Association between patients’ word use and symptom reduction in an internet-based cognitive behavioral intervention for prolonged grief symptoms: A secondary analysis of a randomized controlled trial

Bereaved by suicide face unique challenges and have differences in their language compared to bereaved by other causes of death, however their language during therapy has not been studied yet. This study investigates the association between patients’ language and reduction in prolonged grief symptoms in an internet-based intervention for people bereaved by suicide. Data stems from a randomized controlled trial including 47 people completing self-reported surveys. Patient language was analyzed using the Linguistic Inquiry and Word Count program. Symptom change was determined through absolute change scores. Stepwise forward regression and repeated measures analyses of variances were calculated. During confrontation, a higher reduction of prolonged grief symptoms was predicted by more words describing perceptual (β = − 0.43, p = .002) and cognitive processes (β = − 0.63, p = .002) and less present focus words (β = 0.66, p = .002). During cognitive restructuring, more words describing drives (β = − 0.40, p = .004), less past focus words (β = 0.59, p = .002) and less informal language (β = 0.40, p = .01) predicted a higher reduction of prolonged grief symptoms. Lastly, during behavioral activation, more past focus words (β = − 0.54, p = .002) predicted a higher grief reduction. Findings underline the importance of exposure and cognitive restructuring during therapy and further suggest the relevance of the previously not studied linguistic perceptual processes. Moreover, this study emphasizes the importance of different tenses throughout the intervention, adding knowledge to previous studies assessing time at a single point in therapy.