Volume 56, March–April 2024, Pages 285-290Author links open overlay panel, Highlights•

Adapting an evidence-based intervention for depression to the context of social connectedness is promising.

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The framework for reporting adaptations and modifications-enhanced facilitated a comprehensive documentation of the adaptations.

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Modifications to content and delivery reflect the goal of improving behavioral activation intervention fit in the context of social connectedness experienced by informal caregivers.

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Technology-enhanced delivery of interventions may support efforts to address social connection barriers common to caregivers.

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Individualized behavioral activation intervention may increase social connectedness across generations of caregivers.

Abstract

Informal caregivers of older adults with chronic illness have unique barriers to social connection. As the older adult population increases, individualized interventions are urgently needed to address the social disconnection experienced across generations of informal caregivers. Adapting an evidenced-based intervention to target social connectedness and leverage technology-mediated communication may be a promising approach. This article describes the adaptation of the Brief Behavioral Activation Treatment for Depression-Revised intervention using elements of the Framework for Reporting Adaptations and Modifications-Enhanced. Facilitating the comprehensive documentation of modifications made, we discuss the (a) rationale for modifications, (b) timing and approach to modifications, (c) nature of context and content modifications, and (d) fidelity in modifications. The Behavioral Activation for Family Caregiver Connectedness intervention addresses unique barriers to caregiver social connection with individualized value-based plans. Modifications to content and delivery reflect the goal of improving intervention fit in the context of social connectedness experienced by informal caregivers.

Section snippetsBehavioral activation for depression: The intervention adapted

The Behavioral Activation Treatment for Depression (BATD),31 is a manualized intervention designed to increase behavior that is likely to reinforce environmental contingencies. The intervention evolved out of the reinforcement explanation of depression, which proposes that depressed behavior patterns are the result of a loss or lack of response-contingent positive reinforcement.27 Emphasizing the association between behavior and mood, the BATD intervention facilitates: (a) the identification of

Rationale for modifications

The prevalence and health effects of social isolation and loneliness are significant among informal caregivers.5 Few interventions target engagement in individually valued activities, despite research indicating that such engagement might be particularly beneficial.10,12 Research evaluating behavioral activation for late-life depression found that participation in rewarding social activities with significant others increased treatment benefits.35,36 Reviews of literature identified the BATD-R

Discussion

This paper described the process of adapting the Behavioral Activation Treatment for Depression Revised (BATD-R)25 as the basis for the Behavioral Activation for Family Caregiver Connectedness (BAFCC).26 The Framework for Reporting Adaptations and Modifications-Enhanced (FRAME),29 guided this work, with the goal of improving intervention fit in the context of social connectedness among informal caregivers of older adults with chronic illness. The caregiver social connectedness modifications to

Conclusion

Informal caregivers may be unable to overcome certain barriers to social connectedness, as in many cases, the primary barrier is the duty of caregiving itself. It may be helpful for caregivers to consider their self-care as part of the duty that benefits their care recipient. The BAFCC addresses the barrier for caregivers, using individualized value-based plans to promote social connectedness and implement social goals. This work advances the science of social disconnection in caregivers of

CRediT authorship contribution statement

Janet S. Pohl: Conceptualization, Methodology, Project administration, Visualization, Writing – original draft. Julie Fleury: Methodology, Resources, Writing – original draft, Writing – review & editing.

Declaration of competing interest

The authors declare that there is no conflict of interest to report in this work.

Acknowledgement

We thank the Institute for Social Science Research at Arizona State University for support of this work.

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