Losing a close relative, either by death or by separation, is common but counts among the major stressful life events possible. A significant part of people (about 10%) experience substantial and persistent distress after such a loss. Meta-analyses indicate that supporting them with interventions is efficient. Recently, internet-based interventions (IBIs) were developed to support grieving individuals and have shown promising results. The best results of the latter were attained with guided IBIs. In particular, our partners Brodbeck, Berger and Znoj (2017, 2019) obtained very good results with a cognitive-behaviorally oriented IBI, the LIVIA 1 program. In a pilot study, our team tested LIVIA 1 in an unguided form; it was efficient, but to a lesser degree than the guided counterpart.
This might not only be due to the lack of guidance, but rather because these interventions were restricted in psychotherapeutical tasks and goals. Unguided interventions have the clear advantage of being more cost-effective, because once developed, they can be applied very broadly with limited resources. Thus, the present research project aims at developing a minimally guided IBI, based on empirically validated tools for promoting mental health restoration and preventing deleterious effects of prolonged grief in vulnerable people after the loss of a close relative. More specifically, we aim to compare Brodbeck and colleagues’ IBI (but with minimal guidance; LIVIA-FR-I) to a new unguided IBI that we will develop (LIVIA 2.0). It will comprise the following modifications to promote adherence and effectiveness (see Debrot et al., 2022):
- Including the evaluation and encouraging the use of individual resources (using the AERES; Bellier-Teichmann et al., 2018)
- Individually tailoring the order in which the modules are completed
- Sending automated e-mails in specific situations
- Increasing interactivity (with tools such as quizzes and videos)
- Integrating a module on identity and autobiographic memory.
These modifications target processes that have shown high relevance in the context of internet interventions. Participants will be adults who have lost a close relative at least 6 months ago and who subjectively suffer from this. We will randomly allocate them to two treatment conditions: LIVIA-FR-I or LIVIA 2.0. We will measure results on both distress and well-being scales at post-intervention and six-month follow-up. Moreover, we will explore the effects on social integration measures, and whether some measures (attachment style, type of loss, interpersonal closeness to the lost person, and symptom severity) moderate the efficacy.
The project (including the preparation and online implementation of LIVIA 2.0, the data collection, the data analyses and publications) will last four years, with a possible extension to apply the design to other mental disorders. It will enable to advance knowledge on IBIs and hopefully show that their effectiveness can be significantly improved. Additionally, there is a dramatic lack in French empirically validated IBIs. As French is a widely spoken language, the potential further application of such IBIs is broad and the consequential benefits for public health important.
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