Nicole R Fowler1,2,3, Katherine S Judge4, Kaitlyn Lucas4, Tayler Gowan5, Patrick Stutz6,7, Mu Shan6,8, Laura Wilhelm9, Tommy Parry10, Shelley A Johns6,7,5,10,11. 1. Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA. fowlern@iupui.edu. 2. Division of General Internal Medicine, Geriatrics, and Palliative Care, Indianapolis, IN, 46202, USA. fowlern@iupui.edu. 3. Regenstrief Institute, Indiana University Center for Aging Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA. fowlern@iupui.edu. 4. Department of Psychology, College of Sciences and Health Professions, Cleveland State University, 1836 Euclid Avenue, Cleveland, OH, 44115, USA. 5. Regenstrief Institute, Center for Health Services Research, 1101 West 10th Street, Indianapolis, IN, 46202, USA. 6. Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA. 7. Division of General Internal Medicine, Geriatrics, and Palliative Care, Indianapolis, IN, 46202, USA. 8. Department of Biostatistics, School of Medicine, Indiana University, 410 W. 10th Street, Suite 3000, Indianapolis, IN, 46202, USA. 9. Department of Behavioral Medicine and Psychiatry, West Virginia University, 3200 MacCorkle Ave., SE, Charleston, WV, 25304, USA. 10. Department of Psychology, Indiana University-Purdue University Indianapolis (IUPUI), 402 N Blackford St, Indianapolis, IN, 46202, USA. 11. IUPUI Research in Palliative and End-of-Life Communication and Training Center, Indiana University-Purdue University Indianapolis, Indianapolis, USA.
Abstract
BACKGROUND: Caregivers of patients with Alzheimer's disease or a related dementia (ADRD) report high levels of distress, including symptoms of anxiety and depression, caregiving burden, and existential suffering; however, those with support and healthy coping strategies have less stress and burden. Acceptance and Commitment Therapy (ACT) aims to foster greater acceptance of internal events while promoting actions aligned with personal values to increase psychological flexibility in the face of challenges. The objective of this single-arm pilot, Telephone Acceptance and Commitment Therapy Intervention for Caregivers (TACTICs), was to evaluate the feasibility, acceptability, and preliminary effects of an ACT intervention on ADRD caregiver anxiety, depressive symptoms, burden, caregiver suffering, and psychological flexibility. METHODS: ADRD caregivers ≥21 years of age with a Generalized Anxiety Disorder Scale (GAD-7) score ≥ 10 indicative of moderate or higher symptoms of anxiety were enrolled (N = 15). Participants received a telephone-based ACT intervention delivered by a non-licensed, bachelor's-prepared trained interventionist over 6 weekly 1-h sessions that included engaging experiential exercises and metaphors designed to increase psychological flexibility. The following outcome measures were administered at baseline (T1), immediately post-intervention (T2), 3 months post-intervention (T3), and 6 months post-intervention (T4): anxiety symptoms (GAD-7; primary outcome); secondary outcomes of depressive symptoms (Patient Health Questionnaire-9), burden (Zarit Burden Interview), suffering (The Experience of Suffering measure), psychological flexibility/experiential avoidance (Acceptance and Action Questionnaire-II), and coping skills (Brief COPE). RESULTS: All 15 participants completed the study and 93.3% rated their overall satisfaction with their TACTICs experience as "completely satisfied." At T2, caregivers showed large reduction in anxiety symptoms (SRM 1.42, 95% CI [0.87, 1.97], p < 0.001) that were maintained at T3 and T4. At T4, psychological suffering (SRM 0.99, 95% CI [0.41, 1.56], p = 0.0027) and caregiver burden (SRM 0.79, 95% CI [0.21, 1.37], p = 0.0113) also decreased. CONCLUSIONS: Despite a small sample size, the 6-session manualized TACTICs program was effective in reducing anxiety, suggesting that non-clinically trained staff may be able to provide an effective therapeutic intervention by phone to maximize intervention scalability and reach. TRIAL REGISTRATION: Institutional Review Board (IRB) protocol #1904631305 version 05-14-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019.
BACKGROUND: Caregivers of patients with Alzheimer's disease or a related dementia (ADRD) report high levels of distress, including symptoms of anxiety and depression, caregiving burden, and existential suffering; however, those with support and healthy coping strategies have less stress and burden. Acceptance and Commitment Therapy (ACT) aims to foster greater acceptance of internal events while promoting actions aligned with personal values to increase psychological flexibility in the face of challenges. The objective of this single-arm pilot, Telephone Acceptance and Commitment Therapy Intervention for Caregivers (TACTICs), was to evaluate the feasibility, acceptability, and preliminary effects of an ACT intervention on ADRD caregiver anxiety, depressive symptoms, burden, caregiver suffering, and psychological flexibility. METHODS: ADRD caregivers ≥21 years of age with a Generalized Anxiety Disorder Scale (GAD-7) score ≥ 10 indicative of moderate or higher symptoms of anxiety were enrolled (N = 15). Participants received a telephone-based ACT intervention delivered by a non-licensed, bachelor's-prepared trained interventionist over 6 weekly 1-h sessions that included engaging experiential exercises and metaphors designed to increase psychological flexibility. The following outcome measures were administered at baseline (T1), immediately post-intervention (T2), 3 months post-intervention (T3), and 6 months post-intervention (T4): anxiety symptoms (GAD-7; primary outcome); secondary outcomes of depressive symptoms (Patient Health Questionnaire-9), burden (Zarit Burden Interview), suffering (The Experience of Suffering measure), psychological flexibility/experiential avoidance (Acceptance and Action Questionnaire-II), and coping skills (Brief COPE). RESULTS: All 15 participants completed the study and 93.3% rated their overall satisfaction with their TACTICs experience as "completely satisfied." At T2, caregivers showed large reduction in anxiety symptoms (SRM 1.42, 95% CI [0.87, 1.97], p < 0.001) that were maintained at T3 and T4. At T4, psychological suffering (SRM 0.99, 95% CI [0.41, 1.56], p = 0.0027) and caregiver burden (SRM 0.79, 95% CI [0.21, 1.37], p = 0.0113) also decreased. CONCLUSIONS: Despite a small sample size, the 6-session manualized TACTICs program was effective in reducing anxiety, suggesting that non-clinically trained staff may be able to provide an effective therapeutic intervention by phone to maximize intervention scalability and reach. TRIAL REGISTRATION: Institutional Review Board (IRB) protocol #1904631305 version 05-14-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019.
Entities:
Keywords:
Acceptance and commitment therapy; Alzheimer’s disease; Anxiety; dementia; Caregiver
Authors: Christopher M Callahan; Malaz A Boustani; Michael Weiner; Robin A Beck; Lee R Livin; Jeffrey J Kellams; Deanna R Willis; Hugh C Hendrie Journal: Aging Ment Health Date: 2011-01 Impact factor: 3.658
Authors: P Campbell; J Wright; J Oyebode; D Job; P Crome; P Bentham; L Jones; C Lendon Journal: Int J Geriatr Psychiatry Date: 2008-10 Impact factor: 3.485