In addition to treating negative outcomes such as depression, practitioners and researchers should, identify means to promote positive gains. Strategies mentioned in the caregivers' diaries, such as reframing stressful situations in a more positive light, may provide input into the design of such interventions.

Cognitive approaches focusing on benefit-finding are feasible among Chinese caregivers, with preliminary evidence suggesting an effect on alleviating depression.

BackgroundCaregivers of relatives with Alzheimer’s disease are highly stressed and at risk for physical and psychiatric conditions. Interventions are usually focused on providing caregivers with knowledge of dementia, skills, and/or support, to help them cope with the stress. This model, though true to a certain extent, ignores how caregiver stress is construed in the first place. Besides burden, caregivers also report rewards, uplifts, and gains, such as a sense of purpose and personal growth. Finding benefits through positive reappraisal may offset the effect of caregiving on caregiver outcomes.DesignTwo randomized controlled trials are planned. They are essentially the same except that Trial 1 is a cluster trial (that is, randomization based on groups of participants) whereas in Trial 2, randomization is based on individuals. Participants are randomized into three groups - benefit finding, psychoeducation, and simplified psychoeducation. Participants in each group receive a total of approximately 12 hours of training either in group or individually at home. Booster sessions are provided at around 14 months after the initial treatment. The primary outcomes are caregiver stress (subjective burden, role overload, and cortisol), perceived benefits, subjective health, psychological well-being, and depression. The secondary outcomes are caregiver coping, and behavioral problems and functional impairment of the care-recipient. Outcome measures are obtained at baseline, post-treatment (2 months), and 6, 12, 18 and 30 months.DiscussionThe emphasis on benefits, rather than losses and difficulties, provides a new dimension to the way interventions for caregivers can be conceptualized and delivered. By focusing on the positive, caregivers may be empowered to sustain caregiving efforts in the long term despite the day-to-day challenges. The two parallel trials will provide an assessment of whether the effectiveness of the intervention depends on the mode of delivery.Trial registrationChinese Clinical Trial Registry (http://www.chictr.org/en/) identifier number ChiCTR-TRC-10000881.

This study investigated whether a brief gratitude induction could reduce death anxiety. 83 Chinese older adults (mean age = 62.7, SD = 7.13) were randomly assigned into one of three conditions: gratitude, hassle, and neutral, in which they wrote different types of life events before responding to measures of death anxiety and affect. Participants in the gratitude induction reported lower death anxiety than the hassle and the neutral condition, whereas no difference was observed for the latter two conditions. There was no experimental effect on positive affect, and a significant effect on negative affect but which did not favor the gratitude condition. By reexamining life events with a thankful attitude, people may become less fearful of death due to a sense that life has been well-lived. Because gratitude can be induced using a very brief procedure, there are broad applications in clinical and health-care settings for the relief of death anxiety.