Group Grief Therapy Works as Well as Individual: What a Noninferiority Trial Means for Access
- Group CBT for prolonged grief disorder (PGD) was noninferior to individual CBT at 6-month follow-up (d = 0.09, 95% CI −0.06 to 0.25) in 113 older adults (mean age 71.6)
- Both formats produced large symptom reductions — group d = 1.74, individual d = 1.46 — across grief severity, depression, anxiety, PTSD, loneliness, and quality of life
- Dropout was comparable between formats (23% group vs 19% individual), countering the assumption that grief work requires privacy
- The 12-session protocol combined exposure to loss reminders, cognitive restructuring of grief cognitions, and behavioural activation — delivered in 2-hour group sessions versus 1-hour individual sessions
Prolonged grief disorder entered ICD-11 and DSM-5-TR as a formal diagnosis. The treatment evidence is growing, but the delivery model has remained individual therapy — expensive, slow to scale, and bottlenecked by therapist availability. This JAMA Psychiatry trial asks the obvious next question: can we deliver grief-focused CBT in groups without losing efficacy?
The noninferiority case
The study randomised 113 older adults with clinically relevant PGD — mean age 71.6, predominantly bereaved of spouses — to 12 sessions of grief-focused CBT in either group (n=56) or individual (n=57) format. The protocol was identical: exposure to avoided loss reminders, cognitive restructuring of maladaptive grief cognitions, and behavioural activation to rebuild meaningful activities.
The primary outcome was grief symptom severity at 6-month follow-up. The between-group effect size was d = 0.09 — effectively zero difference. The 95% confidence interval (−0.06 to 0.25) fell entirely within the pre-specified noninferiority margin. Both arms showed large within-group effects: d = 1.74 for group, d = 1.46 for individual.
Critically, noninferiority held across every secondary outcome: PTSD symptoms, depression, anxiety, loneliness, and quality of life. Dropout rates were comparable, suggesting participants tolerated group-based grief processing without the privacy concerns clinicians often anticipate.
The access argument
One therapist, one patient, one hour — this is the standard model. One therapist, six patients, two hours — this is three times the throughput at roughly the same cost. For a disorder that disproportionately affects older adults — a population with limited mobility, fixed incomes, and long waitlists — the format question is not academic. It is an access question.
Group format also offers something individual therapy cannot: normalisation. Hearing another person describe the same stuck grief, the same avoidance patterns, the same guilt cognitions. For older adults who often grieve in isolation, this may be therapeutic in itself.
Group grief CBT matched individual therapy on every outcome measure — turning a 1:1 bottleneck into a scalable treatment model for older adults.
Sample was predominantly White, female, and bereaved of spouses — limiting generalisation to other loss types and demographics. The study was powered for noninferiority, not superiority; subtle differences favouring one format may exist but were not detectable.