At least 5 million Americans have Alzheimer's disease which can be physically and emotionally burdensome for patients and caregivers, especially spouses. Beginning in the early stages of Alzheimer's, couples may experience communication deterioration and uncertainty about the future. Enhancing daily self-regulation skills may benefit couples coping with Alzheimer's and related dementias. Research has shown that self-regulation, defined as monitoring and controlling one's own behavior, emotions, or thoughts in response to the demands of a stressful context, can protect psychological and physical health. Although there have been successful traditional cognitive behavioral interventions for caregiving couples, to our knowledge, there are no existing self-guided, self-regulation interventions that are low in cost and can easily be disseminated to a wider population of couples in need. The overarching aim of this project is to adapt an existing, easy-to-use, daily self-regulation intervention, Wish, Outcome, Obstacle, Plan (WOOP), shown to be effective in a variety of health contexts (e.g., back pain, stroke, relationship dysfunction), including those with cognitive limitations, to couples coping with early stage Alzheimer's and related dementias. The WOOP intervention is centered around a four-step mental process that helps individuals accomplish their goals for well-being. WOOP changes behavior via cognitive, motivational, and feedback processes which are outside of people's awareness, which may prove particularly useful for persons with Alzheimer's as their disease progresses. WOOP has also been used to improve relationship satisfaction. The present WOOP study will include an in-person training session, daily self-guided WOOP activities for two weeks with phone check-ins, and additional phone booster sessions.
Aim 1 will assess the feasibility of WOOP for persons with early stage Alzheimer's or related dementias and their close, committed partners. We will monitor (a) recruitment, (b) adherence, and (c) missing data. We will explicitly qualitatively and quantitatively examine how AD-related factors (e.g. cognitive functioning, dementia symptoms, quality of life) impact WOOP instruction and use.
Aim 2 examines the extent to which WOOP improves self-regulation skills, behavioral change, and psychological well-being for each partner.
Aim 3 explores whether there are additive or interactive effects of both partners participating in WOOP. Fifty couples in which one person has early Alzheimer's or a related dementia will participate in a study in which both partners' positive emotions, self-regulation skills, health behaviors, and relationship satisfaction will be assessed at baseline, 2-weeks, 5-weeks, and 3 month interviews. Monitoring feasibility outcomes and qualitative coding of interviews will guide the adaptation of WOOP to the AD context. Dyadic repeated measures analysis will examine individual and partner outcomes longitudinally. Information from this study will be used to inform a Stage 2 RCT trial as part of an R01 application to examine the effectiveness of WOOP to enhance the individual and relational well-being of couples coping with Alzheimer's and related dementias.

Public Health Relevance

An estimated 5 million Americans have Alzheimer?s disease, most of whom receive care from a close family member. Spousal caregivers often experience emotional burden and relationship distress, negatively affecting both partners? quality of life. This research will adapt a reliable, effective, and easy-to-use psychosocial intervention that teaches spousal dyads in the context of early Alzheimer?s disease and related dementias to use daily self-regulation skills to improve or maintain their own and their relational well-being.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1)
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Gerald, Melissa S
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Yale University
Public Health & Prev Medicine
Schools of Medicine
New Haven
United States
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