Positive emotion skills yield benefits in physical, emotional health for dementia caregivers

Caring for family members with dementia causes significant emotional and physical stress that can increase a caregivers' risk of depression, anxiety, and death. Teaching individuals to focus on positive emotions led to reduced anxiety and depression, better self-reported physical health, and positive attitudes towards caregiving, according to a new paper published in the journal Health Psychology.

A research team from the Northwestern University Feinberg School of Medicine in Chicago, Illinois, designed an intervention, which included eight skills that evidence shows increase positive emotions. They include noticing and capitalizing on positive events, gratitude, mindfulness, positive reappraisal, personal strengths, attainable goals, and acts of kindness. Skills taught to participants in the study, according to the study abstract, include:

1. Recognizing a positive event each day
2. Savoring that positive event and logging it in a journal or telling someone about it
3. Starting a daily gratitude journal
4. Listing a personal strength each day and noting how you used this strength recently
5. Setting an attainable goal each day and noting your progress
6. Reporting a relatively minor stressor each day, then listing ways in which the event can be positively reappraised or reframed
7. Understanding small acts of kindness can have a big impact on positive emotion and practicing a small act of kindness each day
8. Practicing mindfulness through paying attention to daily experiences and with a daily 10-minute breathing exercise, concentrating on the breath

In the trial, 170 dementia caregivers were randomly assigned to either the intervention group in which they learned positive emotion skills, such as recognizing a daily positive event and keeping a gratitude journal, or to a control group in which they filled out a daily questionnaire about their emotions. The positive emotion skill sessions, called Life Enhancing Activities for Family Caregivers (LEAF), were presented by a facilitator via web conference.

In six weekly sessions, caregivers reviewed positive emotion skills and then had daily homework to practice the skills, including audio recordings. All participants filled out a questionnaire about their depression, anxiety, physical health, and caregiver burden at the start and completion of the study.

The researchers found LEAF participants had a 7 percent greater drop in depression and a 9 percent greater drop in anxiety compared to the control group. Participants in the intervention group decreased from showing moderate symptoms of depression relative to the population norm, to falling within the normal range of depressive symptoms by the post-intervention assessment. In contrast, participants in the control condition showed a smaller decrease in depression scores and remained within the mild to moderate range.

The positive-emotion intervention does not require a licensed therapist and can be widely implemented, making it accessible and affordable for busy caregivers, according to Judith Moskowitz, professor of medical social sciences and lead author of the study.

Most current approaches to helping caregivers focus on education about dementia or problem solving around challenging behaviors, she said, but haven't specifically addressed reducing the emotional burden of providing care.

Moskowitz said she wasn't sure how many caregivers would be able to complete the program, but they were engaged and committed, which speaks to how much they need programs like this, she said.

There are more than 5.8 million people in the U.S. and 44 million people worldwide living with Alzheimer’s disease, according to the Alzheimer’s Association. The average life expectancy post-diagnosis is eight to 10 years, although some people live as long as 20 years.

Moskowitz said she will launch a new study funded by the National Institute of Aging where she will compare the facilitated version of the intervention to a self-guided online version of the intervention. If the self-guided version is as effective as the facilitated one, she said the LEAF program can be implemented widely at relatively low cost to help the growing number of dementia caregivers in the U.S.