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A Controlled Pilot Study of the Wish Outcome Obstacle Plan Strategy for Spouses of Persons With Early-Stage Dementia

Contact Information


Joan K Monin,

Affect, Behavioral interventions, Caregiving, Dementia, Mental contrasting with implementation intentions


Objectives: Behavioral interventions can reduce distress for couples coping with early-stage dementia. However, most interventions are limited in accessibility and fail to address individualized goals. This pilot study examined the dyadic effects on multiple indicators of well-being of the Wish Outcome Obstacle Plan (WOOP) intervention, which guides participants to use Mental Contrasting with Implementation Intentions to achieve attainable goals in their daily lives.Methods: This randomized controlled trial included 45 older persons with early-stage dementia (PWD) and their spousal care partners (CPs: n = 90 individuals). CPs were assigned randomly to WOOP training immediately after baseline (WOOP) or after a 3-month follow-up interview (Control; CON). Both groups received a dementia care education booklet. WOOP CPs were instructed to practice WOOP at least once a day for 2 weeks. All CPs and PWDs completed home surveys (baseline, 2 weeks, and 3 months), measuring perceived stress, depressive symptoms, quality of life, and affect. Results: Mixed-effects models showed significant intervention × time interaction effects with large effect sizes for CPs on three of the five outcomes over 3 months. Compared with CON, WOOP CPs had decreased perceived stress (δ = 1.71) and increased quality of life (δ = 1.55) and positive affect (δ = 2.30). WOOP PWD showed decreased perceived stress (δ = 0.87) and increased quality of life (δ = 1.26), but these effects were not statistically significant. Discussion: WOOP is a promising, brief intervention to improve dementia CPs' well-being that may also positively affect their partners with dementia.


Joan K Monin, Gabriele Oettingen, Holly Laws, Daniel David, Lyndsay DeMatteo, Richard Marottoli, A Controlled Pilot Study of the Wish Outcome Obstacle Plan Strategy for Spouses of Persons With Early-Stage Dementia, The Journals of Gerontology: Series B, Volume 77, Issue 3, March 2022, Pages 513–524,





Conent Area

Joan K Monin

EWB-Related Construct

(4) Quality of Life

Study Design

Species or Study Population

(5) RCT

Sex (%Female)

Care Partners 68.89%
Persons with dementia 35.56%

Age (Mean, SD)

Total: 75.24, 7.46
Care Partners: 74.03, 7.25
Persons with dementia: 76.45, 7.49

Younger Controls?


Longitudinal Data?


Sample Size



Wish Outcome Obstacle Plan strategy intervention

Ethnicity (%white)

Care Partners: 91.11%
Persons with dementia: 86.67%

Inclusion Criteria

(a) the couple was married or in a cohabiting, committed relationship, (b) one partner was told by a clinician they had Alzheimer’s disease or a related dementia (ADRD), (c) the person with suspected ADRD scored ≥ 16 and ≤ 27 on the Mini-Mental State Examination (MMSE; Folstein et al., 1975), (d) the spouse care partner scored a 27 or higher on the MMSE, (e) both participants agreed to participate, and (f) both partners were 55 years of age or older. Our previous work shows that persons with ADRD can complete interviews reliably with an MMSE score of 16 or higher (Schulz et al., 2010).

Exclusion Criteria

Couples were ineligible due to lack of cognitive impairment (n = 1), the inability of a person with dementia to complete interviews due to mid and late stage of disease (n = 3), the person with dementia not being comfortable participating (n = 2), too much of a time commitment for the couple (n = 2), unable to schedule (n = 6), or decided to do a different study (n = 1).

EWB Measures

(1) Quality of Life in Alzheimer’s Disease (QOL-AD
(2) Positive and Negative Affect Scale: Life Satisfaction, Positive Affect

Non-EWB Behavioral

(1) Perceived Stress Scale
(2) Neuropsychiatric Inventory (NPI)
(3) Depression Short Form
(4) MMSE
(5) Physical Comorbidity Index

Physiological Measures


Brain IMaging Modality

Brain IMaging Paradigm


Brain Region/Circuit


Biological Measures


Other Neural Measures

Data Availability?


Data Avalability Details

Data and study materials will be made available through e-mail to other researchers upon request.

Diagnostic Measures

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