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Durepos P, MacLean R, Ricketts N, Boamah SA, Witherspoon R, Gould O, Olthuis JV, Totton K, Tucker K, Boulay I, Robitaille A, Aquino-Russell C, Kaasalainen S. Engaging care partners of persons living with dementia in acceptance and commitment therapy (ACT) programs: a scoping review. Aging Ment Health 2024; 28:725-737. [PMID: 38100551 DOI: 10.1080/13607863.2023.2288864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Acceptance and commitment therapy (ACT) is a relatively new type of psychotherapy effective for treating depression and anxiety amongst family care partners of persons living with dementia [PLWD]. However, care partner engagement in mental health services is low and specific guidelines for designing ACT programs for care partners of PLWD do not exist. The purpose of this scoping review was to examine patterns in care partner engagement in ACT programs to identify program factors potentially influencing engagement. METHODS A comprehensive scoping review according to Arksey and O'Malley's framework was followed. Databases and grey literature were searched for primary studies of ACT programs with care partners of PLWD. Data were charted and synthesized. RESULTS Ten studies met inclusion criteria and were analyzed. Amongst these, engagement was highest in three ACT programs that were delivered individually, remotely and were therapist-led or supported. Conversely, engagement was the lowest in two ACT programs that were self-directed, web-based and had minimal or no care partner-therapist interaction. Program factors perceived as influencing engagement included tailoring and personalization, mode of delivery and format, therapeutic support and connectedness, program duration and pace. CONCLUSION Findings from this review suggest that care partners engagement may be promoted by designing ACT programs that focus on the therapeutic client-therapist relationship, are delivered remotely and individually. Future research should focus on evaluation of best implementation practices for engagement and effectiveness.
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Affiliation(s)
- Pamela Durepos
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | - Rachel MacLean
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | | | | | | | - Odette Gould
- Department of Psychology, Mount Allison University, Sackville, Canada
| | - Janine V Olthuis
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| | - Karen Totton
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | - Kate Tucker
- Master of Applied Health Services Research, University of New Brunswick, Fredericton, Canada
| | | | - Annie Robitaille
- Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, Canada
- Centre of Excellence in Frailty-Informed Care, The Perley and Rideau Veterans' Health Centre, Ottawa, Canada
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2
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Morimoto H. Profiles of psychological flexibility and caregiving experience in dementia family caregivers: A latent profile analysis. J Clin Psychol 2024. [PMID: 38639034 DOI: 10.1002/jclp.23696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVES To explore the profiles of psychological flexibility among dementia family caregivers and examine their associations with psychological well-being and caregiving factors. METHODS Participants were 521 dementia family caregivers in Japan. Latent profile analysis was conducted to explore the profiles of psychological flexibility. The analyses examined differences in depression, anxiety, life satisfaction, and work-family conflict/enrichment between the profiles, and whether sociodemographic variables and caregiving stressors predict the profile. RESULTS Four distinct profiles were identified: high psychological flexibility (14.2%), moderate psychological flexibility with high commitment (24.7%), moderate psychological flexibility with low commitment (48.0%), and low psychological flexibility (13.1%). The low psychological flexibility profile exhibited the highest scores of depression, anxiety and work-family conflict, followed by the moderate psychological flexibility with low/high commitment profiles, and the high psychological flexibility profile. The high psychological flexibility and moderate psychological flexibility with high commitment profiles exhibited higher life satisfaction than the moderate psychological flexibility with low commitment profile. Caregiving stressors, marital status, and caregiver status predicted the profile. CONCLUSION Enhancing defusion and acceptance, rather than increasing commitment to personal values, may be beneficial in supporting distressed caregivers. Having more caregiving stressors, being single/divorced/bereaved, and being a primary caregiver may be useful indicators of decreased psychological flexibility among dementia family caregivers.
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3
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Atefi GL, van Knippenberg RJM, Bartels SL, Losada-Baltar A, Márquez-González M, Verhey FRJ, de Vugt ME. A Web-Based Intervention Based on Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Mixed Methods Feasibility Study. JMIR Aging 2024; 7:e53489. [PMID: 38574360 PMCID: PMC11027053 DOI: 10.2196/53489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/24/2023] [Accepted: 01/12/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Acceptance and commitment therapy (ACT), as an empirically based third-wave cognitive behavioral therapy, has shown promise in enhancing well-being and functioning across diverse populations. However, in the context of caregiving, the effect size of available ACT interventions remains at best moderate, sometimes accompanied by high dropout rates, highlighting the need for more effective and feasible intervention designs. OBJECTIVE The objective of our study was to evaluate the feasibility and acceptability of a fully online ACT program designed for family caregivers of people with dementia. This study aimed to boost psychological flexibility and support caregivers, enabling them to realize and prioritize their own life values alongside their caregiving responsibilities. METHODS A mixed methods feasibility study using an uncontrolled pretest-posttest design was conducted. This intervention included a 9-week web-based self-help program based on ACT incorporating collaborative goal setting and weekly web-based motivational coaching for family caregivers of people with dementia. This study involved 30 informal caregivers recruited through memory clinics and social media platforms in the Netherlands and received approval from the Medical Ethics Committee of the Maastricht University Medical Center+ (NL77389.068.21/metc21-029). RESULTS A total of 24 caregivers completed the postintervention assessment, indicating a high adherence rate (24/29, 83%). Caregivers reported positive feedback regarding collaborative goal setting, but some found challenges in implementing new skills due to their own habitual responses or the unpredictable context of dementia caregiving. Personalizing the intervention based on individual value preferences was highlighted as beneficial. CONCLUSIONS Compared to other web-based self-help ACT interventions for family caregivers, this intervention showed a high adherence and sufficient level of feasibility, which underscores the use of personalization in delivering web-based interventions. Moreover, the potential of this ACT-based intervention for family caregivers of people with dementia was demonstrated, suggesting that further research and a larger-scale controlled trial are warranted to validate its effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2022-070499.
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Affiliation(s)
- Golnaz L Atefi
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Rosalia J M van Knippenberg
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Sara Laureen Bartels
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Andrés Losada-Baltar
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain
| | - María Márquez-González
- Biological and Health Psychology Department, School of Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Maastricht, Netherlands
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Spiers G, Tan MMC, Astbury JL, Hall A, Ahmed N, Lanyi K, Williams O, Beyer F, Craig D, Hanratty B. What works to support carers of older people and older carers? an international evidence map of interventions and outcomes. BMC Geriatr 2024; 24:301. [PMID: 38553679 PMCID: PMC10979610 DOI: 10.1186/s12877-024-04897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Unpaid carers of older people, and older unpaid carers, experience a range of adverse outcomes. Supporting carers should therefore be a public health priority. Our understanding of what works to support carers could be enhanced if future evaluations prioritise under-researched interventions and outcomes. To support this, we aimed to: map evidence about interventions to support carers, and the outcomes evaluated; and identify key gaps in current evidence. METHODS Evidence gap map review methods were used. Searches were carried out in three bibliographic databases for quantitative evaluations of carer interventions published in OECD high-income countries between 2013 and 2023. Interventions were eligible if they supported older carers (50 + years) of any aged recipient, or any aged carers of older people (50 + years). FINDINGS 205 studies reported across 208 publications were included in the evidence map. The majority evaluated the impact of therapeutic and educational interventions on carer burden and carers' mental health. Some studies reported evidence about physical exercise interventions and befriending and peer support for carers, but these considered a limited range of outcomes. Few studies evaluated interventions that focused on delivering financial information and advice, pain management, and physical skills training for carers. Evaluations rarely considered the impact of interventions on carers' physical health, quality of life, and social and financial wellbeing. Very few studies considered whether interventions delivered equitable outcomes. CONCLUSION Evidence on what works best to support carers is extensive but limited in scope. A disproportionate focus on mental health and burden outcomes neglects other important areas where carers may need support. Given the impact of caring on carers' physical health, financial and social wellbeing, future research could evaluate interventions that aim to support these outcomes. Appraisal of whether interventions deliver equitable outcomes across diverse carer populations is critical.
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Affiliation(s)
- Gemma Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.
| | - Michelle M C Tan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jayne L Astbury
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Alex Hall
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Nisar Ahmed
- School of Health Sciences, University of Manchester, Manchester, UK
| | - Kate Lanyi
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Oleta Williams
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Beyer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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García-Batalloso I, Cabrera I, Losada-Baltar A, Mérida-Herrera L, Olazarán J, Márquez-González M. Network Analysis of Comorbid Depressive and Anxious Symptoms in Family Caregivers of People with Dementia. Clin Gerontol 2024; 47:244-256. [PMID: 37230486 DOI: 10.1080/07317115.2023.2217162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The aim of this study is an in-depth approach to depressive-anxious comorbidity in caregivers according to stress reactivity to disruptive behaviors using network analysis. METHODS The sample was composed of 317 primary family caregivers recruited through Day Care Centers and Neurology Services. The sample was split into low and high stress reactivity groups, based on their reports of reaction to disruptive behaviors. Depressive and anxious symptoms, daily hours dedicated to caregiving, time of caring, frequency of disruptive behaviors, co-residence, and kinship were also cross-sectionally measured. RESULTS The sample had a mean age of 62.38 years (SD = 12.97) and 68.5% were women. Regarding the network analysis, while the low reactivity group presents a sparse network, with no connection between anxious and depressive symptoms, the high reactivity group shows a high connection of intra and intercategory symptoms, with apathy, sadness, feeling depressed, and tension being the bridge symptoms between disorders. CONCLUSIONS Caregivers' stress reaction to disruptive behaviors might be a key factor for understanding comorbidity between depressive and anxious symptoms. CLINICAL IMPLICATIONS Tension, apathy, sadness, and feeling depressed should be clinical targets in the interventions, as they act as bridge symptoms between anxious and depressive symptomatology.
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Affiliation(s)
- Inés García-Batalloso
- Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain
| | - Isabel Cabrera
- Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Laura Mérida-Herrera
- Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Olazarán
- Service of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - María Márquez-González
- Departamento de Psicología Biológica y de la Salud, Universidad Autónoma de Madrid, Madrid, Spain
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Jiménez-Gonzalo L, Vara-García C, Romero-Moreno R, Márquez-González M, Olazarán J, von Känel R, Mausbach BT, Losada-Baltar A. An integrated model of psychosocial correlates of insomnia severity in family caregivers of people with dementia. Aging Ment Health 2023:1-8. [PMID: 38100598 DOI: 10.1080/13607863.2023.2293052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVES Research has shown the relevance of stress and coping factors in explaining caregivers' insomnia symptoms. However, few attempts have been made to empirically test an integrative model for insomnia severity in family caregivers of people with dementia. The aim of this study was to test such a model, in which insomnia severity is proposed to be influenced by predisposing factors, precipitated by stressors, and perpetuated by behaviors to cope with these stressors. METHODS 311 family caregivers of people with dementia were assessed for variables categorized as predisposing (e.g. female gender), precipitating (e.g. care-recipient's behavioral and psychological symptoms of dementia [BPSD]), and perpetuating factors (e.g. sleep aids). A theoretical model was developed and then statistically tested using structural equation modelling, analyzing the direct and indirect effects of the assessed variables on caregivers' insomnia severity. RESULTS Distress, sleep aids, and experiential avoidance showed a direct association with insomnia severity. Female gender, younger age, cognitive fusion, leisure activities, dysfunctional thoughts, frequency and distress caused by care-recipient's BPSD showed indirect associations with insomnia severity. The model explained 22% of the variance of caregivers' insomnia severity. CONCLUSION The results provide additional empirical support for the importance of predisposing, precipitating and perpetuating factors associated with caregivers' insomnia severity. The integrative model we propose may also be useful for developing interventions targeting insomnia symptoms in family dementia caregivers.
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Affiliation(s)
| | | | | | - María Márquez-González
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Olazarán
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Fundación Maria Wolff, Madrid, Spain
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University of Zürich and University Hospital Zurich, Switzerland
| | - Brent T Mausbach
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Ye F, Lee JJ, Xue D, Yu DSF. Acceptance and Commitment Therapy Among Informal Caregivers of People With Chronic Health Conditions: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2346216. [PMID: 38051530 DOI: 10.1001/jamanetworkopen.2023.46216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2023] Open
Abstract
Importance Although there is substantial evidence to suggest the health benefits of acceptance and commitment therapy (ACT) among informal caregivers of people with chronic health conditions, the great variation in intervention designs among published studies limits its application. Objectives To identify intervention characteristics of ACT that are associated with improved psychological health and to assess the acceptability of ACT among informal caregivers. Data Sources Seven English- and 3 Chinese-language databases without limits on publication dates, the reference lists of previous reviews, and gray literature were searched up to February 2023. Study Selection Randomized clinical trials comparing the effect of ACT vs control groups on improving psychological health among informal caregivers. Data Extraction and Synthesis Two reviewers independently screened searched records and extracted data from eligible studies. Random-effects meta-analysis and mixed-effects metaregression were performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed. Main Outcomes and Measures Psychological health outcomes (eg, depressive symptoms) measured by valid measurements and the acceptability of ACT based on identified parameters. Results A total of 29 studies with 2010 participants, published between 2015 and 2023, were identified. ACT showed moderate to large effect sizes for improving psychological health at postintervention assessments (Hedges g range, -0.55 [95% CI, -0.98 to -0.12] to -1.14 [95% CI, -1.83 to -0.45]) and at 1-to-3-month and 4-to-6-month follow-ups (Hedges g range, -0.47 [95% CI, -0.69 to -0.25] to -1.29 [95% CI, -2.33 to -0.24]). Multivariable metaregression analysis regarding intervention characteristics found that ACT delivered in a mixed individual- and group-based format, face-to-face, or through more intervention sessions was associated with greater improvements for experiential avoidance (face-to-face: β = -1.170 [95% CI, -2.020 to -0.319]; number of sessions: β = -0.242 [95% CI, -0.353 to -0.130]), depressive symptoms (mixed delivery format: β = -2.583 [95% CI, -4.845 to -0.321]; face-to-face: β = -1.555 [95% CI, -3.002 to -0.108]), or anxiety symptoms (face-to-face: β = -1.241 [95% CI, -2.337 to -0.146]). In general, ACT had low attrition rates (11%), and participants' adherence (51%-80%) and satisfactory ratings (72%-95%) lend support to its acceptability. Conclusions and Relevance This systematic review and meta-analysis found that ACT was consistently associated with improvements in psychological health, supporting its application to improve informal care for chronic disease management. This review provides specific details on the design parameters of ACT for achieving greater efficacy.
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Affiliation(s)
- Fen Ye
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jung Jae Lee
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Dandan Xue
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Doris Sau-Fung Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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8
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Atefi GL, de Vugt ME, van Knippenberg RJM, Levin ME, Verhey FRJ, Bartels SL. The use of Acceptance and Commitment Therapy (ACT) in informal caregivers of people with dementia and other long-term or chronic conditions: A systematic review and conceptual integration. Clin Psychol Rev 2023; 105:102341. [PMID: 37776577 DOI: 10.1016/j.cpr.2023.102341] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 10/02/2023]
Abstract
Informal caregivers are the primary source of support for adults with chronic conditions and disabilities. Empirical research highlights chronic stress and other risks of adverse outcomes of caregiving. Acceptance and Commitment Therapy (ACT) is an emerging evidenced-based practice that shows promise in improving an array of outcomes, theoretically by increasing psychological flexibility as the primary process of change. Research has begun to evaluate ACT among informal caregivers of adult populations, and a systematic review is now needed to summarise this evidence base. Electronic searches from five databases, including PubMed, PsycInfo, Embase, CINAHL, and Cochrane Library, yielded an initial 7896 hits, which after screening for inclusion criteria, resulted in 21 clinical trials. Studies were coded to synthesise the feasibility, effectiveness, and quality of evidence. Findings show that ACT was reported to be largely feasible and acceptable. However, the efficacy of ACT was mixed, with a more consistent pattern for informal caregivers of people with dementia. Several methodological quality issues limited the findings. However, theoretical synthesis and preliminary evidence support the promising effect of ACT in subgroups of informal caregivers. Research on the process of change, as well as larger-scale, methodologically rigorous trials, are needed to consolidate these findings.
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Affiliation(s)
- Golnaz L Atefi
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands.
| | - Marjolein E de Vugt
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands
| | - Rosalia J M van Knippenberg
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, UT 84322, USA
| | - Frans R J Verhey
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands
| | - Sara Laureen Bartels
- Department of Psychiatry and Neuropsychology, Alzheimer Centrum Limburg, Maastricht University, Dr. Tanslaan 12, 6229 ET, Maastricht, The Netherlands; Department of Clinical Neuroscience, Karolinska Institute, Sweden
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9
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Fang S, Ding D. The differences between acceptance and commitment therapy (ACT) and cognitive behavioral therapy: A three-level meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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10
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Fang S, Ding D, Zhang R, Huang M. Psychological mechanism of acceptance and commitment therapy and rational emotive behavior therapy for treating hoarding: Evidence from randomized controlled trials. Front Public Health 2023; 11:1084467. [PMID: 36844862 PMCID: PMC9950404 DOI: 10.3389/fpubh.2023.1084467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/16/2023] [Indexed: 02/12/2023] Open
Abstract
Hoarding is a common problem behavior worldwide and is detrimental to the physical and mental health of individuals and groups. Currently, effective interventions for hoarding are cognitive-behavioral therapies, but their post-intervention efficacy is questionable, and the available research does not examine the mediating variables of the effects of interventions on clinical outcomes. Moreover, current research on hoarding has focused on Western countries. Therefore, there is a need to investigate the efficacy of other forms of cognitive behavioral therapy on hoarding as well as other psychological outcomes related to hoarding and mediating variables that contribute to its effectiveness in different cultural contexts. One hundred thirty-nine college students with higher hoarding behaviors were randomly divided into three groups: 45 in the Acceptance and Commitment Therapy (ACT) group, 47 in the Rational Emotive Behavior Therapy (REBT) group, and 47 in the control group. They completed the Saving Inventory-Revised (SI-R), Obsessive-Compulsive Symptom Scale (OCSS), Difficulties in Emotion Regulation Scale (DERS), Experiences in Close Relationships Inventory-Attachment Anxiety Subscale (ECR), Depression Anxiety Stress Scales (DASS-21), Acceptance and Action Questionnaire II (AAQ-II), and Cognitive Fusion Questionnaire (CFQ) before and immediately after the intervention. The results showed that ACT and REBT improved individuals' psychological flexibility, cognitive fusion, acquisition-difficulty discarding, clutter, negative affect (anxiety, depression, stress), attachment anxiety, obsessive-compulsive disorder, and difficulty in emotion regulation compared to the control group. In addition, ACT was more effective than REBT in improving psychological flexibility and reducing hoarding, cognitive fusion, depression, stress, and obsessive-compulsive disorder; there were no significant differences between the two in anxiety and emotion regulation difficulties. Furthermore, psychological flexibility is a mediator of the effect of ACT and REBT on some behavioral and psychological outcomes (hoarding, negative affect, attachment anxiety). Limitations were discussed.
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Affiliation(s)
- Shuanghu Fang
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Dongyan Ding
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Ru Zhang
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Mingjie Huang
- School of Educational Science, Anhui Normal University, Wuhu, China
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11
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Han A, Yuen HK, Jenkins J. The feasibility and preliminary effects of a pilot randomized controlled trial: Videoconferencing acceptance and commitment therapy in distressed family caregivers of people with dementia. J Health Psychol 2023; 28:554-567. [PMID: 36591636 PMCID: PMC10119897 DOI: 10.1177/13591053221141131] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
This pilot randomized controlled trial (RCT) examined preliminary effects of an 8-week videoconferencing acceptance and commitment therapy (ACT) program supplemented with psychoeducation materials on distressed family caregivers of persons living with dementia (PLWD) compared to the control group provided with psychoeducation materials only. Nineteen family caregivers of PLWD in the USA were randomly assigned to the ACT group or the control group. Data was collected at pretest, posttest, and 1-month follow-up (F/U). Compared to the control group, the ACT group showed a significantly larger reduction in grief at posttest, with a medium effect size. Small effects of ACT were found in anxiety, psychological quality of life, and engagement in meaningful activities at posttest and grief, engagement in meaningful activities, and psychological flexibility at F/U compared to the control group. These promising findings warrant a full-scale RCT with adequate power to measure the efficacy of videoconferencing ACT for caregivers of PLWD.
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Affiliation(s)
- Areum Han
- University of Alabama at Birmingham, USA
| | - Hon K Yuen
- University of Alabama at Birmingham, USA
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Contreras M, Van Hout E, Farquhar M, McCracken LM, Gould RL, Hornberger M, Richmond E, Kishita N. Internet-delivered guided self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): a qualitative study of carer views and acceptability. Int J Qual Stud Health Well-being 2022; 17:2066255. [PMID: 35435153 PMCID: PMC9037213 DOI: 10.1080/17482631.2022.2066255] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Milena Contreras
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | - Rebecca L Gould
- Division of Psychiatry, University College London, London, UK
| | | | - Erica Richmond
- Older People’s Community Team, Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, UK
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Kishita N, Morimoto H, Márquez-González M, Barrera-Caballero S, Vara-García C, Van Hout E, Contreras M, Losada-Baltar A. Family Carers of People with Dementia in Japan, Spain, and the UK: A Cross-Cultural Comparison of the Relationships between Experiential Avoidance, Cognitive Fusion, and Carer Depression. J Geriatr Psychiatry Neurol 2022; 36:254-264. [PMID: 36261123 PMCID: PMC10114255 DOI: 10.1177/08919887221130269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective and research design This study investigated whether the relationship between experiential avoidance and carer depression is mediated by cognitive fusion using path analysis and whether this model differs between family carers from Japan, Spain, and the UK using multi-group path analysis. Results The whole sample model (N = 745) showed a good fit to the data. The direct effect of experiential avoidance on carer depression (β = .10) and its indirect effect on carer depression through cognitive fusion (β = .15) were significant. Examined variables accounted for 45% of the variance of depression. Multi-group path analysis confirmed the same pattern of indirect path across 3 countries, while the direct path was no longer significant in Spanish and UK samples.Conclusion These findings suggest that targeting cognitive fusion may be particularly critical in culturally diverse carers and pre-emptive efforts to reduce experiential avoidance using psychological techniques may be beneficial among family carers prone to cognitive fusion regardless of cultural differences.
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Affiliation(s)
- Naoko Kishita
- School of Health Sciences, 6106University of East Anglia, Norwich, UK
| | - Hiroshi Morimoto
- Faculty of Psychology, 12940Meiji Gakuin University, Tokyo, Japan
| | - María Márquez-González
- Department of Biological and Clinical Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Carlos Vara-García
- Department of Psychology, 16776Universidad Rey Juan Carlos, Madrid, Spain
| | - Elien Van Hout
- School of Health Sciences, 6106University of East Anglia, Norwich, UK
| | - Milena Contreras
- School of Health Sciences, 6106University of East Anglia, Norwich, UK
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14
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Kishita N, Gould RL, Farquhar M, Contreras M, Van Hout E, Losada A, Cabrera I, Hornberger M, Richmond E, McCracken LM. Internet-delivered guided self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS): a feasibility study. Aging Ment Health 2022; 26:1933-1941. [PMID: 34617489 PMCID: PMC9629048 DOI: 10.1080/13607863.2021.1985966] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The feasibility of research into internet-delivered guided self-help Acceptance and Commitment Therapy (ACT) for family carers of people with dementia is not known. This study assessed this in an uncontrolled feasibility study. METHOD Family carers of people with dementia with mild to moderate anxiety or depression were recruited from primary and secondary healthcare services in the UK. Participants were offered eight, guided, self-help online ACT sessions adapted for the needs of family carers of people with dementia with optional online peer support groups. Pre-defined primary indicators of success included recruitment of 30 eligible carers over 6 months and ≥70% completing at least two online sessions. RESULTS Thirty-three participants (110% of the target sample) were recruited over 6 months and 30 participants (91%) completed two or more sessions, and thus both indicators of success were met. Further, 70% of participants completed seven or all eight sessions, and 27% of participants were lost to follow-up, but none of the reasons for early withdrawal were related to the intervention. CONCLUSION This study supports the feasibility, including recruitment and treatment completion. A full-scale trial to assess the clinical- and cost-effectiveness of the intervention including its long-term effects is warranted.
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Affiliation(s)
- Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, UK,CONTACT Naoko Kishita
| | | | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Milena Contreras
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Andrés Losada
- Department of Psychology, Universidad Rey Juan Carlos, Madrid, Spain
| | - Isabel Cabrera
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Erica Richmond
- Norfolk and Suffolk NHS Foundation Trust, Older People’s Community Team, Norwich, UK
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15
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Barrera-Caballero S, Romero-Moreno R, Vara-García C, Olmos R, Márquez-González M, Losada-Baltar A. Cognitive fusion and treatment response to depression in caregivers of relatives with dementia. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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16
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Romero-Moreno R, Márquez-González M, Gallego-Alberto L, Cabrera I, Vara-García C, Pedroso-Chaparro MDS, Barrera-Caballero S, Losada A. Guilt Focused Intervention for Family Caregivers. Preliminary Results of a Randomized Clinical Trial. Clin Gerontol 2022; 45:1304-1316. [PMID: 35286236 DOI: 10.1080/07317115.2022.2048287] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES A pilot randomized controlled trial study was conducted for testing the efficacy of a novel Guilt Focused Intervention (GFI), that was compared with a Cognitive Behavioral Intervention (CBI) for caregivers of people with dementia with high levels of guilt and distress. METHODS Participants were 42 caregivers who were randomized assigned to the intervention conditions. RESULTS Participants in the GFI showed significant reductions in depression, anxiety, and guilt at posttreatment and follow-up. Participants in the CBI presented reductions in anxiety and guilt at posttreatment and follow-up. Clinically significant change for guilt was found in 62.5% in the GFI and 9.09% in the CBI group at posttreatment. At follow-up, 58.33% in GFI and 12.5% in the CBI group were recovered. CONCLUSIONS The preliminary results of this pilot study suggest that caregivers with significant levels of guilt and distress might benefit from an intervention specifically designed to target guilt feelings. CLINICAL IMPLICATIONS A novel and initial intervention approach specifically designed for targeting caregivers' feelings of guilt might have the potential to reduce caregiver's emotional distress.
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Affiliation(s)
| | - María Márquez-González
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Laura Gallego-Alberto
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | - Isabel Cabrera
- Department of Biological and Health Psychology, Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | - Andrés Losada
- Department of Psychology, Universidad Rey Juan Carlos, Alcorcón, Spain
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17
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Losada-Baltar A, Kishita N, Jiménez-Gonzalo L, Fernandes-Pires J, Huertas-Domingo C, Contreras M, Van Hout E, Olazarán J, Martínez-Huertas JÁ, Márquez-González M. Cross-cultural analysis of the role of ambivalent feelings for understanding caregivers' depressive symptoms. Aging Ment Health 2022:1-6. [PMID: 36052973 DOI: 10.1080/13607863.2022.2116407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Behavioral and psychological symptoms of dementia (BPSD) are considered to cause ambivalent feelings in caregivers that may contribute to understanding their depressive symptoms. Transnational research is needed in order to increase our knowledge about the cross-cultural equivalence of theoretical models to understand caregivers' mental health. The aim of this study was to cross-culturally analyze the association between BPSD, ambivalent feelings and depressive symptoms in two samples of family caregivers of people with dementia from Spain and the UK. METHODS Participants in this study were 432 caregivers who completed measures of BPSD, ambivalent feelings and depressive symptoms. The association between the assessed variables was tested through path-analysis, with differences between countries tested through multigroup analysis. RESULTS The results suggest that the influence of BPSD on caregivers' depressive symptoms is indirect, through ambivalent feelings. The observed associations were equivalent between countries and explained a significant percentage of the variance of depressive symptoms. CONCLUSION The findings of this study provide, for the first time, evidence of equivalent cross-cultural paths analyzing the role of ambivalent feelings for understanding caregivers' depressive symptoms. The practical implications of these results are discussed.
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Affiliation(s)
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, UK
| | | | | | | | - Milena Contreras
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Elien Van Hout
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Javier Olazarán
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Ángel Martínez-Huertas
- Department of Methodology of Behavioral Sciences, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - María Márquez-González
- Department of Biological and Clinical Psychology, Universidad Autónoma de Madrid, Madrid, Spain
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18
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Fauth EB, Novak JR, Levin ME. Outcomes from a pilot online Acceptance and Commitment Therapy program for dementia family caregivers. Aging Ment Health 2022; 26:1620-1629. [PMID: 34233133 DOI: 10.1080/13607863.2021.1942432] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Psychosocial and cognitive-behavioral dementia caregiver interventions are effective, yet accessing counselor/therapist-led programs can be costly and difficult. Face-to-face therapist-led Acceptance and Commitment Therapy (ACT) is highly effective in dementia caregivers, as established by two different randomized control trials. The current study evaluates a pilot ACT for Caregivers program, which is a community-based, self-guided, online adaptation of ACT. METHOD Participants (N = 51; Mage=66.0 S. D =11.7, 80% women) completed 10 self-guided sessions teaching ACT, along with accessing an online dementia education library. RESULTS Repeated measures ANOVA from pre-, posttest, and 4-week follow-up demonstrated decreased depressive symptoms, burden, and stress reactions to behavioral symptoms, and increased positive aspects of caregiving and quality of life. ACT-specific measures improved, with decreases in cognitive fusion and psychological inflexibility (AAQ-II), and improvements in living according to personal values (ValuingProgress increased; ValuingObstruction decreased). All outcomes were statistically significant (at p < .01) and sustained over 4-week follow-up. Although this was a non-clinical sample, the program demonstrated clinical significance, as average depressive symptoms were at the clinical cutoff at baseline, but one standard deviation below clinical cut-off at post-test and 4-week followup. Use of education materials was low (29% of participants used these, albeit rating them helpful), suggesting that ACT likely contributed more to overall improvements. CONCLUSION The online ACT for Caregivers pilot program offers an empirically supported translation of traditional ACT, improving accessibility, and affordability for family dementia caregivers.
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Affiliation(s)
- Elizabeth B Fauth
- Department of Human Development and Family Studies, Utah State University, Logan, UT, USA
| | - Josh R Novak
- Department of Human Development and Family Science, Auburn University, Auburn, AL, USA
| | - Michael E Levin
- Department of Psychology, Utah State University, Logan, UT, USA
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19
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Han A, Yuen HK, Jenkins J, Yun Lee H. Acceptance and Commitment Therapy (ACT) Guided Online for Distressed Caregivers of Persons Living with Dementia. Clin Gerontol 2022; 45:927-938. [PMID: 33794127 DOI: 10.1080/07317115.2021.1908475] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES This study examined the effects of a guided online acceptance and commitment therapy (ACT) intervention on distressed family caregivers of persons living with dementia and explored the experiences of these caregivers in the ACT intervention. METHODS Seven family caregivers experiencing psychological distress individually participated in 10 ACT videoconference sessions guided by a trained coach. Quantitative data, such as psychological distress, burden, and ACT processes, were collected at pretest and posttest and analyzed using the Wilcoxon signed-rank test. Individual interviews were conducted at posttest and analyzed using interpretative phenomenological analysis. RESULTS Statistically significant reductions were found in depressive symptoms, anxiety, stress, and burden (p < .05) with medium effect sizes. ACT sessions helped caregivers gain renewed strength by: being equipped with resources to use under distress throughout the caregiving journey; being more self-compassionate and taking care of one's self; and being more patient with relatives with dementia. CONCLUSIONS Findings contribute to the limited evidence in guided online ACT for caregivers of persons living with dementia. Further studies with a larger sample size are needed to evaluate the efficacy of guided online ACT. CLINICAL IMPLICATIONS Guided online ACT may reduce depressive symptoms, anxiety, stress, and burden of family caregivers of persons living with dementia.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Hon K Yuen
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Hee Yun Lee
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
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20
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Therapists’ perceptions and acceptability of providing internet-delivered guided self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS): a qualitative study. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
This study aimed to explore therapists’ perceptions and acceptability of providing internet-delivered, therapist-guided, self-help acceptance and commitment therapy (ACT) for family carers of people with dementia (iACT4CARERS). To achieve this, a qualitative approach with semi-structured interviews was employed with eight novice therapists recruited from primary and secondary care services taking part in a feasibility study of iACT4CARERS. The interviews were audio-recorded, transcribed, and analysed using thematic analysis. Four over-arching themes were identified: (1) positive attitudes towards the intervention, (2) therapists’ workload, (3) therapists’ confidence to perform their role, and (4) connecting with family carers in a virtual context. Theme 1 included seeing their involvement as an opportunity for personal growth and perceiving benefits to the family carers, which contributed to greater acceptability. Theme 2 reflected that while workload and the user-friendliness of the online platform were highly acceptable among the therapists, there were also time-consuming cases that increased therapists’ burden. Theme 3 revealed that practical resources provided during the training, continued supervision, and opportunities to learn from other therapists, increased therapist confidence and facilitated greater acceptability. Finally, Theme 4 highlighted that improving the connection between therapists and carers was critical in a virtual context and strategies to improve the therapist–carer relationship were recommended. The implementation of iACT4CARERS was largely acceptable for the therapists involved in the trial. Ways to strengthen the therapeutic relationship in the virtual context and practical strategies to deal with common problems may enhance therapist experience and delivery in a full-scale effectiveness trial.
Key learning aims
(1)
To understand which factors facilitated therapists’ positive perceptions and acceptability of providing internet-delivered guided self-help ACT (iACT4CARERS).
(2)
To understand what challenges acted as barriers to therapists’ positive perceptions and acceptability of providing iACT4CARERS.
(3)
To learn what aspects of the training and the intervention can be refined to improve the acceptability to therapists in trials involving internet-delivered guided self-help interventions for family carers.
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21
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Gallego-Alberto L, Losada A, MÁrquez-GonzÁlez M, Romero-Moreno R, Cabrera I. Family Dynamics in Dementia Caregiving: Development and Validation of the Interpersonal Triggers of Guilt in Dementia Caregiving Questionnaire (ITGDCQ). FAMILY PROCESS 2021; 60:1418-1436. [PMID: 33768596 DOI: 10.1111/famp.12643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The objective was to develop the Interpersonal Triggers of Guilt in Dementia Caregiving Questionnaire (ITGDCQ). An emotion frequently experienced by caregivers is guilt. However, the studies analyzing potential factors that generate guilt are scarce. Guilt may be generated through interpersonal interactions. A total of 201 dementia caregivers were evaluated for frequency of leisure, guilt, anxiety, depression, and a pool of items measuring the frequency, and guilt was derived from different behaviors performed by the care recipient (ITGDCQ-CR) and other relatives (ITGDCQ-OR). Exploratory factor analysis of the ITGDCQ-CR showed a two-factor solution, explaining 56.24% of the variance. The ITGDCQ-OR subscale also showed two factors, explaining 63.24% of the variance. All the factors had acceptable to good reliability indexes. Positive associations were found between both subscales and depression, anxiety, guilt, and stress associated with CR's behavioral problems. ITGDCQ-CR was negatively correlated with frequency of leisure. The interpersonal dynamics assessed with the ITGDCQ generated other emotions such as anger or sadness. Through structural equation modeling, 28% of the variance of caregivers' distress was explained by the assessed variables, including a significant contribution of the interpersonal dynamics assessed with the ITGDCQ. The results provide preliminary support for the use of the ITGDCQ as a valid and reliable measure of care recipients' or other relatives' factors that trigger or facilitate the experience of guilt in the caregivers. The association between these factors and caregiver distress suggests potential clinical implications for the findings.
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Affiliation(s)
- Laura Gallego-Alberto
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - AndrÉs Losada
- Psychology Department, Universidad Rey Juan Carlos de Madrid, Madrid, Spain
| | - MarÍa MÁrquez-GonzÁlez
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rosa Romero-Moreno
- Psychology Department, Universidad Rey Juan Carlos de Madrid, Madrid, Spain
| | - Isabel Cabrera
- Biological and Health Psychology Department, Universidad Autónoma de Madrid, Madrid, Spain
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22
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Han A. Effects of Mindfulness-Based Interventions on Depressive Symptoms, Anxiety, Stress, and Quality of Life in Family Caregivers of Persons Living with Dementia: A Systematic Review and Meta-analysis. Res Aging 2021; 44:494-509. [PMID: 34747241 DOI: 10.1177/01640275211043486] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis examined effects of mindfulness-based interventions (MBIs) on depressive symptoms, anxiety, stress, and quality of life in family caregivers of people with dementia. METHODS A comprehensive search was conducted within the PubMed, CINAHL, PsycINFO, and SCOPUS databases to identify relevant randomized controlled trials (RCTs). Depending on I2 statistic values for heterogeneity, either a random effects model or fixed effects model was used. Subgroup analyses were conducted according to the types of control groups and MBIs. RESULTS 15 RCTs met the eligibility criteria. Meta-analyses showed medium to large effects of MBIs on depressive symptoms, anxiety, stress, and quality of life at the immediate posttest. Small to large effects of MBIs were found at follow-up. CONCLUSIONS Future high-quality studies involving different types of MBIs and delivery modes are needed to better understand effects of MBIs on family caregivers of people with dementia and examine effective intervention features.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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23
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Contreras M, Mioshi E, Kishita N. Factors predicting quality of life in family carers of people with dementia: The role of psychological inflexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Romero-Moreno R, Márquez-González M, Barrera-Caballero S, Vara-García C, Olazarán J, Pedroso-Chaparro MDS, Jiménez-Gonzalo L, Losada-Baltar A. Depressive and Anxious Comorbidity and Treatment Response in Family Caregivers of People with Dementia. J Alzheimers Dis 2021; 83:395-405. [PMID: 34308903 DOI: 10.3233/jad-210348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While most intervention studies conducted with dementia family caregivers have focused on depressive symptoms as the main outcome, no study has analyzed the effects of an intervention on comorbid clinical presentations of depressive and anxious symptomatology. OBJECTIVE The aim of this study was to examine the association between clinical depressive and anxious symptomatology at baseline and treatment responses of dementia family caregivers using samples from two randomized intervention trials with the same pre-post design. METHODS Specifically, the effects on depressive and anxious comorbidity of three intervention conditions (Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and a control group (CG)) were analyzed. Participants were 130 dementia family caregivers. In addition to sociodemographic variables, depressive and anxious symptomatology were measured. RESULTS Caregivers with clinical depressive and anxiety comorbid symptoms at baseline recovered less well from depressive symptoms after CBT (45.45%) and ACT (47.72%) interventions than caregivers with non-comorbidity (100% recovery in both treatments). No significant association between comorbidity and treatment responses on depression was found for the control group. Regarding anxiety, among participants with comorbidity at baseline, 36.36% of caregivers in CBT and 30.9 % in the ACT group recovered from anxiety symptoms after treatment, compared to 6.45% in the control group. Similar results were obtained regarding those caregivers who recovered both from clinical depressive and anxiety symptoms and showed comorbidity at baseline. CONCLUSION Caregivers that show comorbid depressive and anxiety symptoms at baseline may benefit less from interventions than caregivers who do not show comorbidity.
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Affiliation(s)
| | - María Márquez-González
- Autonomous University of Madrid, Department of Biological and Health Psychology, Madrid, Spain
| | | | | | - Javier Olazarán
- Service of Neurology, HGU Gregorio Marañón, Madrid, Spain.,Maria Wolff Foundation, Madrid, Spain
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The role of thought suppression and psychological inflexibility in older family caregivers’ psychological symptoms and quality of life. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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26
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Tamayo-Morales O, Patino-Alonso MC, Losada A, Mora-Simón S, Unzueta-Arce J, González-Sánchez S, Gómez-Marcos MA, García-Ortiz L, Rodríguez-Sánchez E. Behavioural intervention to reduce disruptive behaviours in adult day care centres users: A randomizsed clinical trial (PROCENDIAS study). J Adv Nurs 2020; 77:987-998. [PMID: 33107645 DOI: 10.1111/jan.14618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/17/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
AIM This study assesses the effect of an intervention to reduce the disruptive behaviours (DB) presented by care recipient users of adult day care centres (ADCC), thereby reducing caregiver overload. While ADCC offer beneficial respite for family caregivers, the DB that many care recipients show promote resistance to attending these centres, which can be a great burden on their family caregivers. DESIGN Randomized controlled clinical trial. METHODS The study was carried out with 130 family caregivers of people attending seven ADCC in the municipality of Salamanca (Spain), randomly distributed into intervention and control groups. The intervention was applied across eight sessions, one per week, in groups of 8-10 people where caregivers were trained in the Antecedent-Behavior-Consequence (ABC) model of functional behaviour analysis. The primary outcome was the reduction of DB measured with the Revised Memory and Behavior Problems Checklist (RMBPC). RESULTS An average reduction in the RMBPC of 4.34 points was obtained in the intervention group after applying the intervention (p < 0.01 (U de Mann-Whitney); Cohen d = 1.00); furthermore, differences were found in the Center for Epidemiologic Studies Depression Scale (CES-D) (U = -2.67; p = 0.008; Cohen d = 0.50) and in the Short Zarit Burden Interview (Short ZBI) (t = -4.10; p < 0.01; Cohen d = 0.98). CONCLUSION The results obtained suggest that the implementation of this intervention could reduce both the frequency of DB occurrence and the reaction of the caregiver to their appearance. Improvement was also noted in the results regarding overload and emotional state of the family caregiver. IMPACT To our knowledge, this is the first randomized clinical trial to show that an intervention based on the ABC model could reduce the frequency and reaction of DB of care recipients in ADCC increasing their quality of life, and improving the mental health and overload of their family caregivers.
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Affiliation(s)
- Olaya Tamayo-Morales
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | - María C Patino-Alonso
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Statistics, University of Salamanca, Salamanca, Spain
| | - Andrés Losada
- Psychology Department, Rey Juan Carlos University, Madrid, Spain
| | - Sara Mora-Simón
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Basic Psychology, Psychology and Behavioral Sciences Methodology, University of Salamanca, Salamanca, Spain
| | - Jaime Unzueta-Arce
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Basic Psychology, Psychology and Behavioral Sciences Methodology, University of Salamanca, Salamanca, Spain
| | - Susana González-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Salamanca, Spain
| | - Manuel A Gómez-Marcos
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Medicine, University of Salamanca, Salamanca, Spain
| | - Luis García-Ortiz
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
| | - Emiliano Rodríguez-Sánchez
- Institute of Biomedical Research of Salamanca (IBSAL), Primary Care Research Unit of Salamanca (APISAL), Department of Medicine, University of Salamanca, Salamanca, Spain
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27
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Han A, Yuen HK, Jenkins J. Acceptance and commitment therapy for family caregivers: A systematic review and meta-analysis. J Health Psychol 2020; 26:82-102. [PMID: 32659142 DOI: 10.1177/1359105320941217] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Acceptance and commitment therapy is an emerging evidenced-based practice, but no systematic review regarding the effects of ACT on family caregivers has been conducted. This article examined the effects of ACT on family caregivers by conducting meta-analysis with a random effects model. Twenty-four articles were identified from four electronic databases searched up to 30 March 2020. Meta-analyses found moderate effects of ACT on depressive symptoms and quality of life, small effects on anxiety, and small to moderate effects on stress. Further ACT studies should be conducted to measure effects on different outcomes for various family caregiver populations.
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Affiliation(s)
- Areum Han
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Hon K Yuen
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeremy Jenkins
- Telehealth Private Practice: jeremyjenkins.icouch.me, Montana, USA
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Kishita N, Contreras ML, West J, Mioshi E. Exploring the impact of carer stressors and psychological inflexibility on depression and anxiety in family carers of people with dementia. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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