Supported Web-Based Acceptance and Commitment Therapy for Older Family Caregivers (CareACT) Compared to Usual Care

Abstract

Objectives:The objective of the present study was to investigate whether an acceptance and commitment therapy (ACT)-based web-intervention (Group 1, CareACT), or a standardized rehabilitation in a rehabilitation center (Group 2) was effective in enhancing the psychological well-being of family caregivers aged 60 and over compared to support provided by voluntary caregiver associations (Group 3). Methods: Altogether, 149 family caregivers participated in this quasi-experimental study. Primary outcome measure was depression. Secondary outcomes included anxiety, sense of coherence, quality of life, psychological flexibility, experiential avoidance, and thought suppression. The questionnaires were administered at baseline, and four, and 10 months post-measurement. We investigated differences in the changes between the groups using Mplus modeling techniques. Results: Regarding the main outcome of depression, the results suggest that the CareACT intervention was superior to standardized rehabilitation and to the support given by caregiver associations at four months, both showing a medium-sized difference between the groups. However, the change from four to 10 months post-intervention was not significantly different between these groups (d = 0.32-0.36). Thought suppression showed a significantly different change between the three groups from baseline to four months and to 10 months post-measurement (p = .038). Conclusions: Web-based ACT may have beneficial effects on depressive symptoms and thought suppression in older caregivers. Clinical implications: Web-based ACT could be a feasible alternative to institutional rehabilitation and support provided by voluntary caregiver associations. Web-based ACT responds flexibly to the needs of caregivers and provides them an opportunity for learning new skills to promote wellbeing.

Internet-delivered guided self-help Acceptance and Commitment Therapy for family carers of people with dementia (iACT4CARERS): a qualitative study of carer views and acceptability

“…Previous studies have reported several advantages in using internet-delivered interventions with family carers of people with dementia. For instance, internet-based interventions facilitate access to support among family carers who are often unable to leave the care recipient unattended, as well as those limited by geographic and mobility constraints (Lappalainen et al, 2021 ).…”

“…Subsequently, this can lead to negative consequences for the care recipient, such as a reduction in their quality of life, increased use of healthcare services and institutionalization (Eska et al, 2013 ; Guterman et al, 2019 ; Martyr et al, 2018 ). Despite this, many carers are not able to access timely psychological support due to various barriers, such as reduced mobility, geographical location, lack of respite care, a shortage of skilled therapists leading to long waiting lists, and difficulties in prioritizing their own health needs (Green et al, 2012 ; Lappalainen et al, 2021 ; Tatangelo et al, 2018 ).…”

What are the educational and support needs of family carers looking after someone in the early stages of Alzheimer’s disease? A qualitative retrospective approach

“…Previous studies have found that carers struggle to acknowledge their needs and to accept help in the ES of dementia (Boots et al, 2015). By exploring the retrospective views of experienced carers, this study not only identified the type of information and support that carers needed in the ES, but it also enabled to identify /telephone-delivered) that can facilitate access to those carers that cannot leave the care recipient unattended or that have geographical or mobility limitations (Lappalainen et al, 2021).…”

“…Despite the advantages of face‐to‐face delivered interventions, it is necessary to consider alternative modes of delivery (e.g. internet‐ /telephone‐delivered) that can facilitate access to those carers that cannot leave the care recipient unattended or that have geographical or mobility limitations (Lappalainen et al., 2021).…”

Internet-delivered guided self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS): a feasibility study

“…Recent reviews of RCTs of internet-delivered guided or non-guided self-help ACT demonstrated that internet-delivered self-help ACT can reduce depression and anxiety, although the majority of included studies targeted either general or student populations; studies that targeted family carers were not identified (Brown et al, 2016 ; Thompson et al, 2021 ). A more recent RCT explored the effectiveness of internet-delivered guided self-help ACT for informal carers aged 60 and over providing care to a spouse or child living with or without disease (Lappalainen et al, 2021 ). Twenty-six percent of participants were caring for a family member with memory-related problems and the findings demonstrated that internet-delivered self-help ACT guided by trained psychology and gerontology students was effective in reducing depression when compared to usual care, while no effects were found for anxiety.…”