Early Evidence Supports Videoconference ACT for Dementia Caregivers with Depression

Family caregivers of people with dementia often experience significant mental health burdens, including depression, anxiety, and chronic stress. Acceptance and Commitment Therapy (ACT), a values-based behavioral approach, has shown promise in addressing these challenges, but evidence for its efficacy, particularly in remotely delivered formats, remains limited. To address this gap, researchers conducted a pilot randomized controlled trial (RCT) evaluating the effects of a videoconference-based ACT program specifically targeting caregivers with depressive symptoms. The results, published in JMIR Formative Research in March 2025, provide early insights into the feasibility, clinical relevance, and potential benefits of this intervention.

Thirty-three caregivers were randomized to either a 10-week ACT intervention delivered one-on-one via Zoom or a control group that received psychoeducation materials only. Participants had to report at least mild depressive symptoms at baseline, defined as a score of 5 or higher on the Patient Health Questionnaire-9 (PHQ-9). Outcomes were assessed at baseline, post-intervention, and three months later using validated measures for depression, anxiety, stress, psychological quality of life, caregiver burden, guilt, and grief. The study also evaluated ACT process variables such as experiential avoidance and values-driven action, both of which reflect psychological flexibility, the core therapeutic target of ACT.

At posttest, the ACT group showed statistically significant and clinically meaningful improvements in two primary domains compared to the control group: perceived stress and psychological quality of life. Mean stress scores, measured by the Perceived Stress Scale (PSS-10), decreased by 7.75 points in the ACT group (P < .001), while the control group showed a 3.03-point reduction that did not reach statistical significance. The between-group difference of 4.72 points (P = .043) reflects a tangible stress reduction attributable to the intervention. Similarly, for psychological quality of life, assessed via the WHOQOL-BREF–Psychological Health component, ACT participants reported a 4.03-point gain compared to just 0.56 points in the control group—a between-group difference of 3.48 points (P = .014). Notably, these were the only two outcomes that demonstrated statistically significant between-group differences in the primary analysis.

Within-group changes further emphasized the intervention's impact. ACT participants experienced substantial reductions in depressive symptoms, with mean changes of –6.09 at posttest and –6.71 at follow-up (P < .001 for both), exceeding the minimal clinically important difference (MCID) of 5 points on the PHQ-9. Anxiety symptoms declined by over 4 points on the GAD-7 scale, also surpassing the MCID threshold. Additional improvements were observed in caregiver burden, predeath grief, guilt, experiential avoidance, and values-driven action. These benefits were largely sustained at the 3-month follow-up.

By contrast, the control group exhibited more modest within-group improvements. While depressive symptoms declined over time, the reductions did not reach the MCID threshold. There were minor improvements in self-compassion, values-driven action, and experiential avoidance, though most lacked statistical or clinical significance. It's worth noting that all participants received comprehensive psychoeducation materials, which may have offered modest therapeutic benefit, particularly for participants with limited prior exposure to caregiver support.

To assess the influence of data variability on the results, the researchers conducted a sensitivity analysis excluding one control participant whose data approached outlier status. This analysis revealed additional significant between-group differences in depressive symptoms, caregiver burden, predeath grief, and values-driven action, suggesting that small-sample variability may have obscured broader treatment effects in the original analysis.

Feasibility and participant engagement were high. All but one ACT participant completed the full course and booster session, and session fidelity was closely monitored. The intervention’s structure, personalized, one-on-one delivery by a licensed counselor, reinforced with printed and web-based resources, appears to have contributed to strong adherence and therapeutic alliance. Participants were encouraged to engage in ACT exercises between sessions, supporting integration of emotional regulation strategies and values-guided behavior change into daily life.

While the findings are encouraging, the authors caution that the trial’s small sample size and exploratory design limit generalizability. Most participants were non-Hispanic White women, often adult daughters of individuals with dementia, highlighting a need for broader demographic inclusion in future studies. Additionally, the trial did not collect data on participants’ income or access to caregiving resources, factors that may meaningfully influence both mental health status and intervention responsiveness. Finally, no statistical adjustment was made for multiple comparisons, in keeping with the study’s pilot nature.

Taken together, this study offers preliminary but compelling evidence that videoconference-delivered, therapist-guided ACT may reduce psychological distress and enhance quality of life among family caregivers with depression. Larger, fully powered trials are needed to confirm efficacy and examine long-term durability, especially across more diverse and socioeconomically varied populations.

Reference

Han A, Oster R, Yuen H, Jenkins J, Hawkins J, Edwards L. Videoconference-Delivered Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Pilot Randomized Controlled Trial. JMIR Form Res. 2025;9:e67545. Published 2025 Mar 31.