The Role of Emotion Regulation and Loss-Related Coping Self-Efficacy in an Internet Intervention for Grief: A Mediation Analysis

Background: Internet interventions for mental disorders and psychological problems such as prolonged grief have established their efficacy. However, less is known about how internet interventions work and through which mechanisms they are linked to the outcomes.

Objective: As a first step in identifying mechanisms of change, this study examined emotion regulation and loss-related coping self-efficacy as putative mediators in a randomised controlled trial of a guided internet intervention for prolonged grief symptoms after spousal bereavement or separation/divorce.

Methods: The sample consisted of older adults who reported prolonged grief or adaptation problems after bereavement or separation/divorce and sought help from a guided internet intervention. They were recruited mainly via newspaper articles. Outcome variables were grief symptoms assessed with the Texas Revised Inventory of Grief and psychopathology symptoms assessed with the Brief Symptom Inventory. Six module-related items assessed loss-focused emotion regulation and loss-related coping-self-efficacy. Path models with the simultaneous inclusion of emotion regulation and self-efficacy investigated the specificity and relative strength of these variables as parallel mediators.

Results: A total of 100 participants who took part in the guided internet intervention. Average age was 51 years; 80% were separated/divorced, 69% were female and 76% were of Swiss origin. The internet intervention increased emotion-regulation skills (b = .34; P = .001) and loss-related self-efficacy (b = .30; P = .002) which both correlated with improvements in grief and psychopathology symptoms. Path models including both putative mediators simultaneously indicated that emotion regulation was directly associated with improvements in grief symptoms (b = .40; P = <.001) but not psychopathology symptoms (b = .01; P = .638). Loss-related self-efficacy was directly related to improvements in psychopathology symptoms (b = .28; P = .017) but not grief symptoms (b = .16; P = .186). The path from the intervention to the improvement in grief remained significant (b = .25; P = .007) in contrast to the path from the intervention to improvements in psychopathology (b = .13; P = .179).

Conclusions: Emotion regulation and loss-related coping self-efficacy are promising therapeutic targets for optimizing internet interventions for grief. Emotion regulation appears to be more important for enabling grief processing whereas loss-related coping self-efficacy might be more relevant for improving psychopathology in general. Emotion regulation and coping self-efficacy should be further examined as transdiagnostic or disorder-specific putative mediators in internet interventions for other disorders. Clinical Trial: ClinicalTrials.gov NCT02900534; https://clinicaltrials.gov/ct2/show/NCT02900534.