An internet-based self-help intervention for older adults after marital bereavement, separation or divorce: study protocol for a randomized controlled trial

Jeannette Brodbeck, Thomas Berger, Hans Joerg Znoj, Jeannette Brodbeck, Thomas Berger, Hans Joerg Znoj

Abstract

Background: Marital bereavement and separation or divorce are among the most stressful critical life events in later life. These events require a dissolution of social and emotional ties, adjustments in daily routine and changes in identity and perspectives for the future. After a normative grief or distress reaction, most individuals cope well with the loss. However, some develop a prolonged grief reaction. Internet-based self-help interventions have proved beneficial for a broad range of disorders, including complicated grief. Based on the task model and the dual-process model of coping with bereavement, we developed a guided internet-based self-help intervention for individuals who experienced marital bereavement, separation or divorce at least 6 months prior to enrolment. The intervention consists of 10 text-based self-help sessions and one supportive email a week. The primary purpose of this study is the evaluation of the feasibility and efficacy of the intervention compared with a waiting control group. The secondary purpose is to compare the effects in bereaved and separated participants. Furthermore, we aim to analyze other predictors, moderators and mediators of the outcome, such as age, psychological distress and intensity of use of the intervention.

Methods: The design is a randomized controlled trial with a waiting control condition of 12 weeks and a 24-weeks follow-up. At least 72 widowed or separated participants will be recruited via our study website and internet forums. Primary outcomes are reductions in grief symptoms, depression and psychological distress. Secondary outcome measures are related to loneliness, satisfaction with life, embitterment and the sessions.

Discussion: The trial will provide insights into the acceptance and efficacy of internet-based interventions among adults experiencing grief symptoms, psychological distress and adaptation problems in daily life after spousal bereavement, separation or divorce. Findings will add to existing knowledge by (1) evaluating an internet-based intervention specifically designed for spousal bereavement and its consequences; (2) testing whether this intervention is equally effective for individuals after separation or divorce; and (3) suggesting adaptations to improve the efficacy of the intervention, selective indication and adaptations for different needs.

Trial registration: ClinicalTrials.gov, NCT02900534 . Registered on 1 September 2016.

Keywords: Bereavement; Depression; Divorce; Grief; Internet-based self-help; Older adults; Randomized controlled trial; Separation.

Figures

Fig. 1
Fig. 1
LIVIA flow chart study design
Fig. 2
Fig. 2
SPIRIT figure: schedule of enrolment, interventions, and assessments

References

    1. Znoj H. Trennung, Tod und Trauer [Separation, death and grief] Bern: Hogrefe; 2016.
    1. Aoun SM, Breen LJ, Howting DA, Rumbold B, McNamara B, Hegney D. Who needs bereavement support? A population based survey of bereavement risk and support need. PLoS One. 2015;10(3):e0121101. doi: 10.1371/journal.pone.0121101.
    1. Shear MK, Ghesquiere A, Glickman K. Bereavement and complicated grief. Curr Psychiatry Rep. 2013;15(11):406. doi: 10.1007/s11920-013-0406-z.
    1. Spahni S, Morselli D, Perrig-Chiello P, Bennett KM. Patterns of psychological adaptation to spousal bereavement in old age. Gerontology. 2015;61(5):456–68. doi: 10.1159/000371444.
    1. Perrig-Chiello P, Hutchison S, Morselli D. Patterns of psychological adaptation to divorce after a long-term marriage. J Soc Pers Relatsh. 2015;32(3):386–405. doi: 10.1177/0265407514533769.
    1. Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, et al. Prolonged grief disorder: psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med. 2009;6(8):e1000121. doi: 10.1371/journal.pmed.1000121.
    1. American Psychiatric Association . Diagnostic and statistical manual of mental disorders (DSM-5®) Washington DC: American Psychiatric Publishing; 2013.
    1. Worden JW. Grief counselling and grief therapy: a handbook for the mental health professional. 4. New York: Springer Publishing Company; 2009.
    1. Stroebe M, Schut H. The dual process model of coping with bereavement: rationale and description. Death Stud. 1999;23(3):197–224. doi: 10.1080/074811899201046.
    1. Shear K, Frank E, Houck PR, Reynolds CF. Treatment of complicated grief: a randomized controlled trial. JAMA. 2005;293(21):2601–8. doi: 10.1001/jama.293.21.2601.
    1. Boelen PA, de Keijser J, van den Hout MA, van den Bout J. Treatment of complicated grief: a comparison between cognitive-behavioral therapy and supportive counseling. J Consult Clin Psychol. 2007;75(2):277–84. doi: 10.1037/0022-006X.75.2.277.
    1. Wagner B, Knaevelsrud C, Maercker A. Internet-based cognitive-behavioral therapy for complicated grief: a randomized controlled trial. Death Stud. 2006;30(5):429–53. doi: 10.1080/07481180600614385.
    1. van der Houwen K, Schut H, van den Bout J, Stroebe M, Stroebe W. The efficacy of a brief internet-based self-help intervention for the bereaved. Behav Res Ther. 2010;48(5):359–67. doi: 10.1016/j.brat.2009.12.009.
    1. Litz BT, Schorr Y, Delaney E, Au T, Papa A, Fox AB, et al. A randomized controlled trial of an Internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder. Behav Res Ther. 2014;61:23–34. doi: 10.1016/j.brat.2014.07.005.
    1. Eisma MC, Boelen PA, van den Bout J, Stroebe W, Schut HA, et al. Internet-based exposure and behavioral activation for complicated grief and rumination: a randomized controlled trial. Behav Ther. 2015;46(6):729–48. doi: 10.1016/j.beth.2015.05.007.
    1. Andersson G, Cuijpers P, Carlbring P, Riper H, Hedman E. Guided internet‐based vs. face‐to‐face cognitive behavior therapy for psychiatric and somatic disorders: a systematic review and meta‐analysis. World Psychiatry. 2014;13(3):288–95. doi: 10.1002/wps.20151.
    1. Schröder J, Berger T, Westermann S, Klein JP, Moritz S. Internet interventions for depression: new developments. Dialogues Clin Neurosci. 2016;18:203–12.
    1. Wagner B, Maercker A. A 1.5‐year follow‐up of an internet‐based intervention for complicated grief. J Traum Stress. 2007;20(4):625–9. doi: 10.1002/jts.20230.
    1. LIVES Swiss National Centre of Competence in Research. Overcoming vulnerability: life course perspectives. Relationships in later life IP212. . Accessed 3 Oct 2016.
    1. . . Accessed 3 Oct 2016.
    1. Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91. doi: 10.3758/BF03193146.
    1. Soper D. Calculator: a-priori sample size for structural equation models. . Accessed 3 Oct 2016.
    1. Znoj H. Texas-Revised Inventory of Grief: Validierung der deutschen Version TRIG-D. Psychosom Konsiliarpsychiatr. 2008;2(4):236–9. doi: 10.1007/s11800-008-0131-3.
    1. Futterman A, Holland JM, Brown PJ, Thompson LW, Gallagher-Thompson D. Factorial validity of the Texas-Revised Inventory of Grief – present scale among bereaved older adults. Psychol Assessment. 2010;22(3):675–87. doi: 10.1037/a0019914.
    1. Franke GH. BSI. Brief Symptom Inventory by LR Derogatis. German version. Göttingen: Beltz; 2000.
    1. Brodbeck J, Stulz N, Itten S, Regli D, Znoj H, Caspar F. The structure of psychopathological symptoms and the associations with DSM-diagnoses in treatment seeking individuals. Compr Psychiatry. 2014;55(3):714–26. doi: 10.1016/j.comppsych.2013.11.001.
    1. Kühner C, Buerger C, Keller F, Hautzinger M. Reliabilität und Validität des revidierten Beck-Depressionsinventars (BDI-II) Befunde aus deutschsprachigen Stichproben Nervenarzt. 2007;78(6):651–6.
    1. De Jong GJ, Van Tilburg T. The De Jong Gierveld Short Scales for Emotional and Social Loneliness: tested on data from 7 countries in the UN generations and gender surveys. Eur J Ageing. 2010;7(2):121–30. doi: 10.1007/s10433-010-0144-6.
    1. Znoj H, Schnyder U. Verbitterungsfragebogen Kurzversion. Bern: University of Bern; 2014.
    1. Diener E, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess. 1985;49(1):71–5. doi: 10.1207/s15327752jpa4901_13.
    1. Schumacher J. SWLS – Satisfaction with life scale. Diagnostische Verfahren zu Lebensqualität und Wohlbefinden. Göttingen: Hogrefe; 2003.
    1. Sengpiel M, Dittberner D. The computer literacy scale (CLS) for older adults–development and validation. In: Herczeg M, Kindsmueller MC, editors. Mensch & Computer. Viel Mehr Interaktion. Muenchen: Oldenbourg Verlag; 2008. pp. 7–16.
    1. Ventura J, Green MF, Foster M, Shaner A, Liberman RP. Training and quality assurance with the Brief Psychiatric Rating Scale: “the drift busters”. Int J Methods Psychiatr Res. 1993;3:221–44.
    1. Qualtrics. . Accessed 3 Oct 2016.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit