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Pickett AC, Valdez D, Sinclair KL, Kochell WJ, Fowler B, Werner NE. Social Media Discourse Related to Caregiving for Older Adults Living With Alzheimer Disease and Related Dementias: Computational and Qualitative Study. JMIR Aging 2024; 7:e59294. [PMID: 38896462 DOI: 10.2196/59294] [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: 04/08/2024] [Revised: 05/19/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND In the United States, caregivers of people living with Alzheimer disease and Alzheimer disease-related dementias (AD/ADRD) provide >16 billion hours of unpaid care annually. These caregivers experience high levels of stress and burden related to the challenges associated with providing care. Social media is an emerging space for individuals to seek various forms of support. OBJECTIVE We aimed to explore the primary topics of conversation on the social media site Reddit related to AD/ADRD. We then aimed to explore these topics in depth, specifically examining elements of social support and behavioral symptomology discussed by users. METHODS We first generated an unsupervised topic model from 6563 posts made to 2 dementia-specific subreddit forums (r/Alzheimers and r/dementia). Then, we conducted a manual qualitative content analysis of a random subset of these data to further explore salient themes in the corpus. RESULTS The topic model with the highest overall coherence score (0.38) included 10 topics, including caregiver burden, anxiety, support-seeking, and AD/ADRD behavioral symptomology. Qualitative analyses provided added context, wherein users sought emotional and informational support for many aspects of the care experience, including assistance in making key care-related decisions. Users expressed challenging and complex emotions on Reddit, which may be taboo to express in person. CONCLUSIONS Reddit users seek many different forms of support, including emotional and specific informational support, from others on the internet. Users expressed a variety of concerns, challenges, and behavioral symptoms to manage as part of the care experience. The unique (ie, anonymous and moderated) nature of the forum allowed for a safe space to express emotions free from documented caregiver stigma. Additional support structures are needed to assist caregivers of people living with AD/ADRD.
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Affiliation(s)
- Andrew C Pickett
- Department of Health & Wellness Design, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Danny Valdez
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Kelsey L Sinclair
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Wesley J Kochell
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Boone Fowler
- Department of Applied Health Science, School of Public Health, Indiana University, Bloomington, IN, United States
| | - Nicole E Werner
- Department of Health & Wellness Design, School of Public Health, Indiana University, Bloomington, IN, United States
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Fauth EB, Novak JR, Gossner J, Aller TB, Kelley HH, Levin ME. Family Caregivers' Progress Toward Values Moderates the Associations between Behavioral Symptoms of Dementia, Caregiver Burden, and Depressive Symptoms. Int J Aging Hum Dev 2024:914150241240115. [PMID: 38839099 DOI: 10.1177/00914150241240115] [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: 06/07/2024]
Abstract
Increasingly, dementia caregiver interventions are informed by acceptance-based approaches such as Acceptance and Commitment Therapy. These interventions promote psychological skills like psychological flexibility and value-based living. Less is known how these constructs interact within well-established caregiver stress processes. We examined a moderated mediation model (N = 161 dementia caregivers; PROCESS Procedure; SPSS Release 4.1), with BPSD frequency (Revised Memory and Behavior Problems Checklist) predicting depressive symptoms (10-item CES-D), mediated via caregiver burden (short Burden inventory). The moderator was the Values Questionnaire, and we controlled for gender, caregiver duration, age, income, and education. Results: revealed that the indirect effect of BPSD on depressive symptoms through caregiver burden was weakened through higher progress toward values (moderated mediation significant at p < .05). Committed action toward values signify caregivers' success at balancing care-related stress with other priorities. Interventions that build skills in values-based living have promise for caregivers, offering healthier ways to adjust to being a caregiver.
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Affiliation(s)
- Elizabeth B Fauth
- Human Development and Family Studies, Utah State University, Logan, UT, USA
| | - Joshua R Novak
- Human Development and Family Science, Auburn University, Auburn, AL, USA
| | - Jacob Gossner
- Human Development and Family Studies, Utah State University, Logan, UT, USA
| | - Ty B Aller
- Human Development and Family Studies, Utah State University, Logan, UT, USA
| | - Heather H Kelley
- Human Development and Family Studies, Utah State University, Logan, UT, USA
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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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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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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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Arch JJ, Fishbein JN, Finkelstein LB, Luoma JB. Acceptance and Commitment Therapy Processes and Mediation: Challenges and How to Address Them. Behav Ther 2023; 54:971-988. [PMID: 37863588 PMCID: PMC10665126 DOI: 10.1016/j.beth.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 05/03/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Acceptance and commitment therapy (ACT) emphasizes a focus on theory-driven processes and mediating variables, a laudable approach. The implementation of this approach would be advanced by addressing five challenges, including (a) distinguishing ACT processes in measurement contexts, (b) developing and rigorously validating measures of ACT processes, (c) the wide use of psychometrically weaker ACT process measures and the more limited use of stronger measures in earlier work, (d) the inconsistency of past evidence that ACT processes are sensitive or specific to ACT or mediate ACT outcomes specifically, and (e) improving statistical power and transparency. Drawing on the existing literature, we characterize and provide evidence for each of these challenges. We then offer detailed recommendations for how to address each challenge in ongoing and future work. Given ACT's core focus on theorized processes, improving the measurement and evaluation of these processes would significantly advance the field's understanding of ACT.
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Affiliation(s)
- Joanna J Arch
- University of Colorado Boulder and University of Colorado Cancer Center.
| | | | | | - Jason B Luoma
- Portland Psychotherapy Clinic, Research and Training Center
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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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Hsu T, Adamowicz JL, Thomas EBK. The effect of acceptance and commitment therapy on the psychological flexibility and inflexibility of undergraduate students: A systematic review and three-level meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 30:169-180. [PMID: 37982074 PMCID: PMC10655902 DOI: 10.1016/j.jcbs.2023.10.006] [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] [Indexed: 11/21/2023]
Abstract
Rising rates of mental health problems in undergraduate students is a critical public health issue. There is evidence supporting the efficacy of acceptance and commitment therapy (ACT) in decreasing psychological symptoms in undergraduates, which is thought to be facilitated through increases in psychological flexibility (PF) and decreases in psychological inflexibility (PIF). However, little is known about the effect of ACT on these processes in undergraduates. We conducted a systematic review and three-level meta-analysis examining this effect in 20 studies, which provided 56 effect sizes. A combined sample of 1,750 undergraduates yielded a small-to-medium overall effect (g = .38, SE = .09, p < .001, 95% CI: [0.20, 0.56]). This effect did not depend on control group type, intervention modality, number of sessions, the questionnaire used, whether PF or PIF was measured, or participant age. However, there was a significant mean effect only in studies with a specific clinical target, but not in those without one. Furthermore, the higher the percentage of female participants, the lower the reported effect size. Results suggested that ACT may increase PF and decrease PIF in undergraduates and highlighted various conceptual and measurement issues. Study protocol and materials were preregistered (https://osf.io/un6ce/).
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Affiliation(s)
- Ti Hsu
- Department of Psychological and Brain Sciences, University of Iowa University of Iowa, G60 Psychological and Brain Sciences Building, Iowa City, Iowa 52242-1407
| | - Jenna L. Adamowicz
- Department of Psychological and Brain Sciences, University of Iowa University of Iowa, G60 Psychological and Brain Sciences Building, Iowa City, Iowa 52242-1407
| | - Emily B. K. Thomas
- Department of Psychological and Brain Sciences, University of Iowa University of Iowa, G60 Psychological and Brain Sciences Building, Iowa City, Iowa 52242-1407
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Atefi GL, van Knippenberg RJM, Bartels SL, Verhey FR, de Vugt M. Blended intervention based on acceptance and commitment therapy for informal caregivers of people with dementia (ACT-IC): protocol of a mixed-methods feasibility study. BMJ Open 2023; 13:e070499. [PMID: 37709305 PMCID: PMC10503340 DOI: 10.1136/bmjopen-2022-070499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Numerous caregiver support programmes have shown promise in promoting the mental health of informal caregivers of people with dementia (PwD). However, there is still a lack of evidence-based interventions tailored to the specific needs of this population. This mixed-methods study aims to evaluate the feasibility, acceptability and preliminary efficacy of a blended intervention based on acceptance and commitment therapy (ACT) for informal caregivers of PwD, leading to a better understanding of intervention refinements for future controlled trials. METHODS AND ANALYSIS This study includes an uncontrolled pre-post intervention pilot study. A total of 30 informal caregivers of PwD will be recruited through memory clinics and social media platforms in the Netherlands. The ACT for informal caregiver (ACT-IC) intervention will be delivered over a 9-week period and consists of a collaborative goal-setting session, nine online ACT modules, nine telephone-based motivational coaching sessions and 6 monthly booster sessions following the main intervention period. Feasibility and acceptability will be assessed using attrition rate, adherence to and engagement with the intervention, proportion of missing data and semistructured interviews. Preliminary efficacy will be assessed with retrospective measures of depression, anxiety, stress, sense of competence, burden and self-efficacy at baseline, postintervention, at 3-month and 6-month follow-ups. ETHICS AND DISSEMINATION The Medical Ethical Committee from the Maastricht academic hospital and Maastricht University approved the study. The findings of this study will be shared with healthcare professionals, researchers and public audience through various channels, including scientific publications, conference presentations, online forums and community outreach programmes. TRIAL REGISTRATION NUMBER NCT05064969.
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Affiliation(s)
- Golnaz L Atefi
- Department of Psychiatry & Neuropsychology, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Rosalie J M van Knippenberg
- Department of Psychiatry & Neuropsychology, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Sara L Bartels
- Department of Psychiatry & Neuropsychology, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Frans R Verhey
- Department of Psychiatry & Neuropsychology, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry & Neuropsychology, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
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Contreras M, Khondoker M, Mioshi E, Kishita N. Factors affecting the quality of life of family carers of people with dementia: the role of carer anxiety. PSYCHOL HEALTH MED 2023; 28:843-853. [PMID: 35769020 DOI: 10.1080/13548506.2022.2093926] [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: 10/17/2022]
Abstract
The role of anxiety on the quality of life of family carers of people with dementia is somewhat neglected in the carer literature. The current study aimed to investigate the impact of common risk factors (i.e., care recipient's neuropsychiatric symptoms, carer depression, and burden) and anxiety on QoL. This cross-sectional study recruited 89 family carers. Most of the participants were looking after a spouse with Alzheimer's or mixed dementia. A multiple regression analysis was conducted with carer QoL as a dependent variable. All risk factors (i.e., people with dementia's neuropsychiatric symptoms, carer depression, anxiety, and burden) were entered into the model simultaneously as independent variables. The model's R2 was 33%. The results demonstrated that anxiety was the only significant independent variable predicting carer QoL (β = - 0.34, p = 0.03, 95% CI: - 0.64 to - 0.04). These results indicated that having more symptoms of anxiety was associated with worse QoL as measured by the ICEpop CAPability measure for Older people (ICECAP-O). These findings suggested that improving carer's anxiety may be particularly important in promoting QoL among family carers of people with dementia. Future interventions should target this variable to achieve the desired result of improving carer QoL.
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Affiliation(s)
- Milena Contreras
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Mizanur Khondoker
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Naoko Kishita
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Han A, Wilroy JD, Yuen HK. Effects of acceptance and commitment therapy on depressive symptoms, anxiety, pain intensity, quality of life, acceptance, and functional impairment in individuals with neurological disorders: a systematic review and meta-analysis. CLIN PSYCHOL-UK 2023. [DOI: 10.1080/13284207.2022.2163158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama, Birmingham, AL, USA
| | - Jereme D. Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, AL, USA
| | - Hon K. Yuen
- Department of Occupational Therapy, University of Alabama, Birmingham, AL, USA
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Han A, Wilroy JD, Jenkins J, Yuen HK. Effects of a coach-guided videoconferencing acceptance and commitment therapy intervention combined with psychoeducation on distressed individuals living with spinal cord injury: a preliminary mixed-methods study. Disabil Rehabil 2023; 45:644-654. [PMID: 35156500 DOI: 10.1080/09638288.2022.2038283] [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: 01/28/2023]
Abstract
PURPOSE This study examined effects of coach-guided videoconferencing acceptance and commitment therapy (ACT) accompanied by psychoeducation on distressed individuals with spinal cord injury (SCI) and explored participants' experiences in the intervention. MATERIALS AND METHODS Ten people with SCI participated in 8 individual videoconferencing sessions delivered by trained coaches. Data using self-reported questionnaires and individual interviews was collected at pretest and posttest and analyzing using Wilcoxon signed-rank tests and interpretative phenomenological analysis (ClinicalTrials.gov ID: NCT04670406). RESULTS Statistically significant improvements were found in depression, anxiety, stress, grief, engagement in meaningful activities, and self-compassion with medium to large effect sizes. There was no significant change in quality of life, resilience, and ACT processes. Participants gained a new way of thinking by: being aware of thoughts and emotions; exploring perceptions of others; and focusing on the present. Also, the intervention equipped participants to deal with challenges by: improving coping with SCI-related conditions; practicing self-compassion, acceptance, and meditation; and acquiring skills of value-based decision making and committed action. CONCLUSIONS Findings contribute to the limited evidence as the first study that measured effects of videoconferencing ACT on people with SCI. Future randomized controlled trials are needed to measure efficacy of internet-delivered ACT for people with SCI.IMPLICATIONS FOR REHABILITATIONGuided videoconferencing ACT may reduce depressive symptoms, anxiety, stress, and grief and increase engagement in meaningful activities and self-compassion in people with SCI.Professionals may consider ACT as a supportive or adjunct service for people with SCI who experience psychological distress.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jereme D Wilroy
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeremy Jenkins
- Telehealth Private Practice: jeremyjenkins.icouch.me, Edmond, OK, USA
| | - Hon K Yuen
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
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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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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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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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Han A, Kim TH. Effects of internet-based acceptance and commitment therapy on process measures: A systematic review and meta-analysis (Preprint). J Med Internet Res 2022; 24:e39182. [PMID: 36040783 PMCID: PMC9472046 DOI: 10.2196/39182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background Acceptance and commitment therapy (ACT) is based on a psychological flexibility model that encompasses 6 processes: acceptance, cognitive defusion, self-as-context, being present, values, and committed action. Objective This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the effects of internet-based ACT (iACT) on process measures. Methods A comprehensive search was conducted using 4 databases. The quality of the included RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. A random-effects or fixed-effects model was used. Subgroup analyses for each outcome were conducted according to the type of control group, use of therapist guidance, delivery modes, and use of targeted participants, when applicable. Results A total of 34 RCTs met the inclusion criteria. This meta-analysis found that iACT had a medium effect on psychological flexibility and small effects on mindfulness, valued living, and cognitive defusion at the immediate posttest. In addition, iACT had a small effect on psychological flexibility at follow-up. The overall risk of bias across studies was unclear. Conclusions Relatively few studies have compared the effects of iACT with active control groups and measured the effects on mindfulness, valued living, and cognitive defusion. These findings support the processes of change in iACT, which mental health practitioners can use to support the use of iACT.
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Affiliation(s)
- Areum Han
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Tae Hui Kim
- Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, Gangwon province, Republic of Korea
- Department of Psychiatry, Yonsei University Wonju Christian Hospital, Wonju, Gangwon province, Republic of Korea
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Rickardsson N, Scotland J, Poveda B, Gillanders D. Caring for someone with an acquired brain injury: The role of psychological flexibility. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Andrews ML, Garcia YA, Catagnus RM, Gould ER. Effects of Acceptance and Commitment Training Plus Behavior Parent Training on Parental Implementation of Autism Treatment. PSYCHOLOGICAL RECORD 2021; 72:601-617. [PMID: 34866659 PMCID: PMC8628834 DOI: 10.1007/s40732-021-00496-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2021] [Indexed: 11/27/2022]
Abstract
The objective of this study was to examine the effects of acceptance and commitment training (ACT) plus behavior parent training (BPT), when delivered via telehealth, on parental implementation of behavioral strategies, experiential avoidance (EA), and stress. The study also examined the subsequent effects on the parents’ autistic children’s behaviors. A multiple baseline design was implemented across four parent-child dyads who participated in the online training. The findings showed that ACT+BPT resulted in parental implementation reaching and maintaining high levels. The training also decreased EA and stress in three parents. Moreover, the parents’ ratings of their children’s challenging behaviors decreased. However, such a trend was not as clearly depicted by direct measures of the children’s behaviors. A social validity interview revealed parents found ACT beneficial in assisting them to learn and use the BPT strategies. Implications and suggestions for future research are discussed.
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Affiliation(s)
- Meredith L. Andrews
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
| | | | - Robyn M. Catagnus
- Applied Behavior Analysis Online Program, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL USA
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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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