Caring for people with dementia (PWD) poses many challenges which may cause high levels of caregiver stress. This study aims to investigate the effects of a modified Mindfulness-based Cognitive Therapy for stress reduction in the family caregivers of PWD. A prospective, single-blind, parallel-group randomized controlled trial (RCT) of 76 family caregivers of PWD will be recruited and randomized to either the MBCT or the control groups.The primary outcomes (stress) and secondary outcomes (anxiety, depression, burden, quality of life and resilience) will be measured at immediate post-intervention (T1) and at 3 months follow up (T2) which will be compared with the baseline (T0). Mixed repeated measure MANOVA will be performed to assess the effects of time, group, and time-group interaction on all outcome measurements.To understand the therapeutic components and identify the strengths, limitations, and difficulties of the MBCT program, process evaluation will be conducted through focus group interviews with 15 participants from the MBI group. It is hypothesized that the MBCT group will have a significantly greater reduction of stress (primary outcome) and improvement in the secondary outcomes, namely depression, anxiety, and burden, at T1 and/or T2 than the control group.
Background: Caring for people with dementia (PWD) poses many challenges which may cause high levels of caregiver stress. Mindfulness-based intervention (MBI) is a newly adopted psychosocial intervention through an integration of the mind and body to reduce stress of the participants. A systematic review was conducted with five studies (four RCTs and one quasi-experimental study) to investigate the effect of MBI in stress reduction in the family caregivers of PWD. Of these, three trials involving 144 participants were eligible for the meta-analysis. The result showed that the stress levels dropped significantly after an 8-week MBI in the family caregivers of PWD with a moderate aggregated effect size of 0.57 (95% CI \[0.23, 0.92\], overall effect Z= 3.25 at p= 0.001). While MBI's immediate effect was found, the long term effect was unclear. Besides a limited number of clinical trials and several limitations (such as poor study design and small sample size) were also identified in this review. It signifies that more studies are still required to examine the effects of MBI for family caregivers of PWD. Since MBI is a new intervention for stress management among the family caregivers of PWD, a feasibility study was conducted between 2016 and 2017. It found that the family caregivers could master the mindfulness skill after the mindfulness sessions with a low attrition rate of 3.8%. A modified Mindfulness-based cognitive therapy (MBCT) protocol was also validated in the study to fit the local need and address the limitations identified in previous studies. Objective: This study aims to investigate the effects of a modified MBCT for stress reduction in the family caregivers of PWD in Hong Kong. Methods: A prospective, single-blind, parallel-group randomized controlled trial (RCT) of 76 family caregivers of PWD will be recruited and randomized to either the MBCT or the control groups. The MBI groups will receive a seven-week, group-based MBCT training whereas the control group will receive social interactions and routine education on dementia care program of a frequency and timing similar to those of the MBI group. The primary outcomes (stress) and secondary outcomes (anxiety, depression, burden, quality of life, resilience) will be measured at immediate post-intervention (T1) and at 3 months follow up (T2) which will be compared with the baseline (T0). Mixed repeated measure MANOVA will be performed to assess the effects of time, group, and time-group interaction on all outcome measurements. Both per-protocol (PP) and intention-to-treat (ITT) analysis will be performed in order to find out more factors affecting the use and effectiveness of MBCT such as non-compliance and acceptability. To understand the therapeutic components and identify the strengths, limitations, and difficulties of the MBCT program, process evaluation will be conducted through focus group interviews with 15 participants from the MBI group. It is hypothesized that the MBCT group will have a significantly greater reduction of stress (primary outcome) and improvement in the secondary outcomes, namely anxiety, depression, burden, quality of life, and resilience at T1 and/or T2 than the control group. Significance and Value: Reducing the caregiving stress level can promote the well-being of the family caregivers to maintain their sustainability in terms of providing daily care for their family members with dementia for a longer period of time. Evidence shows a minimal and short term effects of other psychosocial interventions (such as respite care, mutual support group) for reducing caregivers' stress. On the other hand, the MBCT is found effective in stress reduction in other populations. This finding is also supported by a feasibility study of using the MBI in family caregivers of PWD. The results of this study may be able to provide us with evidence for using MBCT as a standard supportive intervention for the family caregivers of PWD.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
113
Compared with the original protocol of Mindfulness-based Cognitive Therapy (Segal et al., 2002), the modified MBCT protocol in this pilot study has the following changes: Outline: Session 1 Awareness and automatic pilot: Session 2 Living in our head Session 3 Gathering the scattered mind Session 4 Recognizing aversion \& allowing Session 5 Thoughts are not facts Session 6 Take care of myself Session 7 Maintaining and extending new learning
The SIRE program includes routine education sessions on dementia care, caregiver skills training, and group sharing on caregiving tasks. Outline: 1. Overview of dementia 2. Pharmacological and non-pharmacological treatment of dementia 3. BPSD in dementia care 4. Person center care 5. Advance planning in people with dementia 6. Principle of mindfulness 7. Non-pharmacological intervention on stress reduction
Patrick Kor
Hong Kong, Hong Kong
Change of Perceived Stress Scale (PSS)
Perceived Stress Scale contains 10 items with 5-point Likert-type scale rating from 0 (never) to 4 (very often). The total score can range from 0 to 40 with higher scores indicating higher perceived stress. Comparisons of changes of Perceived Stress Scale will be considered as follows: T0 - T1; T0 - T2; T1 - T2
Time frame: At baseline (T0), 10th week (immediately post- intervention; T1), and 3 months after the intervention (follow-up assessment, T2)
Zarit Burden Scale (ZBI).
Zarit Burden Scale comprises of 22 items including factors most frequently mentioned by caregivers as problem areas such as carer's health, psychological well-being, and the relationships between the carer and the patient with dementia. The score can range from 0 to 88. A higher score indicates greater carer distress. Comparisons of changes of Zarit Burden Scale will be considered as follows: T0 - T1; T0 - T2; T1 - T2
Time frame: At baseline (T0), 10th week (immediately post- intervention; T1), and 3 months after the intervention (follow-up assessment, T2)
Change of Center for Epidemiologic Studies Depression Scale (CESD)
Center for Epidemiologic Studies Depression Scale is a self-reported measure of depression containing 20 items. It measures the common symptoms of depression in term of depressed mood, feelings of guilt and worthlessness, and feelings of helplessness. The scores can range from 0 to 60 and higher CESDS scores indicate increasing levels of depression. Comparisons of changes of Center for Epidemiologic Studies Depression Scale will be considered as follows: T0 - T1; T0 - T2; T1 - T2
Time frame: At baseline (T0), 10th week (immediately post- intervention; T1), and 3 months after the intervention (follow-up assessment, T2)
Change of Hospital Anxiety and Depression Scale (HADS)
The level of anxiety will be measured by the Hospital Anxiety and Depression Scale which is a 7-item self-report instrument including specific items that assess generalized anxiety including tension, worry, fear, panic, difficulties in relaxing, and restlessness. The scores range from 0 to 21 and higher scores indicate increasing levels of anxiety Comparisons of changes of Hospital Anxiety and Depression Scale will be considered as follows: T0 - T1; T0 - T2; T1 - T2
Time frame: At baseline (T0), 10th week (immediately post- intervention; T1), and 3 months after the intervention (follow-up assessment, T2)
Change of Brief Resilience Scale (BRS)
The level of resilience (the ability to bounce back or recover from stress) will be measured by the Brief Resilience Scale, which is a 6-item, self-report and 5-point rating scale. The scores can range from 6 to 30 with higher scores indicating higher level of resilience. Comparisons of changes of Brief Resilience Scale will be considered as follows: T0 - T1; T0 - T2; T1 - T2
Time frame: At baseline (T0), 10th week (immediately post- intervention; T1), and 3 months after the intervention (follow-up assessment, T2)
Change of 12-Item Short Form Health Survey
Caregivers' health-related quality of life will be measured by 12-Item Short Form Health Survey. It contains twelve questions and ranges from 0 to 100, where a zero score indicates the lowest level of healthmeasured by the scales and 100 indicates the highest level of health Comparisons of changes of 12-Item Short Form Health Survey will be considered as follows: T0 - T1; T0 - T2; T1 - T2
Time frame: At baseline (T0), 10th week (immediately post- intervention; T1), and 3 months after the intervention (follow-up assessment, T2)
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