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Table 1 Components of the Living with Loss online perinatal bereavement program

From: Living with Loss: study protocol for a randomized controlled trial evaluating an internet-based perinatal bereavement program for parents following stillbirth and neonatal death

Module

Topic

Outcomea

Module 1: Understanding grief

• Understanding grief experience

• Managing and coping with behavioral and physical grief reactions (e.g., tension)

• Understanding the difference between grief and anxiety, depression, and trauma; including referral pathways for support

• Activity planning including self-care and sleep quality

• Mindfulness exercise and targeted relaxation and stress reduction techniques

Acceptance of grief as normal; increased understanding of the experiences of challenging mental and emotional states (e.g., feelings of tension, panic, distress or worry); improved daily functioning and increased participation in regular activities.

Module 2: Managing Intense Feelings

• Understanding the emotional impact of grief and loss

• Identifying and accepting intense feelings such as anger, guilt, blame, regret; moving from self-criticism to self-compassion

• Exploring creative practices such as self-compassion through writing

• Mindfulness exercise including elements of acceptance and commitment therapy (ACT)

Improved coping with negative and challenging emotional states and overwhelming feelings of grief.

Module 3: Balancing Thoughts

• Understanding the cognitive impact of grief and loss; how thoughts, feelings, and actions interact

• Identifying and reframing unhelpful thoughts through a thought monitoring strategy

• Mindfulness meditation and grounding activity to reduce anxiety

Improved coping with negative and challenging mental states and overwhelming thoughts of grief.

Module 4: Facing Hard Situations and Conversations

• Understanding the social and functional context of grief

• Identifying and planning for difficult situations and times ahead (e.g., memories, anniversaries) using structured problem-solving and planners (e.g., return to work)

• Managing worried and repetitive thoughts through scheduled worry time and self-compassion breaks

• Mindfulness meditation and self-compassion-focused exercise

Practical strategies for social and occupational reintegration; increased participation in work and social activities; confidence accessing support when needed.

Module 5: Strengthening Relationships and Communication

• Understanding the impact of grief on relationships including differences in grief between partners and family members

• Identifying types of support (practical, emotional) including strategies for how to ask and access help and importance of connectedness with others

• Strategies to communicate and set helpful boundaries with others

• Mindfulness meditation and self-compassion-focused exercise

Effective strategies for enhancing communication and connectedness with others; improved relationships and social functioning.

Module 6: The Future

• Understanding how grief can change over time

• Exploring ways to find meaning in grief and renewed sense of purpose in life

• Planning for the future and accessing appropriate emotional support when needed

• Mindfulness meditation and self-compassion-focused exercise

Finding meaning in grief over the longer term; finding balance between grief and life going forwards; sense of meaning and purpose in life.

  1. aMapped to COS for coping and wellbeing in bereavement [13]