Mechanisms of action of a psychological intervention for dementia caregivers: effects of behavioral activation and modification of dysfunctional thoughts

Abstract

OBJECTIVE: Different studies show the negative effects on caregivers' health of maladaptive thoughts and the positive effects of engaging in pleasurable activities on distress. The aim of this study is to (a) test the efficacy of a cognitive-behavioral intervention aimed at training caregivers to flexibilize maladaptive thoughts regarding caregiving and increasing their leisure activities and to (b) analyse the mediator role in the effects of the intervention of caregivers' change in dysfunctional thoughts and behavioral activation. METHODS: A total of 170 caregivers were contacted and randomly distributed to the intervention condition or to the control group. Depression, behavioral activation, and dysfunctional thoughts were assessed at baseline and post-intervention by 'blinded' interviewers. The intervention consisted in twelve group based sessions in which in addition to cognitive-behavioral techniques, caregivers' were trained in basic principles for caring for a relative with dementia. RESULTS: Significant intervention by time effects were found for depression, dysfunctional thoughts and frequency of leisure activities. Only significant positive effects were found for the intervention group. The regression analysis for testing mediational effects of dysfunctional thoughts and leisure activities on the relationship between participating on the intervention and changes in depressive symptomatology show that mediation is established in both cases. CONCLUSIONS: The results of our study contribute to the literature on interventions for dementia caregivers highlighting the positive mediator effect that modifying caregivers' dysfunctional thoughts and increasing their behavioral activation has on caregivers' depressive symptomatology.