Behavioral activation for dementia caregivers: scheduling pleasant events and enhancing communications

Abstract

Background

Dementia caregiving is often associated with increase in depressive symptoms and strained relationships. This study tested whether telephone-delivered psychoeducation combined with an enhanced behavioral activation (BA) module had a better effect on the well-being of Alzheimer’s caregivers than psychoeducation alone. The focus is on enhancing the competent use of coping skills via BA. The program is delivered by telephone to increase accessibility and sustainability for caregivers. Senior citizens are trained as paraprofessionals to deliver the BA module to increase the potential for sustainability of the program.

Methods and subjects

The study compared two telephone interventions using a 4-month longitudinal randomized controlled trial. For the first 4 weeks, all participants received the same psychoeducation program via telephone. Then for the following 4 months, eight biweekly telephone follow-up calls were carried out. For these eight follow-up calls, participants were randomized into either one of the two following groups with different conditions. For the psychoeducation with BA (PsyED-BA) group, participants received eight biweekly sessions of BA practice focused on pleasant event scheduling and improving communications. For the psychoeducation only (PsyED only) group, participants received eight biweekly sessions of general discussion of psychoeducation and related information. A total of 62 family caregivers of persons living with dementia were recruited and 59 (29 in the PsyED-BA group and 30 in the PsyED only group) completed the whole study.

Results

As compared to the group with psychoeducation and discussion, the group with enhanced BA had decreased levels of depressive symptoms. The study had a low attrition rate.

Conclusion

Results suggested that competence-based training could be effectively administered through the telephone with the help of senior citizens trained and engaged as paraprofessionals. Results contribute to the present literature by offering some framework for developing effective, accessible, sustainable, and less costly interventions.

Keywords:

• telephone-assisted
• paraprofessional
• accessibility
• sustainability

Acknowledgments

We acknowledge the support of funding by the Food and Health Bureau of the Hong Kong SAR Government (HKPolyU-2011-K-JB3). Part of the study has been presented in Invited Symposium at the 16th Asia Pacific Regional Conference of Alzheimer’s Disease International 2013: Capacity Building in Dementia Care held on December 11–13, 2013 in Hong Kong.

We thank Professors Larry Thompson and Dolores Gallagher-Thompson for sharing and allowing us to flexibly adapt the CWC protocol and Ms Sandra Cheng for adapting the materials for telephone administration. We are grateful for the assistance of the senior helpers recruited from the IAA at the Hong Kong Polytechnic University for administrating the follow-up sessions. We also thank all the caregivers and the staff of United Christian Hospital and the Prince of Wales Hospital. The generosity and helpfulness of all those who participated has made this challenging task meaningful and rewarding. We are also grateful to Professor Cheng Sheung Tak from the Hong Kong Institute of Education for his insightful comments on an earlier draft of the paper. Finally, we thank Mrs Teresa Tsien for her inspiring leadership at the Institute of Active Aging of the Hong Kong Polytechnic University.

Disclosure

The authors report no conflicts of interest in this work.