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A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: results of the Pleasant Events Program (PEP)

Contact Information


Brent T. Mausbach,

Alzheimer's disease; Cardiovascular disease; Depression; Intervention; Treatment.


Dementia caregiving is associated with elevations in depressive symptoms and increased risk for cardiovascular diseases (CVD). This study evaluated the efficacy of the Pleasant Events Program (PEP), a 6-week Behavioral Activation intervention designed to reduce CVD risk and depressive symptoms in caregivers. One hundred dementia family caregivers were randomized to either the 6-week PEP intervention (N = 49) or a time-equivalent Information-Support (IS) control condition (N = 51). Assessments were completed pre- and post-intervention and at 1-year follow-up. Biological assessments included CVD risk markers Interleukin-6 (IL-6) and D-dimer. Psychosocial outcomes included depressive symptoms, positive affect, and negative affect. Participants receiving the PEP intervention had significantly greater reductions in IL-6 (p = .040), depressive symptoms (p = .039), and negative affect (p = .021) from pre- to post-treatment. For IL-6, clinically significant improvement was observed in 20.0% of PEP participants and 6.5% of IS participants. For depressive symptoms, clinically significant improvement was found for 32.7% of PEP vs 11.8% of IS participants. Group differences in change from baseline to 1-year follow-up were non-significant for all outcomes. The PEP program decreased depression and improved a measure of physiological health in older dementia caregivers. Future research should examine the efficacy of PEP for improving other CVD biomarkers and seek to sustain the intervention's effects.


Moore, R. C., Chattillion, E. A., Ceglowski, J., Ho, J., von Känel, R., Mills, P. J., Ziegler, M. G., Patterson, T. L., Grant, I., & Mausbach, B. T. (2013). A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: results of the Pleasant Events Program (PEP). Behaviour research and therapy, 51(10), 623–632.





Conent Area

Raeanne C Moore

EWB-Related Construct

(2) Life Satisfaction
(3) Positive Affect

Study Design

Species or Study Population

(5) RCT

Sex (%Female)

Intervention: 81.6%
Control: 66.7%

Age (Mean, SD)

Intervention: 70.86, 7.57
Control: 71.33, 9.08

Younger Controls?


Longitudinal Data?


Sample Size



the Pleasant Events Program (PEP)

Ethnicity (%white)

Intervention: 89.8
Control: 90.2

Inclusion Criteria

Caregivers were eligible if they were aged 55 or older, and were providing at-home care for a care recipient (CR) with a physician-diagnosis of Alzheimer's disease (AD) or related dementia.

Exclusion Criteria

(a) were receiving beta-blocking medications at enrollment, (b) were receiving treatment with Anticoagulant medications, (c) had severe hypertension (>200/120 mmHg), (d) were diagnosed with a terminal illness with a life expectancy of less than 6 months, (e) were enrolled in another intervention study, or (f) were currently or had recently (i.e., during the prior 12 months) received behavioral or cognitive psychotherapy.

EWB Measures

Positive and Negative Affect

Non-EWB Behavioral

(1) Center for Epidemiologic Studies Depression (CESD) scale
(2) Social Support scale
(3) Clinical Dementia Rating (CDR)
(4) Program evaluation

Physiological Measures

(3) vascular

Brain IMaging Modality

Brain IMaging Paradigm


Brain Region/Circuit


Biological Measures


Other Neural Measures

Data Availability?


Data Avalability Details


Diagnostic Measures

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