JMIR Publications

ABSTRACT

Background:

Family caregivers of individuals with Alzheimer's disease and related dementias (ADRD) face significant mental health challenges, including depressive symptoms. Acceptance and commitment therapy (ACT) has emerged as a promising intervention for improving these caregivers' mental health. While various delivery modes of ACT have been explored, there is a need for evidence on the efficacy of videoconference-delivered ACT programs for this population.

Objective:

This study aimed to assess the effects of a videoconference-delivered, therapist-guided ACT program on reducing depressive symptoms and improving other mental health outcomes among depressed family caregivers of individuals with ADRD, compared to a control group that received psychoeducation materials alone, in a pilot randomized controlled trial (RCT).

Methods:

This two-arm, parallel-group pilot RCT randomly assigned 33 family caregivers to either a 10-week videoconference-delivered ACT program (n = 16) or a control group that received psychoeducation materials alone (n = 17). Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire-9 (PHQ-9). Secondary outcomes included anxiety, stress, psychological quality of life (QoL), caregiver burden, grief, guilt, and ACT process measures. Outcomes were assessed at pretest, posttest (10-12 weeks after pretest), and 3-month follow-up (F/U) (3 months after posttest). An intent-to-treat approach was used for all outcome analyses. Linear mixed-effects models for repeated measures were used to analyze outcomes.

Results:

The ACT group reported significantly greater improvements in stress (P = 0.043) and psychological QoL (P = 0.014) at posttest compared to the control group. Within the ACT group, participants experienced a significant decrease in depressive symptoms, with a mean (standard error) change of −6.09 (1.16) points (95% CI, −8.42 to −3.76 points; P < 0.001) at posttest and −6.71 (1.45) points (95% CI, −9.63 to −3.81 points; P < 0.001) at the 3-month F/U. These changes exceed the estimated minimal clinically important difference on the PHQ-9 scale. In addition, the ACT group reported significant improvements in anxiety, stress, psychological QoL, caregiver burden, pre-death grief, guilt, values-driven action, and experiential avoidance at both posttest and 3-month F/U. A sensitivity analysis, excluding one participant with near-outlier data, revealed statistically significant between-group differences in depressive symptoms at posttest (P = 0.037); stress at posttest (P < 0.001) and at 3-month F/U (P = 0.001); psychological QoL at posttest (P < 0.001); caregiver burden at posttest (P = 0.003) and at 3-month F/U (P = 0.003); pre-death grief at 3-month F/U (P = 0.031); and values-driven action at posttest (P = 0.032).

Conclusions:

The videoconference-delivered ACT program showed promise in improving mental health outcomes and ACT processes among depressed family caregivers of individuals with ADRD. Future studies should aim to replicate these findings with larger, more diverse caregiver populations and explore the long-term efficacy of videoconference-delivered ACT programs. Clinical Trial: ClinicalTrials.gov ID: NCT05043441