A Toolkit Intervention for Alzheimer’s Caregivers: Effects on Preparedness, Burden, and Growth

Over 7 million Americans age 65 and older live with Alzheimer’s in the United States, and more than 11 million caregivers of people with Alzheimer’s disease or other dementias provided an estimated 18 billion hours of unpaid care valued at $340 billion (Alzheimer’s Association, 2023). This study implemented a new intervention called an "Awareness Toolkit" for Alzheimer's caregivers comprised of Alzheimer’s disease-related education, community resources, and support tailored to the county where care was provided, including caregiver self-care and coping tips. The aim of this study is to evaluate the impact of an Awareness Toolkit intervention and examine its influence on Alzheimer caregivers’ preparedness, burden, and personal growth. Methods Randomly assigned caregivers in the intervention group were informed about the Awareness Toolkit intervention, supplemented with social work case management services. Conversely, randomly assigned caregivers in the control group received this intervention upon the study's conclusion. A total of 51 completed surveys were returned, comprising 28 surveys from the intervention group and 23 surveys from the control group. Three measurements were used to measure levels of caregiver burden, preparedness, and growth: 1) Zarit Caregiver Burden Assessment (Zarit et al., 2001), 2) Preparedness for Caregiving Scale (Archbold et al., 1990), and 3) Posttraumatic Growth Inventory Short Form (Cann et al., 2010).

Posttraumatic growth as a buffer and a vulnerability for psychological distress in mothers who are breast cancer survivors

Background Prior research has indicated that posttraumatic growth (PTG) often co-occurs with symptoms of posttraumatic stress disorder (PTSD). However, it is yet unclear what longitudinal patterns of posttraumatic symptom levels may predict the development of PTG. Methods World Trade Center (WTC) rescue and recovery workers (2038 police and 2103 non-traditional responders) were assessed an average of 3, 6, 8, and 12 years post-9/11/2001. Responders’ WTC-related PTSD symptoms were characterized by No/Low Symptom, Worsening/Subtly Worsening, Steeply Worsening (only for non-traditional responders), Improving, and Chronic trajectories. PTSD symptom trajectories were examined as predictors of PTG, which was assessed using total scores on the Posttraumatic Growth Inventory-Short Form. Results Across both occupational groups, being female, older, Hispanic, and experiencing more post-9/11 traumatic events were independently associated with self-reported PTG. Among police responders, a greater number of WTC exposures and supportive family members while working at the WTC site were linked to higher PTG. Among non-traditional responders, Black race/ethnicity, less education, fewer pre-9/11 traumatic events, and the presence of support while working at the WTC site were additionally linked to higher PTG. Only the moderate PTSD symptom trajectories (ie, worsening and improving) for police responders and all symptomatic trajectories for non-traditional responders were associated with higher levels of PTG. Conclusions Symptomatic 12-year trajectories of PTSD symptoms and certain sociodemographic characteristics, stressor exposures, and supportive resources were associated with PTG in traditional and non-traditional WTC responders. Results provide insight into subgroups of WTC responders who may benefit from PTG-promoting interventions, as well as potentially modifiable targets to help foster PTG in this population.

Although the COVID-19 pandemic has been shown to be detrimental to mental health, it may hold a parallel potential for positive change. Little is known about posttraumatic growth (PTG) as a potential outcome for individuals with lived experience of psychiatric disorders following trauma exposure, especially in the context of the COVID-19 pandemic. Participants were 1,424 adults with lived experience of a psychiatric disorder who took part in a longitudinal study of mental health during the COVID-19 pandemic conducted by the National Centre for Mental Health. PTG was measured using the Posttraumatic Growth Inventory-Short Form (PTGI-SF). Factors hypothesized to be associated with PTG were investigated using linear regression. The mean participant PTGI score was 12.64 (SD = 11.01). On average, participants reported the highest scores on items related to appreciation of life and lowest on those related to spiritual change subscale. We found the strongest evidence of associations between higher levels of PTG and higher scores on assessment items related to perceived social support, B = 2.86; perceptions of the pandemic as traumatic, B = 4.89; and higher psychological well-being, B = 0.40. Taken together, we did not observe evidence of widespread PTG related to the COVID-19 pandemic among individuals with lived experiences of psychiatric disorders.

Family caregivers in cancer and palliative care often face heavy responsibilities and feel insufficiently prepared for the situation as caregivers. This study evaluates short-term and long-term effects of a psycho-educational group intervention aiming to increase preparedness for family caregiving in specialized palliative home care. The study design was a randomized control trial where family caregivers were allocated either to an intervention or control group. The intervention was delivered as a program including three sessions by health professionals (physician, nurse, and social worker/priest). Family caregivers from 10 specialized palliative home care settings were included. Questionnaires with validated instruments at baseline, upon completion, and 2 months following the intervention were used to measure effects of the intervention. The primary outcome was preparedness for caregiving in family caregivers. In total, 21 intervention programs were delivered, and 119 family caregivers completed all three measurements. The intervention group had significantly increased their preparedness for caregiving in both the short-term and long-term follow-up compared with the control group. The intervention group also reported significantly increased competence for caregiving in short-term but not long. No effects of the intervention were found on rewards for caregiving, caregiver burden, health, anxiety, or depression. The psycho-educational intervention has the potential to be used by health professionals to improve preparedness for caregiving among family caregivers in palliative care both in short and long terms. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

The diagnosis and treatment of cancer triggers not only a negative psychological response for the patient, but also a positive psychological outcome. Positive dyadic coping, as a form of coping for mental health outcomes, can maintain or reestablish internal stability between the patient and his or her spouse, resulting in positive physical and psychological changes. However, there is a paucity of research on body image, dyadic coping, and post-traumatic growth in breast cancer patients. The purpose of this study was to explore the relationship and pathways between body image, dyadic coping, and post-traumatic growth in breast cancer patients. A cross-sectional study was conducted from November 2022 to November 2023 at a tertiary care hospital in Wuxi, Jiangsu, China. This study was conducted among 154 breast cancer patients treated at the Affiliated Hospital of Jiangnan University, all of whom completed demographic and clinical information questionnaires, Body image self-rating questionnaire for breast cancer (BISQ-BC), Dyadic Coping Inventory (DCI) and Post Traumatic Growth Inventory (PTGI). A Pearson correlation analysis was used to explore the relationship between body image, dyadic coping, and post-traumatic growth. Structural equation modeling was used to analyze the path relationships among the three and to explore the mediating role of dyadic coping. The level of body image was negatively correlated with post-traumatic growth (r = -0.462, p < 0.01); and the level of body image was negatively correlated with dyadic coping (r = -0.308, p < 0.01). And dyadic coping was positively associated with post-traumatic growth (r = 0.464, p < 0.01). The structural equation modeling results supported the mediation model with the following model fit indices, chi-square to degrees of freedom ratio (χ2/df = 2.05), goodness of fit index (GFI = 0.93), comparative fit index (CFI = 0.99), canonical fit index (NFI = 0.93), incremental fit index (IFI = 0.99), non-canonical fit index (TLI = 0.99) and the root mean square of the difference in approximation error (RMSEA = 0.03). Body image and dyadic coping directly affected post-traumatic growth (β = -0.33, p < 0.05; β = 0.43, p < 0.05). And body image indirectly influenced post-traumatic growth through dyadic coping (β = -0.17, p < 0.05). Interconnections between body image, dyadic coping, and post-traumatic growth in breast cancer patients. A preliminary validation of the mediating role of dyadic coping between body image and post-traumatic growth, body image can have an impact on dyadic coping, which in turn can have an impact on post-traumatic growth. Whereby higher levels of dyadic coping in patients may also be associated with higher levels of post-traumatic growth, whereas body image disturbance may impede levels of post-traumatic growth.

Post-traumatic growth induced from cancer diagnosis and treatment could benefit the prognosis of cancer survivors, but intervention based on self-disclosure in group is limited. Aimed to examine the effectiveness of a supportive-expressive group intervention on post-traumatic growth. The impact of the intervention on anxiety and depression were also explored. This randomized clinical trial enrolled patients from June 2017 to September 2018 with a one-month follow-up. Data collectors were blinded to patient grouping. A single center study in Chengdu, China. One hundred sixty-eight participants who met the eligibility criteria were randomly assigned to the intervention group (n=84) or control group (n=84); 46 were excluded and 122 patients finished the one-month follow-up. Participants in the intervention group received nurse-led support intervention focusing on topics such as "Being a Patient", "Interpersonal Relationships", "Journey for Recovery", and "Planning the Future" while participants in the control group received health education, rehabilitation training etc. according to the nursing routine of breast cancer patients. The intervention was designed in accordance with the diagnosis and treatment process as well as patient needs. Participants in both groups were evaluated three times (T1-baseline before the intervention, T2-end of the intervention, and T3-1month follow up). Post-traumatic growth, anxiety and depression were evaluated. Participants in the intervention group reported higher level of post-traumatic growth (p<0.01 or 0.05) and reduced anxiety and depression (p<0.01 or 0.05 and p<0.01 or 0.05). The multilevel model indicated that the intervention significantly promoted post-traumatic growth (βT3 =7.87, p<0.05) and dimensions of relating to others (βT3 =4.26, p<0.001), personal strength (βT3 =4.27, p<0.01), appreciation of life (βT3 =8.69, p<0.001), and new possibilities (βT3 =1.91, p<0.05), anxiety (βT3 =-3.63, p<0.001), and depression (βT3 =-2.27, p<0.001), but had no effect on the dimension of spiritual change. In addition, the multi-level model showed that patients with younger ages (β=-0.05~-0.52, p<0.05-0.001), with high school and above education levels (β=1.53~9.29, p<0.01) and accompanied by husbands(β=-1.48~-8.51, p<0.05) had more effective intervention and patients with religious belief had a better spiritual change level (β=1.86, p<0.001). These findings provide evidence for the potential effectiveness of the nurse-led intervention on positive benefits of post-traumatic growth and relieved anxiety and depression for Chinese breast cancer survivors and will inform the design and development of a large randomized controlled trial. The supportive-expression group intervention can be applied independently by nurses. The four themes of self-disclosure can help patients grow after trauma, and this method can be used as a psychological support technique for breast cancer patients during hospitalization.

This study looked at the loss of a parent in adulthood and whether this was followed by post-traumatic growth? Participants, 100 bereaved adults, from Pakistan and England, lost parents in the last 10 years. They completed three questionnaires. The study hypotheses were, first, that participants whose bereavement occurred more than five years ago would show significantly higher levels of post-traumatic growth. Second, participants with higher levels of post-traumatic growth would experience significantly higher grief scores. Thirdly, participants with higher levels of post-traumatic growth would show significantly higher levels of coping skills. Two hypotheses were rejected, only one received partial support. Yet, levels of post-traumatic growth were high in this sample. Post-traumatic growth does not follow every bereavement. The authors provide autoethnographic material to challenge this. Circumstances surrounding bereavement during the Covid-19 pandemic, are more likely to lead to increases in complicated grief reactions, rather than post-traumatic growth.

Recent research indicates that 25%-30% of IBD patients experience chronic post-traumatic stress (IBD-PTS), which is linked to poorer health outcomes. Post-traumatic growth (PTG) refers to positive psychological changes resulting from coping with trauma or major life crises. PTG may mitigate the negative effects of IBD-PTS and may be influenced by disease activity. We aimed to explore the relationship between disease status, expectations about achieving and maintaining remission, and PTG among IBD patients. Adults (18+) with IBD participated in an online survey via Qualtrics, which included demographic information, the Patient Simple Clinical Colitis Activity Index (P-SCCAI), the Post-Traumatic Growth Inventory (PTGI), and the PTSD Checklist for DSM-5 (PCL-5). Participants indicated whether they were in remission or experiencing a flare and their expectations of having a flare in the next two months using a 4-point Likert scale. The study included 313 adults with IBD: 140 with ulcerative colitis (UC) and 173 with Crohn’s disease (CD), aged 18-70 years (M=33, SD=11), with 75.1% being female. Most participants had active disease and exhibited high levels of IBD-PTS. No significant correlation was found between P-SCCAI scores and PTG (r= -.09, p=.127). Those currently experiencing a flare (n=133, 42.4%) reported lower confidence in the longevity of their remission over the next two months compared to those in remission (Χ2=114.01, p&amp;lt;.001), but PTG levels did not differ significantly between groups (p=.310). However, participants confident in their remission status exhibited higher PTG levels (F(3,309)=4.688, p=.003). Participants who endorsed “I am positive I will experience a flare in the next two months” scored lower on PTG (M=65.91, SD=25.33) than those who endorsed “I am positive I will not experience a flare in the next two months” (M=81.52, SD=25.58; p=.004). Those who were at least 50% sure of another flare also showed lower PTG (M=69.99, SD=22.95) compared to the most confident group (p=.026). A linear regression confirmed that confidence in remission significantly influenced PTG levels (F(3,309)=4.688, p=.003), with less confident participants scoring 15.61 points lower on PTG than their most confident counterparts. IBD patients who are confident in remission are likely to have higher levels of PTG than those who are more pessimistic about their disease course independent of current symptom activity.Patients with confidence in remission longevity may conceptualize remission as an “end” to the threat of IBD-PTS, allowing PTG to occur. Conversely, if remission is seen as a temporary reprieve before the next inevitable flare, it may limit patients’ cultivation of PTG. Providers can help patients move towards a PTG mindset by assessing patients’ expectations of remission, modeling confidence, and providing evidence for ongoing hope. Results Table Key Finding

The need to understand posttraumatic growth (PTG) in relation to actual changes in an individual's life has recently been raised. However, the relationship of volunteering, health, and PTG has not yet been assessed. To assess the relationship of volunteer work, health, and PTG, and to assess whether cognitive and emotional processing, emotional expressing, and social support differ in volunteer and non-volunteer breast cancer survivors. Participants were 84 breast cancer survivors who had volunteered to work with newly diagnosed breast cancer patients and 40 breast cancer survivors who did not participate in any volunteer work. Participants completed the PTG inventory, the emotional expression and processing scale, the cognitive processing scale, and the multidimensional scale of perceived social support. Participants in both groups reported similar and relatively high levels of PTG (M = 70.22, SD = 17.38 in a possible range of 0-105). In the volunteer group, PTG levels were not related to self-reported health (r = 0.07, p>0.05), while in the non-volunteer group a high and significant correlation between self-reported health and PTG (r = 0.46, p<0.001), and a significant effect of group × self-reported health on PTG levels, were found. The study variables accounted for 31% of PTG variance, with cognitive and emotional processing and the interaction of group × health being significant predictors. Although volunteers did not differ from non-volunteers in PTG levels, higher PTG was related to better health in the non-volunteers group only. These findings point to the complexity of PTG structure and its multifaceted relation to behavior.

Introduction. Family caregiving preparedness remains a problem particularly for those who live in rural areas. Such conditions can cause a high burden for the family caregivers. The purpose of this study was to determine the effectiveness of providing home-based palliative care training for family caregivers (HBPC-FC) on caregiving preparedness and burden. Method. This was a quasi-experimental study using a pre-post test with the control group. There were 50 family caregivers (n=25 in the intervention group, n=25 in the controlled group) involved. The preparedness on caregiving was measured using the Caregiving Inventory (CGI) and burden was measured using Caregiving Burden Scale questionnaires. Results. After four weeks of HBPC-FC program, the caregiving preparedness improved significantly in the intervention group. Statistically significant differences in caregiving burden were also found between-group where caregiving burden in the intergention group decreased significantly (P &lt; 0.05). The HBPC-FC program had positive outcomes for family caregivers. Conclusion. Home-based palliative care training on symptom mangement could be utilised as a form to improve family caregivers’ readiness in providing care for patients at home.

This longitudinal study tested the effectiveness of a group intervention designed to facilitate posttraumatic growth (PTG). Sample consisted of 205 women diagnosed with non-metastatic breast cancer who were either assigned to an intervention group (n=58) or to a control group (n=147). PTG, challenge to core beliefs, and rumination (intrusive and deliberate) were assessed at baseline (T1), at 6months (T2), and at 12months after baseline (T3). Results from the Latent Growth Modeling suggested that participants from the intervention group have higher levels of PTG. The challenge to core beliefs and the intrusive rumination have a moderator role on PTG, since group intervention is also linked to the enhancement of both variables. Participation in the intervention group increase PTG. Challenge to core beliefs and intrusive rumination are improved by group intervention, which to a certain extent facilitate PTG.

Patients diagnosed with lung cancer report high levels of stigma and psychological distress. This study examined posttraumatic growth among lung cancer survivors as a potential buffer against this relationship between stigma and psychological distress and examined how these relationships differed by the timing of quitting smoking (pre versus post-diagnosis). Stages IA and IB non-small-cell lung cancer survivors (N = 141) who were former smokers, 1-6 years post-treatment, and had no evidence of disease completed standardized questionnaires assessing stigma, posttraumatic growth, timing of quitting smoking history, and psychological distress. Hierarchical linear regression and simple slope analyses indicated that among those who quit smoking prior to diagnosis (pre-diagnosis quitters), stigma had a positive association with psychological distress at high levels of posttraumatic growth (p = 0.003) and had a positive (but non-significant) association with psychological distress among those with low levels of posttraumatic growth (p = 0.167). Among those who quit smoking after diagnosis (post-diagnosis quitters), stigma had a positive association with psychological distress among those with low levels of posttraumatic growth (p = 0.004) but had no relationship among those with high levels of posttraumatic growth (p = 0.880). Findings indicate that posttraumatic growth buffers against the negative effects of stigma on psychological distress but only among post-diagnosis quitters. Future interventions could focus on fostering posttraumatic growth as a way to decrease the negative effects of stigma.

People can experience posttraumatic growth (PTG) when faced with potentially traumatic events. One of the most widely-used instruments to measure PTG is the Posttraumatic Growth Inventory-Short Form (PTGI-SF). However, it has not been validated for the Spanish population. This study explored the psychometric properties of the PTGI-SF in adults living in Spain during the COVID-19 pandemic. Since it is a global disaster, two items were added to assess communal PTG. The participants were adult inhabitants of Spain during the COVID-19 pandemic (N = 855). They completed the PTGI-SF in July 2020, along with the Impact of Event Scale – Revised to measure symptoms of posttraumatic stress disorder (PTSD). They also rated the degree to which they perceived the COVID-19 crisis as being severe. In November 2020, 592 participants once again completed the PTGI-SF. The factorial validity o was tested by Structural Equations Modeling (SEM). McDonald’s ω coefficients were calculated to test internal consistency. The Intra-class Correlation Coefficient (ICC) was obtained to assess test–retest reliability. Sensitivity and criterion-related validity were assessed by exploring the association of the PTGI-SF scores with gender, age, PTSD symptoms, and perceived severity. Results indicated good psychometric properties for an eight-item, four-factor structure of the inventory in terms of structural validity, reliability, sensitivity and criterion-related validity. These factors were: Relating to Others, Personal Strength, Spiritual Change, and Life Value and Opportunities. Communal PTG overlapped with social PTG, and therefore it was not included. Cultural differences need to be addressed when measuring PTG, especially in terms of spiritual growth.

ABSTRACTExtensive evidence has been obtained that supports an association between an attentional bias (AB) toward negative stimuli and vulnerability to stress-related psychopathology, little is known regarding the characteristics of individual AB in different posttraumatic growth (PTG) levels. The current study used a modified dot-probe task to investigate if individual differences in AB towards either positive or negative emotional stimuli, are related to self-reported PTG. A sample of 202 patients completed the experiment. Patients with low levels of PTG did not exhibit AB toward negative or positive stimuli, patients with medium levels of PTG had difficulty disengaging attention from negative stimuli, patients with high levels of PTG had difficulty disengaging attention from positive stimuli. And the AB towards positive stimuli was only predictive for PTG. An implication of this finding is that there are different characteristics of implicit cognitive processing in patients with different levels of PTG, suggesting the necessity of psychological intervention on the accidentally injured patients.