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

• Published in: The American journal of geriatric psychiatry 2016-09, Vol.24 (9), p.740-750
• Main Authors: Cheng, Sheung-Tak, Ph.D, Fung, Helene H., Ph.D, Chan, Wai Chi, M.R.C.Psych., F.H.K.A.M.(Psych.), Lam, Linda C.W., M.D., F.R.C.Psych., F.H.K.A.M.(Psych.)
• Format: Article
• Language: English
• Subjects: Adult; Aged; Caregivers - psychology; cluster-randomized controlled trial; Cost of Illness; Dementia - psychology; dementia caregiving; depression; Depression - diagnosis; Depression - etiology; Depression - psychology; Depression - therapy; Double-Blind Method; Female; Health Education - methods; Humans; Internal Medicine; Male; Optimism - psychology; Outcome Assessment (Health Care); positive aspects of caregiving; Reinforcement, Social; Self Efficacy; Stress, Psychological - complications; Stress, Psychological - psychology
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2016.04.012

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.