Project Description:
Over 55 million people worldwide have dementia, and in the United States, 80% of people with dementia are cared for at home by family.
Acceptance and Commitment Therapy (ACT) is a modern ("third wave") Cognitive Behavioral Therapy (CBT) that addresses clinically significant, or subclinical levels of anxiety, depression, and a myriad of other conditions. The transdiagnostic mechanism in ACT involves increasing psychological flexibility, by changing the impact of negative thoughts and feelings, without having to change the frequency or form of their occurrence.
This proposal is responding to the EMBRACE call for mechanism-focused dementia care and caregiver support intervention development, targeting the level of the caregiver. Guided by the Checklist for Investigating Mechanisms in Behavior-change Research (CLIMBR), our Stage II (N=120) waitlist randomized control trial (RCT) will:
1. Determine the efficacy of an online, self-guided ACT for Caregivers program for improving dementia caregiver psychological distress (CLIMBR: X --> Y pathway).
2. Determine if and how treatment effects explain changes in psychological flexibility (CLIMBR X --> M pathway) and how changes to psychological flexibility account for changes in distress (CLIMBR: M --> Y pathway).
3. Determine if and how user adherence to the program at time 2 (i.e., number of online sessions completed) is associated with the proposed mechanism, psychological flexibility (at time 3).
With this Stage II study, we examine if the proposed mechanism of change in ACT for Caregivers -- psychological flexibility -- influences changes in caregivers' distress. We also explore how user adherence to the program is associated with changes in both the mediator and the outcome. Gathering evidence on the mechanism of change and intervention adherence is a necessary step in establishing ACT for Caregivers as an empirically validated intervention for dementia caregivers.
