RESUMEN

PURPOSE: To discover positive gains as constructed by family caregivers of relatives with Alzheimer's disease. DESIGN AND METHODS: Fifty-seven Hong Kong Chinese primary caregivers provided 669 diary recordings over an 8-week period, describing daily events and experiences in which positive gains were achieved. The diaries were analyzed independently by two researchers using thematic analysis. RESULTS: Ten themes related to positive gains were identified: (a) insights about dementia and acceptance of the condition, (b) a sense of purpose and commitment to the caregiving role, (c) feelings of gratification when the care-recipient (CR) was functioning relatively well, (d) mastering skills to handle the CR, (e) increased patience and tolerance, (f) cultivating positive meanings and humor amidst difficult circumstances, (g) letting go of things, such as when the CR's qualities had been lost or personal agenda had become unrealistic, (h) developing a closer relationship with the CR, (i) finding support, and (j) feeling useful helping other caregivers. IMPLICATIONS: In addition to treating negative outcomes such as depression, practitioners and researchers should, identify means to promote positive gains. Strategies mentioned in the caregivers' diaries, such as reframing stressful situations in a more positive light, may provide input into the design of such interventions.

Asunto(s)

RESUMEN

PURPOSE: To describe an intervention promoting benefit-finding in Alzheimer caregivers, to discuss key issues in implementation and ways to resolve them, and to examine whether the intervention reduced burden and depression in a small randomized trial. DESIGN AND METHODS: Twenty-five caregivers were randomized into benefit-finding and psychoeducation groups. Both groups had eight weekly sessions. Outcome measures including role overload, Zarit Burden Interview, and Hamilton depression scale were collected at baseline and after treatment. Results were analyzed using analysis of covariance. Additionally, the challenges of implementing such interventions, some of which related to cultural issues, were analyzed qualitatively. RESULTS: Controlling for pretest, the benefit-finding group had lower depression than the psychoeducation group at post-test, despite the fact that some caregivers found benefit-finding challenging. The two groups did not differ on overload and burden. However, within-group analysis suggested that both groups showed significant reductions in overload from pretest to post-test. In addition, we discussed participants' difficulties in grasping the technique of thought modification for benefit-finding, recording such exercises at home, and sharing their thoughts and experiences in groups. We described measures undertaken in the main trial to overcome these issues. IMPLICATIONS: Cognitive approaches focusing on benefit-finding are feasible among Chinese caregivers, with preliminary evidence suggesting an effect on alleviating depression.

Asunto(s)

RESUMEN

BACKGROUND: Caregivers of relatives with Alzheimer's disease are highly stressed and at risk for physical and psychiatric conditions. Interventions are usually focused on providing caregivers with knowledge of dementia, skills, and/or support, to help them cope with the stress. This model, though true to a certain extent, ignores how caregiver stress is construed in the first place. Besides burden, caregivers also report rewards, uplifts, and gains, such as a sense of purpose and personal growth. Finding benefits through positive reappraisal may offset the effect of caregiving on caregiver outcomes. DESIGN: Two randomized controlled trials are planned. They are essentially the same except that Trial 1 is a cluster trial (that is, randomization based on groups of participants) whereas in Trial 2, randomization is based on individuals. Participants are randomized into three groups - benefit finding, psychoeducation, and simplified psychoeducation. Participants in each group receive a total of approximately 12 hours of training either in group or individually at home. Booster sessions are provided at around 14 months after the initial treatment. The primary outcomes are caregiver stress (subjective burden, role overload, and cortisol), perceived benefits, subjective health, psychological well-being, and depression. The secondary outcomes are caregiver coping, and behavioral problems and functional impairment of the care-recipient. Outcome measures are obtained at baseline, post-treatment (2 months), and 6, 12, 18 and 30 months. DISCUSSION: The emphasis on benefits, rather than losses and difficulties, provides a new dimension to the way interventions for caregivers can be conceptualized and delivered. By focusing on the positive, caregivers may be empowered to sustain caregiving efforts in the long term despite the day-to-day challenges. The two parallel trials will provide an assessment of whether the effectiveness of the intervention depends on the mode of delivery. TRIAL REGISTRATION: Chinese Clinical Trial Registry (http://www.chictr.org/en/) identifier number ChiCTR-TRC-10000881.

Asunto(s)

RESUMEN

This study aims at investigating whether a gratitude induction procedure can reduce death anxiety and promote emotional well-being. Ninety Chinese undergraduate students were randomly assigned into one of three experimental conditions: gratitude, hassle, and neutral. In each condition, participants were instructed to spend 15-20 minutes to reflect on past events and to write up to five events of the designated category. Subsequently, they responded to measures of death anxiety and affect. Results showed that those in the gratitude condition reported much lower death anxiety than those in the neutral or the hassle group. However, gratitude had no effect on positive or negative affect. The findings suggest that the effect of gratitude may be specific to death anxiety, which does not occur in the context of the enhancement of overall emotional well-being.

Asunto(s)

RESUMEN

This study investigated whether a brief gratitude induction could reduce death anxiety. 83 Chinese older adults (mean age = 62.7, SD = 7.13) were randomly assigned into one of three conditions: gratitude, hassle, and neutral, in which they wrote different types of life events before responding to measures of death anxiety and affect. Participants in the gratitude induction reported lower death anxiety than the hassle and the neutral condition, whereas no difference was observed for the latter two conditions. There was no experimental effect on positive affect, and a significant effect on negative affect but which did not favor the gratitude condition. By reexamining life events with a thankful attitude, people may become less fearful of death due to a sense that life has been well-lived. Because gratitude can be induced using a very brief procedure, there are broad applications in clinical and health-care settings for the relief of death anxiety.