A mediating role of cognitive fusion in the relationship between pre-death grief and depressive symptoms among family caregivers of people with dementia.

This article investigates the mediating role of cognitive fusion—defined as the tendency to become entangled with distressing thoughts—in the relationship between pre-death grief and depressive symptoms among 191 family caregivers of individuals with Alzheimer's disease and related dementias (ADRD) in the United States. Using path analysis while controlling for behavioral and psychological symptoms of dementia (BPSD), the study found that cognitive fusion partially mediates this relationship, accounting for approximately 32% of the total effect. These findings suggest that caregivers who are more fused with grief-related thoughts tend to experience greater depressive symptoms, highlighting cognitive fusion as a potential therapeutic target. The study supports the use of interventions such as acceptance and commitment therapy (ACT) that focus on reducing cognitive fusion to better support caregivers coping with pre-death grief. Limitations include the cross-sectional design, predominance of female participants, and the need for further research on cultural and longitudinal factors.