Problem-Solving Training for Family Caregivers of Persons With Traumatic Brain Injuries: A Randomized Controlled Trial

Abstract

Objective-To test the hypothesis that a problem-solving training program would lower depression, health complaints, and burden, and increase well-being reported by community-residing family caregivers of persons with traumatic brain injuries (TBIs). Design-Randomized controlled trial. Setting-General community.Participants-Of the 180 people who expressed interest in the study, 113 did not meet eligibility criteria. A consenting sample of family caregivers were randomized into a problem-solving training group (4 men, 29 women; average age, 51.3y) or an education-only control group (34 women; average age, 50.8y). Care recipients included 26 men and 7 women in the intervention group (average age, 36.5y) and 24 men and 10 women in the control group (average age, 37.2y).Intervention-Problem-solving training based on the D'Zurilla and Nezu social problem-solving model was provided to caregivers in the intervention group in 4 in-home sessions and 8 telephone follow-up calls over the course of their year-long participation. Control group participants received written educational materials and telephone calls at set intervals throughout their 12 months of participation.Main Outcome Measures-Caregiver depression, health complaints, well-being, and social problem-solving abilities.Results-Hierarchical linear models revealed caregivers receiving problem-solving training reported significant decreases in depression, health complaints, and in dysfunctional problem-solving styles over time. No effects were observed on caregiver well-being, burden, or constructive problemsolving styles.Conclusions-Problem-solving training provided in the home appears to be effective in alleviating distress and in decreasing dysfunctional problem-solving styles among family caregivers of persons Reprint requests to Patricia A. Rivera, PhD, Birmingham VAMC, 700 19th St S, Birmingham, AL 35233, No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated. NIH Public Access KeywordsBrain injuries; Caregivers; Problem-solving; Randomized controlled trials; RehabilitationEvidence accumulating from decades of empirical research substantiates that many family caregivers of persons with traumatic brain injury (TBI) experience considerable distress and compromised quality of life, generally, in the wake of the neurobehavioral changes imposed by TBI. 1 To a great extent, this research has been content to describe the various demographic, social, and psychologic correlates of distress, depression, and burden reported by caregivers. Despite this evidence, a recent critical review identified only 4 published studies to date of interventions to alleviate caregiver distress, and it concluded that there is currently no evidence supporting the usefulness of any single psychosocial intervention for family caregivers of persons with TBI. 2Much of the available research on caregiver distress after TBI...

Adaptation of problem-solving skills training (PSST) for parent caregivers of youth with chronic pain.

“…We did offer telephone sessions during pilot testing and, although there was limited use, we decided to continue to offer telephone sessions in the ongoing RCT in order to enhance treatment retention and further test feasibility of this approach. PSST has been delivered successfully to caregivers of other medical populations via remote modalities such as the telephone, with equivalent effects on caregiver outcomes compared to face-to-face treatment (Rivera, et al, 2008).…”

“…Homework practice involving opportunities to solve identified problems is an important part of the training. Efficacy of PSST has been evaluated in caregivers of both adult and pediatric medical populations, gaining considerable empirical support (Grant, Elliott, Weaver, Bartolucci, & Giger, 2002;Rivera, Elliott, Berry, & Grant, 2008;Sahler et al, 2005;Sahler et al, 2002;Seid, Varni, Gidwani, Gelhard, & Slymen, 2010;Wade, Carey, & Wolfe, 2006). One of the first research teams to use PSST in caregivers of children with health problems was Sahler and colleagues (2002).…”

“…Wade and colleagues (2006) used problem solving therapy successfully in Internet-based sessions to reduce distress in parental caregivers and to promote positive changes in social behavior in youth with traumatic brain injury. Similarly, Rivera et al (2008) used problem solving therapy in a sample of caregivers of adults with traumatic brain injury using a combination of in-home visits and telephone calls to deliver treatment, finding significant reductions in depression and health complaints, and significant improvements in problem-solving skills post- , Sahler, et al, 2005), there is emerging evidence that child outcomes may also be impacted by intervention.Because the evidence base for parent interventions indicated that problem solving therapy and specifically PSST was a promising treatment, we aimed to adapt this intervention to the population of parent caregivers of youth with chronic pain. The aim of the present study was to develop and evaluate feasibility and acceptability of PSST as an intervention to reduce distress in parent caregivers of youth with chronic pain, with a focus on whether a full trial could be successfully performed.…”

“…Wade and colleagues (2006) used problem solving therapy successfully in Internet-based sessions to reduce distress in parental caregivers and to promote positive changes in social behavior in youth with traumatic brain injury. Similarly, Rivera et al (2008) used problem solving therapy in a sample of caregivers of adults with traumatic brain injury using a combination of in-home visits and telephone calls to deliver treatment, finding significant reductions in depression and health complaints, and significant improvements in problem-solving skills post-treatment. Although parent outcomes have been primary in the majority of trials of problem solving interventions (e.g., Sahler, et al, 2005), there is emerging evidence that child outcomes may also be impacted by intervention.…”

Issues in defining and measuring veteran community reintegration: Proceedings of the Working Group on Community Reintegration,VA Rehabilitation Outcomes Conference, Miami, Florida

“…Such a measure could also assess the positive contributions of the individual pursuing community integration to the relationship with the key supporter Routine assessment of supporters' attitudes and experiences concerning the person pursing community integration may both help identify persons at risk for poor integration as well as guide the development of supporter-involved interventions to promote better community integration. For example, family-based interventions incorporating structured training on problem-solving have been found to reduce relapse in schizophrenia [59][60][61] and bipolar disorder [62][63], as well as reduce depression and healthcare complaints in caretakers of persons with TBI [64].…”