Behavioral activation for dementia caregivers: scheduling pleasant events and enhancing communications

Abstract

BackgroundDementia caregiving is often associated with increase in depressive symptoms and strained relationships. This study tested whether telephone-delivered psychoeducation combined with an enhanced behavioral activation (BA) module had a better effect on the well-being of Alzheimer’s caregivers than psychoeducation alone. The focus is on enhancing the competent use of coping skills via BA. The program is delivered by telephone to increase accessibility and sustainability for caregivers. Senior citizens are trained as paraprofessionals to deliver the BA module to increase the potential for sustainability of the program.Methods and subjectsThe study compared two telephone interventions using a 4-month longitudinal randomized controlled trial. For the first 4 weeks, all participants received the same psychoeducation program via telephone. Then for the following 4 months, eight biweekly telephone follow-up calls were carried out. For these eight follow-up calls, participants were randomized into either one of the two following groups with different conditions. For the psychoeducation with BA (PsyED-BA) group, participants received eight biweekly sessions of BA practice focused on pleasant event scheduling and improving communications. For the psychoeducation only (PsyED only) group, participants received eight biweekly sessions of general discussion of psychoeducation and related information. A total of 62 family caregivers of persons living with dementia were recruited and 59 (29 in the PsyED-BA group and 30 in the PsyED only group) completed the whole study.ResultsAs compared to the group with psychoeducation and discussion, the group with enhanced BA had decreased levels of depressive symptoms. The study had a low attrition rate.ConclusionResults suggested that competence-based training could be effectively administered through the telephone with the help of senior citizens trained and engaged as paraprofessionals. Results contribute to the present literature by offering some framework for developing effective, accessible, sustainable, and less costly interventions.

Effectiveness of interventions for co‐residing family caregivers of people with dementia: Systematic review and meta‐analysis

“…The interventions included in this review varied in their composition of strategies (Table ). The most common categories that components fell under include: education and skills training (Au et al ., ; Beauchamp et al ., ; Belle et al ., ; Czaja et al ., ; Elliott et al ., ; Gitlin et al ., , ; Gonyea, O'Connor & Boyle, ; Hepburn et al ., ; Kurz, Wagenpfeil, Hallauer, Schneider‐Schelte & Jansen, ; Marriott, Donaldson, Tarrier & Burns, ; Steffen, ; Waldorff et al ., ), counselling (Connell & Janevic, ; Drentea et al ., ; Mittelman et al ., , , , ; Roth et al ., ; Waldorff et al ., ) and support groups (Belle et al .; Czaja et al .; Drentea et al ., ; Elliott et al .; Mittelman et al .; Roth et al ., ). Other less common components fell under the following categories: stress management (Belle et al .; Elliott et al .; Marriott et al .; Steffen), exercise and health promotion (Belle et al .; Connell & Janevic; Elliott et al .), computerised telephone support system linking caregivers to therapy sessions and community resources (Belle et al .; Eisdorfer et al ., ; Elliott et al .), role play (Belle et al .; Elliott et al .), and environmental modification (Gitlin et al .; Horvath et al ., ).…”

“…One study reported that caregivers worked in part‐time jobs (Beauchamp, Irvine, Seeley & Johnson, ). Fifteen studies included family caregivers (Au et al ., ; Beauchamp et al .; Belle et al .; Connell & Janevic, ; Czaja et al .; Drentea, Clay, Roth & Mittelman, ; Eisdorfer et al .; Elliott et al .; Hepburn, Tornatore, Center & Ostwald, ; Horvath et al ., ; Mittelman, Brodaty, Wallen & Burns, ; Mittelman, Roth, Clay & Haley, ; Mittelman, Roth, Coon & Haley, ; Mittelman et al ., ; Roth, Mittelman, Clay, Madan & Haley, ). In seven studies, the caregivers were the spouses of the care recipients (Au et al .; Connell & Janevic; Drentea et al .; Mittelman et al .; Roth et al .).…”

”I Don’t Believe in Leading a Life of My Own, I Lead His Life”: A Qualitative Investigation of Difficulties Experienced by Informal Caregivers of Stroke Survivors Experiencing Depressive and Anxious Symptoms

“…Supporting caregivers' use behavioral activation may increase engagement in rewarding activities, thereby improving mood. Indeed, behavioral activation has been demonstrated to improve mood in caregivers of people with dementia (Au et al, 2014(Au et al, , 2015Lovett & Gallagher, 1988).…”

Sleep in caregivers

“…Concurrently, there is growing interest in using technology to address problems with access and affordability of caregiver intervention programs. A number of recent telephone-and Internet-delivered psychoeducational and self-help interventions have shown promise for improving mood and reducing burden in dementia caregivers [30][31][32][33][34][35][36]. Although these interventions have not targeted caregiver sleep per se, it would not be a far stretch to incorporate elements of CBT-I strategies or training in ABC problem-solving to help identify activators for care-receiver nighttime awakenings and to brainstorm caregiver response options.…”