Biobehavioral mechanisms of smartphone-based cognitive emotion regulation training for unpaid primary caregivers of persons with Alzheimer's Disease

项目摘要/摘要 阿尔茨海默病(AD)和阿尔茨海默病相关痴呆症(ADRD)不仅会导致严重的 在给患者造成损失的同时，他们还给未付费用的人带来了巨大的情感、身体和经济负担，通常 家人，照顾者。为被诊断为阿尔茨海默病的亲人提供护理的压力，通常跨越几年， 与抑郁症风险升高和整体健康状况较差有关。现有的认知和行为 仍有待澄清。此外，现有干预措施针对许多组成部分和战略。 同时，使对特定策略的有效性的推论难以得出，并涉及 巨大的时间/成本负担。情绪调节技能是心理干预的理想靶点 促进ADRD照顾者的健康应对。这项拟议的研究试图使用一种实验医学 测试一种新的、相对简短的、有针对性的、可扩展的 完全基于智能手机的认知情绪调节干预，旨在改善心理 ADRD无偿服务的结果(即减少感知的压力、照顾者负担和抑郁症状) 主要照顾者以及检查照顾者干预对护理生活质量的潜在好处 收件人。认知再评价(即通过思考改变情绪反应轨迹的能力 以一种替代的、更适应的方式了解和评估情绪信息)代表了一种高度 ADRD照顾者心理干预前景看好。重新评估可以通过以下两种方式实现 主要策略：心理疏远(即客观、公正地评价情绪刺激 (观察员)和重新解释(即想象一个比最初看起来更明显的结果)。这个 拟议的项目建立在有希望的初步工作的基础上，以调查有效性和潜在的 一种新的、为期一周的认知重新评估干预在该人群中的生物行为机制， 分别于2周、4周、3个月进行随访评估。ADRD无偿主要照顾者将随机 被指派接受疏导、重新解释或无规则自然历史控制方面的培训 条件，通过自我报告的积极和消极影响的生态瞬时评估，远程- 收集的与心理生理健康相关的生物标记物(即，使用 基于智能手机的照片体积描记术)和与健康相关的问卷报告。建议进行的研究 目的是将心理和心理生理功能的变化与预测 一种新的情绪调节干预措施实施后的健康相关行为结果 在这个压力很大的高风险群体中。

Project Summary / Abstract Alzheimer’s Disease (AD) and Alzheimer's Disease-Related Dementias (ADRD) not only exact a heavy toll on patients, they also impose an enormous emotional, physical, and financial burden on unpaid, often family, caregivers. The strain of providing care for a loved one diagnosed with AD, often across several years, is associated with elevated depression risk and poorer overall health. Existing cognitive and behavioral intervention approaches for ADRD unpaid primary caregivers operate via biobehavioral mechanisms that remain to be clarified. In addition, existing interventions target many components and strategies simultaneously, making inferences about the effectiveness of particular strategies difficult to draw, and involve substantial time/cost burdens. Emotion regulation skills represent an ideal target for psychological intervention to promote healthy coping in ADRD caregivers. The proposed research seeks to use an experimental medicine approach to test the efficacy and biobehavioral mechanisms of a novel, relatively brief, targeted, scalable, entirely smartphone-based cognitive emotion regulation intervention aimed at improving psychological outcomes (i.e., reducing perceived stress, caregiver burden, and depressive symptoms) in ADRD unpaid primary caregivers as well as examine potential benefits of the caregiver intervention on quality of life in care recipients. Cognitive reappraisal (i.e., the ability to modify the trajectory of an emotional response by thinking about and appraising emotional information in an alternative, more adaptive way) represents a highly promising target for psychological intervention in ADRD caregivers. Reappraisal can be operationalized via two primary tactics: psychological distancing (i.e. appraising an emotional stimulus as an objective, impartial observer) and reinterpretation (i.e., imagining a better outcome than what initially seemed apparent). The proposed project builds upon promising preliminary work to investigate the efficacy and underlying biobehavioral mechanisms of a novel, one-week cognitive reappraisal intervention in this population, with follow-up assessments at 2 weeks, 4 weeks, and 3 months. ADRD unpaid primary caregivers will be randomly assigned to receive training in either distancing, reinterpretation, or a no regulation natural history control condition, with ecological momentary assessments of self-reported positive and negative affect, remotely- collected psychophysiological health-related biomarkers (i.e., heart rate variability data measured using smartphone-based photoplethysmography), and health-related questionnaire reports. The proposed study aims to mechanistically relate changes in psychological and psychophysiological function to prediction of health-relevant behavioral outcomes during a novel emotion regulation intervention never before implemented in this stressed, high risk group.