Introduction
In recent years, the increasing elderly population has posed various challenges, including health, medical, social, psychological, familial, and financial. Caring for patients with Alzheimer disease (AD) also comes with significant pressures that may reduce the quality of life for caregivers. Therefore, the present study investigates the effectiveness of compassion-focused therapy on caregiving burden and psychological flexibility in caregivers of elderly individuals with Alzheimer disease.

Methods & Materials 
This was a semi-experimental study with a pretest-posttest design accompanied by a 3-month follow-up period. The statistical population consisted of caregivers of elderly patients with AD referring to neurology clinics in Tehran City, Iran, during the spring of 2023, of whom 112 individuals expressed initial readiness. Based on the inclusion and exclusion criteria of the study, previous studies, and sample size formula, a total of 30 individuals were selected through the purposive sampling method and randomly assigned into two groups of 15 participants, namely an experimental group (n=15) and a control group (n=15). 
The inclusion criteria for the study included an age range of 30 to 45 years, being married, having at least a diploma degree, scoring above the average in the acceptance and action questionnaire-II (AAQ-2) by Hayes et al. [10] and caregiver burden inventory (CBI) by Novak et al.[36], and individuals’ willingness to participate in the research. Additionally, the exclusion criteria from the study included participants’ unwillingness to participate in the research at any stage of treatment and absence from more than two sessions of intervention sessions. Moreover, diagnostic criteria for AD were evaluated under the supervision of a neurologist and by the guidelines outlined in the diagnostic and statistical manual of mental disorders, 4th edition (DSM-IV), Text Revision, aiming to confirm the presence of symptoms and key indicators associated with this neurological disorder. After administering the questionnaires, the intervention focused on compassion for the experimental group in 90-min sessions over 8 consecutive weeks, while no intervention was performed for the control group. 
The participants responded to the questionnaires again at the end and 3 months after the intervention. Data analysis was conducted using repeated measures analysis of variance using the SPSS software, version 23 (P≤0.05 was considered statistically significant).

Results
The results showed that compassion-focused therapy was effective in reducing caregiving burden and improving psychological flexibility in caregivers of elderly individuals with AD. The examination of the sociodemographic characteristics of participants, distinguished between the experimental and control groups, indicates that in this study, there were 18 women (with a Mean ±SD age of 35.53±3.14) and 12 men (with a Mean ±SD age of 36.40±3.62). Regarding educational level, more than half of the participants had a bachelor’s degree, while the rest were distributed across three levels: diploma, post-diploma, and master’s degree. Furthermore, the results suggest that the mean levels of caregiving burden and psychological flexibility in the treatment group focused on compassion decreased in the post-test and follow-up stages compared to the pre-test stage. 
This was while the mean levels of caregiving burden and psychological flexibility in the control group did not show significant differences across the pre-test, post-test, and follow-up stages. Additionally, the experimental and control groups significantly differ in the components of time pressure, interruption in growth, physical stress, social stress, emotional stress, and overall caregiving burden scores. Moreover, the scores of the two groups in psychological flexibility significantly differ. Intra-group effects analysis indicates significant differences in caregiving stress among pre-test, post-test, and follow-up scores in the time pressure component. Similar significant differences were observed in the interruption in the growth component and the physical stress component. In addition, significant differences were found in caregiving burden among pre-test, post-test, and follow-up scores in the social stress component, emotional stress component, and overall caregiving burden scores. Moreover, significant differences were found in psychological flexibility among pre-test, post-test, and follow-up scores.

Conclusion
The importance of training caregivers for the elderly, especially those dealing with individuals suffering from the AD, is incredibly vital. Given the complexities and unique challenges arising from Alzheimer conditions, caregivers require specific knowledge and skills to effectively and empathetically address the needs of this population. Specialized training can assist caregivers in gaining a better understanding of disease progression, communicative needs, and behaviors of dementia-afflicted elderly individuals. Moreover, focusing on compassion-based approaches and positive communication can lead to stress reduction and improved quality of life for both the elderly and their caregivers. Furthermore, training in coping skills and self-care for caregivers is important to prevent job burnout and mitigate negative psychological and social impacts. Ultimately, equipping caregivers with the necessary skills and knowledge enhances the standards of elderly care, ensuring quality and compassionate care assistance.

Ethical Considerations
Compliance with ethical guidelines
This research has received the Code of Ethics from the Roudehen Branch, Islamic Azad University, Roudehen, Iran (Code: IR.IAU.R.REC.1402.019).

Funding
This study is based on Seyyed Farzan Madani's master's thesis, clinical psychology, Faculty of Psychology and Social Sciences, Roudehen Branch, Islamic Azad University, Roudehen, Iran. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Proposal writing, sampling, and article drafting: Seyed Farzan Madani; Contributed to methodological design, editing, and overseeing all stages of the article: Pegah Farokhzad.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgments
The authors express their gratitude to all participants for their support of this research.

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