Internet-based grief therapy program for bereaved individuals at risk: A case series study

Year 2024, Volume: 8 Issue: 1, 101 - 113, 25.04.2024

Samet Baş Orçun Yorulmaz

https://doi.org/10.57127/kpd.26024438m0000110

Abstract

Interest in internet-based interventions has increased considerably. The effectiveness of these applications continues to be investigated for the treatment of Prolonged Grief Disorder. This study includes preliminary findings of the internet-based and therapist-supported prolonged grief intervention program developed in Turkish. The internet-based program consists of 10 written sessions, and after each session the participants receive written feedback from the therapist. The program takes approximately 6-8 weeks. The preliminary findings of the program were handled in a proof-of-concept study style based on a case series design. Self-report measures were taken from the first eight participants who completed the program at four different times (pre-test, post-test, 1st and 3rd month follow-ups). In addition, the written contents of the first and last sessions were analyzed by content analysis. As a result of the descriptive findings, remarkable decreases were observed in traumatic grief, global meaning violation, depressive symptoms, and stress levels in a significant part of the participants between pre-post and follow-up measurements. Also, five of the participants had considerable increases in meaning reconstruction scores. In addition, the results of the content analysis indicated that following the intervention, the bereaved individuals expressed less negative and more positive content, as expected. These two data show that the intervention program is promising in reducing the symptoms of Prolonged Grief Disorder in bereaved individuals and may yield good results with controlled designs for a broader range of participants.

Keywords

grief, loss, internet-based, prolonged grief, case series

Project Number

220K176

Risk altındaki yaslı bireylere yönelik internet temelli yas terapi programı: Bir vaka serisi çalışması

Abstract

İnternet temelli müdahalelere olan ilgi oldukça artmaktadır. Bu uygulamalar, Uzamış Yas Bozukluğu tedavisi için de etkinliği araştırılan yöntemlerden birisidir. Bu çalışma, Türkçe olarak geliştirilen internet temelli ve terapist destekli uzamış yas müdahale programının ön bulgularını içermektedir. İnternet temelli program 10 yazılı oturumdan oluşmakta ve her oturumdan sonra katılımcılara uygulayıcı tarafından yazılı geri bildirim verilmektedir. Program yaklaşık 6-8 hafta sürmektedir. Programa ilişkin ön bulgular, bir vaka serisi desene dayalı olarak kavram kanıtı çalışması tarzında ele alınmıştır. Programı tamamlayan ilk sekiz katılımcıdan dört farklı zamanda (ön test, son test ve 1. ve 3. ay izlemler) öz-bildirime dayalı ölçümler alınmıştır. Ayrıca, ilk ve son oturumun yazılı içerikleri içerik analiziyle incelenmiştir. Betimsel bulgular sonucunda, katılımcıların önemli bir kısmında ön-son ölçümler ve takip ölçümleri arasında travmatik yas, genel anlamdaki bozulmalar, depresif belirtiler ve stres düzeylerinde belirgin azalmalar gözlenmiştir. Ayrıca, vakaların beşinde anlamın yeniden yapılandırılması puanlarında önemli artışlar gözlenmiştir. Ayrıca içerik analizi sonuçları, yaslı bireylerin müdahale sonrasında beklendiği gibi daha az olumsuz içerik ve daha fazla olumlu içerik ifade ettiğini göstermiştir. Bu iki veri, müdahale programının Uzamış Yas Bozukluğu semptomlarını azaltmada umut verici olduğunu ve daha geniş bir katılımcı yelpazesi için kontrollü desenlerde iyi sonuçlar verebileceğini göstermektedir.

Keywords

yas, kayıp, internet temelli, uzamış yas, vaka serisi

Supporting Institution

Türkiye Bilimsel ve Teknolojik Araştırma Kurumu

Project Number

220K176

Thanks

This study was supported by the Scientific and Technological Research Council of Turkey (TUBITAK) as project 1001 with the number 220K176. We would like to thank TUBITAK for its valuable support. [Bu çalışma Türkiye Bilimsel ve Teknolojik Araştırma Kurumu (TÜBİTAK) tarafından 220K176 sayılı 1001 projesi olarak desteklenmiştir. Değerli destekleri için TÜBİTAK'a teşekkür ederiz.]

References

• Acet, P., Aydoğdu, B. E., & Dirik, G. (2020). Genel Anlamdaki Bozulmalar Ölçeği’nin Türkçe formunun geçerlik ve güvenirlik çalışması. Nesne Dergisi, 8(18), 422-440.
• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association Publishing.
• American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR). American Psychiatric Association Publishing.
• Andersson, G., Carlbring, P., Titov, N., & Lindefors, N. (2019). Internet interventions for adults with anxiety and mood disorders: A narrative umbrella review of recent meta-analyses. The Canadian Journal of Psychiatry, 64(7), 465-470.
• Andersson, G., Cuijpers, P., Carlbring, P., Riper, H., & Hedman, E. (2014). Guided internet-based vs. face-to-face cognitive behavior therapy for psychiatric and somatic disorders: A systematic review and meta-analysis. World Psychiatry, 13(3), 288-295.
• Baş, S., Yüksel, Ö., Ülbe, S., & Güngör, D. (2022). Turkish version of the Traumatic Grief Inventory- Self Report (TGI-SR): Validity and reliability. Death Studies, 46(6), 1481-1489.
• Bendig, E., Bauereiss, N., Ebert, D. D., Snoek, F., Andersson, G., & Baumeister, H. (2018). Internet-based interventions in chronic somatic disease. Deutsches Arzteblatt International, 115(40), 659-665.
• Boelen, P. A. (2006). Cognitive-behavioral therapy for complicated grief: Theoretical underpinnings and case descriptions. Journal of Loss and Trauma, 11(1), 1-30.
• Boelen, P. A., de Keijser, J., van den Hout, M. A., & van den Bout, J. (2007). Treatment of complicated grief: A comparison between cognitive-behavioral therapy and supportive counseling. Journal Of Consulting and Clinical Psychology, 75(2), 277-284.
• Boelen, P. A., Djelantik, A. A. A. M. J., de Keijser, J., Lenferink, L. I. M., & Smid, G. E. (2019). Further validation of the Traumatic Grief Inventory-Self Report (TGI-SR): A measure of persistent complex bereavement disorder and prolonged grief disorder. Death Studies, 43(6), 351-364.
• Boelen, P. A., & Smid, G. E. (2017). The Traumatic Grief Inventory Self-Report Version (TGI-SR): Introduction and preliminary psychometric evaluation. Journal of Loss and Trauma, 22(3), 196-212.
• Brodbeck, J., Berger, T., Biesold, N., Rockstroh, F., & Znoj, H. J. (2019). Evaluation of a guided internet-based self-help intervention for older adults after spousal bereavement or separation/divorce: A randomised controlled trial. Journal of Affective Disorders, 252, 440-449.
• Brooke, J. (1996). SUS-A Quick and Dirty Usability Scale. Usability Evaluation In Industry, 189(194), 4-7.
• Buckley, T., Spinaze, M., Bartrop, R., McKinley, S., Whitfield, V., Havyatt, J., Roche, D., Fethney, J., & Tofler, G. (2015). The nature of death, coping response and intensity of bereavement following death in the critical care environment. Australian Critical Care, 28(2), 64-70.
• Cardoso, É. A. D. O., Silva, B. C. D. A. D., Santos, J. H. D., Lotério, L. D. S., Accoroni, A. G., & Santos, M. A. D. (2020). The effect of suppressing funeral rituals during the COVID-19 pandemic on bereaved families. Revista Latino-Americana De Enfermagem, 28, e3361.
• Demi̇rkol, D., & Şeneler, Ç. (2018). A Turkish translation of the System Usability Scale: The SUS-TR. Uşak Üniversitesi Sosyal Bilimler Dergisi, 11(3), 237-253.
• Diolaiuti, F., Marazziti, D., Beatino, M. F., Mucci, F., & Pozza, A. (2021). Impact and consequences of COVID-19 pandemic on complicated grief and persistent complex bereavement disorder. Psychiatry Research, 300, 113916.
• Eisma, M. C., Boelen, P. A., & Lenferink, L. I. (2020). Prolonged grief disorder following the Coronavirus (COVID-19) pandemic. Psychiatry Research, 288, 1130 31.
• Eisma, M. C., Boelen, P. A., Van den Bout, J., Stroebe, W., Schut, H. A., Lancee, J., & Stroebe, M. S. (2015). Internet-based exposure and behavioral activation for complicated grief and rumination: A randomized controlled trial. Behavior Therapy, 46(6), 729-748.
• Foa, E. B., Hembree, E., & Rothbaum, B. O. (2007). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences therapist guide (Treatments that work). Oxford University Press.
• Gillies, J., & Neimeyer, R. A. (2006). Loss, grief, and the search for significance: Toward a model of meaning reconstruction in bereavement. Journal of Constructivist Psychology, 19(1), 31-65.
• Gillies J. M., Neimeyer, R. A., & Milman, E. (2015). The Grief and Meaning Reconstruction Inventory (GMRI); Initial validation of a new measure. Death Studies, 39, 61-74.
• Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy. Guilford press.
• He, L., Tang, S., Yu, W., Xu, W., Xie, Q., & Wang, J. (2014). The prevalence, comorbidity, and risks of prolonged grief disorder among bereaved Chinese adults.Psychiatry Research, 219(2), 347-352.
• Kersting, A., Dölemeyer, R., Steinig, J., Walter, F., Kroker, K., Baust, K., & Wagner, B. (2013). Brief internet-based intervention reduces posttraumatic stress and prolonged grief in parents after the loss of a child during pregnancy: A randomized controlled trial. Psychotherapy and Psychosomatics, 82(6), 372-381.
• Keser, E., & Işıklı, S. (2018). Yas ve Anlamı Yeniden Yapılandırma Envanteri'nin Türkçe formunun psikometrik özelliklerinin incelenmesi. Düsünen Adam, 31(4), 364-374.
• Lange, A., Schrieken, B., van de Ven, J.-P., Bredeweg, B., Emmelkamp, P. M. G., van der Kolk, J., Lydsdottir, L., Massaro, M., & Reuvers, A. (2000). “Interapy”: The effects of a short, protocolled treatment of posttraumatic stress and pathological grief through the Internet. Behavioural and Cognitive Psychotherapy, 28(2), 175-192.
• Lenferink, L. I., de Keijser, J., Smid, G. E., Djelantik, A. M. J., & Boelen, P. A. (2017). Prolonged grief, depression, and posttraumatic stress in disaster-bereaved individuals: Latent class analysis. European Journal of Psychotraumatology, 8(1), 1298311.
• Litz, B. T., Schorr, Y., Delaney, E., Au, T., Papa, A., Fox, A. B., Morris, S., Nickerson, A., Block, S., & Prigerson, H. G. (2014). A randomized controlled trial of an internet-based therapist-assisted indicated preventive intervention for prolonged grief disorder. Behaviour Research and Therapy, 61, 23-34.
• Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335-342.
• Marques, L., Bui, E., LeBlanc, N., Porter, E., Robinaugh, D., Dryman, M. T., Nadal-Vicens, M., Worthington, J., & Simon, N. (2013). Complicated grief symptoms in anxiety disorders: Prevalence and associated impairment. Depression and Anxiety, 30(12), 1211-1216.
• Neimeyer, R. A. (2000). Searching for the meaning of meaning: Grief therapy and the process of reconstruction. Death Studies, 24(6), 541-558.
• Park, C. L., Riley, K. E., George, L. S., Gutierrez, I. A., Hale, A. E., Cho, D., & Braun, T. D. (2016). Assessing disruptions in meaning: Development of the Global Meaning Violation Scale. Cognitive Therapy and Research, 40(6), 831-846.
• Pasarelu, C. R., Andersson, G., Bergman Nordgren, L., & Dobrean, A. (2017). Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: A systematic review and meta-analysis of randomized controlled trials. Cognitive Behaviour Therapy, 46(1), 1-28.
• Prigerson, H. G., Horowitz, M. J., Jacobs, S. C., Parkes, C. M., Aslan, M., Goodkin, K., Raphael, B., Marwit, S. J., Wortman, C., & Neimeyer, R. A. (2009). Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Medicine, 6(8), e1000121.
• Prigerson, H. G., Shear, M. K., Jacobs, S. C., Reynolds, C. F., Maciejewski, P. K., Davidson, J. R., Rosenheck, R., Pilkonis, P. A., Wortman, C. B., Williams, J. B., Widiger, T. A., Frank, E., Kupfer, D. J., & Zisook, S. (1999). Consensus criteria for traumatic grief: A preliminary empirical test. The British Journal of Psychiatry, 174(1), 67-73.
• Resick, P. A., Monson, C. M., & Chard, K. M. (2017). Cognitive processing therapy for PTSD: A comprehensive manual. Guilford Publications.
• Sayre, J. W., Toklu, H. Z., Ye, F., Mazza, J., & Yale, S. (2017). Case reports, case series–From clinical practice to evidence-based medicine in graduate medical education. Cureus, 9(8), e1546.
• Schaal, S., Richter, A., & Elbert, T. (2014). Prolonged grief disorder and depression in a German community sample. Death Studies, 38(7), 476-481.
• Simon, N. M., Shear, K. M., Thompson, E. H., Zalta, A. K., Perlman, C., Reynolds, C. F., Frank, E., Melhem, N. M., & Silowash, R. (2007). The prevalence and correlates of psychiatric comorbidity in individuals with complicated grief. Comprehensive Psychiatry, 48(5), 395-399.
• She, W. J., Siriaraya, P., Ang, C. S., & Prigerson, H. G. (2021, May). Living memory home: Understanding continuing bond in the digital age through backstage grieving. In Proceedings of the 2021 CHI Conference on Human Factors in Computing Systems (pp. 1-14).
• Shear, M. K. (2015). Complicated grief. New England Journal of Medicine, 372(2), 153-160.
• Staiger, P. K., O'Donnell, R., Liknaitzky, P., Bush, R., & Milward, J. (2020). Mobile apps to reduce tobacco, alcohol, and illicit drug use: Systematic review of the first decade. Journal of Medical Internet Research, 22(11), e17156.
• Stroebe, M. S., Folkman, S., Hansson, R. O., & Schut, H. (2006). The prediction of bereavement outcome: Development of an integrative risk factor framework. Social Science and Medicine, 63(9), 2440-2451.
• Stroebe, M. S., Schut, H. A. W., & Stroebe, W. (2007). Health consequences of bereavement: A review. The Lancet Infectious Diseases, 370(9603), 1960-1973.
• Stroebe, M., & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197-224.
• Szuhany, K. L., Malgaroli, M., Miron, C. D., & Simon, N. M. (2021). Prolonged grief disorder: Course, diagnosis, assessment, and treatment. Focus (American Psychiatric Publishing), 19(2), 161-172.
• Ting, N., Chen, D. G., Ho, S., & Cappelleri, J. C. (2017). Phase II clinical development of new drugs. Springer.
• Van der Houwen, K., Schut, H., van den Bout, J., Stroebe, M., & Stroebe, W. (2010). The efficacy of a brief internet-based self-help intervention for the bereaved. Behaviour Research and Therapy, 48(5), 359-367.
• VERBI Software. (2020). MAXQDA 2020 [computer software]. VERBI Software. maxqda.com
• Wagner, B., Knaevelsrud, C., & Maercker, A. (2005). Internet-based treatment for complicated grief: Concepts and case study. Journal of Loss and Trauma, 10(5), 409-432.
• Wagner, B., Knaevelsrud, C., & Maercker, A. (2006). Internet-based cognitive-behavioral therapy for complicated grief: A randomized controlled trial. Death Studies, 30(5), 429-453.
• Wagner, B., & Maercker, A. (2007). A 1.5‐year follow‐up of an internet‐based intervention for complicated grief. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 20(4), 625-629.
• Worden, J. W. (2018). Grief counselling and grief therapy: A handbook for the mental health practitioner. Springer Publishing Company.
• World Health Organization. (2018). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/
• Xygkou, A., Siriaraya, P., Covaci, A., Prigerson, H. G., Neimeyer, R., Ang, C. S., & She, W. J. (2023). The "conversation" about loss: Understanding how Chatbot technology was used in supporting people in grief. In Proceedings of the 2023 CHI Conference on Human Factors in Computing Systems.
• Yıldırım, A., Boysan, M., & Kefeli, M. C. (2018). Psychometric properties of the Turkish version of the Depression Anxiety Stress Scale-21 (DASS-21). British Journal of Guidance and Counselling, 46(5), 582-595.