Background: 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. Objective: 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. Methods: 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. Results: 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). Conclusions: 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. Trial Registration: ClinicalTrials.gov NCT02900534; https://clinicaltrials.gov/ct2/show/NCT02900534

中文翻译：

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情绪调节和与损失相关的应对自我效能在互联网悲伤干预中的作用：中介分析

背景：针对精神障碍和长期悲伤等心理问题的互联网干预已经确立了其有效性。然而，人们对互联网干预如何发挥作用以及它们与结果相关联的机制知之甚少。目的：作为识别变化机制的第一步，本研究旨在检查情绪调节和与损失相关的应对自我效能感作为假定的中介因素，在一项随机对照试验中，引导互联网干预以解决配偶丧亲或分居后的长期悲伤症状或离婚。方法：样本包括报告丧亲、分居或离婚后长期悲伤或适应问题的老年人，并寻求互联网指导干预的帮助。他们主要是通过报纸文章招募的。结果变量是使用德克萨斯修订的悲伤清单评估的悲伤症状和使用简要症状清单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损失为中心的情绪调节和与损失相关的应对自我效能。在第一步中，路径模型被用来检查情绪调节和与损失相关的应对自我效能感作为改善悲伤和精神病理学症状的单一中介。随后，结果：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 (SD 13.60) 岁；80% (80/100) 分居或离婚，69% (69/100) 为女性，76% (76/100) 为瑞士血统。互联网干预提高了情绪调节技能 (β=.33; P =.001) 和与损失相关的应对自我效能感 (β=.30; P =.002)，这两者都与悲伤和精神病理学症状的改善相关。路径模型表明，情绪调节和与损失相关的应对自我效能是改善悲伤的中介因素。情绪调节表现出显着的间接效应（β=.13；P =.009），而应对自我效能表现出一种趋势（β=.07；P=.06)。两者都被证实为精神病理学的中介（分别为 β=.12，P =.02；β=.10；P =.02）。与从干预到改善悲伤的路径相比，当包括中介时（分别为 β=.26，P =.004；β=.32，P ≤.001），从干预到改善悲伤的路径仍然显着。精神病理学（分别为 β=.15，P =.13；β=.16，P =.10）。结论：情绪调节和与损失相关的应对自我效能是优化互联网干预悲伤的有希望的治疗目标。在其他疾病的互联网干预中，两者都应作为跨诊断或特定疾病的推定中介进一步检查。试验注册： ClinicalTrials.gov NCT02900534；https://clinicaltrials.gov/ct2/show/NCT02900534