixed models. Nine patients (7.63%) experienced a total of 10 sudden gains. Most sudden gains occurred during CBT. We found no differences between sudden gainers and nonsudden gainers regarding PGD symptoms, posttraumatic stress, and depressive symptoms, but problem behaviors declined toward the follow-up assessments in sudden gainers. Sudden gains seem to be a rare event with limited clinical relevance in the treatment of PGD symptoms in children and adolescents. Results imply future research into predictors of sudden gains and other forms of symptom change during PGD treatment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Refugees and asylum seekers (ASRs) are frequently exposed to loss in addition to a variety of other stressors and often display high levels of various psychological symptoms.Objective: The study aimed to primarily determine clusters of prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression symptoms in bereaved ASRs and secondly identify predictors of cluster membership. Sociodemographic - and flight-related variables were investigated in exploratory analyses.Method: ASRs in Germany (N = 92) with interpersonal loss exposure, i.e. at least one missing or deceased relative or friend, were assessed with interview-based questionnaires for PGD, PTSD, and depressive symptoms. We used k-means cluster analysis to distinguish symptom profiles and logistic regression analyses to identify predictors of cluster membership.Results: We found a three-cluster-solution. The PGD-cluster (30%) was characterised predominantly by PGD symptoms, while the PGD/PTSD-cluster (32%) had high PGD and PTSD and moderate depressive symptoms. The resilient cluster (38%) showed low symptoms overall. insecure residence status predicted membership in the PGD and PGD/PTSD clusters relative to the resilient cluster, whilst higher attachment anxiety predicted membership in the PGD/PTSD cluster relative to the other clusters. Explorative analysis revealed duration of stay as a significant predictor.Conclusion: Findings can extend the current knowledge about different symptom profiles among bereaved ASRs in Europe. Insights to attachment - and migration-related variables distinguishing between these profiles offer starting points for interventions.