Department of Medicine, School of Medicine, Indiana University, 1101 West 10th Street, Indianapolis, IN, 46202, USA.
Division of General Internal Medicine, Geriatrics, and Palliative Care, Indianapolis, IN, 46202, USA.
BMC Geriatr. 2021 Feb 16;21(1):127. doi: 10.1186/s12877-021-02078-0.
Caregivers of patients with Alzheimer's disease or a related dementia (ADRD) report high levels of distress, including symptoms of anxiety and depression, caregiving burden, and existential suffering; however, those with support and healthy coping strategies have less stress and burden. Acceptance and Commitment Therapy (ACT) aims to foster greater acceptance of internal events while promoting actions aligned with personal values to increase psychological flexibility in the face of challenges. The objective of this single-arm pilot, Telephone Acceptance and Commitment Therapy Intervention for Caregivers (TACTICs), was to evaluate the feasibility, acceptability, and preliminary effects of an ACT intervention on ADRD caregiver anxiety, depressive symptoms, burden, caregiver suffering, and psychological flexibility.
ADRD caregivers ≥21 years of age with a Generalized Anxiety Disorder Scale (GAD-7) score ≥ 10 indicative of moderate or higher symptoms of anxiety were enrolled (N = 15). Participants received a telephone-based ACT intervention delivered by a non-licensed, bachelor's-prepared trained interventionist over 6 weekly 1-h sessions that included engaging experiential exercises and metaphors designed to increase psychological flexibility. The following outcome measures were administered at baseline (T1), immediately post-intervention (T2), 3 months post-intervention (T3), and 6 months post-intervention (T4): anxiety symptoms (GAD-7; primary outcome); secondary outcomes of depressive symptoms (Patient Health Questionnaire-9), burden (Zarit Burden Interview), suffering (The Experience of Suffering measure), psychological flexibility/experiential avoidance (Acceptance and Action Questionnaire-II), and coping skills (Brief COPE).
All 15 participants completed the study and 93.3% rated their overall satisfaction with their TACTICs experience as "completely satisfied." At T2, caregivers showed large reduction in anxiety symptoms (SRM 1.42, 95% CI [0.87, 1.97], p < 0.001) that were maintained at T3 and T4. At T4, psychological suffering (SRM 0.99, 95% CI [0.41, 1.56], p = 0.0027) and caregiver burden (SRM 0.79, 95% CI [0.21, 1.37], p = 0.0113) also decreased.
Despite a small sample size, the 6-session manualized TACTICs program was effective in reducing anxiety, suggesting that non-clinically trained staff may be able to provide an effective therapeutic intervention by phone to maximize intervention scalability and reach.
Institutional Review Board (IRB) protocol #1904631305 version 05-14-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019. Recruitment began 06-14-2019 and was concluded on 12-09-2019.
阿尔茨海默病或相关痴呆症（ADRD）患者的护理人员报告说他们的压力很大，包括焦虑和抑郁症状、照顾负担和存在性痛苦；然而，那些有支持和健康应对策略的人压力和负担较小。接受与承诺疗法（ACT）旨在促进对内部事件的更大接受，同时促进与个人价值观一致的行动，以提高面对挑战时的心理灵活性。这项单臂试验，电话接受与承诺疗法干预护理人员（TACTICs）的目的是评估 ACT 干预对 ADRD 护理人员焦虑、抑郁症状、负担、护理人员痛苦和心理灵活性的可行性、可接受性和初步效果。
患有广泛性焦虑症量表（GAD-7）得分≥10 分（表示有中度或更高程度的焦虑症状）的年龄在 21 岁及以上的 ADRD 护理人员（N=15）被招募。参与者接受了由非持牌、本科准备的培训干预者进行的基于电话的 6 周 1 小时的 ACT 干预，其中包括参与旨在提高心理灵活性的体验式练习和隐喻。在基线（T1）、干预后立即（T2）、干预后 3 个月（T3）和干预后 6 个月（T4）时进行以下结果测量：焦虑症状（GAD-7；主要结果）；抑郁症状（患者健康问卷-9）、负担（Zarit 负担访谈）、痛苦（痛苦体验量表）、心理灵活性/体验回避（接受和行动问卷-II）和应对技巧（简短应对技巧）的二级结果。
所有 15 名参与者均完成了研究，93.3%的参与者对他们的 TACTICs 体验总体满意度评为“完全满意”。在 T2 时，护理人员的焦虑症状明显减轻（SRM 1.42，95%CI[0.87，1.97]，p<0.001），并且在 T3 和 T4 时保持不变。在 T4 时，心理痛苦（SRM 0.99，95%CI[0.41，1.56]，p=0.0027）和护理人员负担（SRM 0.79，95%CI[0.21，1.37]，p=0.0113）也有所下降。
尽管样本量较小，但 6 节的规范化 TACTICs 方案对减轻焦虑有效，表明非临床培训人员可以通过电话提供有效的治疗干预，以最大限度地提高干预的可扩展性和可及性。
机构审查委员会（IRB）协议 #1904631305 版本 05-14-2019。招募于 2019 年 6 月 14 日开始，于 2019 年 12 月 9 日结束。
