title: Short-Term Effects of a Gain-Focused Reappraisal Intervention for Dementia Caregivers: A Double-Blind Cluster-Randomized Controlled Trial.
abstract: 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.
authors.affiliation: Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong; Norwich Medical School, University of East Anglia, United Kingdom. Electronic address: takcheng@eduhk.hk.
authors.forename: Sheung-Tak
authors.initials: ST
authors.lastname: Cheng
authors.affiliation: Department of Psychology, Chinese University of Hong Kong, Hong Kong.
authors.forename: Helene H
authors.initials: HH
authors.lastname: Fung
authors.affiliation: Department of Psychiatry, University of Hong Kong, Hong Kong.
authors.forename: Wai Chi
authors.initials: WC
authors.lastname: Chan
authors.affiliation: Department of Psychiatry, Chinese University of Hong Kong, Hong Kong.
authors.forename: Linda C W
authors.initials: LC
authors.lastname: Lam
mesh_terms: D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D017281:Cost of Illness; D003704:Dementia / Q000523:psychology*; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000523:psychology / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D000067656:Optimism / Q000523:psychology; D017063:Outcome Assessment, Health Care; D012056:Reinforcement, Social; D020377:Self Efficacy; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology
keywords: cluster-randomized controlled trial; dementia caregiving; depression; positive aspects of caregiving