Reducing CVD Risk in Caregivers: A Brief Behavioral Activation Intervention

描述（由申请人提供）：由于老龄化社会，预计在未来二十年，被诊断患有痴呆症的人数将急剧增加，随之而来的是，为亲人提供非正式照顾的家庭成员数量也会增加。与这种护理有关的压力已在科学文献中得到充分记录，并指出与心理和身体疾病，特别是心血管疾病的风险增加有关。事实上，护理与负面情绪（如抑郁和焦虑症状）的升高有关，这反过来又与被认为预测心血管疾病风险的生物指标（如凝血、内皮损伤或炎症标志物）有关。本研究的主要目的是检查一种简短的行为激活治疗（BAT），称为愉快事件计划（PEP）的有效性，以降低配偶阿尔茨海默病护理者的生物心血管疾病风险指标。我们还将研究这种干预是否成功地改变了交感肾上腺髓质（SAM）的激活，SAM是将压力和影响与CVD风险生物标志物联系起来的一种机制。我们将招募100名痴呆症护理人员，并随机分配他们接受4次PEP或4次支持+信息。我们的PEP干预将在照顾者的家中进行，并将强调监测和增加活动的重要性，这些活动有助于个人与环境中的自然强化物接触，识别和减少消极的应对反应，以及选择和实现更健康生活的行为目标。护理人员将在基线、6周和12周评估我们的生物学结果，以确定干预效果。鉴于PEP干预的简短性质，它可以很容易地应用于现实环境中（例如，社区机构向护理人员提供服务），并且干预人员和护理人员缺乏困难的技能，我们相信我们的PEP干预将很容易转移到“现实世界”的环境中。如果我们的PEP干预是有效的，它可能会对照顾者的身心健康产生相当大的影响，并可能对公共卫生产生影响。

DESCRIPTION (provided by applicant): Due to an aging society, the number of people diagnosed with dementia is expected to increase dramatically over the next two decades, with a concomitant rise in the number of family members providing informal care for their loved ones. The stresses associated with this care have been well-documented in the scientific literature, and are noted to be associated with increased risk for psychological and physical morbidity, particularly cardiovascular disease. Indeed, caregiving is associated with elevations in negative affect (e.g., depressive and anxiety symptoms), which in turn is associated with biological indicators that are thought to predict CVD risk (e.g., markers of coagulation, endothelial injury, or inflammation). The primary goal of this study is to examine the efficacy of a brief Behavioral Activation Treatment (BAT), called the Pleasant Events Program (PEP), for reducing biological CVD risk indicators in a sample of spousal Alzheimer caregivers. We will also examine whether this intervention is successful for modifying Sympathoadrenal Medullary (SAM) activation, which is one mechanism linking stress and affect to CVD risk biomarkers. We will enroll 100 dementia caregivers and randomly assign them to receive 4-sessions of PEP or 4-sessions of support + information. Our PEP intervention will be conducted in caregivers' homes and will emphasize the importance of monitoring and increasing activities that help individuals make contact with natural reinforcers in their environments, identifying and reducing negative coping responses, and selection and achievement of behavioral goals for healthier living. Caregivers will be assessed for our biological outcomes at baseline, 6-, and 12-weeks to determine intervention efficacy. Given the brief nature of the PEP intervention, the ease with which it can be applied in real-world settings (e.g., community agencies providing services to caregivers), and lack of difficult skills for interventionists and caregivers to acquire, we believe our PEP intervention will be easily transferred to "real-world" settings. If our PEP intervention is efficacious, it may have a considerable impact on both the physical and mental health of caregivers, and will likely have public health implications. Public Health Relevance: Cardiovascular disease and depression are some of the most costly illnesses to society, and caring for a loved-one with Alzheimer's disease has been associated with increased risk for both depression and cardiovascular disease. Indeed, depressive symptoms have been linked with elevated plasma concentrations of D-dimer, Interleukin-6 (IL-6), and von Willebrand Factor (vWF), all of which are associated with increased risk for cardiovascular disease (CVD). The present research tests a brief behavioral intervention for reducing both depressive symptoms and CVD biomarkers in Alzheimer caregivers. If successful, this intervention may help improve overall physical and mental health in this population, can be easily implemented into community-based organizations, and ultimately reduce the impact of these conditions on caregivers and society.