Publications by authors named "Maarten C Eisma"

60 Publications

Pragmatic evaluation of methods for retrieving unpublished information on comparator interventions in a systematic review of smoking cessation trials.

Psychol Health 2022 Jul 23:1-17. Epub 2022 Jul 23.

Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.

Objective: Reporting of the content and delivery characteristics of comparator interventions in published articles is often incomplete. This study examines the feasibility and validity of two methods for collecting additional information on comparator interventions from trial authors.

Methods & Measures: In a systematic review of smoking cessation trials (IC-Smoke), all trial authors were asked to send unpublished comparator intervention materials and complete a specially-developed comparator intervention checklist. All published and additionally obtained information from authors were coded for behaviour change techniques (BCTs) and other characteristics (type of comparator, provider, provider training, delivery mode and treatment duration). To assess representativeness, we assessed the amount of additional information obtained from trial authors compared with the amount that was published. We examined known-group and convergent validity of comparator intervention data when using only published or also unpublished information.

Results: Additional information were obtained from 91/136 (67%) of trial authors. Representativeness, known-group and convergent validity improved substantially based on the data collected by means of the comparator intervention checklist, but not by requesting authors to send any existing comparator materials.

Conclusions: Requesting authors for unpublished comparator intervention data, using specially-developed checklists and unpublished materials, substantially improves the quality of data available for systematic reviews.
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http://dx.doi.org/10.1080/08870446.2022.2081688DOI Listing
July 2022

COVID-19, natural, and unnatural bereavement: comprehensive comparisons of loss circumstances and grief severity.

Eur J Psychotraumatol 2022 9;13(1):2062998. Epub 2022 May 9.

Psyned, Psychologen Nederland, Amsterdam, the Netherlands.

Background: Acute grief appears more severe after COVID-19 deaths than natural deaths. Prolonged grief disorder (PGD) also appears prevalent following COVID-19 deaths. Researchers hypothesize that specific loss characteristics and pandemic-related circumstances may precipitate more severe grief following COVID-19 deaths compared to (other) natural deaths. Systematic research on these hypotheses may help identify those most at risk for severe grief reactions, yet it is scant.

Objective: To compare loss characteristics, loss circumstances, and grief levels among people bereaved due to COVID-19, natural, and unnatural causes.

Methods: Adults bereaved through COVID-19 ( = 99), natural causes ( = 1006), and unnatural causes ( = 161) completed an online survey. We administered self-report measures of demographic variables (i.e., age, gender), loss characteristics (i.e., time since loss, relationship with the deceased, intensive care admission, expectedness of death), loss circumstances (i.e., saying goodbye appropriately, COVID-19 infection, quarantine, financial setbacks, social support satisfaction, altered funeral arrangements, funeral satisfaction), and prolonged grief symptoms.

Results: COVID-19 deaths (vs. other deaths) more often were parental deaths and less often child deaths. COVID-19 deaths (vs. natural deaths) were more often unexpected and characterized by an inability to say goodbye appropriately. People bereaved due to COVID-19 (vs. other deaths) were more often infected and quarantined. COVID-19 deaths (vs. other deaths) more often involved intensive care admission and altered funeral arrangements. COVID-19 deaths yielded higher grief levels than natural deaths (but not unnatural deaths). Expectedness of the death and the inability to say goodbye appropriately explained this effect.

Conclusions: Bereavement due to COVID-19 is characterized by a unique set of loss characteristics and circumstances and elevated grief levels. Improving opportunities to say goodbye before and after death (e.g., by means of rituals) may provide an important means to prevent and reduce severe grief following COVID-19 deaths.

Highlights: COVID-19 deaths have unique loss characteristics and circumstances and elicit more severe grief than natural deaths.Death expectedness and the ability to say goodbye appropriately appear important in understanding, preventing and treating grief following COVID-19 deaths.
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http://dx.doi.org/10.1080/20008198.2022.2062998DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103268PMC
May 2022

Concurrent associations of dimensions of anger with posttraumatic stress, depression, and functional impairment following non-fatal traffic accidents.

Eur J Psychotraumatol 2022 11;13(1):2068912. Epub 2022 May 11.

Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.

Background: Anger is associated with dysfunction following potentially traumatic events. It is still unclear to what extent different types of anger are differentially related to poor outcomes. To advance knowledge in this area, the Posttraumatic Anger Questionnaire (PAQ) was designed, measuring anger directed at (i) the justice system, (ii) other people, (iii) the self, (iv) people held accountable for the potential traumatic event, and (v) a desire for revenge to those held responsible. Preliminary evidence shows that these types of anger are distinguishable and differentially associated with posttraumatic stress (PTS). No studies have yet examined whether such findings can be generalized to victims of non-fatal traffic accidents, one of the most common potentially traumatic events.

Objective: This study's aims were (i) to establish if the five-factor structure of the PAQ found in prior studies could be replicated, (ii) to explore whether the intensity of emerging types of anger differed, and (iii) to explore the associations of anger-types with levels of PTS, depression, and functional impairment.

Method: Two-hundred and fifty adults who experienced a traffic accident completed the PAQ and instruments measuring PTS, depression, and functional impairment. They also answered questions about their socio-demographic characteristics and features of the accident.

Results: Confirmatory factor analysis confirmed that the PAQ measures five types of anger. Levels of anger at people held accountable were the highest. Structural equation modelling showed that both anger at others and anger at the self, but not the other three anger types, were associated with PTS, depression, and functional impairment, when controlling for the shared variance between the anger types, socio-demographic variables, and features of the accident.

Conclusions: Findings illustrate the potential importance of considering different types of anger when assessing and treating PTS following traffic accidents.

Highlights: Based on data from people confronted with a traffic accident, we found the Posttraumatic Anger Questionnaire (PAQ) to represent distinguishable dimensions of anger.Anger dimensions were: anger directed at (i) the justice system, (ii) other people, (iii) the self, (iv) people held accountable for the event, and (v) a desire for revenge to those held responsible.Scores on items measuring anger at people held accountable for the event were significantly higher than scores on items measuring other anger types.Anger at the self and other people were most strongly associated with posttraumatic stress, depression, and functional impairment.
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http://dx.doi.org/10.1080/20008198.2022.2068912DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9103591PMC
May 2022

My Grief App for Prolonged Grief in Bereaved Parents: A Pilot Study.

Front Psychiatry 2022 25;13:872314. Epub 2022 Apr 25.

Department of Medical Sciences, National Centre for Disaster Psychiatry, Uppsala University, Uppsala, Sweden.

The death of a child is a devastating experience for most parents. Consequently, bereaved parents are at risk to develop physical and mental health problems, including prolonged grief disorder. Nevertheless, there is a lack of evaluated psychosocial interventions for bereaved parents. The primary aim of this study was to examine the feasibility of the My Grief app for bereaved parents. The secondary aim was to evaluate the potential reduction of symptoms of prolonged grief, depression and post-traumatic stress, and cognitive-behavioral processes proposed to prolong grief reactions. The study was a mixed-method open trial design, using pre- and post-intervention surveys and post-intervention interviews. Thirteen parents had access to the app for 4 weeks, eight parents participated in interviews and 10 parents answered the follow-up survey. The study provided evidence for the app's feasibility and acceptability, with participants reporting satisfaction with the app and stating that they would recommend it to parents in similar situations. According to the participants, the app was easy to use, the content gave a feeling of not being alone or weird in how one grieves, and the app gave a valuable overview of information, knowledge and further support. In addition, all parents expressed that an app like My Grief is needed and would be particularly useful to access early in the grieving process. Significant reductions of prolonged grief symptoms ( = 0.86) and grief-related rumination ( = 0.72), loss avoidance ( = 0.95) and negative cognitions ( = 1.36) from pre- to post-assessment were found. In conclusion, the app appears acceptable and feasible to use and will be evaluated in a larger randomized controlled trial (Trial registration number: NCT04552717, https://clinicaltrials.gov/ct2/show/NCT04552717).
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http://dx.doi.org/10.3389/fpsyt.2022.872314DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9082261PMC
April 2022

Response to Suttle et al., Post-Traumatic Growth in Parents following Their Child's Death in a Pediatric Intensive Care Unit (DOI: 10.1089/jpm.2021.0290).

Authors:
Maarten C Eisma

J Palliat Med 2022 04;25(4):529-530

Department of Clinical Psychology and Experimental Psychopathology, Faculty of Social and Behavioral Sciences, University of Groningen, Groningen, The Netherlands.

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http://dx.doi.org/10.1089/jpm.2021.0661DOI Listing
April 2022

Traumatic stress, depression, and non-bereavement grief following non-fatal traffic accidents: Symptom patterns and correlates.

PLoS One 2022 28;17(2):e0264497. Epub 2022 Feb 28.

Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.

Non-fatal traffic accidents may give rise to mental health problems, including posttraumatic stress (PTS) and depression. Clinical evidence suggests that victims may also experience grief reactions associated with the sudden changes and losses caused by such accidents. The aim of this study was to examine whether there are unique patterns of symptoms of PTS, depression, and grief among victims of non-fatal traffic accidents. We also investigated associations of emerging symptom patterns with sociodemographic variables and characteristics of the accident, and with transdiagnostic variables, including self-efficacy, difficulties in emotion regulation, and trauma rumination. Participants (N = 328, Mage = 32.6, SDage = 17.5 years, 66% female) completed self-report measures tapping the study variables. Using latent class analysis (including symptoms of PTS, depression, and grief), three classes were identified: a no symptoms class (Class 1; 59.1%), a moderate PTS and grief class (Class 2; 23.1%), and a severe symptoms class (Class 3; 17.7%). Summed symptom scores and functional impairment were lowest in Class 1, higher in Class 2, and highest in Class 3. Psychological variables were similarly ordered with the healthiest scores in Class 1, poorer scores in Class 2, and the worst scores in Class 3. Different sociodemographic and accident related variables differentiated between classes, including age, education, and time since the accident. In a regression including all significant univariate predictors, trauma rumination differentiated Class 2 from Class 1, all three psychological variables differentiated Class 3 from Class 1, and difficulties with emotion regulation and trauma rumination differentiated Class 3 from Class 2. This study demonstrates that most people respond resiliently to non-fatal traffic accident. Yet, approximately one in three victims experiences moderate to severe mental health symptoms. Increasing PTS coincided with similarly increasing grief, indicating that grief may be considered in interventions for victims of traffic accidents. Trauma rumination strongly predicted class membership and appears a critical treatment target to alleviate distress.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0264497PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8884715PMC
March 2022

How we continue bonds with deceased persons: The proximity-seeking behavior scale.

Death Stud 2022 Feb 21:1-8. Epub 2022 Feb 21.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands.

Continuing bonds is a multifaceted process, encompassing perceptions, beliefs, illusions and hallucinations, and overt behaviors. We developed the Proximity-Seeking Behavior Scale (PSBS) to assess overt behavior to continue bonds with the deceased person. We had 694 bereaved adults complete an online survey. Exploratory and confirmatory factor analyses yielded a one-factor model for PSBS items. PSBS reliability was good. PSBS scores correlated positively with rumination and yearning, feeling connected to the deceased person, and prolonged grief and depression symptoms. The PSBS appears a reliable and valid instrument to assess proximity-seeking behaviors.
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http://dx.doi.org/10.1080/07481187.2022.2039811DOI Listing
February 2022

Content overlap analyses of ICD-11 and DSM-5 prolonged grief disorder and prior criteria-sets.

Eur J Psychotraumatol 2022 26;13(1):2011691. Epub 2022 Jan 26.

Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.

Background: The International Classification of Diseases eleventh edition (ICD-11) has recently included prolonged grief disorder (PGD), a diagnosis characterized by severe, persistent, and disabling grief. The text revision of the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5-TR) is scheduled to include a similar but distinct diagnosis, also termed PGD. Concerns have been raised that these new diagnoses are qualitatively different from both prior proposed diagnoses for pathological grief and each other, which may affect the generalizability of findings obtained with different criteria sets.

Objective: We conducted a content overlap analysis of PGD, PGD, and previous proposals for pathological grief diagnoses (i.e. PGD 2009; complicated grief (CG), PGD ICD-11 beta draft, persistent complex bereavement disorder (PCBD) per DSM-5).

Methods: Using the Jaccard's Index, we established the degree of content overlap between core and accessory symptoms of PGD, PGD, and prior proposals for pathological grief diagnoses.

Results: Main findings are that PGD and PGD showed moderate content overlap with each other and with most prior proposed diagnoses for pathological grief. PGD and PGD showed the strongest content overlap with their direct predecessors, PGD and PCBD, respectively.

Conclusions: Limited content overlap between PGD and PGD and preceding criteria sets may threaten generalizability of past research on phenomenological characteristics of pathological grief to current criteria sets. Similarly, findings obtained with instruments to assess PGD may not generalize to PGD and vice versa. Researchers should aim to determine under which circumstances criteria sets for PGD yield similar or distinct characteristics. Convergence of criteria sets for PGD remains an important goal for the future.
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http://dx.doi.org/10.1080/20008198.2021.2011691DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8794064PMC
February 2022

Desired attachment and breakup distress relate to automatic approach of the ex-partner.

J Behav Ther Exp Psychiatry 2022 06 9;75:101713. Epub 2021 Dec 9.

Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands.

Background And Objectives: Romantic relationship breakups can lead to severe emotional disturbances including major depression. Anxious attachment and desired attachment with the ex-partner are hypothesized to elicit repetitive thought about the breakup and the former partner and attempts to reunite with (i.e. approach) the ex-partner, which fuel breakup distress. Since prior research on this topic has mostly used survey methodology, the study aim was to examine the relations between above-mentioned variables employing a behavioral measure of approach of the ex-partner.

Methods: Automatic approach-avoidance tendencies toward the former partner were assessed with an Approach Avoidance Task (AAT). Sixty-two students (76% female) moved a manikin towards or away from stimuli pictures (ex-partner, matched stranger, landscape) as fast as possible based on the stimulus frame color (blue, yellow). Participants also completed questionnaires assessing anxious attachment, desired attachment, repetitive thought about the breakup (rumination) and the ex-partner (yearning), and breakup distress (prolonged grief symptoms).

Results: Anxious attachment related positively to rumination and breakup distress. Desired attachment related positively to yearning, automatic approach bias toward the ex-partner, and breakup distress. Both anxious and desired attachment, rumination, yearning, and approach bias related positively to breakup distress.

Limitations: The use of a student sample may limit generalizability. A correlational design precludes causal conclusions.

Conclusions: Together with prior work, results suggests anxious attachment hampers psychological adaptation to a breakup by increasing the use of ruminative coping. Desire to retain an attachment bond with the ex-partner, expressed in yearning and approach of the ex-partner, may also worsen breakup distress.
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http://dx.doi.org/10.1016/j.jbtep.2021.101713DOI Listing
June 2022

Mobile app for prolonged grief among bereaved parents: study protocol for a randomised controlled trial.

BMJ Open 2021 12 7;11(12):e052763. Epub 2021 Dec 7.

Department of Neuroscience, Uppsala University, Uppsala, Sweden.

Introduction: Bereaved parents, who have lost a child, have an elevated risk to develop mental health problems, yet, few studies have evaluated the effect of psychosocial interventions developed for bereaved parents. Cognitive-behavioural therapy (CBT), both face to face or digitally delivered, has shown to be an effective intervention for prolonged grief symptoms. Self-help mobile apps offer various advantages and studies show improved mental health after app interventions. No app has yet been evaluated targeting prolonged grief in bereaved parents. Therefore, the aim of this planned study is to develop and examine the effectiveness of a CBT-based mobile app, called in reducing symptoms of prolonged grief, as well as other psychological symptoms, in bereaved parents. Another aim is to assess users' experiences and adverse events of .

Methods And Analysis: We will conduct a two-armed randomised waitlist-controlled trial. Parents living in Sweden, who lost a child between one and ten years ago, with elevated symptoms of prolonged grief, will be recruited to participate in the trial. The content of covers four main domains (Learn; Self-monitoring; Exercises; Get support) and builds on principles of CBT and the proven-effective app. Participants in the intervention group will fill out online questionnaires at baseline and at 3, 6 and 12 months follow-ups, and the waitlist-controls at baseline and at 3 months. The primary outcome will be prolonged grief symptoms at the 3 months follow-up. Secondary outcomes are post-traumatic stress and depression symptoms, quality of life and cognitive behavioural variables (ie, avoidance, rumination, negative cognitions).

Ethics And Dissemination: Ethical approval has been received from the Swedish Ethical Review Authority (project no. 2021-00770). If the app is shown to be effective, the app will be made publicly accessible on app stores, so that it can benefit other bereaved parents.

Trial Registration Number: NCT04552717.
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http://dx.doi.org/10.1136/bmjopen-2021-052763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655571PMC
December 2021

Public Stigma of Prolonged Grief Disorder: An Experimental Replication and Extension.

J Nerv Ment Dis 2022 Mar;210(3):199-205

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, the Netherlands.

Abstract: Prolonged grief disorder's (PGD's) recent recognition as a psychiatric diagnosis has elicited concerns about stigmatization. Although prior research demonstrated that PGD elicits public stigma, moderators of this effect are unclear, and the effect requires replication in an English-speaking population. Therefore, we investigated the effects of PGD, sex of the bereaved, and death expectedness on public stigma toward bereaved persons. We randomly assigned 195 Australian adults (77% female; mean age, 35.7 years) to read one of eight vignettes describing a bereaved male or female subject, with or without PGD, after an expected or unexpected death. Participants reported their emotional reactions and negative attributions toward, and desired social distance from, the bereaved person. A person with PGD (vs. without) elicited stronger emotional reactions, negative attributions, and desired social distance. No robust moderator effects emerged. Results validate concerns that PGD causes stigma. Stigmatization may be targeted by information campaigns or psychological treatment.
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http://dx.doi.org/10.1097/NMD.0000000000001427DOI Listing
March 2022

Restoration-oriented stressors of bereavement.

Anxiety Stress Coping 2022 05 31;35(3):339-353. Epub 2021 Jul 31.

Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.

Background And Objectives: The Dual Process Model of Coping with Bereavement holds that bereaved people who respond flexibly to loss-oriented stressors (i.e., relating to the loss; to the deceased person) and restoration-oriented stressors (i.e., secondary to loss; daily-life changes, taking on new roles) adapt better to bereavement. Despite growing interest in the Dual Process Model, systematic analyses of the prevalence, characteristics, and correlates of restoration-oriented stressors are lacking. Therefore, we aimed to chart restoration-oriented stressors and their relationship with post-loss adaptation.

Design And Methods: A community sample of 181 bereaved adults (63% women) completed the 20-item expert-construed Restoration-Oriented Stressors Inventory (ROSI) and questionnaires assessing background characteristics, worry, and prolonged grief and depression symptoms.

Results: Main findings were that younger people, and those who lost a parent, partner, or child (vs. other relationship) experienced more restoration-oriented stressors and appraised these as more stressful. Stressors' perceived stressfulness, but not their quantity, related positively to worry. Perceived stressfulness predicted prolonged grief and depression symptoms beyond background characteristics, worry, and the number of stressors.

Conclusion: Restoration-oriented stressors and their appraisal vary and relate to coping and post-loss mental health. Future research should clarify temporal interrelations between stressors, coping mechanisms, and outcomes.
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http://dx.doi.org/10.1080/10615806.2021.1957849DOI Listing
May 2022

Rumination, worry and negative and positive affect in prolonged grief: A daily diary study.

Clin Psychol Psychother 2022 Jan 20;29(1):299-312. Epub 2021 Jul 20.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.

After bereavement, a significant minority experiences severe, persistent, and disabling grief, termed prolonged grief or complicated grief. Prolonged grief treatments may be enhanced by improving understanding of malleable risk factors in post-loss psychological adaptation. Repetitive negative thought (e.g., rumination, worry) constitutes such a risk factor. Rumination and worry are both theorized to be maladaptive through interrelations with affect, yet this assumption has not been systematically investigated in the bereaved. We aimed to fill this gap in knowledge with a baseline survey and 10-day daily diary investigation among a bereaved sample. Survey between-subject analyses (N = 113) demonstrated that trait rumination and worry, trait negative affect and prolonged grief symptoms are positively related to each other and negatively related with trait positive affect. Within-subject multilevel analyses of diaries (N = 62) demonstrated that trait rumination and trait worry relate positively to daily negative affect and negatively to daily positive affect. Daily rumination and worry showed similar relationships with daily negative and positive affect. A stronger relationship emerged between daily rumination and daily negative affect in people with higher prolonged grief symptom levels. Findings consistently support interrelations between repetitive negative thought, affect, and prolonged grief symptoms. Rumination appears particularly detrimental in people with severe grief reactions. Results align with research demonstrating the effectiveness of targeting repetitive negative thought in prolonged grief treatments. Additionally, our study demonstrates the potential feasibility and usefulness of using daily diaries to study behaviours of relevance to post-loss adaptation in everyday life.
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http://dx.doi.org/10.1002/cpp.2635DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9291980PMC
January 2022

Commentary on: A Call to Action: Facing the Shadow Pandemic of Complicated Forms of Grief.

Omega (Westport) 2021 May 21:302228211016227. Epub 2021 May 21.

Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.

In this contribution, we respond to a letter in Omega: Journal of Death and Dying by Doka. Signatories of this letter to the President of the United States convey concerns that deaths during the COVID-19 pandemic will lead to a higher prevalence of severe and persistent grief, i.e., prolonged grief disorder. We support their call to action to direct government funding to helping those who develop this condition during the COVID-19 pandemic. However, we think that concerns about prolonged grief disorder during the pandemic can be more convincingly conveyed by firmly embedding such concerns within scientific literature. Therefore, we highlight prior scientifically informed opinion pieces from various international researchers who voiced similar concerns in the early months of the pandemic. Additionally, we provide an overview of pioneering empirical research elucidating whether prolonged grief disorder and related mental health problems will become more prevalent during the pandemic.
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http://dx.doi.org/10.1177/00302228211016227DOI Listing
May 2021

Upward and Downward Counterfactual Thought After Loss: A Multiwave Controlled Longitudinal Study.

Behav Ther 2021 05 1;52(3):577-593. Epub 2020 Aug 1.

Utrecht University and ARQ National Psychotrauma Centre.

Counterfactual thoughts, mental simulations about how a situation may have turned out differently (i.e., "if only …, then …"), can reduce mental health after stressful life-events. However, how specific counterfactual thought types relate to post-loss mental health problems is unclear. We hypothesized that self-referenced upward counterfactuals (i.e., "If only I had done …, then the current situation would be better") may serve as cognitive avoidance, thereby perpetuating loss-related distress. Conversely, downward counterfactuals (i.e., "If … had happened, then the current situation could have been [even] worse") may facilitate benefit finding, thereby reducing distress. In a longitudinal survey, self-referent, other-referent, and nonreferent upward counterfactuals, and nonreferent downward counterfactuals were assessed at baseline. Prolonged grief and depression symptoms were assessed at baseline, and 6- and 12-month follow-ups. Multiple regression analyses assessed associations between counterfactual thoughts and symptom levels in 65 recently bereaved people who generated counterfactual thoughts about the loss-event. Moderator analyses assessed the unicity of significant effects in the previous step, by comparing these effects in 59 people generating loss-related counterfactuals with those in 59 propensity-score matched participants generating counterfactuals about other negative life-events. Multivariate analyses showed that nonreferent upward counterfactuals were uniquely strongly positively associated with prolonged grief and depression symptoms concurrently. Self-referent upward counterfactuals were uniquely positively associated with prolonged grief and depression symptoms longitudinally. Moderator analyses confirmed that thinking about how one's (in)actions could prevent a death uniquely exacerbated prolonged grief and depression severity. Prolonged grief treatment may be improved by targeting self-blame and guilt.
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http://dx.doi.org/10.1016/j.beth.2020.07.007DOI Listing
May 2021

Correlates of Mental Health After COVID-19 Bereavement in Mainland China.

J Pain Symptom Manage 2021 06 2;61(6):e1-e4. Epub 2021 Mar 2.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.

Context: Pioneering empirical studies show that people bereaved due to COVID-19 experience elevated acute grief, posttraumatic stress, anxiety, and depressive symptom levels, which relate to functional impairment. However, studies focused on Western samples and multivariate analyses of relations between potential risk factors and mental health in this population are lacking.

Objectives: To assess the mental health of Chinese adults bereaved due to COVID-19. To elucidate the associations of demographic and loss-related characteristics with mental health after COVID-19 bereavement.

Methods: Four hundred twenty-two Chinese adults (56% male; Mean age: 32.73 years) recently bereaved due to COVID-19 completed an online survey. Demographic and loss-related characteristics and prolonged grief, posttraumatic stress, anxiety, and depressive symptoms were assessed.

Results: Clinically relevant prolonged grief (49%, n = 207), posttraumatic stress (22%, n = 92), depressive (70%; n = 294), and anxiety symptoms (65%; n = 272) were reported by a substantial group of participants. In four multiple regressions predicting each mental health indicator, Fs(15,406) = 5.08-7.74, Ps < 0.001, loss-characteristics (i.e., a shorter time since loss, βs =  -.12-.11, loss of a first-degree relative, βs =  .18-.37) and subjective loss experiences (i.e., feeling traumatized by the loss, βs =  .13-.18, or a close and/or conflictual relation with the deceased, βs =  .12-.23) related most consistently to mental health problems.

Conclusion: Many Chinese adults bereaved due to COVID-19 experience severe mental health problems. The recent loss of first-degree relatives, feeling traumatized by the loss, and having a close and/or conflictual relationship with the deceased may elevate risk for these mental health problems, which could require indicated psychological treatment.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.02.016DOI Listing
June 2021

Validation of a German Version of the Grief Cognitions Questionnaire and Establishment of a Short Form.

Front Psychol 2020 18;11:620987. Epub 2021 Jan 18.

Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.

Background: Whereas the majority of bereaved persons recover from their grief without professional assistance, a minority develops pathological grief reactions. Etiological models postulate that dysfunctional cognitions may perpetuate such reactions. The Grief Cognitions Questionnaire (GCQ) assesses thoughts after bereavement in nine interrelated domains. A short form (GCQ-SF) with four domains is often used. However, an evaluation of the psychometric properties of the GCQ-SF and its utility compared to the GCQ is lacking and these instruments have not been validated in German.

Method: German bereaved persons (time since loss 35.3 ± 34.6 months) responded to an online survey containing the GCQ, measures of grief severity, grief rumination, symptoms of depression and anxiety, and optimism and pessimism. 585 participants (18-78 years, 88% women) were included. Item analyses and confirmatory factor analyses were conducted. Correlations between the GCQ and GCQ-SF and grief rumination, optimism and pessimism assessed construct validity. Criterion-related validity was assessed by comparing whether the correlation of the GCQ (and the GCQ-SF) with grief severity was higher than with anxious and depressive symptoms. Logistic regression and receiver-operator characteristics (ROC) compared the questionnaires on their ability to predict probable prolonged grief 'caseness' (ICG ≥ 25, time since loss ≥6 months).

Results: Internal consistencies for both questionnaires were identical and excellent (α = 0.96). Confirmatory factor analyses obtained a satisfactory fit for models with nine and four correlated subscales and respective higher-order factor models. The GCQ and the GCQ-SF correlated higher with grief severity than with other measures of psychopathology. The logistic regression showed a significant association between the GCQ-SF and prolonged grief 'caseness'. Of the remaining subscales of the GCQ, only one subscale ('Others') contributed to the prediction. The ROC analyses showed nearly identical areas under the curve.

Conclusion: The translated GCQ and GCQ-SF demonstrated very good psychometric properties. The correlations with grief severity highlight the questionnaires' clinical relevance. The questionnaires possessed identical diagnostic specificity and sensitivity. Whenever a timesaving assessment of the most typical grief-specific cognitions is important, the GCQ-SF represents an alternative to the GCQ. The original GCQ may still be superior when a more detailed description of a bereaved person's cognitions is desirable.
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http://dx.doi.org/10.3389/fpsyg.2020.620987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848142PMC
January 2021

Emotion Regulatory Strategies in Complicated Grief: A Systematic Review.

Behav Ther 2021 01 13;52(1):234-249. Epub 2020 Apr 13.

University of Groningen and Utrecht University.

Prolonged grief disorder, characterized by severe, persistent, and disabling grief, has recently been included in the International Classification of Diseases-11 (ICD-11). Emotional disturbances are central to such complicated grief responses. Accordingly, emotion regulation is assumed critical in the development, persistence, and treatment of complicated grief. Yet, a comprehensive review on this topic is lacking. We conducted a systematic review (PROSPERO: CRD42017076061) searching PsycInfo, Web of Science, and PubMed to identify quantitative research examining relationships between emotion regulation and complicated grief. Sixty-four studies on 7,715 bereaved people were identified, focusing on a variety of emotion regulation strategies (i.e., experiential avoidance, behavioral avoidance, expressive suppression, rumination, worry, problem solving, cognitive reappraisal, positive thought, and mindfulness). Our synthesis showed strong evidence that experiential avoidance and rumination play a role in the persistence of complicated grief. More generally, surveys support positive associations between putative maladaptive emotion regulation strategies and complicated grief, and negative associations between putative adaptive emotion regulation strategies and complicated grief. Laboratory research yielded mixed results. Emotion regulation is critical in complicated grief, and in particular experiential avoidance and rumination form important targets in complicated grief treatments. We advise expanding current knowledge, by employing more advanced, intensive data collection methods and experiments across diverse samples. Increasing knowledge in this domain will improve clinical practice.
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http://dx.doi.org/10.1016/j.beth.2020.04.004DOI Listing
January 2021

Barriers and facilitators of disclosing domestic violence to the healthcare service: A systematic review of qualitative research.

Health Soc Care Community 2021 05 13;29(3):612-630. Epub 2021 Jan 13.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.

Domestic violence victims are in frequent contact with the healthcare service yet rarely disclose. Therefore, it is critical to understand victims' experiences and perceptions regarding disclosure in healthcare settings. The goal of this review is to provide an updated synthesis of qualitative research identifying barriers and facilitators, advice, and positive and negative outcomes of adult victims' disclosure of domestic violence to healthcare professionals (HCPs). A systematic search of PsychINFO, CINAHL and Web of Science was conducted in January 2018. Thirty-four eligible studies were identified, including 783 domestic violence victims (781 females). Formal quality assessment indicated variable study quality. Barriers of disclosure included negative HCPs attitudes, victims' perceptions of safety and concerns about the consequences of disclosing. Facilitators of disclosing included a positive relationship with the HCP, HCPs directly asking victims about abuse, and HCPs ensuring that the environment is safe and disclosure is confidential. Victims advised increased awareness of HCPs reactions to disclosure and avoiding mirroring their perpetrators minimization. HCPs were encouraged to engage in direct questioning and maintain a supportive and secure environment. Positive and negative outcomes of abuse were identified, such as being able to leave the abuser or, on the other hand, the victims' situation not changing. Our results indicate that barriers for disclosure of domestic violence in healthcare settings persist despite the widespread implementation of policies and guidelines to counter them. Based on these findings, we provide recommendations for clinical practice and future research to help improve disclosure in healthcare settings.
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http://dx.doi.org/10.1111/hsc.13282DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248429PMC
May 2021

Does voluntary assisted dying cause public stigma for the bereaved? A vignette-based experiment.

Palliat Support Care 2021 10;19(5):558-562

School of Psychology, Curtin University, Perth, WA6102, Australia.

Objective: Studies in countries where assisted dying is legal show that bereaved people express concern over the potential for social disapproval and social stigma because of the manner of death. There are indications that voluntary assisted dying is judged as less acceptable if the deceased is younger. A vignette-based experiment was used to determine whether public stigma (i.e., negative emotional reactions and desired social distance) and expected grief symptoms are higher for conjugally bereaved people through voluntary assisted dying (vs. long-term illness), when the deceased is a young adult (vs. older adult).

Method: A 2 × 2 randomized factorial design was conducted with 164 Australian adults (130 women, 34 men, Mage = 37.69 years). Each participant was randomized online to read one of four vignettes and completed measures of anger, fear, prosocial emotions, desire for social distance, and expectations of grief symptomatology.

Results: A multivariate analysis of variance (MANOVA) was conducted. Death at a young age (28 years) was significantly associated with stronger negative emotional reactions of fear ($\eta _p^2 = 0.04$, P = 0.048) and anger ($\eta _p^2 = 0.06$, P = 0.010). There were no differences in outcomes associated with the mode of death, nor was there an interaction between mode of death and age group.

Significance Of Results: Concerns that voluntary assisted dying elicits public stigma appear unfounded. The fact that participants reported significantly higher anger and fear in response to bereaved people experiencing loss at a younger (vs. older) age, irrespective of cause of death, indicates that young people who lose their spouse might benefit from additional support.
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http://dx.doi.org/10.1017/S1478951520001352DOI Listing
October 2021

Treatment gap in bereavement care: (Online) bereavement support needs and use after traumatic loss.

Clin Psychol Psychother 2021 Jul 9;28(4):907-916. Epub 2021 Feb 9.

Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.

People bereaved through road traffic accidents (RTAs) are at risk for severe and disabling grief (i.e., pathological grief). Knowledge about needs and use of bereavement care, including psychotherapy, pharmacotherapy, and support groups, is limited. This study charted (correlates of) the needs and use of bereavement care in RTA bereaved people. Furthermore, although online grief treatment seems effective, it is unknown whether it is perceived as acceptable. Accordingly, we examined the acceptability of online treatment. Dutch RTA bereaved adults (N = 273) completed self-report measures about needs and use of bereavement care, acceptability of online grief treatment, and pathological grief. Regression analyses were used to identify correlates of care needs and use and acceptability of online treatment. The majority (63%) had received help from psychotherapy, pharmacotherapy, and/or support groups. One in five participants had not used bereavement care services, despite reporting elevated pathological grief levels and/or expressing a need for care, pointing to a treatment gap. Use of psychological support before the loss was the strongest predictor of bereavement care needs and use following the loss. A minority (35%) reported being inclined to use online grief treatment if in need of support. More openness towards online services was related to greater acceptability of online treatment. In conclusion, 20% of RTA bereaved people with pathological grief or care needs had not received care. This treatment gap may be reduced by improving accessibility of online treatments. However, as only 35% was open to using online treatments, increasing the acceptability of (online) treatments appears important.
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http://dx.doi.org/10.1002/cpp.2544DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451936PMC
July 2021

Grief Before and During the COVID-19 Pandemic: Multiple Group Comparisons.

J Pain Symptom Manage 2020 12 13;60(6):e1-e4. Epub 2020 Oct 13.

Psychologen Nederland (Psyned), Amsterdam, the Netherlands.

Context: Grief researchers are concerned that the coronavirus disease 2019 (COVID-19) pandemic will precipitate increases in severe, persistent, and disabling grief, termed prolonged grief disorder or persistent complex bereavement disorder. We recently demonstrated that higher grief levels are experienced after COVID-19-related bereavement than natural bereavement. Death circumstances during the pandemic (e.g., reduced social support, limited opportunities for death rituals) may also hamper the grief process for non-COVID-19-related bereavement, yet no quantitative research has specifically addressed this issue.

Objectives: To test if grief severity is higher during than before the lockdown after non-COVID-19-related bereavement.

Methods: A cross-sectional survey including questions on sociodemographic and loss-related variables and a grief measure was conducted among a sample of 1600 bereaved adults (78% females), participating before (n = 731) or during (n = 869) the pandemic, including people who had experienced a loss before the pandemic (n = 456) or during the pandemic (n = 200) recently (five months ago or less).

Results: No significant differences emerged between grief levels in people participating before or during the pandemic. However, being recently bereaved during the pandemic elicited more severe grief than before it (d = 0.17; d = 0.18). Effects remained significant after controlling analyses for relevant loss-related variables.

Conclusion: Among all bereaved persons, grief severity was no different during the pandemic compared with before the pandemic. However, experiencing a recent loss during the pandemic elicited more severe acute grief reactions than before the pandemic, suggesting that dealing with loss may be more difficult during this ongoing health crisis.
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http://dx.doi.org/10.1016/j.jpainsymman.2020.10.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553097PMC
December 2020

Prolonged grief disorder in section II of DSM-5: a commentary.

Eur J Psychotraumatol 2020 Jun 25;11(1):1771008. Epub 2020 Jun 25.

Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands.

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http://dx.doi.org/10.1080/20008198.2020.1771008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473035PMC
June 2020

Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison.

J Affect Disord 2021 01 13;278:54-56. Epub 2020 Sep 13.

ARQ National Psychotrauma Centre, Diemen, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.

Background: There are now over 800,000 registered deaths due to the COVID-19 pandemic worldwide. Researchers have suggested that COVID-19 death characteristics (e.g., intensive care admission, unexpected death) and circumstances (e.g., secondary stressors, social isolation) will precipitate a worldwide increase of prolonged grief disorder (PGD) and persistent complex bereavement disorder (PCBD). Yet, no study has investigated this. Since acute grief is a strong predictor of future pathological grief, we compared grief levels among people recently bereaved due to COVID-19, natural, and unnatural causes.

Methods: People bereaved through COVID-19 (n = 49), natural causes (n = 1182), and unnatural causes (n = 210), completed self-report measures of demographic and loss-related characteristics and PGD and PCBD symptoms.

Results: COVID-19 bereavement yielded higher symptom levels of PGD (d = 0.42) and PCBD (d = 0.35) than natural bereavement (but not unnatural bereavement). Effects held when limiting analyses to recent losses and those who participated during the pandemic. Expectedness of the death explained this effect.

Limitations: Limitations include using a convenience sample and self-report measures.

Conclusions: Higher grief levels occur among people bereaved due to COVID-19 compared to people bereaved due to natural loss. We predict that pandemic-related increases in pathological grief will become a worldwide public health concern.
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http://dx.doi.org/10.1016/j.jad.2020.09.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7487144PMC
January 2021

Public stigma towards prolonged grief disorder: Does diagnostic labeling matter?

PLoS One 2020 11;15(9):e0237021. Epub 2020 Sep 11.

Clinical and Biological Psychology, Department of Psychology, Catholic University Eichstaett-Ingolstadt, Eichstaett, Germany.

The recent introduction of prolonged grief disorder (PGD) as a diagnostic category may cause negative social reactions (i.e. public stigma). Vignette experiments demonstrate that persons with both PGD symptoms and a PGD diagnosis elicit more public stigma than persons who experience integrated grief. However, the strength of the influence of the diagnosis itself remains unclear: We aimed to clarify if the diagnostic label PGD produces additional public stigma beyond PGD symptoms. We further compared whether public stigma varies between the label PGD and the label major depressive episode (MDE) (when PGD symptoms are present) and if gender of the bereaved person influences public stigma or moderates the aforementioned effects. Eight-hundred fifty-two participants (77% female; Mage = 32.6 years, SD = 13.3) were randomly assigned to read online one of eight vignettes describing either a bereaved male or female, with PGD symptoms and PGD diagnosis; PGD symptoms and MDE diagnosis; PGD symptoms and no diagnosis, or no PGD symptoms and no diagnosis (i.e., integrated grief). Following the vignettes, participants indicated which negative characteristics they ascribed to the person, their emotional reactions, and preferred social distance from the person. People with PGD symptoms and PGD (or MDE) diagnosis were attributed more negative characteristics, and elicited more negative emotions and a stronger desire for social distance than people with integrated grief. However, public stigma did not differ for people with both PGD symptoms and diagnosis compared to people only experiencing PGD symptoms. Gender of the bereaved only had an influence on desired social distance, which was larger towards men. Helping severely distressed bereaved people (regardless of diagnostic status) cope with negative social reactions may help them adapt to bereavement. Results demonstrate that the experience of severe grief reactions, yet not a diagnostic label per se, causes public stigma.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237021PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485774PMC
October 2020

ICD-11 Prolonged Grief Disorder Criteria: Turning Challenges Into Opportunities With Multiverse Analyses.

Front Psychiatry 2020 7;11:752. Epub 2020 Aug 7.

Department of Psychology, Catholic University Eichstaett-Ingolstadt, Ingolstadt, Germany.

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http://dx.doi.org/10.3389/fpsyt.2020.00752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427562PMC
August 2020

Sleep disturbances in bereavement: A systematic review.

Sleep Med Rev 2020 10 21;53:101331. Epub 2020 May 21.

Department of Clinical Psychology & Experimental Psychopathology, University of Groningen, Groningen, the Netherlands.

Severe, persistent and disabling grief occurs among a sizable minority experiencing bereavement, with diagnostic manuals newly including complicated grief (CG) disorders. Sleep disturbances/disorders have been established as worsening affective and stress-related conditions. However, the role of sleep difficulties in bereavement and CG has not received similar scientific attention. We therefore conducted a systematic review with narrative syntheses on this topic to clarify the role of sleep in bereavement (PROSPERO: CRD42018093145). We searched PubMed, Web of Science and PsychInfo for peer-reviewed English-language articles including (at least one) bereaved sample and sleep disturbance measure. We identified 85 articles on 12.294 participants. We answered seven pre-defined research questions demonstrating: high prevalence of sleep disturbances in bereavement; positive associations of grief intensity with sleep difficulties; preliminary indications of risk factors of post-loss sleep disturbance; higher prevalence of sleep disturbances in CG, enhanced by psychiatric comorbidity (i.e., depression); and initial evidence of causal relationships between (complicated) grief and sleep. Grief therapy partly improves sleep difficulties, yet no intervention studies have specifically targeted sleep problems in bereaved persons. Causal relationships between sleep and grief require further examination in intensive longitudinal investigations, including randomized trials, thereby clarifying whether treating sleep problems enhances CG treatment effects.
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http://dx.doi.org/10.1016/j.smrv.2020.101331DOI Listing
October 2020

Wish you were here: The Dutch, German, and English Yearning in Situations of Loss Short Form.

J Clin Psychol 2020 10 1;76(10):1995-2014. Epub 2020 Jun 1.

Department of Psychology, University of Arizona, Tucson, Arizona.

Objective(s): Yearning, a hallmark of grief disorders, relates to rumination and potentially to cognitive avoidance. We developed an 8-item short form of the only existing validated yearning measure, the Yearning in Situations of Loss Scale (YSL), to improve its validity and administration ease.

Method: Cross-sectional surveys were conducted among bereaved Dutch (N = 313) and German (N = 235) community samples and an American treatment-seeking sample (N = 95). All samples completed the YSL, and community samples additionally measures of rumination, loss-related avoidance, complicated grief (CG), and depression.

Results: A one-factor model provided a good fit to the YSL Short Form (YSL-SF) in the community samples. A two-factor structure (cognitive and emotional yearning)best fitted the YSL-SF in the treatment-seeking sample. YSL-SF scores correlated positively with rumination, loss-related avoidance, and with CG symptoms whilst controlling for rumination and loss-related avoidance.

Conclusion: The YSL-SF appears an easy-to-administer and valid measure of yearning after bereavement.
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http://dx.doi.org/10.1002/jclp.22977DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7540291PMC
October 2020

Prolonged grief disorder following the Coronavirus (COVID-19) pandemic.

Psychiatry Res 2020 06 22;288:113031. Epub 2020 Apr 22.

Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, the Netherlands; Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands.

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http://dx.doi.org/10.1016/j.psychres.2020.113031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194880PMC
June 2020

Behaviour change techniques associated with smoking cessation in intervention and comparator groups of randomized controlled trials: a systematic review and meta-regression.

Addiction 2020 11 16;115(11):2008-2020. Epub 2020 Apr 16.

Health Psychology Group, Institute of Applied Health Sciences, University of Aberdeen, Health Sciences Building, Aberdeen, UK.

Aims: To estimate the strengths of associations between use of behaviour change techniques (BCTs) and clusters of BCTs in behavioural smoking cessation interventions and comparators with smoking cessation rates.

Method: Systematic review and meta-regression of biochemically verified smoking cessation rates on BCTs in interventions and comparators in randomized controlled trials, adjusting for a priori-defined potential confounding variables, together with moderation analyses. Studies were drawn from the Cochrane Tobacco Addiction Group Specialised Register. Data were extracted from published and unpublished (i.e. obtained from study authors) study materials by two independent coders. Adequately described intervention (k = 143) and comparator (k = 92) groups were included in the analyses (n = 43 992 participants). Using bivariate mixed-effects meta-regressions, while controlling for key a priori confounders, we regressed smoking cessation on (a) three BCT groupings consistent with dual-process theory (i.e. associative, reflective motivational and self-regulatory), (b) 17 expert-derived BCT groupings (i.e. BCT taxonomy version 1 clusters) and (c) individual BCTs from the BCT taxonomy version 1.

Results: Among person-delivered interventions, higher smoking cessation rates were predicted by BCTs targeting associative and self-regulatory processes (B = 0.034, 0.041, P < 0.05), and by three individual BCTs (prompting commitment, social reward, identity associated with changed behaviour). Among written interventions, BCTs targeting taxonomy cluster 10a (rewards) predicted higher smoking cessation (B = 0.394, P < 0.05). Moderation effects were observed for nicotine dependence, mental health status and mode of delivery.

Conclusions: Among person-delivered behavioural smoking cessation interventions, specific behaviour change techniques and clusters of techniques are associated with higher success rates.
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http://dx.doi.org/10.1111/add.15056DOI Listing
November 2020
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