The Thoughts Questionnaire (TQ) for family caregivers of people with dementia

Profiles of Dementia Caregivers according to Psychosocial and Resource Variables. Importance of Kinship

The present study aims to analyze the existence of different profiles in family caregivers of people with dementia according to psychosocial and resource variables. In addition, it aims to study whether there is a greater representation of each kinship group in each of the profiles and if there are differences in emotional distress among such profiles considering the kinship with the care-recipient. Participants were 288 family dementia caregivers, divided into four kinship groups (wives, husbands, sons and daughters). Psychosocial (familism, dysfunctional thoughts and experiential avoidance), resource (leisure activities and social support) and outcomes (depressive, anxious and guilt symptomatology) variables were collected. A hierarchical cluster analysis using Ward's method, an exploratory factor analysis of two fixed factors and contingency tables were performed. Five clusters were obtained: Low psychosocial vulnerability-High resources, Low psychosocial vulnerability-Low resources, Mixed, High psychosocial vulnerability-High resources, and High psychosocial vulnerability-Low resources. Results suggested that clusters associated with lower distress were the Low psychosocial vulnerability-High resources and the High psychosocial vulnerability-High resources. Clusters associated with higher distress were the Low psychosocial vulnerability-Low resources and Mixed. High levels of dysfunctional thoughts, familism and experiential avoidance do not always have a maladaptive function. This could depend on sociocultural and resource variables such as the kinship with the caregiver or perceived social support. The identification of profiles of family caregivers potentially needing protection and vulnerable to psychological distress could help to increase the effectiveness of interventions aimed at this population.

Cognitive behavioural therapy for depression and anxiety in a carer for two family members with dementia: a single case experimental design study

BACKGROUND

Evidence suggests that cognitive behavioural therapy (CBT) can be a helpful approach for older adults experiencing anxiety and depression. Some research has suggested this is also the case for those caring for a family member with dementia. Little research has been conducted into the impact of CBT for older adults juggling the demands of caring for multiple family members with dementia.

AIMS

This case study aimed to evaluate the application of CBT to 'Mrs P', a 68-year-old client experiencing anxiety and depression whilst caring for two family members with dementia.

METHOD

A single case experimental design study was conducted to assess the effectiveness of CBT formulation and intervention, including cognitive restructuring of unhelpful thoughts about caregiving and increasing engagement in pleasurable activities.

RESULTS

Mrs P's depression and anxiety scores improved significantly throughout treatment, and she met her goal of being able to manage when caregiving activities go wrong during daily life.

CONCLUSIONS

CBT may be a helpful approach to reducing anxiety and depression in dementia family caregivers.

Associations Between Dysfunctional Thoughts, Leisure Activities, and IL-6 in Caregivers of Family Members With Dementia

OBJECTIVE

Dementia caregiving is associated with negative physical health consequences, including inflammation processes. The objective of this study was to analyze the associations between dysfunctional thoughts, frequency of leisure activities, and interleukin 6 (IL-6) in a sample of dementia family caregivers.

METHODS

One hundred forty dementia caregivers participated in this cross-sectional study. The relationships among caregivers' dysfunctional thoughts, leisure activities, and IL-6 were adjusted for demographic characteristics, stressors, and physical and mental health indicators in a linear regression analysis.

RESULTS

Higher levels of dysfunctional thoughts ( t = -2.02, p = .045) were significantly associated with lower frequency of leisure activities. In turn, lower frequency of leisure activities was significantly associated with higher levels of IL-6 ( t = -2.03, p = .045). Dysfunctional thoughts were no longer significantly associated with IL-6 levels when both dysfunctional thoughts and leisure activities were included in the same model ( t = 1.78, p = .076). A significant indirect effect was found for the association between higher levels of dysfunctional thoughts and higher levels of IL-6 (standardized indirect effect = 0.036, bootstrap standard error = 0.026, 95% confidence interval = 0.0001-0.1000) through its association with fewer leisure activities.

CONCLUSIONS

Our findings suggest that the direct effect of caregivers' dysfunctional thoughts on IL-6 may be mediated by the impact on caregivers' frequency of leisure activities. Results suggest that training caregivers in reducing dysfunctional thoughts to thereby increase leisure activities may be useful in reducing inflammation.

The Caregiver Thoughts Scale: An Instrument to Assess Functional and Dysfunctional Thoughts about Caregiving

OBJECTIVES

Caregivers' care-related thoughts critically effect their well-being. Currently, there is a lack of validated measures to systematically assess caregivers' functional and dysfunctional thoughts. We therefore aimed to develop a measure of caregivers' thoughts that assesses not only their dysfunctional but also their functional thoughts in multiple domains.

METHODS

A pool of potential questionnaire items was generated from therapy sessions with caregivers and was rated by experts. A sample of 322 main family caregivers (M_age = 63.9 years) of a person with dementia then completed a set of 28 items about their care-related thoughts and a number of related measures at three measurement points. Items were then aggregated via a formative measurement approach based on theoretical considerations. Correlational analyses were used to examine the construct validity of the subscale scores.

RESULTS

The final 28-item scale assesses caregiving thoughts in four distinct domains: dysfunctional caregiving standards, self-care, dysfunctional assumptions about dementia, and acceptance. The correlational analyses demonstrated the subscales' construct validity, by showing that scale scores are meaningfully related to theoretically relevant constructs.

CONCLUSIONS

The Caregiving Thoughts Scale is a promising measure of caregivers' thoughts in four important domains.

CLINICAL IMPLICATIONS

The scale can be applied in clinical research settings.

Development and Validation of an Implicit Relational Assessment Procedure (IRAP) to Measure Implicit Dysfunctional Beliefs about Caregiving in Dementia Family Caregivers

Caregivers of people with dementia who endorse dysfunctional beliefs about caregiving are at high risk of experiencing higher levels of distress. These dysfunctional beliefs are presented in the form of rules, verbal statements that specify what responsibilities one should expect in order to be a “good caregiver,” and are characterized as rigid, unrealistic, or highly demanding. Previous studies relied exclusively on self-report measures when assessing such dysfunctional beliefs about caregiving. The objectives of this study were: 1) to develop and validate an Implicit Relational Assessment Procedure (IRAP) to measure implicit dysfunctional beliefs about caregiving (CARE-IRAP), and 2) considering the relatively high age of the sample, to analyze the adaptation of the IRAP for older adults, comparing the IRAP performance between older adult caregivers and middle-aged caregivers. Participants were 123 dementia family caregivers with a mean age of 62.24 ± 12.89. Adaptations were made to the IRAP by adjusting the accuracy and response time criteria. The sample was split into middle-aged caregivers (below 60 years) and older adult caregivers (60 or older). The CARE-IRAP scores presented significant positive correlations with explicit measures of dysfunctional beliefs about caregiving and experiential avoidance in caregiving. A similar pattern of results was observed across the two age groups. The results revealed that caregivers endorse implicit dysfunctional beliefs about caregiving and offer preliminary support for the use of the IRAP as a valid measure of implicit caregiving beliefs. This exploratory study is the first to adapt the IRAP criteria to older adults, and future studies should further explore criteria suitable for this population.

[Feasibility and effects of a psychotherapeutic group intervention for caregiving relatives of people with dementia]

INTRODUCTION

Family caregivers of people with dementia (PwD) have a high burden and therefore are themselves at a high risk for psychiatric and somatic morbidities. Although individual psychotherapy has been shown to be a potentially effective treatment, it is rarely used by family caregivers. Possible reasons are poor accessibility and time restrictions on the side of the caregiver.

AIM

To test the efficacy of a short-term and low threshold psychotherapeutic group intervention for family caregivers of PwD with respect to mental stability of the caregivers.

MATERIAL AND METHODS

Data from a 12-week psychotherapeutic group intervention (10 participants each in the intervention and control groups) were analyzed. Main topics of the intervention were: personal limits, dysfunctional thoughts, emotions and resource activation. Primary endpoints were an increase of perceived self-efficacy and reduction of depressive symptoms using SWE and ADS questionnaires before, directly and 3 months after the end of the intervention.

RESULTS

A gain in perceived self-efficacy did not reach statistical significance, whereas depressive symptoms showed a statistically significant increase in the intervention group over time compared to the control group.

DISCUSSION

The intervention did not reach its primary endpoints. Possible reasons are the fact that the group was highly heterogeneous with respect to dementia etiology and the low number of participants. The short duration of the intervention may have reduced the potential of the program to address all urgent needs of the participants.