Virtual rescripting after loss using deepfake technology in prolonged grief treatment: a study protocol for a multiple baseline design

<b>Background:</b> Prolonged grief disorder (PGD) is characterized by severe and persistent grief that impairs daily functioning. Cognitive behavioural therapy is the first-line treatment but yields only small-to-moderate effects. Imagery rescripting, which targets distressing loss-related memories, is increasingly used for PGD and related trauma complaints. Incorporating deepfake technology into imagery rescripting, i.e. virtual rescripting, may increase emotional engagement and facilitate processing of the loss, potentially improving treatment outcomes. However, this approach has not yet been empirically examined for PGD.<b>Objective:</b> This study aims to explore the potential effectiveness of virtual rescripting in reducing prolonged grief intensity, loss-related unfinished business, grief rumination, guilt, regret, and negative affect, and increasing well-being and positive affect.<b>Methods:</b> A multiple baseline design will be employed (ethics ID: NL-010145). Nine participants will be randomly assigned to a baseline length of five, six, or seven weeks. The intervention phase will span five weeks and include three therapist-guided sessions: (1) introduction, (2) virtual rescripting, and (3) evaluation. Participants will complete weekly questionnaires during both the baseline and intervention phases. Data will be analyzed using randomization tests to compare the intensity levels of the outcomes of interest between the baseline and intervention phases.<b>Conclusions:</b> This is the first study to explore the potential effectiveness of virtual rescripting in PGD treatment, providing preliminary evidence for future large-scale trials to improve bereavement care.