Noticing the Silver Lining in Caring for Someone with Dementia
Monday, July 29th, 2019
Of the near half a million Australians currently living with dementia, 91% of these individuals rely on the informal unpaid support of a family member or friend [1]. Most people with dementia and their families prefer that the person with the condition remain living at home for as long as possible; yet, without adequate support services in place, the demands of caring for someone with dementia can be stressful and take its toll on both the carers’ and their loved ones’ health.
Positive Vs Negative
Most community interventions to support carers in their role, focus on reducing negative emotions and burden [2]. However, over the past few decades, it has become clear that positive emotions are uniquely related to better wellbeing, independent of the effects of negative emotions. A team of researchers developed this idea into an online training program to help dementia caregivers focus on the positives of their experience.
Crossover Trial
In a recently published trial of the program, 170 dementia caregivers were randomly assigned to either the intervention group in which they spent six weeks learning positive emotion skills, or to a control group in which they completed a daily feelings survey [3]. After the initial six weeks, the control group were also given the intervention. The skill sessions were presented by a trained facilitator via a web conference-call on tablets provided to each volunteer. All volunteers filled out questionnaires about their depression, anxiety, physical health and caregiver burden at the start and end of the study period.
Thinking Positively
The eight techniques taught in the study were:
- Noticing one positive event each day.
- Savouring that positive event, by writing it down or telling someone about it.
- Starting a daily gratitude journal
- Identifying a personal strength each day and reflecting on how one used it
- Setting an attainable goal each day and tracking one’s progress
- Reporting a relatively minor stressor each day and reframing it into something more positive.
- Performing a small daily act of kindness
- Practicing mindfulness through paying attention to everyday activities like brushing teeth or washing the dishes, or concentrating on one’s breath for ten minutes.
Improved mood
Participants in the intervention group went from showing moderate symptoms of depression to being within the normal range of depressive symptoms relative to the population. In contrast, participants in the control group showed a smaller decrease in depression scores, staying in the mild to moderate range. Participants in the intervention group also reported improvements in positive emotions, anxiety, physical health and positive attitudes towards caregiving, compared to control participants. There was no difference between groups in change in caregiving burden or perceived stress.
Chin up! P*ss off!
The study was of a high standard, meeting five of six global quality standards. However, we do not know how long the effects of the program might last, as there were no follow-up assessments beyond the program end. Also, the authors recognise that declaring the importance of positive affect can seem to minimise the pain and complex issues faced by people with dementia and their caregivers. The research team are quick to point out that they are not advocating for a simplistic “don’t worry, be happy” approach, but rather the view that people can experience positive emotion alongside negative emotion, and that positive emotion might help us to cope better. Future studies can assess whether self-guided versions of the online program, without a facilitator, might have similar impacts on caregiver outcomes. In a country as large as Australia, this could be a cost-effective way to reach carers living in the nation’s more regional and rural areas.
[1] https://www.dementia.org.au/files/NATIONAL/documents/Alzheimers-Australia-Numbered-Publication-42.pdf
[2] https://journals.sagepub.com/doi/10.1037/1089-2680.2.3.300
[3] https://www.ncbi.nlm.nih.gov/pubmed/31045422
