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

NCT06904976 | Completed

• 1 other identifier: 250441
• Study Type: interventional
• Target: 262
• Locations: 1 country
• Sites: 1

Brief Summary

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

Conditions

Grief; Spiritual Wellbeing

Outcome Measures

Primary Outcomes (4)

• Spiritual well-being measured by Spiritual Attitude and Involvement List-Short Form

  Measured using the Spiritual Attitude and Involvement List-Short Form (SAIL-SF; Bohlmeijer et al., 2023). The SAIL-SF measures seven dimensions of spiritual well-being: meaningfulness, trust, acceptance, caring for others, connectedness with nature, transcendent experiences, and spiritual activities. Each dimension is assessed by one item (e.g., "I experience the things I do as meaningful", "I try to take life as it comes"). Items are rated on a 6-point Likert scale ranging from 1 (not at all) to 6 (to a very high degree), with higher scores indicating greater spiritual well-being. The total score is calculated as the mean of all items.

  Baseline

• Spiritual well-being measured by Spiritual Attitude and Involvement List-Short Form

  Measured using the Spiritual Attitude and Involvement List-Short Form (SAIL-SF; Bohlmeijer et al., 2023). The SAIL-SF measures seven dimensions of spiritual well-being: meaningfulness, trust, acceptance, caring for others, connectedness with nature, transcendent experiences, and spiritual activities. Each dimension is assessed by one item (e.g., "I experience the things I do as meaningful", "I try to take life as it comes"). Items are rated on a 6-point Likert scale ranging from 1 (not at all) to 6 (to a very high degree), with higher scores indicating greater spiritual well-being. The total score is calculated as the mean of all items.

  1 month after baseline

• Spiritual well-being measured by Spiritual Attitude and Involvement List-Short Form

  Measured using the Spiritual Attitude and Involvement List-Short Form (SAIL-SF; Bohlmeijer et al., 2023). The SAIL-SF measures seven dimensions of spiritual well-being: meaningfulness, trust, acceptance, caring for others, connectedness with nature, transcendent experiences, and spiritual activities. Each dimension is assessed by one item (e.g., "I experience the things I do as meaningful", "I try to take life as it comes"). Items are rated on a 6-point Likert scale ranging from 1 (not at all) to 6 (to a very high degree), with higher scores indicating greater spiritual well-being. The total score is calculated as the mean of all items.

  2 months after baseline

• Spiritual well-being measured by Spiritual Attitude and Involvement List-Short Form

  Measured using the Spiritual Attitude and Involvement List-Short Form (SAIL-SF; Bohlmeijer et al., 2023). The SAIL-SF measures seven dimensions of spiritual well-being: meaningfulness, trust, acceptance, caring for others, connectedness with nature, transcendent experiences, and spiritual activities. Each dimension is assessed by one item (e.g., "I experience the things I do as meaningful", "I try to take life as it comes"). Items are rated on a 6-point Likert scale ranging from 1 (not at all) to 6 (to a very high degree), with higher scores indicating greater spiritual well-being. The total score is calculated as the mean of all items.

  4 months after baseline

Secondary Outcomes (37)

• Grief intensity measured by Traumatic Grief Inventory-Self Report Plus

  Baseline

• Grief intensity measured by Traumatic Grief Inventory-Self Report Plus

  1 month after baseline

• Grief intensity measured by Traumatic Grief Inventory-Self Report Plus

  2 months after baseline

• Grief intensity measured by Traumatic Grief Inventory-Self Report Plus

  4 months after baseline

• Nature connectedness measured by Inclusion of Nature in Self scale

  Baseline

Other Outcomes (7)

• Demographic characteristics

  Baseline

• Loss-related characteristics

  Baseline

• Previous mindfulness experience

  Baseline

Study Arms (3)

Nature-based contemplation

EXPERIMENTAL

10 minutes walking to a chosen natural location, 10 minutes guided contemplation practice, 10 minutes walking back.

Behavioral: Nature-based contemplation

Noticing-nature

ACTIVE COMPARATOR

walk in nature for 30 minutes per day and pay attention to how the natural objects/scenes they encounter in their daily surroundings make them feel over the 14-day period.

Behavioral: Noticing-nature

Waitlist

NO INTERVENTION

Interventions

Noticing-nature BEHAVIORAL

Participants allocated to the noticing-nature active control group will be instructed to walk in nature for 30 minutes per day and pay attention to how the natural objects/scenes they encounter in their daily surroundings make them feel over the 14-day period.

Noticing-nature

Nature-based contemplation BEHAVIORAL

The intervention consisted of a daily 30-minute self-guided practice structured in three parts: (1) participants first walked mindfully for 10 minutes in a natural environment of their choosing (e.g., local park, forest, garden), (2) upon reaching a suitable location, they engaged in a 10-minute guided contemplative practice, and (3) concluded with a 10-minute mindful walk back.

Nature-based contemplation

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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.

You may not qualify if:

• 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.

Sponsors & Collaborators

• University of Twente: lead

Study Sites (1)

University of Twente

Enschede, 7522 NB, Netherlands

Location

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: SUPPORTIVE CARE
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Principal Investigator

Study Record Dates

• First Submitted: March 12, 2025
• First Posted: April 1, 2025
• Study Start: March 24, 2025
• Primary Completion: October 1, 2025
• Study Completion: October 1, 2025
• Last Updated: May 5, 2026

Record last verified: 2026-04

Locations

NL (1)