Feasibility and acceptability of an acceptance and commitment therapy intervention for caregivers of adults with Alzheimer’s disease and related dementias

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.

Is acceptance and commitment therapy helpful in reducing anxiety symptomatology in people aged 65 or over? A systematic review

“…These studies showed how ACT was effective in reducing depressive (15, 43-47), and anxiety symptoms (15, 42,44,47). Regarding anxiety, the results are less consistent, with studies concluding that ACT could reduce anxiety symptoms (15, 42,44,47) and other studies finding that it does not (43,45,46).…”

“…These studies showed how ACT was effective in reducing depressive (15, 43-47), and anxiety symptoms (15, 42,44,47). Regarding anxiety, the results are less consistent, with studies concluding that ACT could reduce anxiety symptoms (15, 42,44,47) and other studies finding that it does not (43,45,46). One of the studies (47) compared the benefits of ACT with those of traditional CBT, concluding that both procedures effectively reduce symptoms of anxiety and depression.…”

“…Four studies report that the therapy was conducted by qualified psychologists, while the rest do not provide any information. Most interventions lasted for about 12 weeks, but in one case (42), treatment lasted for 6 sessions, and in another (15), it lasted for 16 sessions. There was also heterogeneity in the presentation of the therapies.…”

“…There was also heterogeneity in the presentation of the therapies. Overall, 4 studies were individual and face-to-face, while one study (42) was conducted over the telephone and two studies were conducted over online modules. In this regard, the two reviewers (LL-T and JM-M) assessed the presence or absence of a control group and the presentation format, with inter-rater reliability reaching an almost perfect level of agreement (κ = 90).…”

Brief Acceptance and Commitment Group Therapy for Nursing Home Staff: Effects on Stress, Performance, and Quality of Life

“…The empirical findings have been valuable in describing how values and committed action core processes provide potential benefits for staff working in nursing home settings; however, no study has examined the effects of both processes (which results in engaged living) conducted in group intervention setting among nursing home staff. Several studies found positive effects of ACT for family caregivers of adults with dementia (Fowler et al, 2021;Losada et al, 2015). ACT conducted in group setting also provides new findings when conducted among caregivers of chronic illness patients (Williams et al, 2014) and among informal caregivers of people with psychosis (Jolley et al, 2020).…”