Hostname: page-component-78c5997874-lj6df Total loading time: 0 Render date: 2024-11-19T23:22:37.712Z Has data issue: false hasContentIssue false
  • English
  • Français

A meta-analysis of low-intensity cognitive behavioral therapy-based interventions for dementia caregivers

Published online by Cambridge University Press:  12 November 2018

Laura Kaddour ,
Naoko Kishita  and
Anthony Schaller
Laura Kaddour*
Affiliation:
Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
Naoko Kishita
Affiliation:
School of Health Sciences, University of East Anglia, Norwich, UK
Anthony Schaller
Affiliation:
Mid Essex Specialist Dementia and Frailty Service, Essex Partnership University NHS Foundation Trust, Essex, UK
*
Correspondence should be addressed to: Laura Kaddour, Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK. Phone: 01603 593599; Email: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives:

This study aimed to review the effectiveness of low-intensity cognitive behavioral therapy (CBT)–based interventions for informal dementia caregivers when compared to non-active control conditions.

Design:

Literature searches were conducted in databases of published (PsycINFO, MEDLINE, CINAHL, Scopus) and unpublished (Open Grey, ISRCTN registry, ClinicalTrials.gov, ProQuest) literature. Individual meta-analyses were conducted for each outcome variable. Pooled intervention effect estimates were calculated as Hedge’s g using a random-effects model.

Included studies:

Studies examining the effect of low-intensity CBT-based interventions for informal caregivers for people with any progressive dementia were included. Randomized controlled trials and controlled clinical trials were included.

Measurements:

Outcomes included the psychological variables of anxiety, depression, burden, and distress (defined as stress or strain).

Results:

A total of five studies reported anxiety outcomes, 12 reported on depression, three reported on burden, and six reported distress outcomes. Results demonstrated a significant effect of low-intensity CBT-based interventions in reducing all examined psychological difficulties. Small effect sizes were found for anxiety (g = 0.35), depression (g = 0.27), and distress (g = 0.33). A medium effect was found for burden (g = 0.53).

Conclusions:

The results provide initial support for low-intensity CBT-based interventions for dementia caregivers. Clinical implications and research recommendations are explored. Strengths and limitations of the study are discussed.

Keywords

dementia caregiverscognitive behavioral therapyCBTlow intensityanxietydepressionburdendistress
Type
Review Article
Information
International Psychogeriatrics , Volume 31 , Issue 7: Issue Theme: Diverse Approaches to Stemming Cognitive Decline , July 2019 , pp. 961 - 976
Copyright
© International Psychogeriatric Association 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Ali, S. et al. (2017). How durable is the effect of low intensity CBT for depression and anxiety? Remission and relapse in a longitudinal cohort study. Behaviour Research and Therapy, 94, 1–8. doi: 10.1016/j.brat.2017.04.006.CrossRefGoogle Scholar
Au, A. et al. (2010). The coping with caregiving group program for Chinese caregivers of patients with Alzheimer’s disease in Hong Kong. Patient Education and Counseling, 78, 256–260. doi: 10.1016/j.pec.2009.06.005.CrossRefGoogle ScholarPubMed
BABCP. (2012). BABCP minimum training standards. Available at http://www.babcp.com/files/Minimum-training-standards-V6-0413.pdf, accessed 27 December 2017.Google Scholar
Bass, D. M., McClendon, M., Brennan, P. and McCarthy, C. (1998). The buffering effect of a computer support network on caregiver strain. Journal of Aging and Health, 10, 20–43. doi: 10.1177/089826439801000102.CrossRefGoogle ScholarPubMed
Beauchamp, N. et al. (2005). Worksite-based internet multimedia program for family caregivers of persons with dementia. The Gerontologist, 45, 793–801. doi: 10.1093/geront/45.6.793.CrossRefGoogle ScholarPubMed
Beck, A. T. (1979). Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond, 2nd edn. New York and London: Guilford Press.Google Scholar
Bennett, J. M., Fagundes, C. P. and Kiecolt-Glaser, J. K. (2013). The chronic stress of caregiving accelerates the natural aging of the immune system. In: Immunosenescence (pp. 35–46). New York, NY: Springer.CrossRefGoogle Scholar
Bennett-Levy, J. et al. (2010). Low intensity CBT interventions: a revolution in mental health care. In: Oxford Guide to Low Intensity CBT Interventions. Oxford: Oxford University Press.Google Scholar
Bertrand, R. M., Fredman, L. and Saczynski, J. (2006). Are all caregivers created equal? Stress in caregivers to adults with and without dementia. Journal of Aging and Health, 18, 534–551. doi: 10.1177/0898264306289620.CrossRefGoogle ScholarPubMed
Biostat Inc. (2014). Comprehensive meta-analysis software (CMA). Available at =https://www.meta-analysis.com/index.php?cart=B5T5990373, accessed 27 December 2017.Google Scholar
Blom, M. M., Zarit, S. H., Groot Zwaaftink, R. B., Cuijpers, P. and Pot, A. M. (2015). Effectiveness of an internet intervention for family caregivers of people with dementia: results of a randomized controlled trial. PLOS ONE, 10, e0116622. doi: 10.1371/journal.pone.0116622.CrossRefGoogle ScholarPubMed
Borenstein, M., Hedges, L. V., Higgins, J. and Rothstein, H. (2009). Introduction to Meta-Analysis. Chichester, UK: John Wiley & Sons.CrossRefGoogle Scholar
Bower, P. et al. (2013). Influence of initial severity of depression on effectiveness of low intensity interventions: meta-analysis of individual patient data. BMJ, 346, f540. doi: 10.1136/bmj.f540.CrossRefGoogle ScholarPubMed
Brodaty, H. and Donkin, M. (2009). Family caregivers of people with dementia. Dialogues in Clinical Neuroscience, 11, 217–228.Google ScholarPubMed
Brodaty, H. et al. (2014). Prevalence and predictors of burden in caregivers of people with dementia. American Journal of Geriatric Psychiatry, 22, 756–765. doi: 10.1016/j.jagp.2013.05.004.CrossRefGoogle ScholarPubMed
Chang, B. L. (1999). Cognitive-behavioral intervention for homebound caregivers of persons with dementia. Nursing Research, 48, 173–182. doi: 10.1097/00006199-199905000-00007.CrossRefGoogle ScholarPubMed
Chiu, M., Pauley, T., Wesson, V., Pushpakumar, D. and Sadavoy, J. (2015). Evaluation of a problem-solving (PS) techniques-based intervention for informal carers of patients with dementia receiving in-home care. International Psychogeriatrics, 27, 937–948. doi: 10.1017/S1041610214002798.CrossRefGoogle ScholarPubMed
Cohen, S., Kamarck, T. and Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behaviour, 24, 385–396. doi: 10.2307/2136404.CrossRefGoogle ScholarPubMed
Cohen, S. and Williamson, G. (1998). Perceived stress in a probability sample of the United States. In: Spacapan, S. and Oskamp, S. (eds.), The Social Psychology of Health: Claremont Symposium on Applied Social Psychology (pp. 31–67). Newbury Park, CA: SAGE Publications.Google Scholar
Cress, C. (2009). Handbook of Geriatric Care Management. Sudbury, MA: Jones and Bartlett Publishers. Available at http://www.jblearning.com/catalog/9781284078985/; accessed 23 January 2018.Google Scholar
Cuijpers, P. (2016). Meta-Analyses in Mental Health Research: A Practical Guide. Amsterdam: Vrije Universiteit Amsterdam.Google Scholar
Derogatis, L. R. (1993). BSI Brief Symptom Inventory: Administration, Scoring, and Procedure Manual, 4th edn. Minneapolis, MN: Pearson.Google Scholar
Dowling, G., Hubbard, E. M. and Moskowitz, J. T. (2013). Life enhancing activities for family caregivers of people with frontotemporal dementia. Alzheimer Disease and Associated Disorders, 28, 175–181. doi: 10.1097/WAD.0b013e3182a6b905.CrossRefGoogle Scholar
Duval, S. and Tweedie, R. (2000). Trim and fill: a simple funnel plot based method of testing and adjusting for publication bias in meta-analysis. Biometrics, 56, 455–463. doi: 10.1111/j.0006-341x.2000.00455.x.CrossRefGoogle ScholarPubMed
Elvish, R., Lever, S., Johnstone, J., Cawley, R. and Keady, J. (2013). Psychological interventions for carers of people with dementia: a systematic review of quantitative and qualitative evidence. Counselling and Psychotherapy Research, 13, 106–125. doi: 10.1080/14733145.2012.739632.CrossRefGoogle Scholar
Ferrara, M., Langiano, E., Di Brango, T., De Vito, E., Di Cioccio, L. and Bauco, C. (2008). Prevalence of stress, anxiety and depression in with Alzheimer caregivers. BioMed Central, 6, 93. doi: 10.1186/1477-7525-6-93.Google ScholarPubMed
Franca, C. (2017). Fix Dementia Care: Funding. Alzheimer’s Society. Available at https://www.alzheimers.org.uk/info/20016/campaigns/1022/fix_dementia_care_funding; accessed 14 December 2017.Google Scholar
Friedman, E. M. et al. (2015). US prevalence and predictors of informal caregiving for dementia. Health Affairs, 34, 1637–1641. doi: 10.1377/hlthaff.2015.0510.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D. and Coon, D. W. (2007). Evidence-based psychological treatments for distress in family caregivers of older adults. Psychology and Aging, 22, 37–51. doi: 10.1037/0882-7974.22.1.37.CrossRefGoogle ScholarPubMed
Gallagher-Thompson, D. et al. (2008)*. Effectiveness of cognitive/behavioral small group intervention for reduction of depression and stress in non-Hispanic White and Hispanic/Latino women dementia family caregivers: outcomes and mediators of change. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 26, 286–303. doi: 10.1007/s10942-008-0087-4.CrossRefGoogle ScholarPubMed
Higgins, J. and Green, S. (2011). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. West Sussex, England: John Wiley & Sons.Google Scholar
Kajiyama, B. et al. (2013). Exploring the effectiveness of an internet-based program for reducing caregiver distress using the iCare stress management e-training program. Aging & Mental Health, 17, 544–554. doi: 10.1080/13607863.2013.775641.CrossRefGoogle ScholarPubMed
Kalula, S. and Petros, G. (2011). Responses to dementia in less developed countries with a focus on South Africa. International Federation of Aging: Global Ageing, 7, 31–40.Google Scholar
Karlsson, P. and Bergmark, A. (2015). Compared with what? An analysis of control-group types in Cochrane and Campbell reviews of psychosocial treatment efficacy with substance use disorders. Addiction, 110, 420–428. doi: 10.1111/add.12799.CrossRefGoogle ScholarPubMed
Knapp, M. et al. (2007). Dementia UK Report. London, UK: Alzheimer’s Society.Google Scholar
Kocsis, J. H. et al. (2010). A new scale for assessing the quality of randomized clinical trials of psychotherapy. Comprehensive Psychiatry, 51, 319–324. doi: 10.1016/j.comppsych.2009.07.001.CrossRefGoogle ScholarPubMed
Kwon, O. Y., Ahn, H. S., Kim, J. J. and Park, K. W. (2017). Effectiveness of cognitive behavioral therapy for caregivers of people with dementia: a systematic review and meta-analysis. Journal of Clinical Neurology, 13, 394. doi: 10.3988/jcn.2017.13.4.394.CrossRefGoogle ScholarPubMed
Laidlaw, K. (2015). CBT for Older People: An Introduction, 1st edn. London: Sage Publications Ltd.CrossRefGoogle Scholar
Li, R., Cooper, C., Austin, A. and Livingston, G. (2013). Do changes in coping style explain the effectiveness of interventions for psychological morbidity in family carers of people with dementia? A systematic review and meta-analysis. International Psychogeriatrics, 25, 204–214. doi: 10.1017/S1041610212001755.CrossRefGoogle ScholarPubMed
Liu, S. et al. (2017). Caregiver burden and prevalence of depression, anxiety and sleep disturbances in Alzheimer’s disease caregivers in China. Journal of Clinical Nursing, 26, 1291–1300. doi: 10.1111/jocn.13601.CrossRefGoogle Scholar
Lubin, B. and Zuckerman, M. (1985). Manual for the MAACL-R: Multiple Affect Adjective Check List–Revised. Lubin, B. and Zuckerman, M. (eds.). San Diego, CA: EdITS.Google Scholar
McKeith, I. and Cummings, J. (2005). Behavioural changes and psychological symptoms in dementia disorders. Lancet Neurology, 4, 735–742. doi: 10.1016/S1474-4422(05)70219-2.CrossRefGoogle ScholarPubMed
NACBT. (2016). Certifications: national association of cognitive-behavioral therapists. Available at http://www.nacbt.org/certifications-htm/; accessed 27 December 2017.Google Scholar
National Institute for Health and Clinical Excellence. (2009). Depression in Adults: Recognition and Management Clinical Guideline: NICE Guideline [CG90]. London: National Collaborating Centre for Mental Health.Google Scholar
National Institute for Health and Clinical Excellence. (2011a). Generalised Anxiety Disorder and Panic Disorder in Adults: Management. Leicester: National Institute for Health and Clinical Excellence.Google Scholar
National Institute for Health and Care Excellence. (2011b). Common Mental Health Disorders: The NICE Guideline on Identification and Pathways to Care. Manchester, UK: National Institute for Health and Care Excellence.Google Scholar
Orwin, R. G. (1983). A fail-safe N for effect size in meta-analysis. Journal of Educational Statistics, 8, 157. doi: 10.2307/1164923.Google Scholar
Pinquart, M. and Sörensen, S. (2006). Helping caregivers of persons with dementia: which interventions work and how large are their effects? International Psychogeriatrics, 18, 577. doi: 10.1017/S1041610206003462.CrossRefGoogle ScholarPubMed
Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W. and Ferri, C. P. (2013). The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s & Dementia, 9, 63–75.e2. doi: 10.1016/J.JALZ.2012.11.007.CrossRefGoogle ScholarPubMed
United Nation Development Programme (2016). Human Development Report 2016 Human Development for Everyone. Available at hdr.undp.org/sites/default/files/2016_human_development_report.pdf.Google Scholar
Richards, D. A. et al. (2010). Developing evidence based and acceptable stepped care systems in mental health care: an operational research project. Final report. NIHR Service Delivery and Organisation programme. Available at https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/081504109/#/; accessed 19 January 2018.Google Scholar
Riedijk, S. R. et al. (2006). Caregiver burden, health-related quality of life and coping in dementia caregivers: a comparison of frontotemporal dementia and Alzheimer’s disease. Dementia and Geriatric Cognitive Disorders, 22, 405–412. doi: 10.1159/000095750.CrossRefGoogle ScholarPubMed
Rodgers, M. et al. (2012). The clinical effectiveness and cost-effectiveness of low-intensity psychological interventions for the secondary prevention of relapse after depression: a systematic review. Health Technology Assessment, 16, 1–130. doi: 10.3310/hta16280.CrossRefGoogle ScholarPubMed
Scammacca, N., Roberts, G. and Stuebing, K. K. (2014). Meta-analysis with complex research designs: dealing with dependence from multiple measures and multiple group comparisons. Review of Educational Research, 84, 328–364. doi: 10.3102/0034654313500826.CrossRefGoogle ScholarPubMed
Schulz, R. and Martire, L. M. (2004). Family caregiving of persons with dementia: prevalence, health effects, and support strategies. American Journal of Geriatric Psychiatry, 12, 240–249. doi: 10.1097/00019442-200405000-00002.CrossRefGoogle ScholarPubMed
Schulz, R., O’Brien, A., Bookwala, J. and Fleissner, K. (1995). Psychiatric and physical morbidity effects of dementia caregiving: prevalence, correlates, and causes. Gerontologist, 35, 771–791. doi: 10.1093/geront/35.6.771.CrossRefGoogle ScholarPubMed
Schulz, R. et al. (2002). Dementia caregiver intervention research: in search of clinical significance. The Gerontologist, 42, 589–602. doi: 10.1093/geront/42.5.589.CrossRefGoogle ScholarPubMed
Sörensen, S. and Conwell, Y. (2011). Issues in dementia caregiving: effects on mental and physical health, intervention strategies, and research needs. American Journal of Geriatric Psychiatry, 19, 491–496. doi: 10.1097/JGP.0b013e31821c0e6e.CrossRefGoogle ScholarPubMed
Spielberger, C. D. and Diaz-Guerrero, R. (2002). [IDARE: Inventory of Anxiety] IDARE: Inventario de ansiedad: Rasgo-Estado. Mexico City, Mexico: El Manual Moderno.Google Scholar
Spielberger, C. D., Gorsuch, R. L. and Lushene, R. E. (1970). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Steffen, A. M. (2000)**. Anger management for dementia caregivers: a preliminary study using video and telephone interventions. Behavior Therapy, 31, 281–299. doi: 10.1016/S0005-7894(00)80016-7.CrossRefGoogle Scholar
Steffen, A. M. and Gant, J. R. (2016). A Telehealth behavioral coaching intervention for neurocognitive disorder family carers. International Journal of Geriatric Psychiatry, 31, 195–203. doi: 10.1002/gps.4312.CrossRefGoogle ScholarPubMed
Thomas, P. et al. (2006). Dementia patients caregivers quality of life: the PIXEL study. International Journal of Geriatric Psychiatry, 21, 50–56. doi: 10.1002/gps.1422.CrossRefGoogle ScholarPubMed
Tremont, G., Duncan Davis, J., Bishop, D. S. and Fortinsky, R. H. (2008). Telephone-delivered psychosocial intervention reduces burden in dementia caregivers. Dementia, 7, 503–520. doi: 10.1177/1471301208096632.CrossRefGoogle ScholarPubMed
Villareal-Reyna, M., Salazar-Gonzalez, B. C., Cruz-Quevedo, J. E., Carrillo-Cervantes, A. L. and Champion, J. D. (2012). Outcomes of interventions for Alzheimer’s family caregivers in Mexico. Western Journal of Nursing Research, 34, 973–990. doi: 10.1177/0193945910387283.CrossRefGoogle Scholar
World Health Organization. (2012). Dementia: A public health priority. Dementia. Geneva: World Health Organization.Google Scholar
World Health Organization. (2014). 2014 Mental Health Atlas. Geneva: World Health Organization.Google Scholar
Zarit, S. H., Reever, K. E. and Bach-Peterson, J. (1980). Relatives of the impaired elderly: correlates of feelings of burden. Gerontologist, 20, 649–655. doi: 10.1093/geront/20.6.649.CrossRefGoogle ScholarPubMed
Zigmond, A. S. and Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale (HADS). Acta Psychiatrica Scandinavica, 120, A638. doi: 10.1016/S0016-5085(01)83173-5.Google Scholar
Supplementary material: File

Kaddour et al. supplementary material

Appendix A1

Download Kaddour et al. supplementary material(File)
File 19.8 KB
Supplementary material: File

Kaddour et al. supplementary material

Appendix A2

Download Kaddour et al. supplementary material(File)
File 529.6 KB
Supplementary material: File

Kaddour et al. supplementary material

Appendix A3

Download Kaddour et al. supplementary material(File)
File 364.1 KB