Development of an online self-directed Acceptance and Commitment Therapy (ACT) intervention to improve ability to cope and quality of life after bereavement

Grieving is a natural process, and typically 60% of people who are bereaved adjust with support from family and
friends. Approximately 40% need additional support, yet service availability is inconsistent across the UK. Since
the COVID-19 pandemic, the demand for bereavement support has increased, as has the level of need. A recent
national survey identified high levels of unmet need, with over half of respondents reporting problems with
grieving. Less than one-third felt that the support provided to them by friends and family was enough, yet most were
not accessing support services. This was due to long waiting lists, limited availability and feeling uncomfortable
seeking support. This urgently needs to be addressed by improved access to evidence-based bereavement support.
We propose that an online Acceptance and Commitment Therapy (ACT) psychological intervention has
strong potential to improve coping and quality of life following bereavement, and can be scaled-up to meet
growing demand for bereavement support across the UK. ACT provides strategies that help people to be
open to the pain of loss, to not run from their grief and instead to learn how to live effectively, after
bereavement. ACT is an established and empirically supported form of cognitive behavioural therapy
which uses behavioural psychology, values, acceptance, and mindfulness techniques to improve mental
health and wellbeing. Recent systematic reviews have found that ACT is efficacious in treating
depression and anxiety, and improves wellbeing in a broad range of settings. However, evidence on ACT
for bereavement support is lacking. We know of only one published study investigating an ACT
intervention for grief. This Australian study found that a brief ACT intervention using a self-help booklet
and telephone follow-up was feasible and acceptable. Given its potential, UK studies evaluating ACT to
improve coping and wellbeing following bereavement are warranted.
In-person interventions, delivered by psychological support specialists are costly, resource intensive and
difficult to offer at scale. While these services play a vital role in supporting people with complex bereavement support needs, they cannot meet the needs of everyone with lower level or moderate
bereavement support needs. Online interventions can increase service accessibility and availability, and
there is recent systematic review evidence for their effectiveness. The aims of our proposed research are:
(1) To develop a programme theory describing how an online ACT intervention can lead to improved
coping, quality of life and wellbeing after bereavement for people with low and moderate bereavement
support needs and (2) to design, test and refine an online ACT-based psychological intervention to
improve ability to cope and quality of life after bereavement.
We will follow best practice intervention development, informed by partnership, implementation-based
and person-centred approaches, set within Medical Research Council framework. We will work closely
with our stakeholders, including a bereaved persons PPI group, to co-design the intervention, so that it is
tailored to the needs of bereaved people. To inform intervention development, we will first articulate our
overall programme theory, specifying intervention implementation determinants (context related barriers
and facilitators), intervention implementation strategies, mechanisms and outcomes. We will draw on
systematic review evidence conducted by our team and others; data generated from interviews with ACT
practitioners; workshops with bereaved people and other stakeholders to help design our initial programme
theory. We will then use this evidence to co-create a prototype intervention which will consist of selfdirected online ACT-based audio-visual materials to support coping with grief. This online support
package will include optional facilitation by existing bereavement support volunteers. The intervention
will be user-tested by stakeholders and our bereaved persons PPI group initially, then further tested and
refined over three test-cycles involving 30 to 45 bereaved participants in total. Data from bereaved carer
and bereavement volunteer facilitator interviews, brief questionnaires on usefulness and impact of the
online ACT materials, alongside stakeholder workshops, will be used to further refine and finalise the
intervention.
A key output from this project will be an evidence-based online self-directed ACT bereavement support
intervention, which can be used with or without volunteer facilitation. This will be available for use by
bereavement support services to meet increased demand for bereavement support and for further feasibility testing and full scale evaluation.

After bereavement, many people grieve with support from family and friends. Approximately 40% require
additional support from bereavement services, yet availability varies across the UK. Since the COVID-19
pandemic, the need for bereavement support has increased greatly. A national survey found unmet needs for
emotional support, with more than half of people struggling with grief. Our study will help support bereaved people
by developing an online support package based on Acceptance and Commitment Therapy (ACT). ACT has strong
evidence in improving mental health and wellbeing, but outside of one promising Australian study, hasn’t yet been
tested for bereavement support. This package will improve coping and quality of life after a bereavement and can
be scaled-up to meet needs across the UK.
The aims of our research study are: (1) to synthesise bereavement research with the experience of
bereaved people and service providers to inform the support package (2) to design, test and refine an
online ACT-based psychological support package to improve ability to cope and quality of life after
bereavement.
We will work closely with bereaved people and related services to co-create a prototype ACT support
package consisting of online audio-visual materials, that includes optional facilitation by existing
bereavement support volunteers. The intervention will be tested by our bereaved persons group,
stakeholders and with up 45 bereaved research participants. We will conduct interviews with
participants and invite them to complete short questionnaires on the usefulness and impact of the online
resource, and use this information to make sure it is as good as it can be