Ecological Momentary Intervention for Grief in Young Adults: A Pilot Randomized Trial

Importance: This study is the first to examine the potential effectiveness of an Ecological Momentary Intervention (EMI) for grief in a bereaved Chinese community sample. Cognitive Behavioral Therapy (CBT) -based exercises were delivered throughout the day in response to participants’ grief symptoms, offering timely, symptom-tailored support in daily life. Objective: To assess the feasibility and preliminary effectiveness of a 3-arm pilot Randomized Control Trial (RCT) for a newly develop CBT-based EMI for grief among bereaved Chinese young adults. Design, Setting, and Participants: This 3-arm randomized pilot trial recruited bereaved young adults (18-35 years old) in China from July 15 to August 7, 2026, with final follow-up completed on August 29, 2026. Participants were randomized to three groups: EMA + EMI(G1), EMA only(G2), Control (assessments only, G3). Eligible participants were aged 18 to 35 years and had experienced the death of a significant person 3 to 12 months previously. Sixty participants were randomized 1:1:1, and all completed postintervention assessments. Interventions: The study lasted 21 days. G1 and G2 completed EMA assessments 4 times daily. In G1, 13 CBT-based self-guided psychological intervention modules became available from day 8, with recommendations provided in response to EMA grief symptom tracking. Main Outcomes and Measures: The primary outcome was grief symptoms measured using the 13-item standard International Prolonged Grief Disorder Scale (IPGDS) at baseline (day 0), midpoint (day 7), and postintervention (day 22). Secondary outcomes included depressive, anxiety, and somatic symptoms and psychological well-being. Momentary psychological outcomes, EMA completion, and EMI uptake were also examined. Results: All the 60 randomized participants (20 per group) completed the study, with an overall EMA completion rate of 91.5%. In the EMA + EMI group, 531 unique intervention module initiations were recorded; 155 (29.2%) of these module initiations occurred within 30 minutes after an EMA assessment, of which 77 (49.7%) matched a recommended module. Grief symptoms decreased over time across all groups, with a significant group × time interaction (P = .043). From midpoint to postintervention, reductions were greater in the EMA + EMI group than in the EMA Only (Holm-adjusted P = .013) and Control (Holm-adjusted P = .043) groups. EMA + EMI was also associated with greater improvement in psychological well-being than Control group, whereas no significant group × time interactions were observed for depressive, anxiety, or somatic symptoms. No significant between-group differences were also observed in longitudinal EMA trajectories. Conclusions and Relevance: This randomized pilot trial suggests that EMI may represent a promising new approach to grief intervention among bereaved young adults. Larger trials with longer follow-up are needed to confirm these findings and further evaluate the effectiveness of EMI for grief.