A new study from Virginia Tech suggests patterns of repetitive negative thinking explain how anxiety develops into deeper stress for caregivers of people living with dementia, and that mindfulness training may help identify and interrupt that progression.
“Our hypothesis centered on rumination — that mental habit of replaying worries, going over the same difficult moments again and again without resolution,” said Tina Savla, professor of human development and family science and lead author of the study. “We wanted to know two things: first, whether rumination is the cognitive bridge that carries anxiety into deeper distress, and second, whether training caregivers in mindfulness changes how that bridge operates.”
Published in The Gerontologist , the study highlighted rumination as a cognitive pathway for anxiety to develop into deeper psychological stress among caregivers of veterans living with dementia. Researchers also found that mindfulness practices, especially if introduced early, can help these caregivers identify and navigate their stress before it develops further and rumination begins.
Beyond daily hands-on assistance, caregivers of people living with dementia often manage unpredictable behaviors and the slow decline of their loved ones, while also navigating the personal impacts of caring for someone with this progressive and incurable disease. The researchers said that while anxiety and heightened levels of stress have been well-documented among these caregivers, less is known about the processes that can cause those feelings to progress into deeper psychological distress, and the ways to stop that progression from the start.
This study, led by Savla in collaboration with clinicians from the Salem Veterans Affairs Health Care System in Salem, Virginia, recruited 133 caregivers of veterans living with dementia through the Department of Veterans of Affairs system and primary care clinics. Each caregiver previously reported moderate to severe caregiving burden and anxiety.
The caregivers were then split between two evidence-based intervention programs, Practice of Awareness, Acceptance, and Compassion in Caregiving and Resources for Enhancing All Caregivers Health, to measure whether participants experienced post-intervention anxiety after completing either program.
The latter program centers around problem solving, reframing negative thinking, and acceptance, whereas the former integrates mindfulness exercises to help manage stress and work with ruminative thinking.
“Caregivers of veterans living with dementia are, in many ways, a window into caregiving at its most demanding,” said Savla, who is also a core faculty member of the Center for Gerontology . “This population let us observe, in a real healthcare system with families under sustained strain, how anxiety feeds into those repetitive thought cycles and how those cycles relate to depression and stress.”
Both groups participated in four sessions that provided evidence-based stress management skills and support that varied upon the intervention program. Researchers then examined if post-intervention anxiety developed into rumination behaviors, leading caregivers to feel overwhelmed and experience depressive symptoms and caregiver burden.
The researchers say the findings suggest that healthcare providers may need to look beyond traditional caregiver support methods. Current screening practices measure the hours of caregiving and the severity of their relatives living with dementia, not the caregiver’s daily stress and well-being. By adding caregiver-specific screening questions that capture daily stress and rumination, healthcare practitioners could identify at-risk caregivers earlier, when support may do the most good.
“Some anxious groups can benefit from one intervention, but another group might not,” said Nahyun Kim, a doctoral student in human development and family science and co-author of the study. “We have to consider the full context of each caregiver and provide support in a customized way.”
Moving forward, the researchers want to follow these caregivers more closely over time and expand the study to examine a variety of caregivers of people living with dementia. The participants of this study were mainly white women caring for spouses within the local Veterans Affairs Healthcare System, limiting the overall representation of cultural, gender, and socioeconomic contexts of caregivers of people living with dementia.
The researchers believe that by examining a larger pool of participants, researchers could better understand the ways these contexts impact individual caregivers of people living with dementia, helping to identify the support and resources that are right for them. However, the researchers note that these intervention programs and skills cannot solve caregiver burden, anxiety, rumination, and depressive symptoms alone.
“The real future of this work is pairing psychological tools with structural relief,” Savla said. “Expanded respite benefits, caregiver leave policies, Medicare-covered caregiver training, and comprehensive models like the Program of All-Inclusive Care for the Elderly that integrate medical, social, and long-term care into a single, personalized plan for families.”
Original study DOI: 10.1093/geront/gnag103
The Gerontologist
Data/statistical analysis
People
Mindfulness and Rumination: Stress Pathways for Caregivers of Persons Living with Dementia
6-Jul-2026