Nature-based Contemplation and Spiritual Well-being Among Adults With Moderate Prolonged Grief Symptoms

Nature-based Contemplation and Spiritual Well-being Among Adults With Moderate Prolonged Grief Symptoms: A Randomized Controlled Trial

The goal of this randomized controlled trial is to evaluate whether a nature-based contemplation intervention can enhance spiritual well-being and reduce grief symptoms among adults with moderate prolonged grief symptoms. The main questions it aims to answer are:

Does a nature-based contemplation intervention improve spiritual well-being compared to an active control condition (noticing nature) and a waitlist control condition?

Does a nature-based contemplation intervention reduce grief severity and improve mental well-being, nature connectedness, selflessness, ability to adapt, personal recovery, and elevation compared to control conditions?

How do spiritual well-being, ability to adapt, nature connectedness, selflessness, grief reactions, and positive/negative affect change during the intervention period?

Researchers will compare a nature-based contemplation intervention to both a noticing-nature active control group and a waitlist control group to isolate mindfulness-specific effects from possible general nature exposure benefits.

Participants will:

Complete baseline, post-intervention, and follow-up assessments (at one and three months) Engage in either 10 sessions of nature-based contemplation practice or noticing nature activities over a two-week period (intervention and active control groups) Provide daily diary responses about their experiences throughout the 14-day intervention period

Inclusion Criteria:

• Be a family member, spouse, or friend of a person who died at least 6 months prior to study enrollment;
• Be ≥18 years of age;
• Report moderate subclinical grief (score range from 47-70) based on the Traumatic Grief Inventory-Self Report Plus (TGI-SR+, Lenferink, Eisma, et al., 2022);
• Have access to a natural environment suitable for the intervention;
• Be willing and able to move in nature daily (with or without mobility assistance devices) and engage in brief mindfulness practices;
• Have sufficient Dutch language proficiency;
• Have access to Internet and mobile applications.

Exclusion Criteria:

• Acute suicide risk assessed in the screening step;
• A score lower than 47 or higher than 70 on TGI-SR+;
• Physical limitations that prevent moving outdoors for 30 minutes daily, even with mobility assistance devices.