Feasibility and acceptability of a telephone-based ACT intervention for caregivers (TACTICs) of adults with Alzheimer's disease and related dementias (ADRD): a randomized pilot during the COVID-19 pandemic.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All TACTICs sessions were audio-recorded and assessed for fidelity and ACT skill level using a standardized fidelity checklist adopted from previous ACT pilots.

“Additionally, all TACTICs sessions were audio-recorded and assessed for fidelity and ACT skill level using a standardized fidelity checklist adopted from our previous ACT pilots (Fowler et al., 2021; Johns et al., 2020).”

• cites Fowler et al., 2021 sourcePartly supported

  The Methods (Intervention and procedures; page unavailable) report that 23 audio-recorded TACTICs sessions—25.6% of sessions—were assessed for fidelity using a structured checklist similar to one used in previous ACT interventions. The source does not say that all sessions were assessed or that ACT skill level was assessed separately. (LLM, conf=0.93)

  Experimental — accuracy not yet measured
• cites Johns et al., 2020 sourcePartly supported

  The Methods (Interventions, Treatment Fidelity; page unavailable) report that fidelity checklists were developed for ACT and survivorship-education sessions and that external experts rated 50% of sessions. The paper does not say that all sessions were audio-recorded, that ACT skill level was assessed, or that TACTICs sessions used its checklist. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

At baseline, the average anticipatory grief score was 80.9 with a standard deviation of 14.9, which is higher than reported in other studies of ADRD caregivers.

“The average anticipatory grief score was 80.9 (SD 14.9), which is higher than reported in other studies of ADRD caregivers (Fowler et al., 2013; Marwit & Meuser, 2005).”

• cites Fowler et al., 2013 sourcePartly supported

  The Results (Descriptive results) report a mean anticipatory grief score of 70.1 (SD 14.8), not 80.9 (SD 14.9). The Discussion supports the comparison with other caregivers, stating that this sample’s mean was higher than a previously reported mean of 61.2. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites Marwit & Meuser, 2005 sourceNot checked — no full text of the source

May combine two claims.

Before the COVID-19 pandemic, the authors ran a single-arm TACTICs pilot and observed significant anxiety reductions in caregivers after the intervention.

“Prior to the COVID-19 pandemic, we conducted a single arm pilot of Telephone Acceptance and Commitment Therapy intervention for ADRD caregivers (TACTICs) and the results were favorable, demonstrating significant reductions in caregiver anxiety after the TACTICs intervention (Fowler et al., 2021).”

• cites Fowler et al., 2021 sourceSupported

May combine two claims.

ADRD caregivers suffer excessive distress from dementia symptoms that they often cannot change.

“ADRD caregivers experience excessive distress as a result of the challenging behavioral and psychological symptoms of dementia that the caregiver is often unable to change (Cheng, 2017).”

• cites Cheng, 2017 sourcePartly supported

  The Individual Neuropsychiatric Symptoms or Symptom Clusters section reports that disruptive behaviors and other dementia symptoms can be highly distressing to caregivers. The supplied Concluding Remarks likewise describe delusions and disruptive behaviors as distressing. Neither passage establishes that caregivers are often unable to change those symptoms. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

TACTICs was created for complete telephone delivery by a non-licensed interventionist with a bachelor's degree, aiming to improve scalability of ADRD caregiver interventions.

“TACTICs was innovatively designed to be delivered completely by telephone by a non-licensed, Bachelor’s-prepared interventionist to specifically address the issue of scalability (Alzheimer’s Association, 2024; Gitlin et al., 2015) of ADRD caregiver interventions.”

• cites Alzheimer’s Association, 2024Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Gitlin et al., 2015 sourceSupported

Classified as probably not a substantial claim.

ACT combines mindfulness and acceptance with commitment and behavior change to help people cope adaptively.

“ACT is rooted in functional contextualism and (Hayes et al., 2011) incorporates mindfulness and acceptance-based processes along with commitment and behavior change processes to support adaptive coping with life’s realities (Hayes et al., 2012; Twohig & Levin, 2017).”

• cites Hayes et al., 2011Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Hayes et al., 2012Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Twohig & Levin, 2017 sourceSupported

May combine two claims.

Every measure had prior statistical validation in adult caregiver samples and showed good internal consistency in earlier trials.

“All measures have been statistically validated in adult caregiving populations and have demonstrated good internal consistency in prior trials (Bond et al., 2011; Grégoire & et al., 2020; Hébert et al., 2000; Kroenke et al., 2001; Schulz et al., 2010; Spitzer et al., 2006; Theut et al., 1991).”

• cites Bond et al., 2011 sourcePartly supported

  The Results and Discussion report acceptable AAQ-II internal consistency (alpha .78–.88) across university students, people receiving substance-misuse treatment, and financial-services workers. The paper therefore supports validation and reliability for the AAQ-II, but not the claim that it—or every measure in the citing study—was validated in adult caregiver samples or showed good internal consistency in earlier trials. (LLM, conf=0.90)

  Experimental — accuracy not yet measured
• cites Grégoire & et al., 2020 sourceNot checked — no full text of the source
• cites Hébert et al., 2000 sourceNot checked — no full text of the source

May combine two claims.

The CRISIS survey was administered only to the second cohort and found a significant relationship between COVID-19 anxiety and caregiver burden overall.

“The NIH Coronavirus Health Impact Survey (CRISIS) was administered to participants in the second cohort (only) to test for pandemic effects, which found a significant relationship between COVID-19 anxiety and caregiver burden overall(Lucas et al., 2021).”

• cites Lucas et al., 2021 sourcePartly supported

  The paper’s text (pp. 1049–1050) says COVID-19 anxiety was measured using CRISIS questions and reports a significant association with caregiver burden (χ²=9.07, p<0.05). It describes caregivers enrolled in TACTICs pilot trials but does not say that CRISIS was administered only to a second cohort. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Morimoto (2024) identified four caregiver profiles related to depressive symptoms, anxiety symptoms, and work-family conflict.

“Morimoto (2024) identified four separate caregiver profiles that were related to depressive symptoms, anxiety symptoms, and work-family conflict.”

• cites Morimoto (2024) sourceSupported

May combine two claims.

Caregivers with high psychological flexibility or moderate psychological flexibility with high commitment fared better.

“Caregivers with high psychological flexibility or moderate psychological flexibility high commitment fared better.”

• cites Morimoto (2024) sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Caregivers provided comments about improving delivery, including difficulty accessing the audio relaxation exercises.

“We also received valuable comments about improving the delivery of TACTICs, such as this quote from a caregiver: “Older adults need an easier way to access the audio relaxation exercises.”

May combine two claims.

The TACTICs group saw reductions in anxiety, depressive symptoms, caregiver burden, anticipatory grief, and suffering.

“the TACTICs group saw reductions in anxiety, depressive symptoms, caregiver burden, anticipatory grief, and suffering.”

May combine two claims.

In the sensitivity analysis of participants who completed all six sessions, there were significant trends over time for anxiety, caregiver burden, and anticipatory grief, but no significant interaction effect.

“Results show that there are significant trends over time for anxiety, caregiver burden, and anticipatory grief scores, but there is no difference in the trend over time as the interaction effect is not significant.”

May combine two claims.

The TACTICs group reductions were not statistically significant compared with mEUC for depression (T4 p=0.4955), burden (T4 p=0.6169), or anticipatory grief (T4 p=0.9888).

“The reductions in the TACTICs group were not found to be statistically significant compared to the mEUC for depression (T4 p=0.4955), burden (T4 p=0.6169), or anticipatory grief (T4 p=0.9888).”

May combine two claims.

In the intent-to-treat analysis, there was a statistically significant effect of time on anxiety, depressive symptoms, and caregiver burden scores between the TACTICs and mEUC groups, but no time-by-intervention effect.

“We did find a statistically significant effect of time on anxiety, depressive symptoms, and caregiver burden scores between the caregivers in the TACTICs group vs mEUC group, but not a time and intervention effect.”

May combine two claims.

On average, caregivers indicated they would be quite a bit or very much confident to recommend the program and likely or extremely likely to continue using what they learned.

“On average, caregivers also indicated that they would be “quite a bit” or “very much” confident that they would recommend the program to others, and “likely” or “extremely likely” to continue using what they learned in the intervention.”

May combine two claims.

At T2, the TACTICs group showed a moderate reduction in anxiety symptoms (SRM 4.7, 95% CI [3.2,6.2]), which was maintained to T3 and reduced slightly at T4 (SRM 4.1, 95% CI [2.3,5.8]).

“At T2, caregivers in the TACTICs group showed a moderate reduction in anxiety symptoms (SRM 4.7, 95% CI [3.2,6.2]), which was maintained to T3, and reduced slightly at T4 (SRM 4.1, 95% CI [2.3,5.8]).”

May combine two claims.

The mEUC group also demonstrated reductions in depressive symptoms, caregiver burden, and anticipatory grief.

“The mEUC group also demonstrated reductions in depressive symptoms, caregiver burden, and anticipatory grief.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Allocation was 1:1, with 58 participants in TACTICs and 59 in mEUC.

“Allocation was 1:1, with 58 enrolled in TACTICs and 59 enrolled in the mEUC group.”

May combine two claims.

Participants reported high satisfaction with the intervention and intended to use the skills they learned moving forward.

“It is additionally reassuring that the participants reported such a high satisfaction with the intervention and intend to use the skills they learned moving forward.”

May combine two claims.

The recruitment rate was 96%, with 120 of 125 eligible caregivers enrolled.

“We achieved a 96% recruitment rate, with 120 of 125 eligible caregivers were enrolled.”

May combine two claims.

The mean satisfaction score was 9.35 (SD 0.91) out of 10, indicating very high satisfaction with the intervention.

“The mean satisfaction score was 9.35 (SD 0.91) out of 10, indicating very high satisfaction with the intervention”

May combine two claims.

The two cohorts participated during different phases of the pandemic: the first from May 2020 to March 2021 and the second from June 2021 to June 2022.

“Both cohorts participated during a different phase of the pandemic, with the first trial running May 2020 to March 2021, and the second running June 2021 to June 2022.”

May combine two claims.

The enrollment rate exceeded the threshold during the COVID-19 pandemic, but the intervention completion rate was lower than anticipated.

“While the rate of enrollment exceeded our threshold during the COVID-19 pandemic, the rate of intervention completion was lower than anticipated.”

May combine two claims.

TACTICs was feasible and acceptable.

“TACTICs was feasible and acceptable with 96% enrollment, 98.6% adherence, 65.5% completion, and a mean satisfaction score of 9.35 out of 10 (SD 0.91).”

• Also stated in: § Conclusion · plain

  “Implementation of TACTICs during the COVID-19 pandemic was feasible and acceptable.”

• AssumptionRests on an assumption: The observed enrollment, adherence, completion, and satisfaction levels are sufficient to establish feasibility and acceptability.

Classified as probably not a substantial claim.

Participants were randomized to TACTICs or to a minimally enhanced usual care control.

“Following the informed consent, a baseline assessment was completed, and caregivers were randomly assigned to TACTICs or to a mEUC control condition.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Some caregiver well-being outcomes, such as anxiety, are not suitable targets for caregiving aspects that cannot be changed, like existential suffering and anticipatory grief.

“However, not all caregivers equally benefit from these programs, and not all caregiver well-being outcomes, such as anxiety, are appropriate outcomes for the unchangeable aspects of caregiving such as existential suffering and anticipatory grief.”

May combine two claims.

The effects were not strong enough to overcome the placebo effect observed in the mEUC group, but this does not negate the impact of the reductions themselves.

“The effects were simply not strong enough to defeat the placebo effect noted in the mEUC group, but that does not negate impact of the reductions themselves.”

Classified as probably not a substantial claim. May combine two claims.

ACT teaches people to notice and accept their thoughts without treating them as literal truths, so thoughts do not block a flexible, meaningful life.

“Acceptance and Commitment Therapy (ACT) is part of the larger CBT tradition that includes approaches which share many features (Herbert et al., 2013) and focuses on noticing and accepting one’s thoughts (e.g., mindful awareness) without taking thoughts literally (e.g., cognitive defusion) so that these thoughts do not prevent the person from living a flexible, meaningful life (e.g., values-based”

• cites Herbert et al., 2013 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based). May combine two claims.

ACT-based interventions like TACTICs may require a different level of engagement and greater caregiver readiness, and may serve as a complementary approach to traditional programs.

“Compared to other protocols, it may be that ACT- based interventions like TACTICs require caregivers to employ a different level of engagement and participation that necessitates greater caregiver readiness, and ACT-based protocols may serve as a complimentary approach to traditional programs.”

• AssumptionRests on an assumption: Existing evidence-based protocols address different aspects of caregiving and may not help all caregivers.

Classified as probably not a substantial claim.

Using non-licensed staff may enable implementation across various settings.

“Use of non-licensed personnel could support implementation in a variety of settings.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All study procedures received approval from the Indiana University institutional review board.

“The Indiana University institutional review board approved all study procedures.”

May combine two claims.

Psychological flexibility is theoretically associated with better anxiety, depressive symptoms, and wellbeing.

“Psychological flexibility is theoretically linked to improvements in anxiety (Bluett et al., 2014), depressive symptoms, and wellbeing (Kohtala et al., 2015).”

• cites Bluett et al., 2014 sourceNot checked — no full text of the source
• cites Kohtala et al., 2015 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Interventionists attended weekly supervision sessions with a master's level ACT clinician throughout the study.

“Throughout the study, interventionists attended weekly supervision sessions with a master’s level ACT clinician.”

May combine two claims.

The pilot results demonstrate that the TACTICs intervention was feasible and acceptable according to the outlined benchmarks.

“The pilot results demonstrate that the TACTICs intervention was feasible and acceptable according to the benchmarks outlined.”

May combine two claims.

Fidelity ratings were 98.9% (SD=3.10) and 98.4% (SD=3.75) adherence for the first and second cohorts, suggesting high adherence to the intervention manual.

“Fidelity ratings of TACTICs sessions yielded 98.9% (SD=3.10) and 98.4% (SD=3.75) adherence for the first and second cohorts, respectively, suggesting the interventionists delivered TACTICs with high adherence to the intervention manual.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Eligible interested caregivers completed informed consent, which included a decisional-capacity assessment.

“Caregivers who expressed interest and were eligible underwent the informed consent process that included an assessment of decisional capacity with four open-ended study-specific teach back questions assessing, in their own words, key aspect of the information presented to them about the research study and the risks and benefits of their participation.”

May combine two claims.

The European ACT interventions were delivered face-to-face by doctoral-level therapists, which makes them hard and costly to replicate, disseminate, and scale.

“Additionally, these interventions were delivered in-person by doctoral level therapists, making them difficult and expensive to replicate, disseminate, and scale.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Safety of the pilot trial was monitored throughout the study and ended at the conclusion of data collection.

“Safety of the pilot trial was monitored throughout the study and ended at the conclusion of data collection.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants with PHQ-8 and/or GAD-7 scores of 15 or higher at any follow-up were contacted by the clinical psychologist, informed of their scores, and offered referrals or coordination of follow-up psychological care.

“all participants with PHQ-8 and/or GAD-7 scores ≥ 15 (suggesting moderate to severe levels of depression and anxiety) at any follow-up assessment were contacted by the clinical psychologist on the team (SAJ).”

May combine two claims.

ACT may be especially suitable for anxious ADRD caregivers because, unlike CBT or mindfulness-only approaches, it helps them relate differently to experiences they cannot change.

“ACT may be ideal for ADRD caregivers with anxiety because unlike CBT or interventions that include only mindfulness practice, ACT aims to support the development of a healthier relationship with unchangeable personal experiences so caregivers can be more mentally flexible and have more meaningful interactions.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The research assistants who administered assessments were blinded to group assignment.

“Trained research assistants administering the assessments were blind to study condition.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

All analytical assumptions were verified.

“Analyses were performed using SAS version 9.4 (SAS Institute, Inc., Cary, NC) and all analytical assumptions were verified.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Interventionists completed an 8-hour online ACT training, assigned readings, protocol and manual study, listening to prior session recordings, and role-playing with debriefing by a clinical health psychologist.

“Interventionist training included completion of an online 8-hour ACT training course offered through Praxis Continuing Education and Training, assigned readings from an ACT text (Harris, R., 2019), in-depth study of the TACTICs study protocol, intervention manual, and participant notebook”

• cites Harris, R., 2019Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

ACT-based interventions may target different caregiver outcomes, such as compassion, emotion regulation, caregiver stress and strains, quality of life, personal gain, and purpose, which were not assessed in the current study.

“it may be that ACT-based interventions target different caregiver outcomes, such as compassion, emotion regulation, caregiver stress and strains, quality of life, personal gain, and purpose which were not assessed in the current study.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Learning to accept and navigate unchangeable aspects of dementia care may produce benefits that were not assessed in the current study.

“Learning how to accept and skillfully navigate unchangeable aspects of providing dementia care may result in benefits not assessed in the current study.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Fauth and colleagues (2022) found decreased caregiver stress due to behavioral symptoms along with improvements in positive aspects of caregiving and quality of life.

“Fauth and colleagues (2022) found decreased caregiver stress due to behavioral symptoms along with improvements in positive aspects of caregiving and quality of life.”

• cites Fauth and colleagues (2022)Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

Psychological flexibility may be an important mediator to include in subsequent analyses to more precisely examine the impact of ACT on outcomes.

“These findings suggest psychological flexibility may be an important mediator to include in subsequent analyses for more precisely examining the impact of ACT on outcomes.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Overall, research has found support for the acceptability and feasibility of ACT protocols, but questions remain about the appropriate dose, length of implementation, and measures for demonstrating efficacy.

“Overall, research has found support for the acceptability and feasibility of ACT protocols, yet questions remain pertaining to the appropriate intervention does and length of time needed for implementation along with the appropriate measures for demonstrating efficacy.”