May 11, 2022
Caring for a loved one with Alzheimer’s disease can take a toll on both mind and body. The near-constant stresses of day-to-day Alzheimer’s care can suppress immunity, leading to increased days of illness for the caregiver. Alzheimer’s caregivers are also at 50 percent risk of developing depression, higher than the risk of depression in caregivers for people with cancer or other chronic disorders.
But a new study suggests that a novel psychological therapy called mentalizing imagery therapy, or MIT, may provide unique benefits for caregivers of someone with Alzheimer’s disease. The study, led by Dr. Felipe Jain, director of Health Aging Studies at Massachusetts General Hospital, found that a four-week program that taught caregivers mindfulness meditation and guided imagery techniques changed the brain, leading to lower levels of depression and anxiety and boosting caregivers’ sense of well-being.
For the study, published in the journal Psychotherapy and Psychosomatics, Dr. Jain and his colleagues enrolled 46 people who were caring for a loved with Alzheimer’s disease or another form of dementia. Half were assigned to attend a weekly, 120-minute support group, for four weeks. Family caregivers are often referred to support groups, where they can share stories about the challenges of caring for a loved one with dementia, to help combat the stress of caregiving.
The other half got MIT training for 120 minutes a week, over four weeks. The training included low-impact stretching as well as mindfulness and meditation techniques, as well as a range of guided imagery exercises. For example, participants might be asked to stay present in the moment by focusing on their breathing, or to focus their awareness on places in the body they were feeling specific thoughts and emotions, like where they might be experiencing anxiety or tension. Or, the caregiver might be asked to imagine a time when they were in a difficult conflict with another person, and the thoughts, feelings and sensations that were occurring in their own body, and then to imagine what was going on in the body of the other person.
The aim of such exercises is to make caregivers more mindful of what is going on in their own minds and bodies, as well as to provide new perspectives on their own and others’ challenges. Caregivers may, for example, find it hard to understand what’s going on in the mind of a loved one with Alzheimer’s. Or they may wrestle with shame and guilt regarding their own reactions and behaviors under the chronic strain of caregiving.
“MIT teaches mindfulness and guided imagery skills to help caregivers better understand the mind of their loved one and how they are reacting to that person,” said Dr. Jain, who is also an assistant professor at Harvard Medical School. “This therapy pushes the boundaries of how we think about ourselves and interact with others and incorporates new views on self and identity,” helping to bolster our self-compassion.
In earlier research, Dr. Jain recounted how one 66-year-old woman who was caring for her spouse of 40 years who now had dementia “dreaded” helping him get dressed each morning. She had trouble coming to terms with his illness but, after going through a mindfulness program, realized her husband was trying as hard as he could and that they were in this “together.” She learned to reframe the experience and relax while dressing him. He in turn sensed her new attitude and turned to her and said, “You are so caring.”
In the current study, Dr. Jain and his colleagues found that after four weeks, caregivers who participated in mentalizing imagery therapy had lower rates of depression and anxiety than those who were in the support group. The MIT group also scored higher on tests of self-compassion and happiness, and showed brain changes related to better emotional regulation. These improvements persisted three months after the training ended.
Dr. Jain noted that optimal care for family caregivers might include mindfulness training in combination with support groups. “MIT is designed to be a short-term intervention to help people reframe how they view themselves as caregivers and how they experience their loved ones,” he said. “Support groups are longer-term interventions designed to maintain support for caregivers over the course of the disease. There is a need for both.”
A growing number of health and community centers now offer mindfulness and guided imagery classes, and online sessions are also available. If the stress of caregiving is feeling overwhelming, a mindfulness class or support group could be a useful addition to your caregiving routine.
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: Jain F.A, Chernyak S.V., Nickerson L.D., et al: “Four-Week Mentalizing Imagery Therapy for Family Dementia Caregivers: A Randomized Controlled Trial with Neural Circuit Changes.” Psychotherapy and Psychosomatics, March 2022.