title: An internet-based self-help intervention for older adults after marital bereavement, separation or divorce: study protocol for a randomized controlled trial.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  ClinicalTrials.gov, NCT02900534 . Registered on 1 September 2016.
authors.affiliation: Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland. jeannette.brodbeck@psy.unibe.ch.
authors.forename: Jeannette
authors.identifier: 0000-0003-3124-4828
authors.initials: J
authors.lastname: Brodbeck
authors.affiliation: Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Berger
authors.affiliation: Department of Psychology, University of Bern, Fabrikstrasse 8, 3012, Bern, Switzerland.
authors.forename: Hans Joerg
authors.initials: HJ
authors.lastname: Znoj
mesh_terms: D000223:Adaptation, Psychological; D000367:Age Factors; D001601:Bereavement; D002985:Clinical Protocols; D004243:Divorce / Q000523:psychology*; D005240:Feasibility Studies; D005260:Female; D006117:Grief; D006801:Humans; D020407:Internet; D008132:Loneliness; D008297:Male; D010549:Personal Satisfaction; D012107:Research Design; D012648:Self Care / Q000379:methods*; D013315:Stress, Psychological / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D013557:Switzerland; D013813:Therapy, Computer-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D017805:Widowhood / Q000523:psychology*
keywords: Bereavement; Depression; Divorce; Grief; Internet-based self-help; Older adults; Randomized controlled trial; Separation