A Mixed-Methods Analysis of a Telephone-Based Acceptance and Commitment Therapy Intervention Aimed at Reducing Anxiety in Dementia Caregivers

Abstract

Over 5.8 million people in the U.S. have Alzheimer’s disease or a related dementia (ADRD). Eighty percent of those with ADRD receive care in their homes, often unpaid care from family and friends. Due to the considerable physical and mental demands of providing care to a loved one with ADRD, these caregivers are especially prone to increased anxiety. A paradigm-shifting approach that may be useful for ADRD caregiver anxiety is acceptance and commitment therapy (ACT). ACT focuses on mindfulness and values-based action to increase psychological flexibility in managing life stress. This non-randomized pilot study enrolled unpaid ADRD caregivers (N=15) with clinically significant anxiety (Generalized Anxiety Disorder-7 [GAD-7] scale score ≥10). Using a mixed-methods approach, the effectiveness of TACTICs (Telephone Acceptance and Commitment Therapy Intervention for Caregivers of adults with ADRD) in decreasing anxiety was evaluated. Participants completed the GAD-7 at baseline, post-intervention, and 3 months later, along with a post-intervention qualitative interview. Interviews were transcribed verbatim, and each interview was analyzed thematically by at least two members of the TACTICs team. Mean GAD-7 scores were 13.33 (SD=2.79) at baseline and decreased to a mean of 8.36 (SD=3.00) post-intervention. This is a statistically large effect (d=1.72). Maintenance of effects on anxiety at 3 months post-intervention will be reported upon study completion in June. In post-intervention qualitative interviews, participants described their experiences with TACTICs and offered suggestions for improving the intervention. Participants reported reduced emotional reactivity, greater compassion for self and others, and increased psychological flexibility, which may explain how the intervention decreased caregiver anxiety. Participants’ suggestions for improvement will be summarized and used to improve the TACTICs program to better meet the needs of ADRD caregivers. 1 https://www.alz.org/alzheimers-dementia/facts-figures 2 https://www.cdc.gov/aging/caregiving/alzheimer.htm