Effectiveness of Cognitive Behavioral Therapy for Caregivers of People with Dementia: A Systematic Review and Meta-Analysis

Kwon, Oh Young; Ahn, Hyeong Sik; Kim, Hyun Jung; Park, Kun Woo

doi:10.3988/jcn.2017.13.4.394

Cited by 55 publications

(45 citation statements)

References 30 publications

(203 reference statements)

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“…17 An overall reduction in depression was found with a small effect size of 0.27 pooled across the twelve included studies. The obtained effect is smaller than reports of the effect of CBT for DCs when not restricted to low-intensity (Kwon et al, 2017). It could be argued that low-intensity CBT-based interventions may only be beneficial for DCs with low levels of depression, and the studies included in this meta-analysis did not place limits on participant depression levels.…”

Section: Low-intensity Cbt For Dementia Caregiversmentioning

confidence: 56%

“…Previous comprehensive reviews of DC interventions suggested that psychoeducational programmes and Cognitive-Behavioural Therapy (CBT) can impact on the wellbeing of DCs, with the latter approach shown to be more effective for psychological difficulties (Pinquart & Sörensen, 2006;Gallagher-Thompson and Coon, 2007;Elvish et al, 2013). CBT is a psychological intervention with growing global empirical support for DCs, particularly with regards to depression outcomes (Kwon et al, 2017). It has been suggested that CBT alters negative caregiving related appraisals, reduces the use of unhelpful coping strategies and encourages caregivers to engage in positive activities (Laidlaw, 2015).…”

Section: Introductionmentioning

confidence: 99%

“…Specific higher-education qualifications are usually required to license a therapist to deliver CBT, though the exact requirements are dependent upon the country in which it is being delivered (BABCP, 2012;NACBT, 2016). A recent review conducted by Kwon et al (2017) reported the number of CBT sessions delivered for DCs ranged from 8 to 13 sessions, and such a number of sessions could be described as resource intense when delivered by accredited/licensed therapists. Less developed and poorly funded countries have less access to licensed health professionals, and are therefore less able to provide resourceintense psychological interventions such as high-intensity CBT (World Health Organization, 2014).…”

Section: Introductionmentioning

confidence: 99%

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

Kaddour

Kishita

Schaller

2018

Int. Psychogeriatr.

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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.

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Section: Low-intensity Cbt For Dementia Caregiversmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Kaddour

Kishita

Schaller

2018

Int. Psychogeriatr.

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“…Four reviews were further deleted because three were re-analysis of the same pool of studies by the same research teams, and one review was an attempt to break programs down to different components, without directly linking outcomes to the individual programs. In addition, we found three reviews with significant flaws (including removal of studies with nonsignificant effects from meta-analysis [73], misrepresenting raw mean differences as effect sizes [74], and misrepresenting effects with confidence intervals containing zeros as significant [75]), which were also excluded. Thus, 60 reviews were selected for this meta-review.…”

Section: Study Characteristicsmentioning

confidence: 99%

A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

Cheng

Zhang

2020

BMC Geriatr

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Background: Many reviews with conflicting findings on dementia caregiver interventions have been published. A meta-review was conducted to synthesize the findings of systematic reviews and meta-analyses. Methods: MEDLINE, PsycINFO, CINAHL and Cochrane Library were searched to identify reviews published during 2006-2018. Results: Sixty reviews covering > 500 intervention studies were selected and appraised with Assessment of Multiple Systematic Reviews (AMSTAR) II. The great majority of studies were of low quality according to AMSTAR II, but quality factors appeared unrelated to the conclusions obtained. Depression was most modifiable, with effects found across a spectrum of interventions (psychoeducation, counseling/psychotherapy, occupational therapy, mindfulnessbased interventions, multicomponent interventions, etc.). Evidence of intervention effect was also found for quality of life (psychoeducation), mastery (psychoeducation, occupational therapy and multicomponent interventions) and communication skills (communication training). Null or weak results were found for anxiety, social support and burden. Support groups and respite were generally ineffective. There was no evidence that dyadic programs were better than caregiver-only programs, or that programs delivered individually or in groups would differ in their impacts. The evidence also does not support multicomponent interventions to have broader impacts than single-component programs. Methodological issues in the existing reviews (e.g., selective use of studies to serve different research purposes and inconsistent classification of interventions) were noted and taken into account when interpreting findings. (Continued on next page)Conclusions: This meta-review clarified variations in review methodology and identified a few potent groups of intervention (most notably psychoeducation, psychotherapy, occupational therapy, and multicomponent interventions), although no intervention type had broad effects on caregiver outcomes. We note that improvements are needed in the reporting of intervention studies and in making the classification of interventions more transparent and consistent. We further recommend fewer and larger-scale reviews and more attention to positive outcomes in order to better inform the field. Developing interventions with broader impacts and packaging them to meet caregivers' changing needs in the course of dementia should be a priority for researchers and practitioners.

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“…The increase in average life expectancy has made interacting and living with elderly people a more normative part of life. However, those who assist dependent, elderly family members for a prolonged time encounter difficulties that often lead to a decline in their physical and socioemotional health (Amador-Marín and Guerra-Martin, 2017; Kwon, Ahn, Kim, and Park, 2017;Tomomitsu et al, 2014). Many caregivers experience reduced quality of life, significant stress, depression, anxiety, social isolation, and fatigue.…”

Section: Challenges Faced By Those Who Care For An Elderly Family Membermentioning

confidence: 99%

Process and Outcomes: the Influence of Gains in Knowledge and Socioemotional Skills on Caregivers’ Well-being

et al. 2020

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To assess the validity of intervention programs, we need to understand how they work and for whom. We evaluated a program for caregivers, ComTato, using a quasiexperimental design (pretest, posttest), to determine (a) which specific programrelated gains are associated with improvements in well-being and (b) whether participants' initial repertoire influences program benefits. All 37 participants (average age of 52.7 years) cared for a family member with Alzheimer's disease. Participants completed instruments to evaluate their caregiving repertoire and their socioemotional wellbeing (use of constructive coping strategies, perceptions of burden, and quality of the caregiver-care recipient relationship). Caregivers learned about dementia, stress management, principles of social skills, the use of specific social skills, and principles of cognitive stimulation. We observed that (a) the greater the increase in knowledge and skills, the greater the increase in caregivers' use of constructive coping strategies (r = .30, p = .037), with use of social skills being the component with the strongest association (r = .36, p = .014); (b) the greater the improvements in knowledge about social skills, the larger the reductions in conflicts with the care recipient (rho = − .28, p = .048); and (c) seven correlations indicated that the lower the caregivers' initial repertoire, the greater their socioemotional health gains. Thus, increases in caregivers' knowledge and socioemotional skills seem to contribute to improvements in their socioemotional well-being, and the lower their pre-existing repertoire, the more they benefitted from the program. In future studies, researchers should investigate how other socioemotional factors influence program benefits.

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Effectiveness of Cognitive Behavioral Therapy for Caregivers of People with Dementia: A Systematic Review and Meta-Analysis

Cited by 55 publications

References 30 publications

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

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

A comprehensive meta-review of systematic reviews and meta-analyses on nonpharmacological interventions for informal dementia caregivers

Process and Outcomes: the Influence of Gains in Knowledge and Socioemotional Skills on Caregivers’ Well-being

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