Mindfulness and guided imagery for depressed family caregivers of patients with Alzheimer's disease and related dementias: clinical outcomes and neural mechanisms

阿尔茨海默病和相关痴呆症患者抑郁家庭护理人员的正念和引导意象：临床结果和神经机制

• 批准号: 9655650
• 负责人: Felipe A. Jain
• 金额: $ 10.99万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-09-01 至 2019-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9655650
• 关键词: Mindfulness; guided; imagery; depressed; family

Family caregivers of patients with Alzheimer’s disease and related dementias are a vulnerable population at increased risk of physical and psychological complications due to increased stress. Notably, caregivers who report psychological stress are at a greater risk of early death relative to non-caregivers, whereas unstressed caregivers do not share this risk. Increased mortality, lower immunity, and increased depression – all of which are found in caregivers of family members with Alzheimer’s disease – indicate that caregiving stress interferes with the process of normal biological aging. Psychological symptoms in caregivers also increase the risk of institutionalization of the relative with dementia. It is therefore crucial to develop interventions that can lower caregiver stress and reduce depression, and to understand neural mechanisms of improvement. Central Meditation and Imagery Therapy for Caregivers (CMIT) is a 4-week group mindfulness and guided imagery group therapy intervention that aims to reduce negative psychological symptoms such as depression and stress, and promote healthy aging. It was designed as a brief intervention to fit with caregivers’ busy schedules. CMIT provides practical relaxation and mindfulness techniques that aid with individual peace of mind, and also improve perspective taking with participants’ loved ones with dementia. These benefits combined may bolster caregivers’ mental and social functioning as they age. We obtained feasibility data from a small, controlled trial of CMIT (N = 20) with depressed caregivers of family members with Alzheimer’s disease and related dementias, that demonstrated a large effect of CMIT relative to a relaxation control condition on reducing caregiver depression, and provided preliminary evidence in a subset of caregivers (N = 8) that CMIT may effect structural and functional brain changes. With this R21 grant, we will conduct a randomized, controlled, single-blind pilot clinical trial of 50 depressed caregivers, and obtain neuroimaging to determine mechanisms of caregiver improvement relative to a support group. We hypothesize that CMIT will have moderately greater effects on reducing caregiver depression than a support group, and that participants in CMIT but not the support group will demonstrate changes in brain structure and function. These hypotheses will be tested with our Specific Aims: (1) Determine an effect size of CMIT for the treatment of depression symptoms in caregivers with Alzheimer’s disease and related dementias relative to a support group, (2) Identify brain circuits that correlate with improvement from pre to post intervention, (3) Determine whether structural brain changes are associated with improvement of caregiver depression with CMIT over 4 weeks. These experiments may help to establish a new, brief therapy for caregiver depression and understand neural mechanisms of improvement to help guide future research.

阿尔茨海默氏病和相关痴呆症患者的家庭护理人员是脆弱的人群，由于压力增加而导致身体和心理并发症的风险增加。值得注意的是，报告心理压力的护理人员相对于非照顾者，早期死亡的风险更大，而无压力的护理人员则没有这种风险。死亡率增加，免疫力降低和抑郁症增加 - 所有这些都在患有阿尔茨海默氏病的家庭成员的照料者中发现 - 表明护理应力干扰正常生物学衰老的过程。护理人员的心理症状还增加了痴呆症的亲戚制度化的风险。因此，至关重要的是制定可以降低护理人员压力并减少抑郁症的干预措施，并了解改善的神经机制。护理人员的中央冥想和图像疗法（CMIT）是一个为期4周的小组正念和指导的图像组治疗干预措施，旨在减少抑郁症和压力等负面心理症状，并促进健康的衰老。它被设计为简短的干预措施，以适合看护人的繁忙日程。 CMIT提供了实用的放松和正念技巧，可帮助您个人的安心，并改善参与者患有痴呆症的亲人的观点。随着年龄的增长，这些好处可能会增强护理人员的心理和社会功能。我们从CMIT（n = 20）的小型，对照试验中获得了可行性数据，患有阿尔茨海默氏病和相关痴呆症的家庭成员的抑郁症患者表明，这表明CMIT相对于减少护理人员抑郁症的放松控制条件的影响很大，并且在减少护理人员的抑郁症上，并提供了Caregers（n = 8）的预先证据，可以使Careger（n = 8）具有效果和功能性的结构变化。借助此R21赠款，我们将对50名抑郁症护理人员进行随机，控制，单盲试验临床试验，并获得神经成像，以确定相对于支持组的护理人员改善的机制。我们假设CMIT对减少护理人员的抑郁症的影响将比支持组更大，而CMIT的参与者（但没有支持组）将证明大脑结构和功能的变化。这些假设将通过我们的具体目的进行测试：（1）确定CMIT的影响，用于治疗患有阿尔茨海默氏病和相关痴呆症相对于支持组的护理人员的抑郁症状的影响，（2）确定与干预前的改善相关的大脑回路，（3）确定结构性大脑变化是否与Caregement caregement caregiver caregiver caregiver carsiver cartiver smite contergiver consime spmit smitt contergiver consime cosive cosive aptive cocrects上均不足。这些实验可能有助于建立一种新的简短疗法，以治疗护理人员抑郁症，并了解改善的神经机制，以帮助指导未来的研究。

项目成果

Mentalizing Imagery Therapy Mobile App to Enhance the Mood of Family Dementia Caregivers: Feasibility and Limited Efficacy Testing.

心理意象疗法移动应用程序可增强家庭痴呆症护理人员的情绪：可行性和有限功效测试。

• DOI: 10.2196/12850
• 发表时间: 2019
• 期刊: JMIR aging
• 影响因子: 4.9
• 作者: Sikder,AbuTaher;Yang,FrancisCheng;Schafer,Rhiana;Dowling,GlennaA;Traeger,Lara;Jain,FelipeAnanda
• 通讯作者: Jain,FelipeAnanda

How family dementia caregivers perceive benefits of a 4-week Mentalizing Imagery Therapy program: a pilot study.

• DOI: 10.1037/pro0000388
• 发表时间: 2022-10
• 期刊: Professional psychology, research and practice
• 作者: Yang FC;Zamaria J;Morgan S;Lin E;Leuchter AF;Abrams M;Chang SE;Mischoulon D;Pedrelli P;Fisher L;Nyer M;Yeung A;Jain FA
• 通讯作者: Jain FA

Four-Week Mentalizing Imagery Therapy for Family Dementia Caregivers: A Randomized Controlled Trial with Neural Circuit Changes.

• DOI: 10.1159/000521950
• 发表时间: 2022
• 期刊: PSYCHOTHERAPY AND PSYCHOSOMATICS
• 影响因子: 22.8
• 作者: Jain, Felipe A.;Chernyak, Sergey V.;Nickerson, Lisa D.;Morgan, Stefana;Schafer, Rhiana;Mischoulon, David;Bernard-Negron, Richard;Nyer, Maren;Cusin, Cristina;Gomez, Liliana Ramireza;Yeung, Albert
• 通讯作者: Yeung, Albert