Brodbeck Jeannette, Berger Thomas, Biesold Nicola, Rockstroh Franziska, Schmidt Stefanie J, Znoj Hansjoerg
Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
School of Social Work, University of Applied Sciences and Arts Northwestern Switzerland, Olten, Switzerland.
JMIR Ment Health. 2022 May 6;9(5):e27707. doi: 10.2196/27707.
Internet interventions for mental disorders and psychological problems such as prolonged grief have established their efficacy. However, little is known about how internet interventions work and the mechanisms through which they are linked to the outcomes.
As a first step in identifying mechanisms of change, this study aimed to examine emotion regulation and loss-related coping self-efficacy as putative mediators in a randomized controlled trial of a guided internet intervention for prolonged grief symptoms after spousal bereavement or separation or divorce.
The sample comprised older adults who reported prolonged grief or adaptation problems after bereavement, separation, or divorce and sought help from a guided internet intervention. They were recruited mainly via newspaper articles. The outcome variables were grief symptoms assessed using the Texas Revised Inventory of Grief and psychopathology symptoms assessed using the Brief Symptom Inventory. A total of 6 module-related items assessed loss-focused emotion regulation and loss-related coping self-efficacy. In the first step, path models were used to examine emotion regulation and loss-related coping self-efficacy as single mediators for improvements in grief and psychopathology symptoms. Subsequently, exploratory path models with the simultaneous inclusion of emotion regulation and self-efficacy were used to investigate the specificity and relative strength of these variables as parallel mediators.
A total of 100 participants took part in the guided internet intervention. The average age was 51.11 (SD 13.60) years; 80% (80/100) were separated or divorced, 69% (69/100) were female, and 76% (76/100) were of Swiss origin. The internet intervention increased emotion regulation skills (β=.33; P=.001) and loss-related coping self-efficacy (β=.30; P=.002), both of which correlated with improvements in grief and psychopathology symptoms. Path models suggested that emotion regulation and loss-related coping self-efficacy were mediators for improvement in grief. Emotion regulation showed a significant indirect effect (β=.13; P=.009), whereas coping self-efficacy showed a trend (β=.07; P=.06). Both were confirmed as mediators for psychopathology (β=.12, P=.02; β=.10; P=.02, respectively). The path from the intervention to the improvement in grief remained significant when including the mediators (β=.26, P=.004; β=.32, P≤.001, respectively) in contrast to the path from the intervention to improvements in psychopathology (β=.15, P=.13; β=.16, P=.10, respectively).
Emotion regulation and loss-related coping self-efficacy are promising therapeutic targets for optimizing internet interventions for grief. Both should be further examined as transdiagnostic or disorder-specific putative mediators in internet interventions for other disorders.
ClinicalTrials.gov NCT02900534; https://clinicaltrials.gov/ct2/show/NCT02900534.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-016-1759-5.
针对精神障碍和心理问题（如持续性悲伤）的互联网干预已证实其有效性。然而，对于互联网干预如何发挥作用以及它们与治疗效果相关的机制却知之甚少。
作为确定变化机制的第一步，本研究旨在检验情绪调节和与丧失相关的应对自我效能感，将其作为一项随机对照试验中的假定中介变量，该试验是针对配偶丧亲、分居或离婚后出现的持续性悲伤症状进行的指导性互联网干预。
样本包括在经历丧亲、分居或离婚后报告有持续性悲伤或适应问题并寻求指导性互联网干预帮助的老年人。他们主要通过报纸文章招募而来。结果变量包括使用《德克萨斯修订悲伤量表》评估的悲伤症状以及使用《症状自评量表》评估的精神病理学症状。共有6个与模块相关的项目评估了以丧失为重点的情绪调节和与丧失相关的应对自我效能感。第一步，使用路径模型检验情绪调节和与丧失相关的应对自我效能感作为悲伤和精神病理学症状改善的单一中介变量。随后，使用同时纳入情绪调节和自我效能感的探索性路径模型来研究这些变量作为平行中介变量的特异性和相对强度。
共有100名参与者参加了指导性互联网干预。平均年龄为51.11（标准差13.60）岁；80%（80/100）为分居或离婚状态，69%（69/100）为女性，76%（76/100）为瑞士籍。互联网干预提高了情绪调节技能（β = 0.33；P = 0.001）和与丧失相关的应对自我效能感（β = 0.30；P = 0.002），二者均与悲伤和精神病理学症状的改善相关。路径模型表明，情绪调节和与丧失相关的应对自我效能感是悲伤改善的中介变量。情绪调节显示出显著的间接效应（β = 0.13；P = 0.009），而应对自我效能感呈趋势（β = 0.07；P = 0.06）。二者均被确认为精神病理学的中介变量（分别为β = 0.12，P = 0.02；β = 0.10；P = 0.02）。与从干预到精神病理学改善的路径（分别为β = 0.15，P = 0.13；β = 0.16，P = 0.10）相比，当纳入中介变量时，从干预到悲伤改善的路径仍然显著（分别为β = 0.26，P = 0.004；β = 0.32，P≤0.001）。
情绪调节和与丧失相关的应对自我效能感是优化针对悲伤的互联网干预的有前景的治疗靶点。二者均应作为互联网干预其他疾病时的跨诊断或特定疾病假定中介变量进行进一步研究。
ClinicalTrials.gov NCT02900534；https://clinicaltrials.gov/ct2/show/NCT02900534。
国际注册报告识别码（IRRID）：RR2 - 10.1186/s13063 - 016 - 1759 - 5。
