Pilot RCT of Mindfulness-Based Stress Reduction (MBSR) Versus Progressive Muscle Relaxation (PMR) to Reduce Symptoms of Distress Among Elderly Dementia Caregivers: Results at One Year Post-Intervention

Abstract

Providing care for a frail older adult who is suffering from dementia has been described as a stressful experience that may erode psychological well-being and physical health of caregivers. The burden and stress is increased when the caregivers are themselves elderly. The present study investigated an 8-week stress-reduction program, Mindfulness-Based Stress Reduction (MBSR), and compared it to a similarly structured, alternative behavioral intervention, Progressive Muscle Relaxation (PMR), to determine if MBSR was as effective or more effective than PMR at reducing subjective burden, symptoms of depression, perceived loneliness or perceived stress among middle-aged and older family caregivers of persons with dementia and other neurocognitive disorders. Twenty-eight participants were randomly assigned to either MBSR or PMR. Self-report and biological measures were collected on five occasions: At the beginning and end of intervention training, and at 8 weeks, 6 months and 1 year following the end of intervention training. In addition to a packet of self-report questionnaires and home-collected salivary cortisol, a laboratory controlled emotional stress test was designed to elicit an emotionally stressful response relevant to caregivers’ experience of caregiving, and facilitate the measurement of stress-related changes in systolic blood pressure and cortisol reactivity. At 1 year post-intervention, the PMR group showed a significantly greater reduction in perceived stress and disruptive patient behaviors. A reduction in emotional reactivity to patient problem behaviors approached significance (p = .08) at 1 year post-intervention for the PMR group. The MBSR group showed significantly greater reductions in self-reported symptoms of depression and perceived isolation from pre- to post-intervention, and those changes remained significant at 8 weeks post-intervention. However, by 1 year post-intervention, interaction effects were non-significant as both groups showed similar decreases in symptoms of depression and perceived isolation. Both groups showed similar decreases in diurnal cortisol, cortisol awakening response, and daily average cortisol (but not laboratory cortisol) from pre- to post-intervention and further decreases at 8 weeks post-intervention, and showed similar reductions in magnitude of change by 1 year post-intervention. This pattern was similar for both groups with systolic blood pressure, showing decreases from pre- to post-intervention, additional decreases at 8 weeks post-intervention, and returning towards baseline by 1 year post-intervention. Both groups also reported similar increases in levels of dispositional mindfulness and self-compassion and similar improvement in overall sleep quality that was sustained at 1 year post-intervention. No changes were seen for perceived burden or loneliness. Significant correlations with amount of daily practice of the instructed stress-reduction approaches were observed for several of the dependent measures from pre- to post-intervention and 8 weeks post-intervention. From pre-intervention to 1 year post-intervention, an overall pattern emerged, where both groups showed similar improvements from pre- to post-intervention, and additional improvements at 8 weeks post-intervention, but displayed a curvilinear reduction in improvements—with some exceptions—and a return towards baseline at 6 months and 1 year post-intervention. In general, reductions in the magnitude of changes observed by 1 year post-intervention remained below baseline levels. Results suggest that both MBSR and relaxation-based interventions may be differentially effective in reducing psychological and physiological indices of chronic stress among older caregivers of relatives with neurocognitive disorders. However, further research, employing wait-list control participants, will be necessary for unambiguous interpretation of the present results.