The ACT and control groups
guilt, dementia, BPSD
Participants in the ACT group received individual ACT sessions guided by a trained ACT
coach (Mr. Jenkins) through Zoom videoconferencing 1 hour per week for 8 weeks. The
overview of the eight weekly ACT sessions are reported in Hard copies of ACT session worksheets were mailed to the participants in the intervention
group before the first ACT session. The ACT coach, a licensed professional counselor with
substantial clinical experiences and expertise in ACT, delivered ACT sessions to all
participants in the intervention group. Active interactions with the coach and engagement
with the materials were encouraged using various in-session learning activities (e.g.
in-session worksheets, metaphors, and case scenario exercise) and homework assignment. For
example, the coach and the participant worked on learning activities, which helped the
participant acknowledge that it was normal to have negative emotions and thoughts in
stressful care situations and accept those emotions and thoughts, such as feelings of
guilt arising from a mistake or a thought that he or she was not doing enough to be a
perfect caregiver. After each session, the coach sent each participant additional online
ACT resources matched to weekly learning aims (i.e. guided ACT exercise video clips) and a
summary of strategies and skills covered during the session to encourage participants to
practice between sessions. Participants were also provided with links to short video clips
and hard copies of psychoeducation materials as supplemental resources before the first
ACT session to better meet the needs of this population. These psychoeducation resources
were aimed at increasing caregivers’ understanding of dementia (e.g. types, stages, and
symptoms); care strategies for different stages of dementia; BPSD in PLWD and how to
manage these behaviors; and communication strategies. Participants in the control group
maintained care as usual and received the same psychoeducation materials given to the
participants in the ACT group during the study period. After the study period ended, the
control group received links to online ACT resources.