GriefNCT06904976
Nature-based Contemplation and Spiritual Well-being Among Adults With Moderate Prolonged Grief Symptoms
A study testing Nature-based contemplation and Noticing-nature in people with Grief and Spiritual Wellbeing, run by University of Twente at 1 site in Netherlands.
Trial 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. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Grief, Spiritual Wellbeing
- What is being tested?
- Nature-based contemplation and Noticing-nature
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 262 participants
- Where
- 1 siteNetherlands
- Study dates
- 24 Mar 2025to 1 Oct 2025
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- 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.
Who cannot join
- 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.
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Nature-based Contemplation and Spiritual Well-being Among Adults With Moderate Prolonged Grief Symptoms: A Randomized Controlled Trial
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?
Read more
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
- Being tested
- Nature-based contemplation, Noticing-nature
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Nature-based contemplationBehavioural
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.
Noticing-natureBehavioural
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.
| Study group | Role | What they receive |
|---|---|---|
| Nature-based contemplation | Experimental | 10 minutes walking to a chosen natural location, 10 minutes guided contemplation practice, 10 minutes walking back. Receives: 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. Receives: Behavioral: Noticing-nature |
| Waitlist | No intervention | Not described |
What is being measured
The primary outcome is the main question the study is designed to answer.
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.
Measured: 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.
Measured: 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.
Measured: 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.
Measured: 4 months after baseline
Secondary outcomes (37)
Grief intensity measured by Traumatic Grief Inventory-Self Report Plus
Measured using the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+; Lenferink et al., 2022). Participants rated the extent to which they experienced each grief symptom during the past two weeks on 5-point Likert scale (1 = never to 5 = always). Total scores are calculated by summing all items (range: 22-110), with higher scores indicating greater grief intensity. A total score ≥71 indicates probable clinical DSM-5-TR PGD.
Measured: Baseline
Grief intensity measured by Traumatic Grief Inventory-Self Report Plus
Measured using the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+; Lenferink et al., 2022). Participants rated the extent to which they experienced each grief symptom during the past two weeks on 5-point Likert scale (1 = never to 5 = always). Total scores are calculated by summing all items (range: 22-110), with higher scores indicating greater grief intensity. A total score ≥71 indicates probable clinical DSM-5-TR PGD.
Measured: 1 month after baseline
Grief intensity measured by Traumatic Grief Inventory-Self Report Plus
Measured using the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+; Lenferink et al., 2022). Participants rated the extent to which they experienced each grief symptom during the past two weeks on 5-point Likert scale (1 = never to 5 = always). Total scores are calculated by summing all items (range: 22-110), with higher scores indicating greater grief intensity. A total score ≥71 indicates probable clinical DSM-5-TR PGD.
Measured: 2 months after baseline
Grief intensity measured by Traumatic Grief Inventory-Self Report Plus
Measured using the 22-item Traumatic Grief Inventory-Self Report Plus (TGI-SR+; Lenferink et al., 2022). Participants rated the extent to which they experienced each grief symptom during the past two weeks on 5-point Likert scale (1 = never to 5 = always). Total scores are calculated by summing all items (range: 22-110), with higher scores indicating greater grief intensity. A total score ≥71 indicates probable clinical DSM-5-TR PGD.
Measured: 4 months after baseline
Nature connectedness measured by Inclusion of Nature in Self scale
Measured using 1-item Inclusion of Nature in Self scale (INS; Schultz, 2001). The INS is a single-item pictorial measure that assesses the extent to which individuals include nature within their cognitive representation of self. The measure consists of seven pairs of circles labeled "self" and "nature" with varying degrees of overlap, from completely separate (1) to almost completely overlapping (7). Participants select the picture that best describes their relationship with the natural environment.
Measured: Baseline
Nature connectedness measured by Inclusion of Nature in Self scale
Measured using 1-item Inclusion of Nature in Self scale (INS; Schultz, 2001). The INS is a single-item pictorial measure that assesses the extent to which individuals include nature within their cognitive representation of self. The measure consists of seven pairs of circles labeled "self" and "nature" with varying degrees of overlap, from completely separate (1) to almost completely overlapping (7). Participants select the picture that best describes their relationship with the natural environment.
Measured: 1 month after baseline
Nature connectedness measured by Inclusion of Nature in Self scale
Measured using 1-item Inclusion of Nature in Self scale (INS; Schultz, 2001). The INS is a single-item pictorial measure that assesses the extent to which individuals include nature within their cognitive representation of self. The measure consists of seven pairs of circles labeled "self" and "nature" with varying degrees of overlap, from completely separate (1) to almost completely overlapping (7). Participants select the picture that best describes their relationship with the natural environment.
Measured: 2 months after baseline
Nature connectedness measured by Inclusion of Nature in Self scale
Measured using 1-item Inclusion of Nature in Self scale (INS; Schultz, 2001). The INS is a single-item pictorial measure that assesses the extent to which individuals include nature within their cognitive representation of self. The measure consists of seven pairs of circles labeled "self" and "nature" with varying degrees of overlap, from completely separate (1) to almost completely overlapping (7). Participants select the picture that best describes their relationship with the natural environment.
Measured: 4 months after baseline
Nature connectedness measured by Connectedness to Nature Scale
Measured using 14-item Connectedness to Nature Scale (CNS; Mayer \& Frantz, 2004). The CNS measures individuals' trait levels of feeling emotionally and experientially connected to the natural world. Participants rated items such as "I often feel a sense of oneness with the natural world around me" and "I think of the natural world as a community to which I belong" on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The total score is calculated as the mean of all items after reverse-scoring items 4, 12, and 14, with higher scores indicating greater connectedness to nature.
Measured: Baseline
Nature connectedness measured by Connectedness to Nature Scale
Measured using 14-item Connectedness to Nature Scale (CNS; Mayer \& Frantz, 2004). The CNS measures individuals' trait levels of feeling emotionally and experientially connected to the natural world. Participants rated items such as "I often feel a sense of oneness with the natural world around me" and "I think of the natural world as a community to which I belong" on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The total score is calculated as the mean of all items after reverse-scoring items 4, 12, and 14, with higher scores indicating greater connectedness to nature.
Measured: 1 month after baseline
Nature connectedness measured by Connectedness to Nature Scale
Measured using 14-item Connectedness to Nature Scale (CNS; Mayer \& Frantz, 2004). The CNS measures individuals' trait levels of feeling emotionally and experientially connected to the natural world. Participants rated items such as "I often feel a sense of oneness with the natural world around me" and "I think of the natural world as a community to which I belong" on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The total score is calculated as the mean of all items after reverse-scoring items 4, 12, and 14, with higher scores indicating greater connectedness to nature.
Measured: 2 months after baseline
Nature connectedness measured by Connectedness to Nature Scale
Measured using 14-item Connectedness to Nature Scale (CNS; Mayer \& Frantz, 2004). The CNS measures individuals' trait levels of feeling emotionally and experientially connected to the natural world. Participants rated items such as "I often feel a sense of oneness with the natural world around me" and "I think of the natural world as a community to which I belong" on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The total score is calculated as the mean of all items after reverse-scoring items 4, 12, and 14, with higher scores indicating greater connectedness to nature.
Measured: 4 months after baseline
Mental well-being measured by Mental Health Continuum-Short Form
Measured using the Mental Health Continuum-Short Form (MHC-SF; Lamers et al., 2011), a 14-item scale measuring three dimensions of well-being: emotional (3 items), psychological (6 items), and social well-being (5 items). Participants rated the frequency of experiencing various feelings of well-being during the past month on a 6-point Likert scale (0 = never to 5 = every day). Scores are calculated as the mean of all items, with higher scores indicating greater well-being.
Measured: Baseline
Mental well-being measured by Mental Health Continuum-Short Form
Measured using the Mental Health Continuum-Short Form (MHC-SF; Lamers et al., 2011), a 14-item scale measuring three dimensions of well-being: emotional (3 items), psychological (6 items), and social well-being (5 items). Participants rated the frequency of experiencing various feelings of well-being during the past month on a 6-point Likert scale (0 = never to 5 = every day). Scores are calculated as the mean of all items, with higher scores indicating greater well-being.
Measured: 1 month after baseline
Mental well-being measured by Mental Health Continuum-Short Form
Measured using the Mental Health Continuum-Short Form (MHC-SF; Lamers et al., 2011), a 14-item scale measuring three dimensions of well-being: emotional (3 items), psychological (6 items), and social well-being (5 items). Participants rated the frequency of experiencing various feelings of well-being during the past month on a 6-point Likert scale (0 = never to 5 = every day). Scores are calculated as the mean of all items, with higher scores indicating greater well-being.
Measured: 2 months after baseline
Mental well-being measured by Mental Health Continuum-Short Form
Measured using the Mental Health Continuum-Short Form (MHC-SF; Lamers et al., 2011), a 14-item scale measuring three dimensions of well-being: emotional (3 items), psychological (6 items), and social well-being (5 items). Participants rated the frequency of experiencing various feelings of well-being during the past month on a 6-point Likert scale (0 = never to 5 = every day). Scores are calculated as the mean of all items, with higher scores indicating greater well-being.
Measured: 4 months after baseline
Selflessness measured by Perceived Body Boundaries Scale
Perceived Body Boundaries Scale (PBBS; Dambrun, 2016). This scale comprises a single item designed to assess the strength of participants' perceived body boundaries.
A series of images of human forms with increasingly transparent boundaries to indicate gradations of body boundary salience. "Which images best represent your perception of your body's boundaries right now?" Responses range from 1 (no boundary dissolution) to 7 (a lot of boundary dissolution).
Measured: Baseline
Selflessness measured by Perceived Body Boundaries Scale
Perceived Body Boundaries Scale (PBBS; Dambrun, 2016). This scale comprises a single item designed to assess the strength of participants' perceived body boundaries.
A series of images of human forms with increasingly transparent boundaries to indicate gradations of body boundary salience. "Which images best represent your perception of your body's boundaries right now?" Responses range from 1 (no boundary dissolution) to 7 (a lot of boundary dissolution).
Measured: 1 month after baseline
Selflessness measured by Perceived Body Boundaries Scale
Perceived Body Boundaries Scale (PBBS; Dambrun, 2016). This scale comprises a single item designed to assess the strength of participants' perceived body boundaries.
A series of images of human forms with increasingly transparent boundaries to indicate gradations of body boundary salience. "Which images best represent your perception of your body's boundaries right now?" Responses range from 1 (no boundary dissolution) to 7 (a lot of boundary dissolution).
Measured: 2 months after baseline
Selflessness measured by Perceived Body Boundaries Scale
Perceived Body Boundaries Scale (PBBS; Dambrun, 2016). This scale comprises a single item designed to assess the strength of participants' perceived body boundaries.
A series of images of human forms with increasingly transparent boundaries to indicate gradations of body boundary salience. "Which images best represent your perception of your body's boundaries right now?" Responses range from 1 (no boundary dissolution) to 7 (a lot of boundary dissolution).
Measured: 4 months after baseline
Selflessness measured by Spatial Frame of Reference Continuum
Spatial Frame of Reference Continuum (SFoRC; Hanley \& Garland, 2019). This scale comprises a single item used to assess the extent to which the field of awareness is perceived to extend beyond the physical body.
How far does your self extend into the world? Using the letters and image below, please indicate how far you feel that your self extends beyond your physical body. "A" represents your self stopping at your physical body. "F" represents your self extending into everything (e.g., the entire Universe). The letters inbetween "A" and "F" represent different levels of self-extension. The rings are symbolic, and do not represent actual distances.
Measured: Baseline
Selflessness (Spatial Frame of Reference Continuum)
Spatial Frame of Reference Continuum (SFoRC; Hanley \& Garland, 2019). This scale comprises a single item used to assess the extent to which the field of awareness is perceived to extend beyond the physical body.
How far does your self extend into the world? Using the letters and image below, please indicate how far you feel that your self extends beyond your physical body. "A" represents your self stopping at your physical body. "F" represents your self extending into everything (e.g., the entire Universe). The letters inbetween "A" and "F" represent different levels of self-extension. The rings are symbolic, and do not represent actual distances.
Measured: 1 month after baseline
Selflessness measured by Spatial Frame of Reference Continuum
Spatial Frame of Reference Continuum (SFoRC; Hanley \& Garland, 2019). This scale comprises a single item used to assess the extent to which the field of awareness is perceived to extend beyond the physical body.
How far does your self extend into the world? Using the letters and image below, please indicate how far you feel that your self extends beyond your physical body. "A" represents your self stopping at your physical body. "F" represents your self extending into everything (e.g., the entire Universe). The letters inbetween "A" and "F" represent different levels of self-extension. The rings are symbolic, and do not represent actual distances.
Measured: 2 months after baseline
Selflessness measured by Spatial Frame of Reference Continuum
Spatial Frame of Reference Continuum (SFoRC; Hanley \& Garland, 2019). This scale comprises a single item used to assess the extent to which the field of awareness is perceived to extend beyond the physical body.
How far does your self extend into the world? Using the letters and image below, please indicate how far you feel that your self extends beyond your physical body. "A" represents your self stopping at your physical body. "F" represents your self extending into everything (e.g., the entire Universe). The letters inbetween "A" and "F" represent different levels of self-extension. The rings are symbolic, and do not represent actual distances.
Measured: 4 months after baseline
Elevation measured by Elevating Experiences Scale
Measured using the Elevating Experiences Scale (EES; Huta \& Ryan, 2010), a 13-item measure that captures feelings of transcendence, moral inspiration, and connection to something greater than oneself. Participants rated their experiences over the past two weeks using a 7-point Likert-type scale ranging from 1 (not at all) to 7 (extremely). Scores are calculated as the mean of all items, with higher scores indicating greater elevation.
Measured: Baseline
Elevation measured by Elevating Experiences Scale
Measured using the Elevating Experiences Scale (EES; Huta \& Ryan, 2010), a 13-item measure that captures feelings of transcendence, moral inspiration, and connection to something greater than oneself. Participants rated their experiences over the past two weeks using a 7-point Likert-type scale ranging from 1 (not at all) to 7 (extremely). Scores are calculated as the mean of all items, with higher scores indicating greater elevation.
Measured: 1 month after baseline
Elevation measured by Elevating Experiences Scale
Measured using the Elevating Experiences Scale (EES; Huta \& Ryan, 2010), a 13-item measure that captures feelings of transcendence, moral inspiration, and connection to something greater than oneself. Participants rated their experiences over the past two weeks using a 7-point Likert-type scale ranging from 1 (not at all) to 7 (extremely). Scores are calculated as the mean of all items, with higher scores indicating greater elevation.
Measured: 2 months after baseline
Elevation measured by Elevating Experiences Scale
Measured using the Elevating Experiences Scale (EES; Huta \& Ryan, 2010), a 13-item measure that captures feelings of transcendence, moral inspiration, and connection to something greater than oneself. Participants rated their experiences over the past two weeks using a 7-point Likert-type scale ranging from 1 (not at all) to 7 (extremely). Scores are calculated as the mean of all items, with higher scores indicating greater elevation.
Measured: 4 months after baseline
Ability to adapt measured by Generic Sense of Ability to Adapt Scale
Measured using the Generic Sense of Ability to Adapt Scale (GSAAS; Franken et al., 2023). The GSAAS is a 10-item scale measuring perceived ability to readjust and actively deal with the psychosocial consequences of challenging events. Items (e.g., "If something unexpected happens, I can easily adapt") are rated on a 5-point Likert scale from "not at all" (0) to "always" (4). The total score is calculated as the mean of all items, with higher scores indicating greater ability to adapt.
Measured: Baseline
Ability to adapt measured by Generic Sense of Ability to Adapt Scale
Measured using the Generic Sense of Ability to Adapt Scale (GSAAS; Franken et al., 2023). The GSAAS is a 10-item scale measuring perceived ability to readjust and actively deal with the psychosocial consequences of challenging events. Items (e.g., "If something unexpected happens, I can easily adapt") are rated on a 5-point Likert scale from "not at all" (0) to "always" (4). The total score is calculated as the mean of all items, with higher scores indicating greater ability to adapt.
Measured: 1 month after baseline
Ability to adapt measured by Generic Sense of Ability to Adapt Scale
Measured using the Generic Sense of Ability to Adapt Scale (GSAAS; Franken et al., 2023). The GSAAS is a 10-item scale measuring perceived ability to readjust and actively deal with the psychosocial consequences of challenging events. Items (e.g., "If something unexpected happens, I can easily adapt") are rated on a 5-point Likert scale from "not at all" (0) to "always" (4). The total score is calculated as the mean of all items, with higher scores indicating greater ability to adapt.
Measured: 2 months after baseline
Ability to adapt measured by Generic Sense of Ability to Adapt Scale
Measured using the Generic Sense of Ability to Adapt Scale (GSAAS; Franken et al., 2023). The GSAAS is a 10-item scale measuring perceived ability to readjust and actively deal with the psychosocial consequences of challenging events. Items (e.g., "If something unexpected happens, I can easily adapt") are rated on a 5-point Likert scale from "not at all" (0) to "always" (4). The total score is calculated as the mean of all items, with higher scores indicating greater ability to adapt.
Measured: 4 months after baseline
Personal recovery measured by Brief INSPIRE-O
Measured using the 5-item Brief INSPIRE-O, modified from the Brief INSPIRE support measure (Williams et al., 2015). Items are rated on a 5-point Likert scale from 0 (not at all) to 4 (very much). Following scoring guidelines (Moeller et al., 2023), raw scores were summed and multiplied by 5 to give a total score ranging from 0 to 100, with higher scores indicating better personal functioning.
Measured: Baseline
Personal recovery measured by Brief INSPIRE-O
Measured using the 5-item Brief INSPIRE-O, modified from the Brief INSPIRE support measure (Williams et al., 2015). Items are rated on a 5-point Likert scale from 0 (not at all) to 4 (very much). Following scoring guidelines (Moeller et al., 2023), raw scores were summed and multiplied by 5 to give a total score ranging from 0 to 100, with higher scores indicating better personal functioning.
Measured: 1 month after baseline
Personal recovery measured by Brief INSPIRE-O
Measured using the 5-item Brief INSPIRE-O, modified from the Brief INSPIRE support measure (Williams et al., 2015). Items are rated on a 5-point Likert scale from 0 (not at all) to 4 (very much). Following scoring guidelines (Moeller et al., 2023), raw scores were summed and multiplied by 5 to give a total score ranging from 0 to 100, with higher scores indicating better personal functioning.
Measured: 2 months after baseline
Personal recovery measured by Brief INSPIRE-O
Measured using the 5-item Brief INSPIRE-O, modified from the Brief INSPIRE support measure (Williams et al., 2015). Items are rated on a 5-point Likert scale from 0 (not at all) to 4 (very much). Following scoring guidelines (Moeller et al., 2023), raw scores were summed and multiplied by 5 to give a total score ranging from 0 to 100, with higher scores indicating better personal functioning.
Measured: 4 months after baseline
Daily diary (assessed daily during 14-day intervention period)
"Please respond to the following items based on your experiences and feelings today, reflecting specifically on the past 24 hours." Responses range from 1 (not at all) to 7 (very much).
- Grief reactions (2 items)
- Positive affect (2 items)
- Negative affect (2 items)
- Nature connectedness (1 item; Schultz, 2001)
- Selflessness (1 item; Dambrun, 2016)
- Spiritual well-being (1 item; Underwood, 2011)
- Ability to adapt (1 item; Franken et al., 2023)
- Analysis metric: Daily fluctuations and sudden gains
Measured: From baseline to post-intervention (2-weeks)
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted1 Apr 2025
- Study start24 Mar 2025
- Primary completion1 Oct 2025
- Study completion1 Oct 2025
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for GriefStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 262 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of Twente
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Jannis Kraiss, University of Twente
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06904976
- Sponsor's protocol ID
- 250441
- Status last verified
- Apr 2026
- First submitted
- 12 Mar 2025
- Last updated
- 5 May 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- Undecided
Study at a glance
From the registry record, last updated by the sponsor on 5 May 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Nature-based Contemplation and Spiritual Well-being Among Adults With Moderate Prolonged Grief Symptoms: A Randomized Controlled Trial
- ClinicalTrials.gov ID
- NCT06904976
- Acronym / sponsor ID
- 250441
- Conditions
- Grief, Spiritual Wellbeing
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 262 participants (actual)
- Lead sponsor
- University of TwenteUniversity, hospital or other
- Study start
- 24 Mar 2025 (actual)
- Primary completion
- 1 Oct 2025 (actual)
- Study completion
- 1 Oct 2025 (actual)
- First posted
- 1 Apr 2025 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
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
Study design
- Primary purpose
- Supportive care
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 3
| Arm | Type | Receives |
|---|---|---|
| Nature-based contemplation | Experimental | Behavioral: Nature-based contemplation10 minutes walking to a chosen natural location, 10 minutes guided contemplation practice, 10 minutes walking back. |
| Noticing-nature | Active comparator | Behavioral: Noticing-naturewalk 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. |
| Waitlist | No intervention | – |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (7 listed)
- 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;
Key exclusion criteria (3 listed)
- 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.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Nature-based contemplationThe 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. | Behavioural | Nature-based contemplation |
| Noticing-natureParticipants 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. | Behavioural | Noticing-nature |
Primary outcome
Spiritual well-being measured by Spiritual Attitude and Involvement List-Short Form
Time frame: Baseline
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.
Spiritual well-being measured by Spiritual Attitude and Involvement List-Short Form
Time frame: 1 month after baseline
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.
Spiritual well-being measured by Spiritual Attitude and Involvement List-Short Form
Time frame: 2 months after baseline
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.
Spiritual well-being measured by Spiritual Attitude and Involvement List-Short Form
Time frame: 4 months after baseline
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.
37 secondary outcomes
Grief intensity measured by Traumatic Grief Inventory-Self Report Plus
Time frame: Baseline
Grief intensity measured by Traumatic Grief Inventory-Self Report Plus
Time frame: 1 month after baseline
Grief intensity measured by Traumatic Grief Inventory-Self Report Plus
Time frame: 2 months after baseline
Grief intensity measured by Traumatic Grief Inventory-Self Report Plus
Time frame: 4 months after baseline
Nature connectedness measured by Inclusion of Nature in Self scale
Time frame: Baseline
Nature connectedness measured by Inclusion of Nature in Self scale
Time frame: 1 month after baseline
Nature connectedness measured by Inclusion of Nature in Self scale
Time frame: 2 months after baseline
Nature connectedness measured by Inclusion of Nature in Self scale
Time frame: 4 months after baseline
Nature connectedness measured by Connectedness to Nature Scale
Time frame: Baseline
Nature connectedness measured by Connectedness to Nature Scale
Time frame: 1 month after baseline
Nature connectedness measured by Connectedness to Nature Scale
Time frame: 2 months after baseline
Nature connectedness measured by Connectedness to Nature Scale
Time frame: 4 months after baseline
Mental well-being measured by Mental Health Continuum-Short Form
Time frame: Baseline
Mental well-being measured by Mental Health Continuum-Short Form
Time frame: 1 month after baseline
Mental well-being measured by Mental Health Continuum-Short Form
Time frame: 2 months after baseline
Mental well-being measured by Mental Health Continuum-Short Form
Time frame: 4 months after baseline
Selflessness measured by Perceived Body Boundaries Scale
Time frame: Baseline
Selflessness measured by Perceived Body Boundaries Scale
Time frame: 1 month after baseline
Selflessness measured by Perceived Body Boundaries Scale
Time frame: 2 months after baseline
Selflessness measured by Perceived Body Boundaries Scale
Time frame: 4 months after baseline
Selflessness measured by Spatial Frame of Reference Continuum
Time frame: Baseline
Selflessness (Spatial Frame of Reference Continuum)
Time frame: 1 month after baseline
Selflessness measured by Spatial Frame of Reference Continuum
Time frame: 2 months after baseline
Selflessness measured by Spatial Frame of Reference Continuum
Time frame: 4 months after baseline
Elevation measured by Elevating Experiences Scale
Time frame: Baseline
Elevation measured by Elevating Experiences Scale
Time frame: 1 month after baseline
Elevation measured by Elevating Experiences Scale
Time frame: 2 months after baseline
Elevation measured by Elevating Experiences Scale
Time frame: 4 months after baseline
Ability to adapt measured by Generic Sense of Ability to Adapt Scale
Time frame: Baseline
Ability to adapt measured by Generic Sense of Ability to Adapt Scale
Time frame: 1 month after baseline
Ability to adapt measured by Generic Sense of Ability to Adapt Scale
Time frame: 2 months after baseline
Ability to adapt measured by Generic Sense of Ability to Adapt Scale
Time frame: 4 months after baseline
Personal recovery measured by Brief INSPIRE-O
Time frame: Baseline
Personal recovery measured by Brief INSPIRE-O
Time frame: 1 month after baseline
Personal recovery measured by Brief INSPIRE-O
Time frame: 2 months after baseline
Personal recovery measured by Brief INSPIRE-O
Time frame: 4 months after baseline
Daily diary (assessed daily during 14-day intervention period)
Time frame: From baseline to post-intervention (2-weeks)
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 5 May 2026.
- Individual participant dataSharing planned: Undecided
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Nature-based contemplation and Noticing-nature in people with Grief and Spiritual Wellbeing, run by University of Twente at 1 site in Netherlands.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 5 May 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Netherlands. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Spiritual well-being measured by Spiritual Attitude and Involvement List-Short Form (time frame: Baseline). The study lists 4 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 5 May 2026.