Mobile Web-based Behavioral Intervention for Improving Caregiver Well-being

Over 15 million men and women provide informal caregiving services to family members who have
dementia. The literature is replete with evidence that caregiving results in high rates of
depression and distress, and potentially high rates of physical morbidity. For example, 40%
of caregivers are at risk for depression compared to just 5% of non-caregiving older adults.
Further, increased symptoms of depression and distress in caregivers are associated with
accelerated risk for developing cardiovascular disease. Thus, efficacious interventions for
reducing caregiver distress appear potentially valuable for both mental and physical
well-being.

Given the distress experienced by caregivers, it is no surprise that over 80 intervention
studies for reducing caregiver distress have been published. The message from these studies
is that caregiver interventions, in general, are effective for reducing distress. Yet, the
implementation of Evidence Based Treatments (EBTs) continues to be a challenge. Despite
identification of EBTs, their use at the community-level has been absent. In 2007, NIH
sponsored a workshop on the use of EBTs for caregivers. The conclusion was that "The majority
of effective interventions for caregivers were not being implemented through the aging
network." Ten years later, this lack of implementation remains. It is critical that
scientists develop interventions for caregivers with maximal reach and minimal cost.
Currently, most caregiver intervention frameworks require caregivers to meet with a therapist
in one of four formats: a) face-to-face meetings with a therapist outside the caregiver's
home, b) face-to-face meetings with a therapist in the caregiver's home, c) in-person,
group-based meetings, or d) phone-based interventions in which caregivers call a therapist or
support group. While possibly efficacious, these therapeutic formats are limited because: a)
community agencies serving caregivers do not offer EBTs, b) the interventions are often not
accessible to caregivers who reside outside the care network, c) they require caregivers to
attend therapy sessions on specific days and times that may not be convenient for them, or d)
they may require caregivers to find alternate care for their care recipients while they
attend the therapy. To address these limitations, the investigators have adapted an
evidence-based, brief Behavioral Activation (BA) program to be delivered to caregivers via
mobile phones with internet-based capabilities, thereby increasing caregivers' access to
quality care. This mobile intervention is now being tested in this full-scale trial. The
investigators will test mechanisms of action, namely that increased behavioral activation
promotes well-being in caregivers. To do so, the investigators will recruit and randomize 200
caregivers to receive either a mobile BA intervention (N = 100) known as the mobile pleasant
events program (mPEP), or a web-based bibliotherapy condition (N = 100) teaching skills on
coping with caregiving. Participants will be assessed for depressive symptoms, positive and
negative affect, well-being, and blood pressure at baseline, 3-months, 9-months, and
15-months follow-up time points.

Inclusion Criteria -

- English-speaking

- Spouse or Child Caregiver of a loved-one with Alzheimer's Disease or Related Dementia
(ADRD)

- Aged 40 years or older at the time of enrollment

- Providing at least 20 hours of in-home care per week

- Screening positive for mild depressive symptoms (CESD-R≥16).

Exclusion Criteria -

- Diagnosed with a terminal illness

- Demonstrates cognitive impairment (MMSE<27)

- Severe hypertension (>200/120 mm Hg)

- Participating in another active caregiver intervention (other than support groups)

- Receiving psychiatric care for serious mental illnesses such as schizophrenia or
bipolar disorder