ARTICLE IN PRESS
Benefit-Finding for
Dementia Caregivers
Through Cognitive
Reappraisal
TO THE EDITOR:
Many societies are facing the chal-
lenge of caring for the increasing
number of people with dementia.
As well as providing symptomatic
treatment to patients, healthcare
practitioners have to deal with the
needs of family caregivers who are
at elevated risk for depression and
health problems. Programs to
support caregivers to exercise their
role in the long term and to reduce
the likelihood of adverse health out-
comes are urgently needed.1
Within this context, I read with
interest Cheng et al.’s article describ-
ing a benefit-finding intervention
for dementia caregivers. 2 In this
intervention program, a cognitive re-
appraisal component was added to
a typical psychoeducation program
to help caregivers interpret their
challenges in a positive way. This is
an interesting and innovative ap-
proach, as programs for caregivers
are overwhelmingly oriented toward
educating them to handle behavioral
problems and functional dependen-
cies in a practical way, without
dealing with the caregivers’ mindset.
Thus, in addition to enhancing
the competence of caregivers, the
benefit-finding program promotes
the use of positive reappraisals
to reduce the extent of negative
thoughts in relation to everyday
Am J Geriatr Psychiatry ■■:■■, ■■ 2017
challenges, and to focus more on the
positive aspects of caregiving.
The benefit-finding intervention is
based on the theoretical founda-
tion of cognitive-behavioral therapy,
framed in terms of searching for
benefits rather than correcting dys-
functional thoughts. Moreover, the
training was not delivered by psy-
chotherapists, further avoiding
perception on the part of the
caregivers that they were being
“fixed”. From a psychotherapeutic
point of view, this has the advan-
tage of minimizing resistance to
change. Evaluated against two
psychoeducational programs in a
cluster-randomized controlled trial,
the benefit-finding intervention
was found to have a large effect on
reducing depressive symptoms
and moderate effects on burden,
role overload, and psychological
well-being.2
Lingler, in a thoughtful commen-
tary, attributed such positive results
to running this program in groups
in which a sense of universality and
mutual support could be fostered
among the caregivers.3 This is in con-
trast to most psychotherapeutic
interventions for caregivers, which
are delivered on a one-to-one basis.
Lingler’s speculation seems to be rea-
sonable as Cheng’s team conducted
another randomized controlled trial
of the same intervention, but on a
one-to-one basis in caregivers’
homes.4 This second trial was needed
because leaving home to receive train-
ing is often impractical for caregivers
as alternative arrangements for en-
suring care and attention to their
family members while they are away
may not be available. As Lingler sur-
mised, this one-to-one intervention,4
though producing similar results,
yielded effect sizes (moderate effects
on depressive symptoms and role
overload only) smaller than those ob-
served in the first trial,2 in which the
intervention was conducted in
groups. Still, the effects were
impressive.
Despite the descriptions of the in-
tervention in the papers2,4 as well as
the study protocol,5 however, I am
still not clear how benefit-finding
through cognitive reappraisal was
accomplished. Given the promise of
this intervention, it will be desirable
if Cheng and his team can elaborate
in greater detail how this was done
so that the methods can be replicated
by others who work with caregivers.
Resa Gersdorf, Dr. Med.
Private practice, Berlin, Germany
References
1. Schulz R, Czaja SJ: Family caregiving: a vision
for the future. Am J Geriatr Psychiatry 2017
2. Cheng ST, Fung HH, Chan WC, et al: Short-
term effects of a gain-focused reappraisal
intervention for dementia caregivers:
a double-blind cluster-randomized con-
trolled trial. Am J Geriatr Psychiatry 2016;
24:740–750
3. Lingler JH: Commentary on a gain-focused
reappraisal intervention for dementia care-
givers. Am J Geriatr Psychiatry 2016; 24:751–
752
4. Cheng ST, Mak EPM, Fung HH, et al: Benefit-
finding and effect on caregiver depression:
a double-blind randomized controlled trial.
J Consult Clin Psychol 2017; 85:521–529
5. Cheng ST,Lau RWL,Mak EPM,et al:A benefit-
finding intervention for family caregivers of
persons with Alzheimer disease: study pro-
tocol of a randomized controlled trial. Trials
2012; 13:98
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