Benefits of psychodynamic group therapy on depression, burden and quality of life of family caregivers to Alzheimer’s disease patients

Abstract

Background: Family members providing continuous care to demented patients suffer from severe burden that impairs quality of life and often evolves to depression. Objective: This study aims to evaluate the effect of psychodynamic group psychotherapy (PGT) compared to body awareness therapy (BAT) on caregiver burden, depressive symptoms, and quality of life among family caregivers to Alzheimer disease (AD) patients. Methods: Thirty-seven healthy family caregivers were randomly allocated to receive PGT (n = 20) or BAT (n = 17). Interventions were administered in the format of 14 weekly group sessions. Outcome measures were: modification of scores on Zarit Burden Scale, Beck Depression Inventory and WHO-QoL Scale. Results: Participants in the PGT group displayed significant reduction on burden (p = 0.01) and depression scores (p = 0.005), and improved quality of life (p = 0.002), whereas those in the BAT group showed improvements in burden of care (p = 0.001) and quality of life (p = 0.01), but not on depressive symptoms (p = 0.13). Discussion: Psychodynamic psychotherapy was associated with amelioration of depressive symptoms, but overall benefits on burden of care and quality of life were similar irrespective of the type of intervention, i.e., psychologically-oriented or not. We hypothesize that these interventions can be complementary to improve depression and burden of care among family caregivers of AD patients.

Cognitive Behavioral Therapy for Depression, Anxiety, and Stress in Caregivers of Dementia Patients: A Systematic Review and Meta-Analysis

“…CBT interventions comprising ≤8 and >8 total number of sessions both demonstrated statistically significant reductions in depression; SMD=-0.34; 95% CI: -0.61 and -0.07; p=0.01 Gendron et al, 1996;Losada-Baltar et al, 2004;Losada et al, 2015Losada et al, , 2005Márquez-González et al, 2007;Quayhagen et al, 2000; and SMD=-0.38; 95% CI: -0.56 to -0.19; p<0.001 (Coon et al, 2003;Gallagher-Thompson et al, 2003;Kamkhagi et al, 2015;Losada et al, 2011), respectively. Stress was also significantly reduced relative to comparators in both groups receiving ≤8 and >8 CBT sessions; SMD=-0.43; 95% CI: -0.69 to -0.17; p=0.001 Gallagher-Thompson et al, 2007;Losada-Baltar et al, 2004;Losada et al, 2005;Quayhagen et al, 2000) and SMD=-0.32; 95% CI: -0.52 to -0.11; p=0.003 (Bourgeois et al, 2002;Etxeberria-Arritxabal et al, 2005;Etxeberria Arritxabal et al, 2014;Gallagher-Thompson et al, 2008), respectively.…”

“…However, a subgroup analysis was conducted with the exclusion of studies using telephone CBT to assess the efficacy of in-person CBT. Changes to caregivers' depression (SMD=-0.36; 95% CI: -0.50 to -0.22; p<0.001) (Arango-Lasprilla et al, 2014;Coon et al, 2003;Gallagher-Thompson et al, 2003;Gendron et al, 1996;Kamkhagi et al, 2015;Losada-Baltar et al, 2004;Losada et al, 2015Losada et al, , 2011Losada et al, , 2005Márquez-González et al, 2007;Quayhagen et al, 2000) and anxiety (SMD=0.12; 95% CI: -0.20 to 0.43; p=0.46) (Akkerman & Ostwald, 2004;Bourgeois et al, 2002;Gendron et al, 1996;Gonzalez et al, 2014;Hébert et al, 2003;Livingston et al, 2013;Losada et al, 2015;Passoni et al, 2014;Quayhagen et al, 2000) evident in the original forest plots were not significantly influenced by these exclusions.…”

“…Caregivers receiving CBT demonstrated statistically significant reductions in depression (n=12; 995 participants; SMD=-0.34; 95% CI -0.47 to -0.21; p<0.001) (Arango-Lasprilla et al, 2014;Coon, Thompson, Steffen, Sorocco, & Gallagher-Thompson, 2003;Gallagher-Thompson et al, 2003;Gendron, Poitras, Dastoor, & Perodeau, 1996;Kamkhagi et al, 2015;Losada-Baltar et al, 2004;Losada et al, 2015Losada et al, , 2011Losada et al, , 2005Márquez-González et al, 2007;Quayhagen et al, 2000; and stress (n=9; 626 participants; SMD=-0.36; 95% CI -0.52 to -0.20; p<0.001) (Arango-Lasprilla et al, 2014;Bourgeois, Schulz, Burgio, & Beach, 2002;Etxeberria-Arritxabal et al, 2005;Etxeberria Arritxabal et al, 2014;Gallagher-Thompson et al, 2007;Gallagher-Thompson, Gray, Dupart, Jimenez, & Thompson, 2008;Losada-Baltar et al, 2004;Losada et al, 2005;Quayhagen et al, 2000) relative to comparator groups immediately after the intervention end-point ( Figure 2A; Figure 2B; Table 3). There was no significant difference in caregiver anxiety (n=10; 829 participants; SMD=0.10 (95% CI -0.18 to 0.39; p=0.47) (Akkerman & Ostwald, 2004;Bourgeois et al, 2002;Gendron et al, 1996;Gonyea, Lopez, & Velasquez, 2016;Gonzalez, Polansky, Lippa, Gitlin, & Zauszniewski, 2014;Hébert et al, 2003;Livingston, Barber, Rapaport, Knapp, & Griffin, 2013;Losada-Baltar et al, 2004;Passoni et al, 2014;Quayhagen et al, 2000) between those receiving CBT and the comparator groups, immediately following completion of the inter...…”

“…Only two studies (Kamkhagi et al, 2015; investigated changes to caregivers' quality of life between baseline and post-intervention. Both studies used the WHO Quality of Life (WHO-QoL) assessment and detailed mean improvements post-CBT; MD=13.2 (SD=13.36) (Kamkhagi et al, 2015) and MD=0.64 (SD=17.65) . Combining study effects did not demonstrate a significant change in quality of life with CBT relative to comparator (SMD=-0.03; 95% CI: -0.40 to 0.33; p=0.86).…”

Psychodramatic group therapy on Alzheimer patients' caregiver relatives

“…AH bakım veren aile üyeleriyle yapı-lan grup terapilerinin yönelimi ne olursa olsun yararlı olduğu bildirilmiştir. 12,37 Bir çalışmada, psikodramatik grup terapisinin demans ve Alzheimer hastalarına bakım verenlerin kendilerini ifade etmelerine ve iyi hissetmelerine katkı-da bulunduğu, hasta yakınlarının yalnız olmadık-larını gördükleri, grubun hastalığın kabulünü kolaylaştığı ve birbirlerinin deneyimlerinden yararlanma olanağı sağladığı vurgulanmıştır. Bu grubun anksiyete ve depresyon düzeylerinde belirgin bir değişiklik saptanmamıştır.…”