Objectives To examine the effects of a benefit-finding intervention, the key feature being the use of gain-focused reappraisal strategies to find positive meanings and benefits in caring for someone with dementia. Design: Cluster-randomized double-blind controlled trial. Setting: Social centers and clinics. Participants: 129 caregivers. Inclusion criteria were (a) primary caregiver aged 18+ and without cognitive impairment, (b) providing ≥14 care hours per week to a relative with mild-to-moderate Alzheimer's disease, and (c) scoring ≥3 on the Hamilton Depression Rating Scale. Exclusion criterion was care-recipient having parkinsonism or other forms of dementia. Interventions: The benefit-finding intervention was evaluated against two treatment-as-usuals, namely, simplified psychoeducation (lectures only) and standard psychoeducation. Each intervention lasted eight weeks, with a 2-hour session per week. Randomization into these conditions was based on center/clinic membership. Measurements: Primary outcome was depressive symptom. Secondary outcomes were Zarit Burden Interview, role overload, and psychological well-being. Self-efficacy beliefs and positive gains were treated as mediators. Measures were collected at baseline and posttreatment. Results: Regression analyses showed BF treatment effects on all outcomes when compared with SIM-PE, and effects on depressive symptoms and Zarit burden when compared with STD-PE. Effect sizes were medium-to-large for depressive symptoms (d=-0.77– -0.96), and medium for the secondary outcomes (d=|0.42–0.65|). Furthermore, using the bootstrapping method, we found significant mediating effects by self-efficacy in controlling upsetting thoughts and positive gains, with the former being the primary mediator. Conclusions: Finding positive gains reduces depressive symptoms and burden and promotes psychological well-being primarily through enhancing self-efficacy in controlling upsetting thoughts
