Mentalizing imagery therapy for depressed family dementia caregivers: Feasibility, clinical outcomes and brain connectivity changes

Felipe A Jain, Sergey Chernyak, Lisa Nickerson, Michelle Abrams, Marco Iacoboni, Leonardo Christov-Moore, Colm G Connolly, Lauren B Fisher, Hitoshi Sakurai, Kate Bentley, Emily Tan, Michael Pittman, Helen Lavretsky, Andrew F Leuchter, Felipe A Jain, Sergey Chernyak, Lisa Nickerson, Michelle Abrams, Marco Iacoboni, Leonardo Christov-Moore, Colm G Connolly, Lauren B Fisher, Hitoshi Sakurai, Kate Bentley, Emily Tan, Michael Pittman, Helen Lavretsky, Andrew F Leuchter

Abstract

Background: Family dementia caregivers experience high rates of depression and anxiety that often go untreated due to time demands. We aimed to determine the feasibility of a brief, 4-week Mentalizing Imagery Therapy intervention, which couples mindfulness with guided imagery practices aimed at bolstering mentalizing capacity, to reduce caregiver psychological symptoms and to explore potential impact on dorsolateral prefrontal cortex connectivity.

Methods: Twenty-four family dementia caregivers with moderate depression symptoms (a score of 10 in Patient Health Questionnaire-9) were assigned to either group Mentalizing Imagery Therapy (MIT, n = 12) or a waitlist augmented by optional relaxation exercises (n = 12). Participants completed questionnaires to measure depression and anxiety at baseline and followup, and those eligible also underwent resting state functional magnetic resonance (fMRI) brain imaging at these time points.

Results: Eleven of 12 caregivers assigned to MIT completed the intervention and attended weekly groups 98% of the time. MIT home practice logs indicated average practice of 5 ± 2 sessions per week for 23 ± 8 min per session. All participants in waitlist completed the post-assessment. MIT participants exhibited significantly greater improvement than waitlist on self-reported depression and anxiety symptoms (p<.05) after 4 weeks. Neuroimaging results revealed increased dorsolateral prefrontal cortex connectivity with a putative emotion regulation network in the MIT group (p = .05) but not in waitlist (p = 1.0).

Limitations: Sample size limitations necessitate validation of findings in larger, randomized controlled trials.

Conclusions: A 4-week group MIT program was feasible for caregivers, with high levels of participation in weekly group meetings and home practice exercises.

Keywords: Dementia; Depression; Family caregivers; Mindfulness; Neuroimaging.

Conflict of interest statement

Declaration of Competing Interest Sergey Chernyak, Lisa Nickerson, Liliana Ramirez Gomez, Leonardo Christov-Moore, Colm Connolly, Lauren Fisher, Marco Iacoboni, Helen Lavretsky, Kate Bentley, Emily Tan, Michelle Abrams, and Michael Pittman report no financial relationships with commercial interests. Hitoshi Sakurai has received grants from Japanese Society of Clinical Neuropsychopharmacology and Uehara Memorial Foundation, and personal fees from Yoshitomi Yakuhin. Hitoshi Sakurai has also received salary support from the MGH Clinical Trials Network and Institute (CTNI), which has received research funding from multiple pharmaceutical companies and NIMH. Felipe Jain has received salary support from CTNI. Andrew F. Leuchter discloses that within the past 36 months he has received research support from the National Institutes of Health, Department of Defense, CHDI Foundation, and NeuroSigma, Inc. He has served as a consultant to NeoSync, Inc., Ionis Pharmaceuticals, Inc., and ElMindA. He is Chief Scientific Officer of Brain Biomarker Analytics LLC (BBA). Dr. Leuchter has equity interest in BBA.

Figures

Fig. 1.
Fig. 1.
Neural connectivity change in MIT versus wait list A. Emotion regulation network shown in orange. Bilateral dorsolateral prefrontal cortex (DLPFC) region of interest in blue. B. Change in connectivity between DLPFC and network pre to post Mentalizing Imagery Therapy (MIT) (p = .05) or wait list (p = 1.0).

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Source: PubMed

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