Relationships Among Caregiver Burden, Psychological Flexibility Processes, and Anxiety in Family Caregivers of People with Dementia

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ABSTRACT Objectives This cross-sectional study examined the relationships among caregiver burden, anxiety, and key psychological flexibility processes – cognitive fusion, experiential avoidance, and values-driven actions – in family caregivers of individuals with dementia. Methods Data were collected from 191 caregivers in the United States. Structural equation modeling was used to assess direct and indirect relationships among caregiver burden, anxiety, and key psychological flexibility processes. Results The model showed excellent fit. Caregiver burden had a significant direct effect on anxiety (59.1% of the total effect), while indirect effects accounted for 40.9%. Cognitive fusion was the only significant mediator between caregiver burden and anxiety, accounting for 20.8% of the total effect. Additionally, experiential avoidance – both alone and when preceded by cognitive fusion – significantly mediated the relationship between caregiver burden and reduced engagement in values-driven actions. Conclusions These findings highlight cognitive fusion as a key mechanism linking caregiver burden to anxiety. Furthermore, both cognitive fusion followed by experiential avoidance and experiential avoidance alone appear to influence the relationship between caregiver burden and values-driven actions. Clinical Implications Clinicians may consider implementing skills training targeting cognitive fusion and experiential avoidance to mitigate the negative impact of caregiver burden on anxiety and values-driven actions.