Short-Term Effects of a Gain-Focused Reappraisal Intervention for Dementia Caregivers: A Double-Blind Cluster-Randomized Controlled Trial

Contact Information

Keywords

Sheung-Tak Cheng, PhD, takcheng@eduhk.hk

dementia caregiving depression, positive aspects of caregiving, cluster-randomized controlled trial

Abstract

Objective: To examine the effects of a benefit-finding intervention, the key feature being the use of gain-focused reappraisal strategies to find positive meanings and benefits in caring for someone with dementia. Methods: In a cluster-randomized, double-blind, controlled trial conducted in social centers and clinics, 129 caregivers aged 18 + and without cognitive impairment, providing at least 14 care hours per week to a relative with mild-to-moderate Alzheimer disease, and scoring ≥ 3 on the Hamilton Depression Rating Scale were studied. Exclusion criterion was care recipient having parkinsonism or other forms of dementia. The benefit-finding intervention was evaluated against two treatment-as-usuals, namely, simplified psychoeducation (lectures only) and standard psychoeducation. Each intervention lasted 8 weeks, with a 2-hour session per week. Randomization into these conditions was based on center/clinic membership. Primary outcome was depressive symptom. Secondary outcomes were Zarit Burden Interview, role overload, and psychological well-being. Self-efficacy beliefs and positive gains were treated as mediators. Measures were collected at baseline and post-treatment. Results: Regression analyses showed benefit-finding treatment effects on all outcomes when compared with simplified psychoeducation and effects on depressive symptoms and Zarit burden when compared with standard psychoeducation. Effect sizes were medium-to-large for depressive symptoms (d = -0.77 to -0.96) and medium for secondary outcomes (d = |0.42-0.65|). Furthermore, using the bootstrapping method, we found significant mediating effects by self-efficacy in controlling upsetting thoughts and positive gains, with the former being the primary mediator. Conclusion: Finding positive gains reduces depressive symptoms and burden and promotespsychological well-being primarily through enhancing self-efficacy in controlling upsetting thoughts.

Citation

Cheng, S. T., Fung, H. H., Chan, W. C., & Lam, L. C. (2016). Short-Term Effects of a Gain-Focused Reappraisal Intervention for Dementia Caregivers: A Double-Blind Cluster-Randomized Controlled Trial. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 24(9), 740–750. https://doi.org/10.1016/j.jagp.2016.04.012

DOI

10.1016/j.jagp.2016.04.012

EWB Constructs:

(1) goal pursuit; (2) life satisfaction; (3) positive affect; (5) sense of meaning

EWB Measures:

(1) Ryff's Psychological Well-being Scale

data availability:

data availability details:

N/A

brain imaging paradigm:

N/A

brain region/circuit:

Exclusion Criteria:

Exclusion criterion were the care recipient having parkinsonism or other forms of dementia.

Inclusion Criteria

Inclusion criteria were primary caregiver aged 18 + and without cognitive impairment, providing at least 14 care hours per week to a care recipient with mild-to-moderate Alzheimer disease (physician diagnosed or applying the National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association criteria for possible Alzheimer disease), with stage of dementia confirmed by Clinical Dementia Rating, and scoring at least 3 on the Hamilton Depression Rating Scale

Non-EWB Behavioral
Measures:

(1) Hamilton Depression Rating Scale
(2) Multidimensional Functional Assessment Questionnaire,
(3) Zarit Burden Interview: caregiver burden
(4) Revised Scale for Caregiving Self-Efficacy
(5) qualitative questionnaire for positive gains

First author:

Sheung-Tak Cheng, PhD, takcheng@eduhk.hk

species:

Human

sample size:

129

study design:

(5) RCT

longitudinal data?

Yes

younger controls?

interventions:

Gain-Focused Reappraisal Intervention

study population:

(1) cognitively healthy adults

sex (% female):

standard psychoeducation:83.3%
simplified psychoeducation: 88.9%
benefit-finding intervention: 85.7%

ethnicity (%white)

none stated (Hongkong)

Age (mean, sd):

standard psychoeducation: 56.67, 11.14
simplified psychoeducation: 52.98, 10.67
benefit-finding intervention: 56.99, 10.86

biological/Physiological Measures:

N/A