Bereaved Young Adults Study

Study Overview
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Brief Summary
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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.

Official Title
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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

Conditions
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Bereavement

Intervention / Treatment
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* Behavioral: Expressive Disclosure
* Behavioral: Expressive Helping
* Behavioral: Fact-Writing


Participation Criteria
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Eligibility Criteria
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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: 1. Express active psychosis or suicidal ideation, or any other circumstances that, in the opinion of the investigators, compromise participant safety.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 26 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Expressive Disclosure<br>Participants will be instructed to write about their deepest thoughts and feelings surrounding their bereavement experience. | Behavioral: Expressive Disclosure<br>* 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.<br>|
| Experimental: Expressive Helping<br>Participants will be instructed to write about their deepest thoughts and feeling surrounding their bereavement experience in their first two essays and to provide advice and support for someone who recently experienced a loss in their final essay. | Behavioral: Expressive Helping<br>* 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.<br>|
| Sham Comparator: Fact-Writing<br>Participants will be instructed to write objectively about different time frames (e.g., routine for getting up in the morning, routine for going to sleep at night). | Behavioral: Fact-Writing<br>* 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).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Wellbeing | 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. | 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. | 
| Change in Grief Reactions | 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. | 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. | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Physical Symptoms | 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. | 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. | 
| Change in Anxiety | 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. | 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. | 
| Change in Depressive Symptoms | 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. | 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. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Expressive Disclosure, Prosocial, Expressive Writing, Peer Helping, Young Adults