Alzheimer’s Caregivers May Benefit from Happiness Training

happy caregiver - LEAF program

September 18, 2019

Caring for a loved one with Alzheimer’s disease is highly stressful and can lead to depression, anxiety and other potentially life-threatening ills. Cultivating positive emotional skills in caregivers may have lasting benefits for physical and emotional health, according to a new study.

Researchers at Northwestern Medicine in Illinois report that a six-week, web-based program that teaches caregivers to focus on positive events, gratitude, mindfulness, acts of kindness and other positive emotions lowers anxiety and depression levels in those caring for a loved one with Alzheimer’s disease or other forms of dementia.

Caregivers also said that the program improved their physical health and their attitudes about care. “The techniques I learned brought a serenity and calmness to my life and to that of my husband,” said one woman in the program who was caring for her spouse with Alzheimer’s disease.

“The caregivers who learned the skills had less depression, better self-reported physical health, more feelings of happiness and other positive emotions than the control group,” said lead study author Judith Moskowitz, professor of medical social sciences at Northwestern University Feinberg School of Medicine. The findings were published in the journal Health Psychology.

The program, called LEAF, for Life Enhancing Activities for Family caregivers, was designed by Dr. Moskowitz and colleagues and focused on eight skills that evidence shows increase positive emotions. Among the skills taught to participants in the study were:  

  1. Recognizing a positive event each day.
  2. Savoring that positive event and logging it in a journal or telling someone about it.
  3. Starting a daily gratitude journal.
  4. Listing a personal strength each day and noting how you used this strength recently.
  5. Setting an attainable goal each day and noting your progress.
  6. Reporting a relatively minor stressor each day, then listing ways in which the event can be positively reappraised or reframed.
  7. Understanding small acts of kindness can have a big impact on positive emotion and practicing a small act of kindness each day.
  8. Practicing mindfulness through paying attention to daily experiences and with a daily 10-minute breathing exercise, concentrating on the breath. 

The trial looked at 170 caregivers across the United States, mostly women, who were caring for a loved one with dementia. Half were randomly assigned to the group in which they learned positive emotion skills, such as recognizing a daily positive event and keeping a gratitude journal. Others were in a control group in which they filled out a daily questionnaire about their emotions.

Via web conferencing, a facilitator taught positive emotional skills in six weekly sessions. Caregivers completed daily homework assignments. If the topic was acts of kindness, for example, their homework was to go out and practice an act of kindness. 

Participants filled out a questionnaire about their depression, anxiety, physical health and how burdened they felt from caregiving at the start and completion of the study. 

LEAF participants had a 7 percent greater drop in depression levels and a 9 percent greater drop in anxiety levels compared to the control group. That put them in a normal range for depression and anxiety levels compared to the general population.

One participant said, “Doing this study helped me look at my life, not as a big neon sign that says ‘DEMENTIA’ in front of me, but little bitty things like, ‘We’re having a meal with L’s sister, and we’ll have a great visit.’ I’m seeing the trees are green, the wind is blowing. Yeah, dementia is out there, but I’ve kind of unplugged the neon sign and scaled down the size of the letters.”

The researchers are looking to expand the availability of the program to caregivers across the country.

By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Marc Flajolet, Ph.D., Fisher Center for Alzheimer’s Research Foundation at The Rockefeller University.

Source: Moskowitz, Judith T.; Cheung, Elaine O.; Snowberg, Karin E.; et al: “Randomized controlled trial of a facilitated online positive emotional regulation intervention for dementia caregivers.” Health Psychology, Vol 38(5), May 2019


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