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

Alma Au,1,2 Dolores Gallagher-Thompson,3 Meng-Kong Wong,4 Jess Leung,4 Wai-Chi Chan,5 Chun Chung Chan,6 Hui-Jing Lu,1 Man Kin Lai,1 Kevin Chan11Department of Applied Social Sciences, 2Institute of Active Aging, The Hong Kong Polytechnic University, Hong Kong, People’s Republic of China; 3Department of Psychiatry and Behavioral Sciences and Geriatric Education Centre, School of Medicine, Stanford University, Stanford, CA, USA; 4Department of Psychiatry, United Christian Hospital, 5Department of Psychiatry, University of Hong Kong, 6Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong, People’s Republic of ChinaBackground: 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, sustainabilit