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

Abstract

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

Internet-based self-administered intervention to reduce anxiety and depression symptomatology and improve well-being in 7 countries: protocol of a randomized control trial

“…We then tried to confirm and extend these findings using simulations based on real data from a similar previous study conducted by Dominguez-Rodriguez et al (2021 , 2023) . The data included the results of 114 participants, 45 on the treatment condition and 69 on the control condition, which after finishing a waiting period of 36 days, were assigned to the treatment condition.…”

“…The multiple evaluations carried out during the intervention will also provide estimated data on anxiety, depression, stress, sleep quality, experiential avoidance and psychological inflexibility, satisfaction with life, mental psychological well-being, perceived deficits, post-traumatic stress and suicidal ideation, on users in different countries, which can also be compared by the sociodemographic variables collected. Furthermore, although the number of questionnaires implemented in different parts of the study could be perceived as a high number, we ensured to select questionnaires that are short and widely validated, furthermore previous studies conducted by the team members ( Dominguez-Rodriguez et al, 2023 ; Martínez-Arriaga et al, 2023 ) have found that participants do answer all the assessments, and this helps to analyze the impact of the intervention.…”

“…Specifically, the treatment components shown to be effective when applied online are Acceptance and Commitment Therapy ( Thompson et al, 2021 ), Cognitive Behavioral Therapy ( Morgan et al, 2017 ), Mindfulness ( Spijkerman et al, 2016 ), and Behavioral Activation ( Huguet et al, 2018 ), also, multicomponent proposals ( Marcelle et al, 2019 ; Wijnen et al, 2023 ). Other approaches from ITLAS group have demonstrated the effectiveness of multimodal interventions in the Latino population for grief treatment ( Dominguez-Rodriguez et al, 2023 ). However, the results of these meta-analyses are mainly based on internet interventions designed and applied in high-income countries.…”

Healing grief – an online self-help intervention programme for bereaved Chinese with prolonged grief: study protocol for a randomised controlled trial

“…Early interventions were mainly based on cognitive behavioural therapy (CBT) (Kersting et al, 2011 ; Kersting et al, 2013 ; Lange et al, 2000 ; Litz et al, 2014 ; van der Houwen et al, 2010 ; Wagner et al, 2006 ), including self-confrontation/exposure, cognitive restructuring/cognitive reappraisal, and social sharing as elements. Recently, some interventions were innovatively designed to combine CBT with grief theory such as the dual process model of coping with bereavement (DPM) (Brodbeck et al, 2019 ) and the Worden’s task model of grieving (Dominguez-Rodriguez et al, 2023 ). Internet-based grief interventions have been also expanded to art therapy based on solution-focused brief therapy and the meaning-making approach to bereavement (Park & Cha, 2023 ) and yoga intervention combining physical exercise and mindfulness cultivation (Huberty et al, 2020 ; Sullivan et al, 2022 ).…”

“…Meta-analyses of RCT demonstrated that Internet-based grief interventions are effective, with moderate to large effect sizes (Wagner et al, 2020 ; Zuelke et al, 2021 ). While studies included in the meta-analyses mostly adopted therapist-assisted interventions, Internet-based self-help grief interventions were also effective enough to improve mental health (Dominguez-Rodriguez et al, 2023 ; Huberty et al, 2020 ; Reitsma et al, 2023 ; Schrauwen, 2021 ; van der Houwen et al, 2010 ).…”