Method

Results

156 papers were reviewed after having eliminated duplicates and 13 articles satisfying the inclusion criteria were included in the systematic review (see Figure 1). Three of them were from the United Stated, three from Iran, two from Indonesia, one from Bolivia, one from Colombia, one from Spain, one from Mexico, and one from Pakistan.

Figure 1 Flowchart of the selection of therapeutic treatment studies to deal with love breakups. 

Regarding the methodological characteristics of the studies included, the number of participants ranged from 1 to 152 adults between the age of 18 and 59 having recently ended a love relationship. It is worth mentioning that in 9 out of 13 studies, the percentage of participants was greater for women (see Table 2).

In general, the objectives of the studies comprised to design and to assess the efficacy of therapeutic interventions involving from 1 to 16 sessions to deal with issues such as anguish, depression symptoms, rumination, anxiety, love grief, and love trauma syndrome defined by ^{Rosse (1999}) as a series of severe symptoms among people suffering a love breakup affecting their functionality and generating maladaptive responses (see Table 2 and Table 3).

Treatments varied depending on their design: five were case studies ^{(Carmona, 2012}, ^{Dehghani, et al., 2011}, ^{Menaldi et al, 2020}; ^{Ponce Valdivia et al 2020}; Valadez et al., 2018), four used quasi-experimental designs ^{(Krisnamurthi et al., 2021}; ^{Novo et al., 2019}; ^{Qasmani et al., 2021}; ^{Soltani et al., 2019}), and four were experimental ^{(Falb, 2015}; ^{Harris, 2015}; ^{Negash et al., 2016}; ^{Rajabi et al., 2018}). Of the 13 studies selected, one of them was applied online (Krisnamurthi et al., 2021) and more than half of them (7) informed on the realization of a follow-up measure starting from the second week up to six months (Dehghani, et al., 2011; Falb, 2015; Harris, 2015; Menaldi et al., 2020; Rajabi et al., 2018; Soltani et al., 2019; Valadez, et al., 2018).

Regarding the theoretical approaches considered in treatments dealing with love breakups, six consisted in Cognitive Behavioral Therapies (CBT ^{Carmona, 2012}; ^{Krisnamurthi et al., 2021}; ^{Menaldi, et al., 2020}; ^{Negash et al., 2016}; ^{Novo et al., 2019}; ^{Soltani et al., 2019}), incorporating some of the following elements: psychoeducation, empathy, healthy relationships, stress management, and identification of personal needs, restructuring on dysfunctional attributions of loss, strengthening of self-love, management of cognitive distortions and an anticipated plan to cope with issues (see Table 2 and Table 3). Plus, two studies considered CBT and other approaches. In one of them, Valadez et al. (2018) considered CBT and Solution-Focused Therapy from Systems Theory (ST) centering its elements in the improvement of self-esteem and the reduction of depression symptoms and anxiety. ^{Rajabi et al. (2018)} carried out an assessment of the efficacy of two protocols: one supporting Emotional Regulation Therapy (ERT) and another one Transactional Analysis.

On the other hand, ^{Qasmani et al. (2021)} used ^{Rando's Six R's Mourning Therapy (1993)} with techniques from Play Therapy and the following topics: acknowledgement of the loss, coping skills and problem solving, confrontation, guided meditation, strategic technique of belonging and self-care. Plus, ^{Ponce Valdivia et al. (2020)} included topics such as the reformulation of the concepts of love and work based in the functioning of the family system of the young person allowing to get over the love relationship, based on Solution-Focused Therapy and Structural Approach. In the same way, the intervention performed by Degahni et al. (2011) incorporated ^{McCullough et al.’s (2003)} Short-Term Anxiety-Regulating Psychotherapy, a model of integrative dynamic psychotherapy using an empathic and collaborative relation for the feelings of the individual and their peers divided in three parts: restructuring of defense, restructuring of affect, and participants’ self-restructuring.

In reference to the use of other techniques, an intervention considered mindfulness meditation and Hatha yoga using the following elements: full attention meditation, body mini-scan, Hatha yoga, pranayama, mantra and savasana ^{(Harris, 2015)}. In the same line, ^{Falb (2015)} based his intervention in mindfulness meditation and relaxation training (see Table 2).

In reference to the effectiveness and the feasibility of the interventions included in this review, six studies informed a decrease in depressive and anxious symptomatology, and an improvement in general functioning ^{(Dehghani, et al., 2011}; ^{Menaldi et al., 2020}; ^{Novo et al., 2019}; Valadez, et al., 2018). Plus, ^{Soltani et al. (2019)} reported significant effects in depression and sadness symptoms and an increment in self-confidence. Nevertheless, in ^{Qasmani et al.’s intervention (2021)}, the decrease in anguish with respect to a control group was reported, not being the case for depressive symptomatology. Additionally, ^{Rajabi et al. (2018)} found that both emotional-regulatory intervention and the one based in transactional analysis reduced love trauma syndrome finding statistically significant differences with respect to the control group. Besides, ^{Krisnamurthi et al. (2021)} obtained differences among scores of participants before and after treatment indicating an increase in self-esteem and the ability to forgive. Likewise, in the research by ^{Negash et al. (2016)}, the participants having experienced psychological aggression from their ex-couples and receiving treatment on education in abusive relationships showed more probabilities in breaking up their relationship compared to the control group.

Carmona’s study (2012) identified the main responses to grief after a breakup and intervention techniques from four case studies in adults. The author recommends techniques for future treatments such as: clarifying the role played by the ex-couple, emotional venting, love, dignity, restructuration of loss dysfunctionality, role towards the couple, and strengthening of self-love. In the same line, Ponce Valdvia et al. (2020) described a qualitative approach to the therapeutic process of a case study from a structural approach and problem-focused therapy of a young person suffering from a love breakup. The intervention was oriented to the acknowledgement of the mistakes made during the couple’s relationship, the reformulation of the concepts of love as the main therapeutic problem, and the coping of their parents’ separation.

In the interventions including mindfulness and Hatha yoga techniques, ^{Falb (2015)} identified the first one as not more statistically effective than relaxation. ^{Harris (2015)} reported statistically significant differences in the use of Hatha yoga and conscious meditation directed to the decrease in rumination associated with love breakups between the experimental group and the control group.

Discussion

This work aimed to review the current trend in therapeutic treatments to cope with love breakups. For this purpose, 156 records in a span of 31 years were reviewed and 13 were selected based in the criteria of inclusion, developed in countries from different regions, suggesting the love grief is a circumstance affecting humans all around the world. This number of studies can be considered low when such a long period of time for this review is taken into account as well as the negative impact on mental health provoked by love grief, an issue affecting a wide sector of the population (^{Barajas-Márquez et al., 2017}; Barajas-Márquez & del Castillo Cruz, 2017; ^{Lewandowski, 2009}; ^{Martínez-Gómez et al., 2021}; ^{Rivera-Aragón et al., 2022}; U.S. Census Bureau, 2021). Plus, there is a lack of studies aimed to empirically assess these programs in several continents and regions such as Europe, Eastern Asia, Africa, and Oceania. In this sense, ^{Peel et al. (2018)} highlighted the lack of interventions based on evidence for individuals and couples experiencing difficulties in their relationship, according to information from 15 psychologists in Australia performing a semi-structured interview. They also pointed out that these difficulties are usually diagnosed and treated like depression or anxiety and that many psychologists use non-evidence-based treatments to deal with these difficulties.

On the other hand, it is interesting to note that in 9 out of the 13 studies selected, most of the participants were women, suggesting that they possess a greater awareness of the need for help for these types of issues than men, due to socio-cultural factors validating this request among women, but not in men, because it goes against gender expectations towards the latter, such as projecting themselves as not being weak, strong and self-contained (^{Soria, 2018}). However, the scope of this study cannot support these claims; therefore, it is recommended to consider in future studies the differences by sex, cultural factors, and marriage perception when dealing with love grief since it represents a topic without a lot of studies available in the literature. On the other hand, it is worth mentioning that none of these programs aimed to teenagers but to young adults and adults although it is well-known that teenagers represent a population usually exposed to factors of psycho-social risk such as sexual abuse, bullying, and violence during dating affecting their physical and sexual health (^{Kim et al., 2019}; World Health Organization, 2022). Plus, adolescence is the period of life cycle in which people commonly experience their first romantic relationships, being that love grief at this stage of life has been related to suicidal behavior (^{Londoño & Cañón, 2020}; ^{Moulinec, 2022}). Therefore, it would be convenient to access to programs with empirical support aimed to deal with love grief in this population.

Moreover, it is noted that 8 out of 13 studies stated that cognitive behavioral treatment was exclusively used or along with techniques coming from other approaches. This suggests a greater interest in empirical validation of psychological treatments for love grief by researchers working from this approach compared to other psychotherapeutic approaches as generally observed in psychotherapy (^{David et al., 2018}).

Although treatments are also part of other approaches, the convergence of some topics and techniques such as psychoeducation on health effects provoked by affective loss, loss acknowledgement, and relationship patterns, knowledge on the characteristics of healthy relationships, self-esteem or self-love, meditation and relaxation techniques, problem solving abilities, and coping strategies become evident. Considering that the studies selected inform, in general, on favorable effects of interventions on emotional symptomatology and aspects such as self-esteem, it would be convenient to consider these topics and techniques for the formulation of new treatment programs.

Nonetheless, methodologically speaking, and despite these positive results, most of these studies did not implement experimental designs but quasi-experimental ones and case studies. Plus, out of the 13 studies, only 4 included more than 50 participants. The independent effect of their elements was not examined either. Although more than half of them carried out follow-up measurements, these did not exceed six months after the implementation of the program. Thus, these interventions require more research to verify their effectiveness to reach criteria of therapeutic efficacy according to the parameters from the American Psychological Association (2002; APA Presidential Task Force on Evidence-Based Practice, 2006).

In conclusion, this review points out a relatively low number of interventions to deal with difficulties associated with affective loss around the world, so it is recommended to create new treatments for love grief and to continue the assessment of treatments with favorable evidence including teenagers and considering socio-cultural factors influencing the management of grief in men opposed to women and evaluated against experimental designs, large enough samples, incorporating yearly, biannual, and 5-year follow-up measurements after the implementation of the program to move towards the administration of these treatments and in other populations and regions. It is also recommended to examine the effect of each individual element, in this way, it will be possible to have empirical evidence available to support the use of these programs in clinical practice avoiding the use of non-specifically designed treatments for these issues improving in this way clinical attention (APA Presidential Task Force on Evidence-Based Practice, 2006; ^{Peel et al., 2018}).

This systematic review is strengthened by the extensive search period, the implementation of information systems including an important number of publications such as Web of Science and EBSCO, and the performance of two independent searches including experimental, quasi-experimental and case studies. However, some limitations include the lack of inclusion of other regional information systems of free access that could have provided studies about treatments for love grief such as Redalyc or Scielo as well as the non-implementation of quality indexes for the paper selection, although this was disregarded due to the low number of papers selected.