Naoko Kishita

There is recognition of the need to design wellbeing interventions in contextually sensitive ways, and report systematic, theory-driven approaches to intervention development. However, many intervention studies in the burgeoning literature on psychological professional trainee wellbeing do not include information on processes or theory surrounding the development of interventions tested. This theory- and stakeholder-informed intervention development study was guided by the MRC framework for developing and evaluating complex interventions and underpinned by the COM-B. Evidence and theory were used to support an initial intervention outline. Meetings were subsequently held to gather stakeholder perspectives, to address unknowns of intervention design, and to support development of a theory of change. Stakeholder (trainees and professional training staff) perspectives and relevant theory were used to inform the design of an acceptance and commitment therapy (ACT) based intervention, to address key stressors experienced by trainees. The intervention was delivered in a group setting, over the course of four sessions spaced 1–3 weeks apart. Collaboratively constructed COM-B analyses identified target behaviours and shaped intervention design. A comprehensive theory of change was developed, outlining key assumptions and setting out hypothesised pathways of change. An evidence-informed ACT-based intervention for psychological professional trainee wellbeing has been developed with key stakeholder collaboration. An acceptability and feasibility evaluation of this intervention is underway. Key learning aims: (1) To understand the processes through which a tailored wellbeing intervention for psychological professional trainees was developed in collaboration with key stakeholders. (2) To consider how an acceptance and commitment therapy (ACT) based intervention was adapted to address specific challenges encountered by psychological professional trainees. (3) To understand the pathways through which an adapted ACT intervention is anticipated to support trainee wellbeing.

Most people living with dementia are cared for at home by unpaid family carers who experience substantially higher rates of anxiety and depression compared to the general population: approximately ...

Investigate the effectiveness of an Acceptance and Commitment Therapy (ACT) group intervention on anxiety symptoms in Brazilian family caregivers of people with dementia (PWD). Single-center, unblinded, double-arm, pilot randomized controlled trial. Fifty-seven family caregivers of PWD with mild to severe anxiety symptoms were randomized to intervention group (n = 29) or waiting list group (n = 28). The intervention group received eight videoconference sessions of group ACT. Participants completed measures of anxiety and depressive symptoms, caregiver burden, psychological flexibility and quality of life (QOL) at Weeks 0, 9 and 20. Participants in the intervention group had lower scores of anxiety compared to control at weeks 9 and 20, when assessed using the GAD-7. No between-group effects were observed for depressive symptoms, caregiver burden (ZBI-12), QOL, or psychological flexibility. In the completer analysis only, a significant reduction in anxiety symptoms measured by HADS-A was observed at Week 20. This pilot study provides initial evidence that group ACT may reduce anxiety symptoms in family caregivers of PWD. Larger, fully powered trials are needed to confirm these findings and to clarify effects on other caregiver outcomes. Videoconference Group ACT, shows potential as a scalable intervention to reduce family caregivers' anxiety.This study was registered in the Brazilian Clinical Trial Registry (Registro Brasileiro de Ensaios Clínicos - REBEC; Identifier: RBR-10m9tg2r).

Background: Dementia does not merely affect individuals, the carer and the person living with dementia, but also has a profound impact on their spousal relationship. As such, this study aimed to gain a deeper understanding of how dementia affects spousal relationships with a focus on interpersonal (i.e. relationship adjustment, communication engagement and emotional connection between two individuals) and intrapersonal (i.e. loss of self within the context of relationships) dynamics using a qualitative approach. The study also explored how carers adapt to such relationship challenges in the context of dementia care. Methods: A phenomenological approach was used to capture the subjective experiences of female spousal carers, who regularly support their partner living with dementia. A total of nine semi-structured interviews were conducted. Results: Relationship adjustment theme highlighted how learning to acknowledge role shifts from a spouse to a carer is critical for carers to manage relationship difficulties. Emotional connection theme demonstrated the importance of reminiscing about the shared history between dyads to cope with feelings of loss of affective intimacy. Communication engagement theme revealed carers’ need to learn a new way of communicating due to the decrease in meaningful communication and two-way interaction. Sense of self theme highlighted the importance of self-compassion to overcome feelings of self-loss and isolation. Conclusion: Findings suggest that improving the relationship between female spousal carers and their partner living with dementia may require targeted interventions addressing different factors. Such interventions can include a couple’s life story approach to enable couples to reminisce about their shared experiences, interactive communication training to enhance meaningful engagements, and a psychological approach such as compassion-focused therapy to overcome emotional challenges and facilitate self-compassion.

To investigate the effect of carer- and disease-related factors on anticipatory grief (AG) in family carers supporting people living with Motor Neurone Disease. Seventy-five carers from the UK and USA participated in this cross-sectional study, between July 2021 and February 2023. Participants completed assessments on: anticipatory grief (MMCGI-SF, comprising three sub-scales: Personal Sacrifice Burden, Heartfelt Sadness and Longing, Worry and Felt Isolation); person with MND (pwMND) behavioral changes (MiND-B) and disease severity (ALSFRS-R); carer-pwMND emotional bond (Relationship Closeness Scale), familism levels (Familism Scale), and reported hours of care provided. Multiple linear regression analyses were conducted to explore factors impacting carer AG. AG total scores showed that 50.7% of carers were experiencing common grieving reactions, 22.6% presented intense grieving emotions, and 26.7% presented low grieving responses.Disease severity (regression coefficient, β = -0.31, p = 0.01, 95%CI -0.91 to -0.13) and behavioral changes (β = -0.34, p = 0.002, 95%CI -1.45 to -0.33) predicted AG total scores (proportion of explained variation, R²=0.38, p < 0.001).Regarding AG subscales, Personal Sacrifice Burden (R²=0.43, p < 0.001) was predicted by disease severity (β = -0.39, p < 0.001, 95%CI -0.42 to -0.11). Behavioral changes predicted Heartfelt Sadness and Longing (β = -0.27, p = 0.03, 95%CI -0.49 to -0.03; R² = 0.21, p = 0.01) and Worry and Felt Isolation (β = -0.42, p < 0.001, 95%CI -0.63 to -0.20; R²=0.33, p < 0.001). This study suggests that disease-related factors may be the strongest predictors of carer AG. Interventions addressing carers' understanding and management of MND symptoms seem crucial to support their experiences of loss and their acceptance of MND. Evidence-based support for carers in MND services is required.