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)

Abstract

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.

Daily Stressors and Adult Day Service Use by Family Caregivers: Effects on Depressive Symptoms, Positive Mood, and Dehydroepiandrosterone-Sulfate

“…It is also one of the few studies demonstrating an effect of a caregiving intervention on physiological indicators of stress. 37 Although effect size was small, these results suggest the value of broadening the focus of caregiver interventions to include their impact on relevant biological risk factors associated with chronic stress and disease.…”

Why does placement of persons with Alzheimer’s disease into long-term care improve caregivers’ well-being? Examination of psychological mediators.

“…Another study found that older adults who participated in a 10-week intervention to enhance perceived control demonstrated increased personal mastery and reduced psychological distress compared with control participants (Reich & Zautra, 1989). Caregiver interventions specifically targeting activity restriction have been rare, although Moore et al (2013) found that a brief intervention (four in-home and two phone sessions) aimed at increasing dementia caregivers’ engagement in pleasant activities resulted in decreased depressive symptoms compared with an information and support control condition. The results of the present study indicate that increased personal mastery and decreased activity restriction mediate post-placement improvements in caregiver depressive symptoms over time.…”

Caregivers as Therapeutic Agents in Dementia Care

“…The groups chose the topic chapters for the remaining eight sessions Moore et al (2013) RCT with two groups: PEP intervention or a time-equivalent Information-Support (IS) control condition 100 Pleasant Events Program At 6-week follow-up, intervention group had significantly greater reductions in Interleukin-6, depression, and negative affect. At 1-year follow-up, no statistically significant outcomes were reported …”