People who care for a family member with dementia have an increased risk of depression, anxiety, and death. A new coping intervention may help.
The method, which teaches caregivers to focus on positive emotions, reduced anxiety and depression after six weeks, according to a new study. It also resulted in better self-reported physical health and positive attitudes toward caregiving.
“The caregivers who learned the skills had less depression, better self-reported physical health, more feelings of happiness, and other positive emotions than the control group,” says lead author Judith Moskowitz, professor of medical social sciences at Northwestern University Feinberg School of Medicine. She also is director of research at the Osher Center for Integrative Medicine at Feinberg.
The positive-emotion intervention doesn’t require a licensed therapist and is accessible and affordable for busy caregivers.
“Nationally we are having a huge increase in informal caregivers,” Moskowitz says. “People are living longer with dementias like Alzheimer’s disease, and their long-term care is falling to family members and friends. This intervention is one way we can help reduce the stress and burden and enable them to provide better care.”
Steps to positive emotions
Most current approaches to helping caregivers focus on education about dementia or problem solving around challenging behaviors but haven’t specifically addressed reducing the emotional burden of providing care.
The new intervention includes eight skills that evidence shows increase positive emotions. They include:
- Recognize a positive event each day.
- Savor that positive event and log it in a journal or tell someone about it.
- Start a daily gratitude journal.
- List a personal strength each day and note how you used this strength recently.
- Set an attainable goal each day and note your progress.
- Report a relatively minor stressor each day, then list ways in which to positively reappraise or reframe the event.
- Understand small acts of kindness can have a big impact on positive emotion and practice a small act of kindness each day.
- Practice mindfulness through paying attention to daily experiences and with a daily 10-minute breathing exercise, concentrating on the breath.
Moskowitz wasn’t sure how many caregivers would be able to complete the program because “they are such a stressed, burdened group. But participants acted engaged and committed, which speaks to how much they need programs like this,” she says.
Currently 5.5 million people in the United States have an Alzheimer’s disease diagnosis, which could increase to 16 million by 2050. The average life expectancy post diagnosis is eight to 10 years, although some people live as long as 20 years.
In the trial, researchers randomly assigned 170 dementia caregivers to either the intervention group in which they learned positive emotion skills such as recognizing a daily positive event and keeping a gratitude journal, or to a control group in which they filled out a daily questionnaire about their emotions.
A facilitator presented the positive emotion skill sessions, called LEAF (Life Enhancing Activities for Family caregivers), via web conference to caregivers across the US. The web delivery is especially important for caregivers who live in rural areas without local caregiver support services, Moskowitz says.
In six weekly sessions, caregivers reviewed positive emotion skills and then had daily homework to practice the skills, including audio recordings. If the topic was acts of kindness, for example, their homework was to go out and practice an act of kindness.
All participants filled out a questionnaire about their depression, anxiety, physical health, and caregiver burden at the start and completion of the study.
‘Serenity and calmness’
Participants in the LEAF intervention saw a 7 percent greater drop in depression and a 9 percent greater drop in anxiety compared to the control group. Participants in the intervention group decreased from showing moderate symptoms of depression relative to the population norm, to falling within the normal range of depressive symptoms by the post-intervention assessment.
In contrast, participants in the control condition showed a smaller decrease in depression scores and remained within the mild to moderate range.
One participant wrote, “The LEAF study and the techniques I learned by participating in it have brought about a serenity and calmness to my life and to that of my husband. We have both benefitted from my changed attitude.”
Another said, “Doing this study helped me look at my life, not as a big neon sign that says, ‘DEMENTIA’ in front of me, but little bitty things like, ‘We’re having a meal with L’s sister, and we’ll have a great visit.’ I’m seeing the trees are green, the wind is blowing. Yeah, dementia is out there, but I’ve kind of unplugged the neon sign and scaled down the size of the letters.”
Moskowitz will next launch a study where she will compare the facilitated version of the intervention to a self-guided online version without a facilitator. If the self-guided version is as effective as the facilitated one, it will mean the LEAF program can be implemented widely at relatively low cost to help the growing number of dementia caregivers in the US, she says.
Additional researchers from Northwestern and the University of California, San Francisco, contributed to the study, which appears in Health Psychology. The National Institute of Nursing Research of the National Institutes of Health funded the work.
Source: Northwestern University