Cheng Sheung-Tak, Fung Helene H, Chan Wai Chi, Lam Linda C W
Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong; Norwich Medical School, University of East Anglia, United Kingdom.
Department of Psychology, Chinese University of Hong Kong, Hong Kong.
Am J Geriatr Psychiatry. 2016 Sep;24(9):740-50. doi: 10.1016/j.jagp.2016.04.012. Epub 2016 Apr 29.
To examine the effects of a benefit-finding intervention, the key feature being the use of gain-focused reappraisal strategies to find positive meanings and benefits in caring for someone with dementia.
In a cluster-randomized, double-blind, controlled trial conducted in social centers and clinics, 129 caregivers aged 18 + and without cognitive impairment, providing at least 14 care hours per week to a relative with mild-to-moderate Alzheimer disease, and scoring ≥ 3 on the Hamilton Depression Rating Scale were studied. Exclusion criterion was care recipient having parkinsonism or other forms of dementia. The benefit-finding intervention was evaluated against two treatment-as-usuals, namely, simplified psychoeducation (lectures only) and standard psychoeducation. Each intervention lasted 8 weeks, with a 2-hour session per week. Randomization into these conditions was based on center/clinic membership. Primary outcome was depressive symptom. Secondary outcomes were Zarit Burden Interview, role overload, and psychological well-being. Self-efficacy beliefs and positive gains were treated as mediators. Measures were collected at baseline and post-treatment.
Regression analyses showed benefit-finding treatment effects on all outcomes when compared with simplified psychoeducation and effects on depressive symptoms and Zarit burden when compared with standard psychoeducation. Effect sizes were medium-to-large for depressive symptoms (d = -0.77 to -0.96) and medium for secondary outcomes (d = |0.42-0.65|). Furthermore, using the bootstrapping method, we found significant mediating effects by self-efficacy in controlling upsetting thoughts and positive gains, with the former being the primary mediator.
Finding positive gains reduces depressive symptoms and burden and promotespsychological well-being primarily through enhancing self-efficacy in controlling upsetting thoughts.
探讨一项益处发现干预措施的效果，其关键特征是运用聚焦收获的重新评估策略，在照顾痴呆症患者的过程中寻找积极意义和益处。
在社会中心和诊所进行的一项整群随机、双盲、对照试验中，研究了129名年龄在18岁及以上且无认知障碍的照料者，他们每周为患有轻至中度阿尔茨海默病的亲属提供至少14小时的照料，且汉密尔顿抑郁量表评分≥3分。排除标准是受照料者患有帕金森病或其他形式的痴呆症。将益处发现干预措施与两种常规治疗方法进行比较评估，即简化心理教育（仅讲座）和标准心理教育。每种干预持续8周，每周进行一次2小时的课程。根据中心/诊所成员身份随机分配到这些条件中。主要结局是抑郁症状。次要结局是扎里特负担访谈、角色过载和心理健康。自我效能信念和积极收获被视为中介变量。在基线和治疗后收集测量数据。
回归分析显示，与简化心理教育相比，益处发现干预措施对所有结局均有治疗效果；与标准心理教育相比，对抑郁症状和扎里特负担有治疗效果。抑郁症状的效应量为中到大型（d = -0.77至-0.96），次要结局的效应量为中型（d = |0.42 - 0.65|）。此外，使用自抽样法，我们发现自我效能在控制烦扰性思维和积极收获方面有显著的中介作用，前者是主要中介变量。
发现积极收获主要通过增强控制烦扰性思维的自我效能来减轻抑郁症状和负担，并促进心理健康。
