Islamically Integrated Chair-Work for Bereaved Muslims

NCT07193732 | Enrolling By Invitation

• 1 other identifier: E-71395021-050.06.04-35013
• Study Type: interventional
• Target: 15
• Locations: 1 country
• Sites: 1

Brief Summary

This study aims to develop and to evaluate the efficacy of an Islamically integrated chair-work intervention designed to assist Muslims experiencing prolonged grief in resolving unfinished business tension. Employing a randomized, non-concurrent, multiple baseline design, the study comprises five phases: (1) baseline assessment, (2) empathic attunement, (3) Traditional Islamically Integrated Psychotherapy (TIIP) chair-work intervention, (4) cognitive consolidation \& spiritually behavioral activation, and (5) follow-up. By integrating insights from early Islamic scholars like Al-Kindi, Abu Bekir er-Razi, and Ibn Sina, alongside psychological counseling and cultural elements, this intervention aims to fill a crucial gap in existing literature. Grief, a normal emotional reaction after the loss of a loved one, is typically resolved over time without professional intervention. However, a small yet significant number of individuals experience prolonged grief disorder (PGD), a persistent and impairing form of grief lasting over 6 months. Unfinished business, indicating unresolved relational issues with the deceased, is a key risk factor for severe PGD. Higher levels of unfinished business are associated with increased psychological problems and unhealthy expressions of grief. Within the framework of Traditional Islamically Integrated Psychotherapy (TIIP), unfinished business is viewed as an emotionally charged problem. Processing this emotional burden during TIIP sessions aims to facilitate resolution, replacing maladaptive emotions with adaptive ones, fulfilling emotional needs, and establishing new meanings for unresolved conflicts. Sense-making of one's loss is crucial for a healthier grieving process, making meaning-oriented techniques more effective in grief therapy. Moreover, research indicates that the expression of grief is influenced by spirituality, religious beliefs, and practices. Yet, there is a lack of faith-based intervention programs tailored for grieving Muslims. This study seeks to address this gap by providing closure and therapeutic methods that cater to the nuanced emotional struggles of bereaved Muslims, offering a faith-based approach previously unavailable in the literature.

Conditions

Grief; Emotion Regulation; Bereavement

Keywords

loss; bereavement; grief; unfinished bussines

Outcome Measures

Primary Outcomes (3)

• The Unfinished Business in Bereavement Scale - Brief

  The Unfinished Business in Bereavement Scale - Brief (UBBS - Brief) is a self-report measurement tool developed by Holland et al. (2020). Utilizing a 5-point Likert scale (ranging from 1 = Not at all distressed to 5 = Extremely distressed), the UBBS - Brief comprises 8 items and includes two subscales: 'unfulfilled wishes' and 'unresolved conflict.'

  Baseline, weekly through Week 7 (end of treatment), and at 1-month follow-up (up to 11 weeks total)

• Prolonged Grief Disorder-13 Scale

  The Prolonged Grief Disorder-13 (PG-13) Scale, developed by Prigerson et al. (2009) serves as a diagnostic tool for prolonged grief disorder (PGD) and aims to assess the severity of symptoms experienced after a loss. PG-13 comprises a total 13 item, with 11 of them utilizing 5-Likert point scale (1 = Not at all, 3= At least once a week, 5= Several times a day) to gauge severity of the struggles associated with the loss. And the remaining two items are yes/no question to designed to determine the duration time post-loss (a minimum of 6 months) and to assess dysfunction criterion. An increase in the cumulative scores obtained from the 11 items on the scale indicates a rise in the severity of prolonged grief symptoms. The PG-13 outlines five criteria (A-E) to diagnose PGD: (A) event criterion; (B) separation distress; (C) Duration Criterion; (D) cognitive, emotional, and behavioral symptoms; and (E) impairment criterion (Prigerson et al., 2009).

  Baseline (Week 0), end of treatment (Week 7), and 1-month follow-up (Week 11; up to 11 weeks total).

• The Grief Cognitions Questionnaire

  The Grief Cognitions Questionnaire (GCQ) was developed by Boelen et al. (2003) comprises a 38-item self-report assessment tool utilizing a 6-point Likert scale (ranging from 0 = strongly disagree to 5 = strongly agree) encompassing nine distinct subscales. Its primary function is to evaluate the negative cognitions experienced by bereaved individuals following a loss, which may contribute to the complexity of the grieving process. The Turkish version includes 30 items, consolidating into six subscales (Cesur and Durak-Batıgün, 2018): (1) negative cognitions about future after loss, (2) negative/threatening interpretation of emotions and reactions to loss, (3) negative cognitions about self after loss, (4) negative cognitions about world after loss, (5) cherish grief and, (6) negative cognitions about others after loss. Scores on the questionnaire range from 0 to 150, with higher scores indicating a greater intensity of negative cognitions.

  Baseline (Week 0), end of treatment (Week 7), and 1-month follow-up (Week 11; up to 11 weeks total).

Secondary Outcomes (3)

• The Client Emotional Arousal Scale III

  Baseline (Week 0), end of treatment (Week 7), and 1-month follow-up (Week 11; up to 11 weeks total).

• Patient Health Questionnaire-9

  Baseline (Week 0), end of treatment (Week 7), and 1-month follow-up (Week 11; up to 11 weeks total).

• Generalized Anxiety Disorder-7

  Baseline (Week 0), end of treatment (Week 7), and 1-month follow-up (Week 11; up to 11 weeks total).

Study Arms (3)

2-weeks baseline

EXPERIMENTAL

Participants will wait for a two-week period before starting psychotherapy sessions, during which time they will complete questionnaires. Following this period, they will engage in a 7-week psychotherapy process.

Behavioral: Psychotherapy-Empathic Attunement Phase; Behavioral: Psychotherapy - Chair-work intervention phase; Behavioral: Psychotherapy - Cognitive consolidation and spiritually behavioral activation phase

4-weeks baseline

EXPERIMENTAL

Participants will wait for a four-weeks period before starting psychotherapy sessions, during which time they will complete questionnaires. Following this period, they will engage in a 7-week psychotherapy process.

Behavioral: Psychotherapy-Empathic Attunement Phase; Behavioral: Psychotherapy - Chair-work intervention phase; Behavioral: Psychotherapy - Cognitive consolidation and spiritually behavioral activation phase

6-weeks baseline

EXPERIMENTAL

Participants will wait for a six-week period before starting psychotherapy sessions, during which time they will complete questionnaires. Following this period, they will engage in a 7-week psychotherapy process.

Behavioral: Psychotherapy-Empathic Attunement Phase; Behavioral: Psychotherapy - Chair-work intervention phase; Behavioral: Psychotherapy - Cognitive consolidation and spiritually behavioral activation phase

Interventions

Psychotherapy-Empathic Attunement Phase BEHAVIORAL

The initial focus of our therapeutic intervention is on establishing empathic attunement to aid individuals in processing the inherent pain of grief in a constructive manner. For this phase, therapists will focus solely on adhering to the relationship formation and introspective exploration. Practitioners aimed at empathetically tuning into the patient's emotional experience, validating and reassuring the patient's emotional state, and adhering to the fundamental principles of empathy, sincerity, and positive regard for establishing and upholding a strong therapeutic alliance. Also, accompanying the patients to uncover and process the natural pain to gain self-awareness about their emotions.

2-weeks baseline; 4-weeks baseline; 6-weeks baseline

Psychotherapy - Chair-work intervention phase BEHAVIORAL

During this phase, bereavement person will conduct imaginal conversation with a deceased. Practitioners utilized the resolution model including 5 components: (1) emotional reaction of the bereavement (blame, hurt, regret etc.) and enactment of the deceased; (2) differentiation of the bereavement's feelings and deceased's specific negative aspects accessed; (3) intense expression of the bereavement's specific emotions; (4) expression of the bereavement's previously unmet interpersonal needs from the deceased and the deceased validates bereavement's feelings; (5) understanding and forgiveness of the deceased or shift in view of the deceased.

2-weeks baseline; 4-weeks baseline; 6-weeks baseline

Psychotherapy - Cognitive consolidation and spiritually behavioral activation phase BEHAVIORAL

Cognitive consolidation and spiritually behavioral activation complement the emotional interventions implemented in earlier stages. This cognitive process aids in the transformation and integration of adaptive growth, enabling patients to assimilate the knowledge and insights acquired during therapy. Therapists take a directive and co-constructivist approach, guiding patients to discover emotionally adaptive reconciliations and meanings that challenge and reshape their emotional and cognitive frameworks in the cognitive consolidation and spiritually behavioral activation phase. Aligned with this cognitive shift, spiritual behavioral activations involve creating plans to address unmet needs.

2-weeks baseline; 4-weeks baseline; 6-weeks baseline

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Loss of a loved one 6 months to 5 years ago,
• Grieving for unresolved tension for a loved one (24 or more points on the Unfinished Business in Bereavement Scale),
• Religiously adherent adults (according to self report)

You may not qualify if:

• Imminent suicide risk or self-harm,
• Current substance or alcohol dependence,
• Past or current psychotic disorders or bipolar disorder;
• Currently receiving any form of psychotherapy

Sponsors & Collaborators

• Ibn Haldun University: lead

Study Sites (1)

Ibn Haldun University

Istanbul, Başakşehir, 34480, Turkey (Türkiye)

Location

Related Publications (25)

• Prigerson HG, Horowitz MJ, Jacobs SC, Parkes CM, Aslan M, Goodkin K, Raphael B, Marwit SJ, Wortman C, Neimeyer RA, Bonanno GA, Block SD, Kissane D, Boelen P, Maercker A, Litz BT, Johnson JG, First MB, Maciejewski PK. Prolonged grief disorder: Psychometric validation of criteria proposed for DSM-V and ICD-11. PLoS Med. 2009 Aug;6(8):e1000121. doi: 10.1371/journal.pmed.1000121. Epub 2009 Aug 4.

  PMID: 19652695 BACKGROUND

• Holland JM, Klingspon KL, Lichtenthal WG, Neimeyer RA. The Unfinished Business in Bereavement Scale (UBBS): Development and psychometric evaluation. Death Stud. 2020;44(2):65-77. doi: 10.1080/07481187.2018.1521101. Epub 2018 Dec 4.

  PMID: 30513256 BACKGROUND

• Boelen, P. A., & Lensvelt-Mulders, G. J. Psychometric properties of the grief cognitions questionnaire (GCQ). Journal of Psychopathology and Behavioral Assessment. 2005; 27(4): 291-303.

  BACKGROUND

• Warwar, S., & Greenberg, L. S. Client emotional arousal scale-III. Unpublished manuscript, York University, Toronto, Ontario, Canada. 1999

  BACKGROUND

• Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13. doi: 10.1046/j.1525-1497.2001.016009606.x.

  PMID: 11556941 BACKGROUND

• Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7. doi: 10.1001/archinte.166.10.1092.

  PMID: 16717171 BACKGROUND

• Papa A, Lancaster NG, Kahler J. Commonalities in grief responding across bereavement and non-bereavement losses. J Affect Disord. 2014 Jun;161:136-43. doi: 10.1016/j.jad.2014.03.018. Epub 2014 Mar 25.

  PMID: 24751321 BACKGROUND

• Holmes TH, Rahe RH. The Social Readjustment Rating Scale. J Psychosom Res. 1967 Aug;11(2):213-8. doi: 10.1016/0022-3999(67)90010-4. No abstract available.

  PMID: 6059863 BACKGROUND

• Prigerson HG, Boelen PA, Xu J, Smith KV, Maciejewski PK. Validation of the new DSM-5-TR criteria for prolonged grief disorder and the PG-13-Revised (PG-13-R) scale. World Psychiatry. 2021 Feb;20(1):96-106. doi: 10.1002/wps.20823.

  PMID: 33432758 BACKGROUND

• Chen Z, Ying J, Ingles J, Zhang D, Rajbhandari-Thapa J, Wang R, Emerson KG, Feng Z. Gender differential impact of bereavement on health outcomes: evidence from the China Health and Retirement Longitudinal Study, 2011-2015. BMC Psychiatry. 2020 Oct 22;20(1):514. doi: 10.1186/s12888-020-02916-2.

  PMID: 33092555 BACKGROUND

• Szuhany KL, Young A, Mauro C, Garcia de la Garza A, Spandorfer J, Lubin R, Skritskaya NA, Hoeppner SS, Li M, Pace-Schott E, Zisook S, Reynolds CF, Shear MK, Simon NM. Impact of sleep on complicated grief severity and outcomes. Depress Anxiety. 2020 Jan;37(1):73-80. doi: 10.1002/da.22929.

  PMID: 31916662 BACKGROUND

• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (5th Ed., Text Rev.).; 2022.

  BACKGROUND

• Pos AE, Paolone DA, Smith CE, Warwar SH. How does client expressed emotional arousal relate to outcome in experiential therapy for depression? Pers Exp Psychother. 2017;16(2):173-190. doi:10.1080/14779757.2017.1323666

  BACKGROUND

• Boelen PA, van den Hout MA, van den Bout J. A cognitive-behavioral conceptualization of complicated grief. Clin Psychol Sci Pract. 2006;13(2):109-128. doi:10.1111/j.1468-2850.2006.00013.x

  BACKGROUND

• Cesur-Soysal G, Durak-Batigun A. Prolonged grief, emotion regulation and loss-related factors: An investigation based on cognitive and behavioral conceptualization. Death Stud. 2022;46(6):1316-1328. doi: 10.1080/07481187.2020.1846639. Epub 2020 Nov 12.

  PMID: 33180665 BACKGROUND

• Holland JM, Thompson KL, Rozalski V, Lichtenthal WG. Bereavement-related regret trajectories among widowed older adults. J Gerontol B Psychol Sci Soc Sci. 2014 Jan;69(1):40-7. doi: 10.1093/geronb/gbt050. Epub 2013 Jun 13.

  PMID: 23766434 BACKGROUND

• Klingspon KL, Holland JM, Neimeyer RA, Lichtenthal WG. Unfinished Business in Bereavement. Death Stud. 2015;39(7):387-98. doi: 10.1080/07481187.2015.1029143.

  PMID: 26057117 BACKGROUND

• Keshavarzi H, Keshavarzi S. Emotionally Oriented Psychotherapy. In: Keshavarzi H, Khan F, Ali B, Awaad R, eds. Applying Islamic Principles to Clinical Mental Health Care. Routledge; 2020:171-208. doi:10.4324/9781003043331-12

  BACKGROUND

• Holland JM, Neimeyer RA. An examination of stage theory of grief among individuals bereaved by natural and violent causes: a meaning-oriented contribution. Omega (Westport). 2010;61(2):103-20. doi: 10.2190/OM.61.2.b.

  PMID: 20712139 BACKGROUND

• De Stefano R, Muscatello MRA, Bruno A, Cedro C, Mento C, Zoccali RA, Pandolfo G. Complicated grief: A systematic review of the last 20 years. Int J Soc Psychiatry. 2021 Aug;67(5):492-499. doi: 10.1177/0020764020960202. Epub 2020 Sep 24.

  PMID: 32972293 BACKGROUND

• Beckett C, Dykeman C. A Metatheory of Grief: implications for Counselors. Ideas Res You Can Use. 2017;(30):1-15.

  BACKGROUND

• Jayyusi-lehn G. The Epistle of Ya'qub ibn Ishaq al-Kindi on the Device for Dispelling Sarrow. 2002;29:121-135. doi:10.1080/135301902200001263

  BACKGROUND

• Melhem NM, Porta G, Walker Payne M, Brent DA. Identifying prolonged grief reactions in children: dimensional and diagnostic approaches. J Am Acad Child Adolesc Psychiatry. 2013 Jun;52(6):599-607.e7. doi: 10.1016/j.jaac.2013.02.015. Epub 2013 Apr 24.

  PMID: 23702449 BACKGROUND

• Ibn Sina, Alî b. Sînâ, Tura, H. Ölüm korkusundan kurtuluş risalesi; Namaz risalesi. orhan Mete ve Ortağı Kollektif Şirketi Matbaası. 1959

  BACKGROUND

• Rāzī ABM ibn Z, Arberry AJ. The Spiritual Physick of Rhazes. Butler & Tanner Ltd.; 1950.

  BACKGROUND

MeSH Terms

Conditions

Emotional Regulation

Condition Hierarchy (Ancestors)

Self-Control; Social Behavior; Behavior

Study Officials

• Hooman Keshavarzi, Psy.D.

  Ibn Haldun University

  STUDY CHAIR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 6, 2024
• First Posted: September 26, 2025
• Study Start: August 27, 2024
• Primary Completion: November 20, 2025
• Study Completion: April 1, 2026
• Last Updated: September 26, 2025

Record last verified: 2025-09

Locations

TU (1)