Family Caregivers of Dementia Patients May Benefit from Learning Positive Emotion Skills, Study Suggests

An online program that teaches how to focus on positive emotions can help caregivers of family members with dementia to cope better with stress, and reduce their depression and anxiety symptoms, results from a clinical study suggest.

The six-week skill-building intervention, called Life Enhancing Activities for Family Caregivers (LEAF), does not require a licensed therapist, and it can be made easily accessible and affordable to a wide population of caregivers.

The researchers who have been developing this new support program are planning to further explore LEAF’s potential by comparing its version, which was found to be the most effective in the study, to a self-guided online version.

Latest results from the ongoing trial (NCT01825681) were reported in a study, “Randomized controlled trial of a facilitated online positive emotion regulation intervention for dementia caregivers,” published in the journal Health Psychology.

Caring for a family member with dementia poses a significant emotional and physical burden that increases the caregiver’s risk for mental problems such as depression and anxiety. Therefore, strategies are needed to provide timely support to this population in order to prevent such health-related problems.

“Nationally we are having a huge increase in informal caregivers,” said Judith Moskowitz, PhD, professor at the Feinberg School of Medicine at Northwestern University, and lead author of the study.

“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,” added Moskowitz, who is also the director of research at the Osher Center for Integrative Medicine at FeinbergA.

Northwestern researchers and collaborators from University of California San Francisco conducted the clinical study to evaluate the effects of LEAF.

The trial enrolled 170 participants who were the primary care providers for their family members with dementia. They were randomly assigned to undergo LEAF or a waitlist control group that recorded their emotions daily for six weeks.

The LEAF intervention consisted of six weekly, one-hour sessions, presented by a facilitator via web conference, for the participating caregivers across the U.S. During these sessions, participants learned skills that are known to cultivate positive emotions such as recognizing and leveraging positive events, gratitude, mindfulness, positive reappraisal, personal strengths, attainable goals, and acts of kindness. They were encouraged, for instance, to notice a positive event each day, start a daily gratitude journal, or go out and practice an act of kindness. After each class, they were asked to practice at home the skills they had learned that day and to listen to audio recordings.

Participants in the control group completed daily reports about their emotions, and after six weeks switched to the LEAF program.

Positive emotion, depression, anxiety, and physical health, as measured by the Patient-Reported Outcomes Measurement Information System, were assessed at the start of the study and at the end of the six-week program.

The study found that LEAF participants experienced a 7% reduction in depression and a 9% drop in anxiety symptoms compared with caregivers on the waitlist. While LEAF participants with moderate symptoms of depression moved into a normal range for depressive symptoms upon completion of the six-week intervention, those in the control group remained within the mild-to-moderate range for depressive symptoms.

Caregivers also reported improvements in their physical health after the LEAF program, with more feelings of happiness and positive emotions about different aspects of their caregiving.

“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,” one participant commented.

“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,” another one said.

Moskowitz is planning a new study to see if a self-guided online version of LEAF is as effective as the version with a facilitator. If it is, the program can be implemented widely at a relatively low cost to help the growing number of dementia caregivers in the U.S., she said. The new study will be sponsored by the National Institute on Aging.