Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial

Reitsma, Lyanne; Boelen, Paul A.; Keijser, Jos de; Lenferink, Lonneke

doi:10.1016/j.brat.2023.104286

Cited by 20 publications

(22 citation statements)

References 70 publications

(115 reference statements)

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“…Another limitation of this study is that there were substantially more women than men in both the CG and the IG. This phenomenon has been observed in other similar studies [ 27 , 29 ]. An additional limitation of this study is that to date, few studies regarding web-based interventions to prevent CGD exist, and there is little evidence to suggest that an unguided intervention can be as effective as a guided intervention in treating grief.…”

Section: Discussionsupporting

confidence: 89%

“…Of 6 participants, 4 completed the intervention; of them, only 2 obtained a clinically significant change in the bereavement measures. Second, Reitsma et al [ 27 ] performed an RCT to examine the short-term effects of an unguided web-based grief-specific CBT in treating persistent complex bereavement disorder, PTSD, and depression symptoms. A total of 65 Dutch adults participated, all of whom had experienced the death of a loved one at least 3 months before the start of the study during the COVID-19 pandemic.…”

Section: Discussionmentioning

confidence: 99%

“…The results of this study have several implications for health care providers and local governments. First, web-based interventions have been shown to be effective in reducing psychological distress, including the symptoms of grief, depression, anxiety, and posttraumatic stress [ 27 , 29 , 52 ]. Second, this treatment modality represents a viable option for people who may have difficulty accessing specialized face-to-face care because of a lack of proximity to services where they live or other reasons.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, in the second part of the intervention, trained psychologists guided the participants via email. The results of this study have recently been published [ 27 ], involving 65 Dutch adults experiencing bereavement during the pandemic. The study showed the effectiveness of this web-based treatment in reducing disturbed grief, posttraumatic stress, and depression symptoms.…”

Section: Introductionmentioning

confidence: 99%

“…Laranjeira et al [10] [14,[26][27][28][29] are scarce, and in some cases, the results on their effectiveness are yet to be published. A small number of studies have provided results with a limited sample size of 4 participants [29].…”

Section: Introductionmentioning

confidence: 99%

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The Efficacy and Usability of an Unguided Web-Based Grief Intervention for Adults Who Lost a Loved One During the COVID-19 Pandemic: Randomized Controlled Trial

Domínguez-Rodríguez¹,

Sanz²,

González-Ramírez³

et al. 2023

J Med Internet Res

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Background The death of a loved one was a challenge many people faced during the COVID-19 pandemic within the context of extraordinary circumstances and great uncertainty. Grief is an unavoidable part of life, and for most people, feelings of grief decrease naturally over time. However, for some people, grieving can become a particularly painful process with clinical symptoms that may require professional help to resolve. To provide psychological support to people who had lost a loved one during the COVID-19 pandemic, an unguided web-based psychological intervention was developed. Objective The main objective of this study was to evaluate the efficacy of the web-based treatment, Grief COVID (Duelo COVID in Spanish; ITLAB), in reducing clinical symptoms of complicated grief, depression, posttraumatic stress, hopelessness, anxiety, and suicidal risk in adults. The secondary aim was to validate the usability of the self-applied intervention system. Methods We used a randomized controlled trial with an intervention group (IG) and a waitlist control group (CG). The groups were assessed 3 times (before beginning the intervention, upon completing the intervention, and 3 months after the intervention). The intervention was delivered on the web in an asynchronous format through the Duelo COVID web page. Participants created an account that could be used on their computers, smartphones, or tablets. The evaluation process was automated as part of the intervention. Results A total of 114 participants were randomly assigned to the IG or CG and met criteria for inclusion in the study (n=45, 39.5% completed the intervention and n=69, 60.5% completed the waitlist period). Most participants (103/114, 90.4%) were women. The results indicated that the treatment significantly reduced baseline clinical symptoms in the IG for all variables (P<.001 to P=.006), with larger effect sizes for depression, hopelessness, grief, anxiety, and risk of suicide (all effect sizes ≥0.5). The follow-up evaluation showed that symptom reduction was maintained at 3 months after the intervention. The results from the CG showed that participants experienced significantly decreased levels of hopelessness after completing the time on the waitlist (P<.001), but their suicidal risk scores increased. Regarding the usability of the self-applied intervention system, the results indicated a high level of satisfaction with the Grief COVID. Conclusions The self-applied web-based intervention Grief COVID was effective in reducing symptoms of anxiety, depression, hopelessness, risk of suicide risk, posttraumatic stress disorder, and complicated grief disorder. Grief COVID was evaluated by the participants, who reported that the system was easy to use. These results affirm the importance of developing additional web-based psychological tools to help reduce clinical symptoms in people experiencing grief because of the loss of a loved one during a pandemic. Trial Registration ClinicalTrials.gov NCT04638842; https://clinicaltrials.gov/ct2/show/NCT04638842

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Efficacy and Usability of an Unguided Web-Based Grief Intervention for Adults Who Lost a Loved One During the COVID-19 Pandemic: Randomized Controlled Trial

Domínguez-Rodríguez¹,

Sanz²,

González-Ramírez³

et al. 2023

J Med Internet Res

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Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder

Bryant,

Azevedo,

Yadav

et al. 2024

JAMA Psychiatry

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ImportanceAlthough grief-focused cognitive behavior therapies are the most empirically supported treatment for prolonged grief disorder, many people find this treatment difficult. A viable alternative for treatment is mindfulness-based cognitive therapy.ObjectiveTo examine the relative efficacies of grief-focused cognitive behavior therapy and mindfulness-based cognitive therapy to reduce prolonged grief disorder severity.Design, Setting, and ParticipantsA single-blind, parallel, randomized clinical trial was conducted among adults aged 18 to 70 years with prolonged grief disorder, as defined in the International Classification of Diseases, 11th Revision, and assessed by clinical interview based on the Prolonged Grief−13 (PG-13) scale. Those with severe suicidal risk, presence of psychosis, or substance dependence were excluded. Between November 2012 and November 2022, eligible participants were randomized 1:1 to eleven 90-minute sessions of grief-focused cognitive behavior therapy or mindfulness-based cognitive therapy at a traumatic stress clinic in Sydney, Australia, with follow-up through 6 months.InterventionsBoth groups received once-weekly 90-minute individual sessions for 11 weeks. Grief-focused cognitive behavior therapy comprised 5 sessions of recalling memories of the deceased, plus cognitive restructuring and planning future social and positive activities. Mindfulness-based cognitive therapy comprised mindfulness exercises adapted to tolerate grief-related distress.Main Outcomes and MeasuresThe primary outcome was change in prolonged grief disorder severity measured by the PG-13 scale assessed at baseline, 1 week posttreatment, and 6 months after treatment (primary outcome time point), as well as secondary outcome measures of depression, anxiety, grief-related cognition, and quality of life.ResultsThe trial included 100 participants (mean [SD] age, 47.3 [13.4] years; 87 [87.0%] female), 50 in the grief-focused cognitive behavior therapy condition and 50 in the mindfulness-based cognitive therapy condition. Linear mixed models indicated that at the 6-month assessment, participants in the grief-focused cognitive behavior therapy group showed greater reduction in PG-13 scale score relative to those in the mindfulness-based cognitive therapy group (mean difference, 7.1; 95% CI, 1.6-12.5; P = .01), with a large between-group effect size (0.8; 95% CI, 0.2-1.3). Participants in the grief-focused cognitive behavior therapy group also demonstrated greater reductions in depression as measured on the Beck Depression Inventory than those in the mindfulness-based cognitive therapy group (mean difference, 6.6; 95% CI, 0.5-12.9; P = .04) and grief-related cognition (mean difference, 14.4; 95% CI, 2.8-25.9; P = .02). There were no other significant differences between treatment groups and no reported adverse events.Conclusions and RelevanceIn this study, grief-focused cognitive behavior therapy conferred more benefit for core prolonged grief disorder symptoms and associated problems 6 months after treatment than mindfulness-based cognitive therapy. Although both treatments may be considered for prolonged grief disorder, grief-focused cognitive behavior therapy might be the more effective choice, taking all factors into consideration.Trial Registrationanzctr.org.au Identifier: ACTRN12612000307808

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A Latent Class Analysis on Indicators of Early Prolonged Grief Disorder and Well‐Being Among Dutch Adults Bereaved During the First Year of the COVID‐19 Pandemic

Reitsma,

Mooren,

Mouthaan

et al. 2024

Clin Psychology and Psychoth

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Most studies examining prolonged grief disorder (PGD) in people bereaved during the COVID‐19 pandemic are focused on psychopathology. However, mental health encompasses both absence of psychopathology and presence of well‐being. This is the first study examining symptom profiles of early PGD and subjective mental well‐being in 266 Dutch adults recently bereaved during the pandemic. Early PGD and well‐being indicators were assessed with the Traumatic Grief Inventory–Self Report Plus and the World Health Organization–Five Well‐Being Index, respectively. Latent class analysis identified four classes: low PGD/high well‐being (32%), low PGD/moderate well‐being (24%), moderate PGD/high well‐being (23%) and high PGD/low well‐being class (21%). People in the poorer mental health classes were more likely to be female, lower educated, suffering from a mental disorder, have a poor health status, closer kinship to the deceased, and higher risk of severe COVID‐19. Classifying adults according to symptom profiles of negative and positive outcomes provides a more complete picture of mental health in bereaved people and offers potential intervention targets.

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Self-guided online treatment of disturbed grief, posttraumatic stress, and depression in adults bereaved during the COVID-19 pandemic: A randomized controlled trial

Cited by 20 publications

References 70 publications

The Efficacy and Usability of an Unguided Web-Based Grief Intervention for Adults Who Lost a Loved One During the COVID-19 Pandemic: Randomized Controlled Trial

The Efficacy and Usability of an Unguided Web-Based Grief Intervention for Adults Who Lost a Loved One During the COVID-19 Pandemic: Randomized Controlled Trial

Cognitive Behavior Therapy vs Mindfulness in Treatment of Prolonged Grief Disorder

A Latent Class Analysis on Indicators of Early Prolonged Grief Disorder and Well‐Being Among Dutch Adults Bereaved During the First Year of the COVID‐19 Pandemic

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