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Completed

NCT Number: NCT05352243

Bereaved Young Adults Study

Bereaved adolescents and emerging adults are at risk for developing psychological disorders and complicated grief. Clinical grief interventions and conventional wisdom reflect an implicit assumption that sharing and expressing one's feelings surrounding a loss (i.e., emotional disclosure) facilitates psychological adjustment. However, studies of emotional disclosure have yielded null results in bereaved samples. Individuals who have encountered stressful life events, including interpersonal loss, often report a desire to "give back" to others in similar situations. Empirical evidence suggests that providing support to others can be equally, if not more, beneficial than receiving support. The opportunity to support others experiencing stressful circumstances may address common feelings of powerlessness and engender a sense of meaning, enhancing positive affect and reducing distress. Interventions that leverage prosocial behaviors are associated with positive effects, including increases in wellbeing in non-bereaved populations. To date, no research has examined the utility of prosocial interventions for bereaved individuals.

The present study tests a novel expressive helping intervention that combines elements of expressive disclosure and prosocial writing. Expressive helping will be compared to traditional expressive disclosure and a neutral writing control condition in a sample of bereaved young adults. Participants (N=156) will be randomized to one of three conditions-expressive disclosure, expressive helping, or a neutral writing control-and complete three weekly 20-minute writing sessions. Measures of psychological distress, well-being, and hypothesized mediators will be administered before, immediately following (within 48 hours of the final writing session), one month, and two months after the writing sessions. It is hypothesized that the participants in the expressive helping condition will evidence greater increases in well-being and decreases in grief-related distress at the one and two-month follow-ups, as compared to the other two groups.

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Key information

Conditions

Age range

18 year–26 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

University of California, Los Angeles

Los Angeles, California, 90095, United States

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

  • Experienced the death of a loved one within the last 5 years, but more than 6 months ago.
  • Endorse having close relationship with loved one at time of their death (i.e., 5 or above on 1-10 likert scale with 1 being not at all close, and 10 being extremely close).
  • Endorse moderate to severe distress about the loss (i.e., 5 or above on 1-10 likert scale with 1 being not at all distressed, and 10 being extremely distressed).
  • Feel comfortable writing in English (due to the linguistic nature of the writing sessions).
  • Have access to the Internet and a computer to complete the assessments and writing sessions.

Exclusion criteria

  • Express active psychosis or suicidal ideation, or any other circumstances that, in the opinion of the investigators, compromise participant safety.

Treatment and study plan

Expressive Disclosure

Behavioral

Prior to each writing session, participants will receive general instructions for completing the writing (e.g., write continuously for 20 minutes, do not worry about grammar, sentence structure, repetition), and be reminded that their writing will remain confidential. Three writing sessions will be spaced 1-2 weeks apart. A weekly writing prompt will instruct participants to write about their deepest thoughts and feelings surrounding their bereavement experience.

Expressive Helping

Behavioral

Prior to each writing session, participants will receive general instructions for completing the writing (e.g., write continuously for 20 minutes, do not worry about grammar, sentence structure, repetition), and be reminded that their first two writing will remain confidential, and their final essay will be de-identified before being provided to newly bereaved young adults. Three writing sessions will be spaced 1-2 weeks apart. In the first two writing sessions, participants will receive a writing prompt that will instruct them to write about their deepest thoughts and feelings surrounding their bereavement experience. For the final writing session, participants will receive a writing prompt instructing them to provide advice and support for a newly bereaved young adult.

Fact-Writing

Behavioral

Prior to each writing session, participants will receive general instructions for completing the writing (e.g., write continuously for 20 minutes, do not worry about grammar, sentence structure, repetition), and be reminded that their writing will remain confidential. Three writing sessions will be spaced 1-2 weeks apart. A weekly writing prompt will instruct participants to write objectively about different time frames (e.g., routine for getting up in the morning, routine for going to sleep at night).

Primary outcomes

  1. Change in Wellbeing

    Time frame: Baseline (≤2 weeks of starting the intervention), post-intervention survey (≤1 week after the final writing assignment), the 1-month follow-up, and 2-month follow up.

    Wellbeing within the past two weeks will be measured at baseline, post-intervention, and the 1-month follow-up via the 14-item Mental Health Continuum-Short Form (MHC-SF; Keyes, 2009). The MHC-SF is comprised of three empirically derived subscales: the 3-item Emotional Well-Being Subscale, the 6-item Psychological Well-Being Subscale, and the 5-item Social Well-Being Subscale. Higher scores on each subscale, and the total score overall (range: 0-56), indicate greater well-being.

  2. Change in Grief Reactions

    Time frame: Baseline (≤2 weeks of starting the intervention), post-intervention survey (≤1 week after the final writing assignment), the 1-month follow-up, and 2-month follow up.

    Grief-related distress within the past two weeks will be measured using the 18-item Traumatic-Grief Inventory Self-Report version (TGI-SR; Boelen et al., 2019). The TGI-SR includes items that reflect the criteria for Prolonged Grief Disorder (PGD) and Persistent Complex Bereavement Disorder set forth by the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases, respectively. Higher scores (range: 18-90) indicate more severe potentially impairing grief reactions.

Secondary outcomes

  1. Change in Physical Symptoms

    Time frame: Baseline (≤2 weeks of starting the intervention), post-intervention survey (≤1 week after the final writing assignment), the 1-month follow-up, and 2-month follow up.

    Physical symptoms within the past two weeks will be measured using the Pennebaker Inventory of Limbic Languidness (PILL; Pennebaker et al., 1982). The PILL contains 54 items measured using a 5-point scale for the frequency of a variety of common physical symptoms (1 = never, 5 = more than once every week). Higher total scores (range, 0-216) indicate greater symptomatology.

  2. Change in Anxiety

    Time frame: Baseline (≤2 weeks of starting the intervention), post-intervention survey (≤1 week after the final writing assignment), the 1-month follow-up, and 2-month follow up.

    Anxiety symptoms over the past 2 weeks will be measured using the 7-item PROMIS - Anxiety Short Form (Pilkonis, 2011). Higher scores (range: 7-35) on this scale indicate greater severity of anxiety symptoms.

  3. Change in Depressive Symptoms

    Time frame: Baseline (≤2 weeks of starting the intervention), post-intervention survey (≤1 week after the final writing assignment), the 1-month follow-up, and 2-month follow up.

    Depressive symptoms over the past two weeks will be measured using the 20-item Center for Epidemiological Studies Depression Scale (CES-D; Radloff, 1977). The CES-D is a measure of symptom severity. Higher scores (range: 0-60) on this scale indicate greater depressive symptom severity.

Other outcomes

  1. Change in Universality

    Time frame: Baseline (≤2 weeks of starting the intervention), directly after each writing session, post-intervention survey (≤1 week after the final writing assignment), the 1-month follow-up, and 2-month follow up.

    Feelings of universality over the past two weeks and during the writing sessions will be measured using adapted versions of items included in a questionnaire used in research regarding group therapy and social support groups (i.e., Weinberg et al., 1995, Yalom, 1995). Feelings of universality will be assessed with 3 items (e.g., "I feel understood and accepted by others who have experienced a loss."). A higher total score (range: 3-21) indicates greater feelings of universality.

  2. Change in Psychological Distance

    Time frame: Baseline (≤2 weeks of starting the intervention), directly after each writing session, post-intervention survey (≤1 week after the final writing assignment), the 1-month follow-up, and 2-month follow up.

    Psychological distance while thinking and while completing the writing sessions will be measured using adapted items from previous research on psychological distance (i.e., Ayduk & Kross, 2010; Libby & Eibach, 2011; Ross & Wilson, 2002). Psychological will be assessed with 4 items. A higher total score (range: 4-28) indicates psychological distance.

  3. Change in Generativity

    Time frame: Baseline (≤2 weeks of starting the intervention), directly after each writing session, post-intervention survey (≤1 week after the final writing assignment), the 1-month follow-up, and 2-month follow up.

    Feelings of generativity over the past two weeks and while completing the writing sessions will be measured using the 6-item generative achievement subscale of the Generativity Scale (Gruenewald et al., 2015). Higher scores (range: 13-78) on this scale indicate greater generativity levels.

  4. Change in Coping Tendency

    Time frame: Baseline (≤2 weeks of starting the intervention), post-intervention survey (≤1 week after the final writing assignment), the 1-month follow-up, and 2-month follow up.

    Coping processes within the past two weeks will be measured using the COPE approach-oriented coping subscales (i.e., positive reinterpretation, emotional support, and acceptance; Carver et al., 1989), emotional approach coping scales (i.e., emotional processing, emotional expression; Stanton et al., 2000), and the COPE avoidance-oriented coping subscales (i.e., mental disengagement, denial; Carver et al., 1989; Eisenberg et al., 2012). Each subscale contains 4 times (28 items total) and assesses coping strategy use. Higher scores on each subscale (range: 4-16) indicate greater use of the associated coping strategy.

Sponsors and collaborators

Lead sponsor

University of California, Los Angeles

Other

Registry information

Official study title

Combined Expressive Disclosure and Prosocial Writing to Promote Well-Being and Decrease Psychological Distress Among Bereaved Emerging Adults: Examining The Roles of Psychological Distancing, Universality, and Generativity

Important dates

Study start
2022
Primary completion
2022
Study completion
2022
First posted
Apr 28, 2022
Registry last updated
May 16, 2023

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

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This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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