Psychological Interventions for Dementia Caregivers: What We Have Achieved, What We Have Learned

Abstract

With the rising dementia population, more and more programs have been developed to help caregivers deal with the care-recipient as well as their own frustrations. Many interventions aim to enhance caregiver’s ability to manage behavior problems and other deteriorations in functioning, with less direct emphasis placed on caring for the caregivers. We argue that techniques based on psychotherapy are strategically important in assistance provided to caregivers because of their utility for promoting emotional health. This article provides a focused review of such methods used in evidence-based intervention programs, along with the mechanisms of change associated with these methods. While cognitive-behavioral therapy (CBT) has a strong evidence base, there is also a growing trend to package CBT techniques into various psychoeducational programs. These programs, which we call psychoeducation with psychotherapeutic programs, have been consistently found to be effective in reducing caregiver distress and are suited for delivery in group format, even by paraprofessionals, to lower the cost of intervention. A recent trend is the effective use of technological aids (e.g., the internet) to deliver CBT and psychoeducation, reaching more caregivers. As for therapeutic mechanisms, the use of coping skills, reduced dysfunctional thoughts, and increased self-efficacy in controlling upsetting thoughts has received support in studies. We conclude that psychotherapeutic techniques are increasingly being used effectively and efficiently to assist caregivers, aided by successful adaptation for educational or technologically advanced means of delivery. More research on therapeutic mechanisms is needed to understand how the techniques work and how they can be further refined.

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

“…Moreover, these psychoeducational programs are best characterized as providing CBT principles and techniques to facilitate self-help by caregivers, rather than directly applying CBT to modify caregivers' thoughts and behaviors [78]. Therefore, merging these psychoeducation programs with CBT obscures important differences between them.…”

“…The foregoing discussion suggests the importance of matching interventions to caregivers' needs [78], and to select outcomes sensitively vis-à-vis what the intervention is intended to achieve. Recruiting the wrong participants (e.g., non-depressed caregivers for a CBT program) or measuring inappropriate outcomes may result in failures in detecting intervention effects.…”

“…Effects were discussed or analyzed without differentiating types of intervention, or without categorizing interventions psychoeducational in nature (i.e., with structured content and delivery using a heavily educational, rather than psychotherapeutic, approach) and included CBT techniques in one or more of their modules. These interventions were recently recognized as psychoeducation with psychotherapeutic components [78,79], a subtype of psychoeducation distinguished from others that do not borrow from psychotherapeutic approaches. Other reviews would have classified these interventions under the category of psychoeducation or psychotherapy.…”

Self‐compassion as an applicable intervention target for family carers of older adults: A conceptual commentary

“…Over the last few decades, there has been a rapid increase in the number of psychological programmes, therapies, and interventions used to help improve the emotional well‐being of family carers of older adult populations. Broadly, this has included four main intervention types: psychoeducation‐skill building, counseling/ psychotherapy, multicomponent interventions, and approaches based on the principles of mindfulness, acceptance, and compassion . Of these interventions, cognitive behavioural therapy (CBT) has been most consistently evidenced in the family caregiving literature, and moderate to large effects have been shown for carers on the outcomes of burden, anxiety, and depression .…”

“…32 Of these interventions, cognitive behavioural therapy (CBT) has been most consistently evidenced in the family caregiving literature, and moderate to large effects have been shown for carers on the outcomes of burden, anxiety, and depression. 32 More recently, however, there is also emerging evidence for the potential efficacy of newer, so-called "third-wave" approaches, such as acceptance and commitment therapy, 33 dialectical behaviour therapy, 34 mindfulness-based stress reduction, 35 and compassion-focused therapy. 36 Evolving from a CBT framework, these transdiagnostic approaches seek to explore how a person associates and responds to their symptoms and experiences in order to address thought patterns.…”