By Linda Carroll
Much has been written about the stresses and emotional demands of caring for family members with dementia, and a new study suggests that some of this burden can be offset by training that helps caregivers focus on the positives of their experience.
In a randomized, controlled trial, researchers showed that a six-session online training program produced modest improvements in caregiver anxiety and depression, according to results published May 2 in Health Psychology.
"Caregivers have high rates of burden and distress and depression," said the study's lead author, Judith Moskowitz, a professor and director of research at the Osher Center for Integrative Medicine at Northwestern University in Chicago. "There are programs out there to help them but those usually have to do with education on how to deal with the actual care activities."
This study shows that "a program that teaches the skills of having more positive emotions helps caregivers cope better with the demands of caregiving," Moskowitz said. "It's unique in that it describes a set of eight skills that help you have more positive emotions on a daily basis."
Past research has found that "even people experiencing major stressors can experience positive emotions alongside," Moskowitz said. "We're not expecting them to deny having negative emotions, instead we're helping them realize they can also have periods of positive emotions."
The intervention designed by Moskowitz and her colleagues taught skills that have been demonstrated to increase positive emotions: noticing and focusing on positive events, feeling gratitude for those events, mindfulness, looking for positive aspects of stressful events, focusing on one's own strengths, setting attainable goals and finding ways to show kindness.
To test their intervention, the researchers recruited 170 dementia caregivers who were randomly assigned to one of two groups: the intervention group, in which volunteers learned positive emotional skills such as recognizing a daily positive event and keeping a gratitude journal, and the control group, in which volunteers were asked to fill out daily questionnaires about their feelings. After the initial six weeks, the control group members were also given the intervention.
At the beginning and end of the study period, volunteers filled out questionnaires that assessed their depression, anxiety, physical health and caregiver burden.
The six sessions that encouraged positive emotions were part of a program called LEAF, for Life Enhancing Activities for Family caregivers, and were presented by a facilitator via web conference-call on tablets provided to each participant. The online aspect of the training allowed the researchers to include caregivers from across the country, including rural areas.
When researchers compared the questionnaires from before and after the six-week training, they found that volunteers in the intervention group had a 7 percent greater drop in depression symptoms and a 9 percent greater drop in anxiety symptoms compared with the control group.
In other words, Moskowitz said, those in the intervention group went from showing moderate symptoms of depression to being within the normal range. In contrast, the volunteers in the control group stayed in the mild to moderate range when it came to depression.
"A lot of the scientific literature has looked at caregiver stress and problems," said David Roth, a professor and director of the Center on Aging and Health at Johns Hopkins University in Baltimore, Maryland. "What's underappreciated are the positives of providing care for an older family member with dementia. This program provides a nice counterbalance to programs that focus on stress management."
This is an intervention to help people find the silver lining in their experiences, Roth said.
"It's impressive that after only six weeks the LEAF intervention impacted health outcomes that commonly affect dementia caregivers," said Sarah Stahl, an assistant professor of psychiatry at the University of Pittsburgh, who wasn't involved in the study.
"It's possible that targeting positive emotions may improve caregivers' overall health and wellbeing, which ultimately impacts the quality of care they are able to provide to their family member with dementia," Stahl said in an email. "LEAF is unique in that it focuses on positive psychology to improve psychological and physical wellbeing."
Health Psychol 2019.
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