Efficacy of behavioral interventions for dementia caregivers. Worksite-based internet multimedia program for family caregivers of persons with dementia. Modification of dysfunctional thoughts about caregiving in dementia family caregivers: description and outcomes of an intervention programme. Impact of in-home behavioral management versus telephone support to reduce depressive symptoms and perceived stress in Chinese caregivers: results of a pilot study. Interventions with care givers of dementia patients: comparison of two approaches. Reducing anxiety in Alzheimer's disease family caregivers: the effectiveness of a nine-week cognitive-behavioral intervention. Anger and depression management: psychoeducational skill training interventions for women caregivers of a relative with dementia. Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. Efficacy of a psychoeducative group program for caregivers of demented persons living at home: a randomized controlled trial.
Behavioral symptoms of Alzheimer's disease, particularly agitation, appear to be a major contributing factor to the emotional distress exhibited by family caregivers. Psychosocial interventions have been shown to reduce caregiver emotional distress, but few studies have examined the efficacy of these interventions with caregivers exposed to high levels of dementia-related behavioral symptoms. The purpose of this study is to test the efficacy of a caregiver skill building intervention in reducing emotional distress to agitated behaviors of care recipients. This study analyzed data from a subgroup of caregivers who participated in a larger randomized clinical trial (N = 295). Data from 143 caregivers of family members with baseline agitated behaviors indicate that the skill building intervention was more effective than an information and support oriented comparison condition in reducing emotional distress over an 18-month period. These findings indicate that dementia caregivers exposed to agitated behaviors can benefit from psychosocial interventions, particularly those aimed at building behavioral management skills. Our goal was to evaluate the efficacy of a multimedia support program delivered over the Internet to employed family caregivers of persons with dementia.
                The evaluation of this program involved 299 employed family caregivers participating in a pretest-posttest randomized clinical trial with a 30-day follow-up and a waitlist control condition. Validated instruments include the Center for Epidemiologic Studies-Depression scale, the State-Trait Anxiety Inventory, the Caregiver Strain scale from Benjamin Rose, and Positive Aspects of Caregiving used in the nationwide REACH study.
                Those who viewed Caregiver's Friend: Dealing with Dementia 30 days postexposure demonstrated significant improvements in depression, anxiety, level and frequency of stress, caregiver strain, self-efficacy, and intention to seek help, as well as perceptions of positive aspects of caregiving.
                Interactive multimedia interventions delivered over the Internet appear to be uniquely suited to provide low-cost, effective, convenient, individually tailored programs that present educational information, cognitive and behavioral skills, and affective learning opportunities. This makes Web-based multimedia a promising avenue for work-life balance programs, employee-assistance providers, and organizations interested in improving family caregiver health and well-being. Among the diverse group of interventions developed to help dementia family caregivers cognitive-behavioural approaches show especially promising results.
                This study describes a cognitive-behavioural group intervention aimed principally at the modification of dysfunctional thoughts associated with caregiving (MDTC). The efficacy of the MDTC intervention in reducing caregivers' depressive symptomatology, together with the frequency and appraisal of problem behaviours, is compared to that of a waiting-list control group (WL). Furthermore, the potential mediating role of the dysfunctional thoughts in the relationship between this intervention and caregivers' depressive symptomatology is analyzed. Of the 74 dementia caregivers who were randomized to one of two conditions (MDTC and WL), 39 completed the post-intervention assessment. Statistical analyses were performed on an intention-to-treat basis, using last observation carried forward. The results reveal that the MDTC intervention is successful in reducing caregivers' level of depressive symptomatology and dysfunctional thoughts about caregiving, as well as in modifying their appraisal of their relative's problem behaviours. Furthermore, a mediating role for dysfunctional thoughts was found in the relationship between the MDTC intervention and levels of depressive symptomatology. The relevance of addressing dysfunctional thoughts and cognitive distortions in group interventions with caregivers is highlighted. Recent work has shown that Chinese Americans caring for a family member with dementia experience considerable psychological distress. However, few studies evaluate treatments for them. This study evaluated the efficacy of in-home intervention, based on cognitive behavior therapy principles, to relieve stress and depression in female Chinese American caregivers (CGs).
                Fifty-five CGs who met inclusion criteria were randomly assigned to a telephone support condition (TSC) or to an in-home behavioral management program (IHBMP) for 4 months. In the TSC, biweekly calls were made and relevant material was mailed. In the IHBMP, specific psychological skills were taught to deal with caregiving stress. CGs were assessed before and after treatment. Outcome measures evaluated overall perceived stress, caregiving-specific stress, and depressive symptoms.
                CGs in IHBMP were less bothered by caregiving-specific stressors and had lower depression levels than CGs in TSC. There was no difference in overall stress. CGs with low baseline level of self-efficacy for obtaining respite benefited from IHBMP, but showed little improvement in the TSC. CGs with higher self-efficacy benefited from both treatments.
                This intervention is promising and warrants replication in future studies. Additional research is needed to evaluate longer-term effects and to identify individual differences associated with improvement. We compared the effect of two approaches, family counseling and support groups, for relieving the stress and burden experienced by care givers of dementia patients. Both treatments are designed to implement features of a stress-management model that have been identified in prior research with this population: providing information about the patient's disease and its effects on behavior, teaching behavioral problem solving for managing difficult behavior, and identifying potential support for care givers. Subjects were primary care givers of dementia patients living in the community; they included husbands, wives, daughters, and other relatives. Although subjects in the treatment groups made significant gains over time, they did not differ from wait-list subjects who showed similar improvements. One-year follow-up interviews indicated that gains made during the treatment period were maintained. Although the literature is replete with studies examining the psychological concomitants and interventions for Alzheimer's disease (AD) family caregivers, a surprisingly small amount of research exists on anxiety. Given prevalence rates suggesting that anxiety significantly impacts one in three family caregivers, brief group cognitive-behavioral therapy (CBT) interventions may offer assistance. To assess CBT's effectiveness, 38 anxious AD family caregivers were recruited and randomly assigned to a nine-week group CBT intervention or to a waitlist control. Caregivers randomized to CBT demonstrated less anxiety on self-report and clinician-administered questionnaires than waitlist group participants at posttreatment and six-week follow-up assessments. A subsample of caregivers also demonstrated improved sleep, as assessed through actigraph measurements. Additional study is recommended with diverse anxious family caregiving groups to further investigate the effectiveness of brief CBT group interventions. This study examines the short-term impact of two theoretically based psychoeducational small group interventions with distressed caregivers, and it also examines the role of specific moderator and mediator variables on caregiver outcomes.
                Female participants (N = 169) aged 50 and older who were caring for a community-dwelling relative with a dementing illness were randomly assigned to one of three treatment interventions: anger management, depression management, or a wait-list control group. These interventions took place over a 3- to 4-month period. The primary outcomes examined were anger or hostile mood, depressed mood, frequency of use of positive and negative coping strategies, and perceived caregiving self-efficacy.
                Significant main effects in the expected direction were found for changes in most of these measures. Participants in both anger management and depression management groups had significant reductions in their levels of anger or hostility and depression from Time 1 to Time 2 in comparison to participants in the wait-list control group. Use of positive cognitive coping strategies increased in the anger management group only. Self-efficacy significantly increased for participants in both intervention groups, and it was also demonstrated to function as a mediator of intervention effects. Pretreatment levels of depressive symptoms and anger expression style (Anger Expression-Out) moderated the relative effects of the two interventions on mood and coping.
                These data are consistent with a growing body of evidence supporting the effectiveness of skills training, in small groups, to improve both the affective states and the type of coping strategies used by caregivers. In addition, this study underscores the need to evaluate key pretreatment variables in order to determine which form of treatment may be more compatible with caregiver characteristics and thus more likely to be beneficial to individuals. The majority of patients with Alzheimer's disease live outside institutions and there is considerable serious psychological morbidity among their carers.
                To evaluate whether family intervention reduces the subjective burden of care in carers of patients with Alzheimer's disease and produces clinical benefits in the patients.
                A prospective single-blind randomised controlled trial with three-month follow-up in which the experimental group received family intervention and was compared with two control groups.
                There were significant reductions in distress and depression in the intervention group compared with control groups at post-treatment and follow-up. There were significant reductions in behavioural disturbance at post-treatment and an increase in activities at three months in patients in the intervention group. Based on an improvement on the General Health Questionnaire resulting in a carer converting from a case to a non-case, the number to treat was three immediately post-treatment and two at follow-up.
                Family intervention can have significant benefits in carers of patients with Alzheimer's disease and has a positive impact on patient behaviour. To test the efficacy of a psychoeducative group program for informal caregivers of persons with dementia.
                The study was a multicenter randomized controlled trial. Randomization was stratified according to sex and kinship. Participants randomized to the control group were referred to the traditional support groups. Participants in the study group had fifteen 2-hr weekly sessions focusing on stress appraisal and coping. Eligible participants (primary caregivers of community-dwelling persons with dementia) were blindly assessed before the randomization and after 16 weeks on the following measures: frequency and reactions to behavioral problems (primary outcome), burden, psychological distress, anxiety, perceived social support, and personal efficacy.
                A total of 158 participants were randomized to the study (n = 79) and control (n = 79) groups in 12 successive waves. Results show that study participants presented a 14% decrease in their reactions to the behavioral problems of the care-receivers as opposed to a 5% decrease in the control group ( p =.04). The frequency of behavior problems also decreased ( p =.06), as did the cross-product frequency/reaction ( p =.02). There was no significant effect on the secondary outcome variables.
                This is one of the first studies showing a significant effect of this type of support group program on the caregivers of participants with dementia.
Cognitive reframing for family carers of people with dementia seems to reduce psychological morbidity and subjective stress but without altering appraisals of coping or burden. The results suggest that it may be an effective component of individualised, multi-component interventions for carers. Identifying studies with relevant interventions was a challenge for this review. The impact of cognitive reframing might be higher when used alongside other interventions because this offers better opportunities to tailor cognitive reframing to actual everyday carer problems.