Mindfulness and Rumination: Stress Pathways for Caregivers of Persons Living with Dementia

BACKGROUND AND OBJECTIVES: Family caregivers of persons living with dementia face persistent caregiving demands that heighten risk for anxiety, depressive symptoms, and perceived stress. Although caregiving distress is well documented, less is known about the cognitive processes that link anxiety to broader psychological distress, or whether mindfulness-based interventions affect these processes. This study examined rumination as a cognitive mediator linking anxiety with these outcomes and tested whether mindfulness training moderated this association. RESEARCH DESIGN AND METHODS: Using data from a randomized controlled trial comparing the Practice of Awareness, Acceptance, and Compassion in Caregiving (PAACC) program with REACH-VA, we conducted a secondary mechanistic analysis using structural equation models (N = 133). Models tested whether post-intervention rumination mediated associations between post-intervention anxiety and depressive symptoms, perceived stress, and caregiver burden, while adjusting for baseline variables, and whether the anxiety-rumination association differed by intervention group. RESULTS: Rumination significantly mediated associations between anxiety and both depressive symptoms and perceived stress, but not caregiver burden. Mindfulness moderated the anxiety-rumination association, with stronger coupling at higher anxiety in PAACC participants. No direct group differences in post-intervention outcomes emerged. Alternate model specifications showed weaker overall fit than the hypothesized model. DISCUSSION: Findings highlight rumination as an important cognitive process linking anxiety with psychological distress and suggest that mindfulness training may influence how anxiety is cognitively elaborated, rather than uniformly reducing distress. Future research in diverse caregiver populations and with longer timeframes is warranted to clarify temporal ordering and variability in responsiveness to mindfulness-based approaches.