Table 3.

Proposed session content of early dyadic interventions for NDDs

	Case 1	Case 2
General Session 1: Individual and Dyadic Appraisal of NDD Diagnosis and Stressors	Education focused on: Common early symptoms, relationship changes, and emotional reactions to changes Skills focused on: Increasing awareness of diagnosis, symptoms, and prognosis for dyad. Increase present moment focus, non-judgmental awareness of symptoms and changes, reduce overwhelming emotions, and set the stage for more effective communication Examples of skills: deep breathing, mindfulness, staying within the 24-hour block, mindfulness meditation)
	Case 1	Case 2
General Session 2: Coping with Uncertainty	Education focused on: Ways to evaluate current abilities and needs for daily tasks (e.g., cooking, driving, working). Common trajectory of NDD and ways of identifying and navigating “transition points” with changing needs Skills focused on: Coping with conflicting thoughts/ feelings, reduce focus on worry-thoughts, understand active vs. emotional coping. Examples of skills: Dialectical thinking, deciding between acceptance and change, problem-solving coping, radical acceptance
	Case 1	Case 2
General Session 3: Content and Skills to Navigate Interpersonal Relationships and Engage Support Resources	Education focused on: Ways to identify historic and current interpersonal communication dynamics and positive communication behaviors (e.g., speaker-listener skills, empathic responding, perspective taking) Skills focused on: building on dyad’s strengths and proactively plan for difficult conversations, collaboratively navigate challenges, and make decisions for the future Examples of skills: interpersonal effectiveness (clarifying goals, dyadic coping)
	Case 1	Case 2
Additional Session Topics: Content and Skills tailored to dyad’s most prominent early stressors (3-4 additional sessions)	Session 4. Dyadic coping for adjusting to symptoms and adhering to medical recommendations Education focused on: safety considerations for daily activities (driving, cooking, working) and modified ways of participating; examples of dyadic coping amid changes Examples of skills: adjusting values and priorities to current functioning, modified pleasant activities based on person with AD’s abilities, positive psychology skills (humor, gratitude, optimism) Session 5. Preparing for transitions and future needs Education on identifying “transition points” and communicating about care and support needs. Using skills (mindfulness, dialectics) to cope ahead of future challenges. Examples of skills: Dialectical thinking to identify ways things have changed and stayed the same in dyads’ relationship and roles, using mindfulness and dialectics to preserve autonomy and relationships throughout AD progression Session 6. Meaning making Education on ways of using skills (e.g., mindfulness, dialectics) to understand the illness experience and transition to care-partners; examples of making meaning in the midst of a terminal diagnosis. Examples of skills: Exercises to promote individual and interpersonal/dyadic valued living (e.g., “bucket list”), radical acceptance, using dialectics to grieve losses and move forward	Session 4. Dyadic coping for adjusting to symptoms and adhering to medical recommendations Education on strategies to adhere to self-care and medical provider recommendations for care; modified ways of participating in daily activities (cooking, physical activity); examples of dyadic coping amid changes Examples of skills: goal setting for adherence to medical regimens; modified pleasant activities based on person with PD’s abilities; positive psychology skills (humor, gratitude, optimism) Session 5. Fear of worsening symptoms and grieving losses Education on fear/worry, observing difficult emotions, and deciding between acceptance and change strategies; communicating about fear and worry as a dyad. Examples of skills: Mindfulness and chain analysis to identify thoughts/feelings of fear and worry and associated behaviors (e.g., rumination, planning); dialectical thinking to identify thoughts/feelings to accept and skills to practice; dyadic coping about difficult thoughts/emotions and asking for support. Session 6. Engaging in positive activities Education on benefits of behavioral activation and social support resources (e.g., weekly activities, support groups, engaging social network). Examples of skills: Daily goals for pleasant activities tailored to person with PD’s abilities; goals for self-care behaviors; self and other-compassion practices to increase motivation.