Introduction
guilt, anxiety, dementia, depressive, depressed, depressive symptoms, depression
RECRUITMENT
This pilot randomized controlled trial (RCT) examined preliminary effects of an 8-week
videoconferencing acceptance and commitment therapy (ACT) program supplemented with
psychoeducation materials on distressed family caregivers of persons living with dementia
(PLWD) compared to the control group provided with psychoeducation materials only.
Nineteen family caregivers of PLWD in the USA were randomly assigned to the ACT group or
the control group. Data was collected at pretest, posttest, and 1-month follow-up (F/U).
Compared to the control group, the ACT group showed a significantly larger reduction in
grief at posttest, with a medium effect size. Small effects of ACT were found in anxiety,
psychological quality of life, and engagement in meaningful activities at posttest and
grief, engagement in meaningful activities, and psychological flexibility at F/U compared
to the control group. These promising findings warrant a full-scale RCT with adequate
power to measure the efficacy of videoconferencing ACT for caregivers of PLWD.About 16 million people in the USA provide unpaid care for persons living with dementia
(PLWD), and the estimated economic value of the unpaid care is about $271 billion (A meta-analysis study found that the aggregate prevalence of depression and anxiety in
family caregivers of PLWD were 34% and 43.6%, respectively (Family caregivers often experience loss and grief while caring for PLWD, with a prevalence
ranging from 47% to 71% (Investigators have made great efforts to develop and test interventions for family
caregivers of PLWD, especially to meet care-related needs, but relatively fewer studies have
investigated interventions focusing on improving these caregivers’ mental health and
participation in their valued activities (A growing body of literature suggests mindfulness-based interventions show promise for
improving mental health outcomes in family caregivers of PLWD, including depressive
symptoms, anxiety, stress, and QoL (Acceptance and commitment therapy (ACT) is an emerging evidence-based approach that can
promote mental health and engagement in personally valued activities through acceptance and
mindfulness processes and behavior change processes for valued living (To our knowledge, there have been eight studies so far that implemented ACT for family
caregivers of PLWD. Two full-scale randomized controlled trials (RCTs) conducted in Spain
for depressed family caregivers of PLWD found statistically significant effects of eight
weekly individual in-person ACT sessions on decreasing depressive symptoms and anxiety
compared to the control condition with a 2-hour psychoeducation session on dementia (Four small-scale one-group pretest-posttest design studies were conducted in the USA (three
studies) and in the UK (one study) that involved six weekly individual telephone-based ACT
sessions (These studies found promising results, including decreased depressive symptoms, anxiety,
stress, and caregiving burden after participants completed ACT sessions, and evidence to
support the feasibility and acceptability of ACT sessions delivered by methods other than
in-person sessions (i.e. phone-based therapy, self-guided online modules, and
videoconferencing sessions; Because there are a few current studies involving ACT for family caregivers of PLWD,
conducting a small-scale RCT before initiating a full-scale RCT will be helpful, especially
to test the feasibility of participant recruitment and retention in studies involving a
control group condition and random allocation to groups and the preliminary effects of
videoconferencing ACT on these caregivers compared to the control group condition. The
current study, therefore, aimed to test the feasibility of participant recruitment and
retention in a pilot RCT in which distressed caregivers of PLWD were randomly assigned to
either an 8-week, coach-guided, videoconferencing, individual ACT group provided with
psychoeducation materials or to a control group provided with psychoeducation materials
only. This study also aimed to test the preliminary effects of ACT on psychological distress
(i.e. depressive symptoms, anxiety, and stress), perceived caregiving burden, grief, guilt,
psychological QoL, and measures relevant to ACT processes (i.e. psychological flexibility,
cognitive fusion, engagement in meaningful activities, and self-compassion) in distressed
caregivers of PLWD compared to the control group. To our knowledge, this pilot study is the
first RCT to investigate ACT for family caregivers of PLWD in the USA and to involve online
ACT for these caregivers in the world.