Prolonged Grief Symptoms Clinical Trial
Official title:
Effects of Ericksonian Hypnotherapy Versus Cognitive Behavioral Therapy on Prolonged Grief Among University Students in Istanbul: A Randomized Controlled Trial
Effects of Ericksonian Hypnotherapy Versus Cognitive Behavioral Therapy on Prolonged Grief Among University Students in Istanbul: A Randomized None-clinical Controlled Trial This randomized controlled trial explores the efficacy of Ericksonian Hypnotherapy versus Cognitive Behavioral Therapy (CBT) in mitigating symptoms of prolonged grief among university students in Istanbul. With a backdrop of transitional academic and socio-emotional challenges, 39 students who experienced significant loss and exhibited symptoms of prolonged grief were enrolled. Participants were randomly assigned to undergo Ericksonian Hypnotherapy, CBT, or placed on a waiting list (control group), each with 13 individuals. The study uniquely positions itself in Istanbul, leveraging the city's cultural context to examine grief processing in an urban, academically engaged population. Utilizing the Prolonged Grief Scale, Beck Depression Inventory, and SCL-90 Symptom Checklist for assessment, the interventions were evaluated for their effectiveness in reducing grief and associated psychological symptoms.
Effects of Ericksonian Hypnotherapy Versus Cognitive Behavioral Therapy on Prolonged Grief Among University Students in Istanbul: A Randomized None-clinical Controlled Trial Abstract This randomized controlled trial explores the efficacy of Ericksonian Hypnotherapy versus Cognitive Behavioral Therapy (CBT) in mitigating symptoms of prolonged grief among university students in Istanbul. With a backdrop of transitional academic and socio-emotional challenges, 39 students who experienced significant loss and exhibited symptoms of prolonged grief were enrolled. Participants were randomly assigned to undergo Ericksonian Hypnotherapy, CBT, or placed on a waiting list (control group), each with 13 individuals. The study uniquely positions itself in Istanbul, leveraging the city's cultural context to examine grief processing in an urban, academically engaged population. Utilizing the Prolonged Grief Scale, Beck Depression Inventory, and SCL-90 Symptom Checklist for assessment, the interventions were evaluated for their effectiveness in reducing grief and associated psychological symptoms. Keywords: Prolonged Grief, Ericksonian Hypnotherapy, Cognitive Behavioral Therapy, University Students, Randomized Controlled Trial Introduction Background Grief is a universal experience, an emotional response to loss that is profoundly personal and deeply affecting. While the journey through grief is unique for each individual, most people gradually find a way to adjust to life without their loved one. However, for some, the process becomes stalled, leading to what is known as prolonged grief disorder (PGD). Characterized by intense longing, preoccupation with the deceased, and persistent inability to engage with life, PGD can significantly impair an individual's functioning and well-being. The transition to university represents a critical developmental period for young adults, marked by new challenges, opportunities for growth, and, at times, the experience of loss. University students are in a unique socio-emotional and developmental stage, navigating the complexities of adulthood while often living away from their traditional support systems. The impact of grief during this period can be particularly profound, potentially affecting academic performance, social relationships, and overall mental health. Despite its significance, the specific needs and experiences of grieving university students have received limited attention in the literature. Istanbul, a city with a rich history and diverse cultural tapestry, serves as a vibrant backdrop for this study. Home to numerous universities and a large student population, Istanbul offers a unique setting to explore the effects of prolonged grief within an urban context. The city's dynamic environment, coupled with the stresses associated with academic life, may influence how grief is experienced and processed by university students. Moreover, cultural factors specific to Turkey may shape the grieving process, including societal attitudes toward loss and mourning practices, underscoring the importance of contextually grounded research. In response to these considerations, the present study aims to investigate the effectiveness of two therapeutic interventions, Ericksonian hypnotherapy and CBT, in treating prolonged grief among university students in Istanbul. This research not only addresses a significant gap in our understanding of grief interventions for young adults but also contributes to the broader discourse on mental health support within academic settings. By focusing on this population and setting, the study endeavors to offer insights that can inform targeted, culturally sensitive approaches to supporting grieving students, ultimately enhancing their well-being and academic success. Rationale Prolonged grief disorder represents a profound, persistent form of bereavement, distinct from normal grief and major depression, that can significantly impair an individual's functioning. CBT has established efficacy in treating a wide range of psychological disorders, including prolonged grief. It operates on the premise that changing maladaptive thoughts and behaviors can lead to improved emotional states. CBT's structured, problem-focused approach has been widely researched and applied in various cultural contexts, including Turkey. However, despite its proven benefits, not all individuals respond to CBT, highlighting the need for alternative therapeutic options. Ericksonian hypnotherapy, developed by Milton H. Erickson, offers a contrasting approach to traditional psychotherapies by utilizing the power of indirect suggestion, metaphors, and storytelling to facilitate change. Unlike the directive techniques of CBT, Ericksonian hypnotherapy emphasizes the unique inner resources and unconscious mind of each individual, allowing for a more personalized therapeutic experience. This approach aligns well with the developmental stage and cognitive flexibility of university students, who are often more open to exploratory and experiential forms of therapy. Moreover, the symbolic and metaphorical nature of Ericksonian techniques may resonate deeply within Istanbul's culturally rich context, potentially offering a more culturally sensitive approach to grief therapy. The need to explore Ericksonian hypnotherapy in comparison to CBT for treating prolonged grief stems from several considerations. First, the varying therapeutic mechanisms between Ericksonian hypnotherapy and CBT suggest that they may differentially affect the grieving process, with implications for treatment personalization. Second, the comparative effectiveness of these therapies for prolonged grief remains under-researched, particularly within university settings and specific cultural contexts. Finally, understanding the potential benefits of Ericksonian hypnotherapy can broaden the repertoire of effective grief interventions, offering clinicians and counselors more tools to support grieving individuals. Given these considerations, this study seeks to fill a critical gap in the literature by comparing the effectiveness of Ericksonian hypnotherapy and CBT in alleviating symptoms of prolonged grief among university students in Istanbul. By doing so, it aims to contribute valuable insights into the adaptability and utility of these therapeutic approaches, enhancing the psychological well-being and academic success of grieving students. Objectives The primary aim of this randomized non-clinical controlled trial is to evaluate and compare the effectiveness of Ericksonian hypnotherapy and CBT in addressing symptoms of prolonged grief among university students in Istanbul. This comparison seeks to achieve several key objectives: 1. Assess the Reduction in Prolonged Grief Symptoms: To quantitatively measure and compare the reduction in symptoms of prolonged grief among participants, as evaluated by the Prolonged Grief Scale, following the completion of Ericksonian hypnotherapy and CBT interventions. This objective seeks to identify which therapeutic approach is more effective in alleviating the core symptoms of prolonged grief. 2. Evaluate Changes in Associated Psychological Symptoms: To examine and compare the impact of Ericksonian hypnotherapy and CBT on associated psychological symptoms, including depression and overall psychological distress, as measured by the Beck Depression Inventory and Prolonged Grief Scale, respectively. This objective aims to understand the broader psychological benefits of each therapy in treating prolonged grief. 3. Investigate Participant Engagement and Satisfaction: To assess and compare participant engagement and satisfaction with Ericksonian hypnotherapy versus CBT, incorporating participant feedback and session attendance rates. This objective is important for evaluating the acceptability and feasibility of both therapeutic approaches among university students. 4. Explore Cultural and Contextual Factors: To explore how cultural and contextual factors inherent to the student population in Istanbul may influence the effectiveness and reception of Ericksonian hypnotherapy and CBT for prolonged grief. This objective recognizes the importance of cultural sensitivity in psychological interventions and aims to provide insights into tailoring therapies to specific populations. Methodology Study Design This research employed a randomized controlled trial design to evaluate the effectiveness of Ericksonian hypnotherapy versus CBT in treating prolonged grief among university students in Istanbul. The study aimed to recruit 150 volunteers who had experienced loss and exhibited symptoms of grief. To ensure participants did not present with other significant psychological symptoms that could confound the results, the SCL-90 Symptom Checklist was utilized alongside the Prolonged Grief Scale and the Beck Depression Inventory. Participants Participants were university students in Istanbul who volunteered for the study, meeting the inclusion criteria of having experienced a significant loss and showing symptoms of prolonged grief as assessed by the Prolonged Grief Scale. Exclusion criteria included undergoing psychotherapy during the past year, significant psychological disorders as identified by the SCL-90, and inability to commit to the full duration of the study. After initial screening, 39 participants who scored high on the Prolonged Grief Scale were selected and randomly assigned into three groups: Ericksonian hypnotherapy, CBT, and a waiting list control, with 13 participants in each group. Interventions The Cognitive Behavioral Therapy (CBT) intervention for prolonged grief was carefully structured into an 8-session manualized program, tailored to address the multifaceted nature of grief among university students. Initially, participants were introduced to the CBT model of grief, focusing on understanding the relationship between thoughts, feelings, and behaviors in the context of their loss. Key components included identifying and challenging maladaptive thoughts related to the loss, employing gradual exposure to avoided situations, and developing coping strategies for managing intense emotions and fostering resilience. Special emphasis was placed on rebuilding meaningful life activities and social connections, acknowledging the loss while encouraging engagement with life's ongoing demands. Ericksonian hypnotherapy provided an alternative approach, with 8 sessions designed to harness the power of indirect suggestion, metaphors, and personal storytelling to navigate the complexities of prolonged grief. Early sessions focused on establishing a therapeutic alliance and utilizing personal strengths and inner resources. Techniques such as guided imagery were used to facilitate a healthy connection with the symptoms, fostering a sense of peace and acceptance. Subsequent sessions aimed to reframe the loss, integrating it into the individual's life narrative in a way that honored the past while promoting openness to future possibilities. This approach sought to cultivate a sense of personal growth and resilience, emphasizing the individual's capacity to find meaning and continue moving forward. Both interventions aimed to provide a supportive and healing environment, addressing the specific challenges of prolonged grief within a university student population. The CBT group worked on concrete skills for tackling the cognitive and behavioral aspects of their grief, while the Ericksonian group delved into the subconscious to elicit change through more symbolic and imaginative processes. Despite their methodological differences, both therapies shared the goal of mitigating the pain of prolonged grief and empowering students to adapt more healthily to their loss. Participants in the waiting list control group were offered information on available grief counseling resources upon conclusion of the study, ensuring they too had access to support. Data Collection and Measures Data were collected at three time points: before the start of the sessions, after the fourth session, and immediately after the eighth and final session. The Prolonged Grief Scale and Beck Depression Inventory were administered at each time point to assess changes in grief intensity, depressive symptoms, and overall psychological distress, respectively. Measurement Tools Prolonged Grief Scale (PGS): The Prolonged Grief Scale is a specialized instrument designed to assess the symptoms and severity of prolonged grief disorder (PGD) among individuals. This scale consists of items that measure the core symptoms of PGD, including persistent yearning for the deceased, difficulty accepting the death, a sense of disbelief regarding the loss, and marked emotional pain related to the bereavement. Each item is rated on a Likert scale, allowing for a quantifiable measure of grief intensity. The reliability and validity of the PGS have been established in various populations, making it a robust tool for identifying individuals suffering from PGD (Prigerson et al., 2021). Beck Depression Inventory (BDI): The Beck Depression Inventory is a widely used 21-item self-report inventory measuring the severity of depression in adolescents and adults. Each item corresponds to a specific symptom or attitude related to depression, such as sadness, pessimism, feelings of failure, and dissatisfaction with life. Respondents are asked to rate how they have felt over the past two weeks on a four-point scale ranging from 0 to 3, with higher scores indicating more severe depressive symptoms. The BDI's reliability and validity are well-documented, making it a valuable tool for assessing depressive symptoms in conjunction with grief (Beck et al., 1987). SCL-90 Symptom Checklist: The SCL-90 is a 90-item self-report symptom inventory designed to reflect the psychological symptom patterns of community, medical, and psychiatric respondents. It measures nine primary symptom dimensions, including depression, anxiety, hostility, and paranoid ideation, and provides an overall index of distress, the Global Severity Index (GSI). Each item is rated on a five-point scale of distress, from "not at all" to "extremely." This tool allows for the comprehensive assessment of a range of psychological symptoms and distress levels, ensuring that participants do not have significant comorbid psychological conditions that could influence the study's outcomes (Derogatis & Unger, 2010). Data Collection Process Recruitment and Screening: Potential participants were recruited through university networks and advertisements, targeting students who had experienced a significant loss. Interested volunteers underwent a preliminary screening using a SCL-90 to confirm eligibility based on the study's inclusion and exclusion criteria. This included assessing their grief experience, previous therapy, and any psychological disorders. Baseline Assessment: Eligible participants completed the Prolonged Grief Scale and Beck Depression Inventory as part of the baseline assessment. These tools were administered in a controlled environment to ensure confidentiality and reduce potential biases. The baseline data collection aimed to establish initial levels of grief, depression, and psychological distress among participants, serving as a reference point for subsequent analyses. Randomization and Group Assignment: Following baseline assessment, participants were randomly assigned to one of three groups: Ericksonian hypnotherapy, CBT, or waiting list control. Randomization was performed using a computer-generated sequence to ensure equal distribution of participants across the groups and minimize selection bias. Intervention and Follow-up Assessments: Participants in the Ericksonian hypnotherapy and CBT groups attended 8 sessions of their respective therapies. Data were collected again after the fourth session and immediately after the eighth session using the same measurement tools (PGS, BDI). This repeated measurement allowed for the tracking of changes in grief and depression over the course of the interventions. Data Handling and Analysis: All collected data were coded and entered into a secure database for analysis. Participant confidentiality was maintained throughout the study, with personal identifiers removed or anonymized. Data analysis focused on comparing pre- and post-intervention scores within and between groups, assessing the effectiveness of Ericksonian hypnotherapy and CBT in reducing symptoms of prolonged grief and associated psychological distress. Statistical Analysis Data analysis was performed using SPSS software. Descriptive statistics were employed to characterize the sample demographics and baseline measures. The primary analysis involved comparing the pre- and post-intervention scores within and between the treatment and control groups using repeated measures ANOVA, followed by post hoc comparisons to identify specific differences. Effect sizes were calculated to determine the magnitude of the interventions' impacts. Significance levels were set at p < 0.05 for all tests. Ethical Considerations The study was approved by the Institutional Review Board (IRB) of İstanbul Nişantaşı University No: 2023/2, ensuring that it met ethical standards for research involving human participants. Informed consent was obtained from all participants, emphasizing the voluntary nature of participation, the confidentiality of their responses, and their right to withdraw from the study at any time without penalty. ;
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