Sounds of Difference: A Typology of Reactions of People With Dementia to Individualized Music in the Presence of a Monitoring Person

BACKGROUND AND OBJECTIVES

Despite promising effects of individualized music listening (IML) for people with dementia, the individualized nature and heterogeneity of reactions to IML remain underexplored. We aimed to develop an empirically derived typology of directly observed reactions of people with dementia to IML and propose recommendations for tailoring the intervention to the respective types.

RESEARCH DESIGN AND METHODS

An ideal-type analysis was conducted on 108 video recordings of 45 people with mainly severe dementia (78% female, mean age of 83.02 years, all White participants) listening to recorded individualized music. Dimensions were identified for capturing similarities and differences between types.

RESULTS

The analysis yielded 10 types of reactions ("expressing and sharing joy," "self-disclosure stimulated by music," "concentrated, absorbed listening," "blissful enjoyment," "experience of the music as bittersweet," "sharing memories," "releasing tension," "tensing up and rejecting," "predominant search for social exchange," "no interpretable reaction") and 3 dimensions ("valence" from negative to positive, "arousal" from calm to activated, "communicative activity" from defensive/resistant to proactive), resulting in a three-dimensional coordinate system, providing a holistic representation and facilitating a systematic contrast of identified reaction types to IML.

DISCUSSION AND IMPLICATIONS

Reactions to IML were influenced by the interaction with the project staff, who monitored the sessions. Based on these observations, we propose recommendations for tailoring both the behavior of the monitoring person (e.g., engaging in synchronous activities like clapping along) and the setup of the intervention (e.g., communal vs individual listening) to each type, which may improve the effects of IML.

Enhancing the acceptance of smart sensing in psychotherapy patients: findings from a randomized controlled trial

Objective

Smart sensing has the potential to make psychotherapeutic treatments more effective. It involves the passive analysis and collection of data generated by digital devices. However, acceptance of smart sensing among psychotherapy patients remains unclear. Based on the unified theory of acceptance and use of technology (UTAUT), this study investigated (1) the acceptance toward smart sensing in a sample of psychotherapy patients (2) the effectiveness of an acceptance facilitating intervention (AFI) and (3) the determinants of acceptance.

Methods

Patients (N = 116) were randomly assigned to a control group (CG) or intervention group (IG). The IG received a video AFI on smart sensing, and the CG a control video. An online questionnaire was used to assess acceptance of smart sensing, performance expectancy, effort expectancy, facilitating conditions and social influence. The intervention effects of the AFI on acceptance were investigated. The determinants of acceptance were analyzed with structural equation modeling (SEM).

Results

The IG showed a moderate level of acceptance (M = 3.16, SD = 0.97), while the CG showed a low level (M = 2.76, SD = 1.0). The increase in acceptance showed a moderate effect in the intervention group (p < .05, d = 0.4). For the IG, performance expectancy (M = 3.92, SD = 0.7), effort expectancy (M = 3.90, SD = 0.98) as well as facilitating conditions (M = 3.91, SD = 0.93) achieved high levels. Performance expectancy (γ = 0.63, p < .001) and effort expectancy (γ = 0.36, p < .001) were identified as the core determinants of acceptance explaining 71.1% of its variance. The fit indices supported the model's validity (CFI = .95, TLI = .93, RMSEA = .08).

Discussion

The low acceptance in the CG suggests that enhancing the acceptance should be considered, potentially increasing the use and adherence to the technology. The current AFI was effective in doing so and is thus a promising approach. The IG also showed significantly higher performance expectancy and social influence and, in general, a strong expression of the UTAUT factors. The results support the applicability of the UTAUT in the context of smart sensing in a clinical sample, as the included predictors were able to explain a great amount of the variance of acceptance.

Prevalence of suicidal ideation in German psychotherapy outpatients: A large multicenter assessment

BACKGROUND

Suicidal ideation is a major concern in clinical practice. Yet, little is known about prevalence rates of suicidal ideation in patients undergoing outpatient psychotherapeutic treatment. Therefore, the aim of the current study is to assess the prevalence of suicidal ideation in a large sample of psychotherapy outpatients in Germany. The data analyzed in this study is taken from the KODAP-project on the coordination of data collection and analysis at German university-based research and training outpatient clinics for psychotherapy.

METHODS

A total of N = 10,357 adult outpatients (64.4 % female; age: M(SD) = 35.94 (13.54), range: 18-92 years of age) starting cognitive-behavioral therapy at one of 27 outpatient clinics in Germany were included in the current study. Prevalence of suicidal ideation was assessed with the Suicide Item (Item 9) of the Beck-Depression Inventory II.

RESULTS

Suicidal ideation was reported by 36.7 % (n = 3795) of the participants. Borderline Personality Disorder, Posttraumatic Stress Disorder, and recurrent Major Depression were the diagnoses most strongly associated with the presence and severity of suicidal ideation.

LIMITATION

Suicide ideation was assessed only with the respective item of the Beck Depression Inventory II.

CONCLUSION

Suicidal ideation is very common among adult patients who start psychotherapy in Germany. A well-founded knowledge of risk assessment in suicidal patients and suicide-specific treatment options is therefore highly relevant.

Study protocol: randomized controlled trial of an individualized music intervention for people with dementia in the home care setting

BACKGROUND

Studies suggest that individualized music listening is an effective, non-pharmacological intervention for improving the quality of life of people with dementia in the institutional care setting. Noting that most people with dementia live at home, we conduct a randomized controlled trial to assess the feasibility and effectiveness of an app-based individualized music listening intervention for people with dementia in the home care setting. The intervention is delivered by family caregivers.

METHODS

We will recruit N = 130 dyads consisting of one person with dementia living at home and their family caregiver. After a baseline assessment, dyads are randomly assigned by gender to either the intervention or control group. People with dementia in the intervention group listen to individualized music playlists for 20 min every other day for six weeks via the self-developed Individualized Music and Dementia app. The control group receives standard care. All dyads complete paper-and-pencil questionnaires six weeks before the start of the intervention (T0), directly before the intervention (T1), directly after the intervention (T2), and six weeks later (T3). During the intervention period, all caregivers also complete daily ecological momentary assessments via the app. During three home visits, a trained project member will observe the dyads and collect hair samples. After the intervention, semi-structured interviews will be conducted to collect information about participants' experiences with the app and intervention. The primary outcome is the attainment of individual goals established during the baseline assessment. Secondary outcomes are the well-being, physiological stress and quality of life of people with dementia and their caregivers; people with dementia's behavioural and psychological symptoms of dementia, resistance during care, and reactions to the music; caregivers' burden of care, positive aspects of care, and caregiving self-efficacy; and the quality of the caregiver-care recipient interaction.

DISCUSSION

Our study will assess the extent to which an app-based individualized music listening intervention is feasible and effective for enhancing the well-being and quality of life of people with dementia living at home and their family caregivers.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00025502 and ISRCTN registry ISRCTN68084105, https://doi.org/10.1186/ISRCTN68084105.

Between- and within-person effects of affective experiences on coping in CBT: Direct effects and interplay with therapeutic alliance and resource activation

OBJECTIVE

The role of affective experiences (AE) in cognitive-behavioral therapy (CBT) has rarely been investigated. We examined between- and within-person effects of AE on coping in CBT for family caregivers and interactions with therapeutic alliance and resource activation.

METHODS

67 family caregivers rated AE, therapeutic alliance, resource activation, and coping after each of 12 sessions of telephone-based CBT. We examined direct session-to-session effects of AE on coping in structural equation modeling and interactions of AE with therapeutic alliance and resource activation in multilevel models.

RESULTS

AE did not directly predict coping. Instead, within-person effects of AE interacted with simultaneous within-person emotional bond. Given strong emotional bond, AE positively predicted coping, whereas given weak emotional bond, AE negatively predicted coping. Further, cross-level interactions of between-person AE and within-person agreement on collaboration and resource activation indicated that these positively predicted coping only in dyads with high between-person AE.

CONCLUSION

AE may enhance coping when complemented with strong emotional bond. Further, within-person effects of agreement on collaboration and resource activation seem to rely on a certain degree of between-person AE. Results are discussed in relation to current findings on emotional processing in CBT.

Face-to-face versus telephone-based cognitive-behavioral therapy for family caregivers of people with dementia

OBJECTIVE

The objective was to directly compare the effects and acceptability of telephone-based (TEL-CBT) with face-to-face cognitive-behavioral therapy (F2F-CBT) for family caregivers of people with dementia (PwD).

METHOD

Caregivers for whom F2F participation was possible were allocated to F2F-CBT (n = 49). The other participants were randomized to TEL-CBT (n = 139) or CG (n = 134). CBT consisted of 12 sessions over 6 months.

RESULTS

TEL-CBT yielded significantly better physical health (d = 0.27) and coping with daily hassles (d = 0.38) at posttest compared to F2F-CBT. Therapist competence, acceptability, and outcomes at follow-up did not differ between TEL-CBT and F2F-CBT.

CONCLUSIONS

TEL-CBT is a valuable alternative to F2F-CBT for family caregivers of PwD as TEL-CBT has the advantage of higher accessibility while it does not significantly differ from F2F-CBT in effectiveness and caregivers' evaluation of the setting, their experience with the therapist, and their satisfaction.

Effects of general change mechanisms on outcome in telephone-based cognitive-behavioral therapy for distressed family caregivers

BACKGROUND

The study investigated the influence of general change mechanisms (GCMs) on outcome in telephone-based cognitive-behavioral therapy (CBT) for family caregivers.

METHODS

In a stepped-care intervention approach, highly distressed family caregivers received telephone-based CBT after completing a care counseling intervention. Sixty-six therapist-caregiver dyads rated emotional bond, agreement on collaboration, problem actuation, resource activation, clarification of meaning, and mastery after each of 12 therapy sessions. Outcomes were caregiver burden (SCQ-AV) and depression (CES-D) after therapy. Associations of GCMs with outcome were examined in multilevel regression models.

RESULTS

Caregiver burden was significantly predicted by caregiver-rated emotional bond (β = -0.18) as well as therapist-rated resource activation (β = -0.26), problem actuation (β = -0.22), clarification of meaning (β = -0.18), and mastery (β = -0.18). None of the GCMs predicted depression from any perspective.

CONCLUSION

The findings suggest that GCMs are relevant for reducing caregiver burden in CBT for family caregivers and should be fostered in treatment manuals, in particular therapist-rated GCMs. Since therapist and caregiver perspectives differed in predicting caregiver burden, future research should investigate perspective congruence and its effect on therapy outcome.

Immediate effects of individualized music listening on behavioral and psychological symptoms of dementia: A randomized controlled trial

OBJECTIVES

Evidence suggests that individualized music listening (IML) can effectively reduce the behavioral and psychological symptoms of dementia (BPSD). So far, however, studies have been primarily based on questionnaire measures of BPSD completed by proxy. We therefore investigate effects of IML on BPSD based on systematic observation. We address the methodological limitations of previous observational studies by using a validated instrument, time-based sampling, and longitudinal analytical methods.

METHODS

We compared BPSD of nursing home residents with dementia in an IML intervention group (IG; n = 44) and a control group (CG; n = 46) in a randomized controlled trial (DRKS00013793; ISRCTN59052178). Trained raters observed 18 BPSD in 15 four-minute intervals before, during and after an IML session. We used t-tests to compare BPSD in the IG and CG before, during and after the session and piecewise latent curve modelling to compare BPSD trajectories across 1 hour.

RESULTS

BPSD were observed less frequently in the IG than in the CG during, but not before or after the session. Likewise, whereas the CG experienced a stable trajectory of BPSD, the IG experienced a u-shaped trajectory characterized by stability before the session, a decrease during the session, and increase after the session. There was significant interindividual variability in baseline BPSD and in the pre- and post-session slopes.

DISCUSSION

Our results provide additional evidence that IML effectively reduces BPSD, although the effect is short-lived. As IML rarely has negative side effects, is highly accepted and easily implemented, IML should be integrated into the everyday care routines for people with dementia.

CLINICAL TRIAL REGISTRATION

German Clinical Trials Register DRKS00013793; ISRCTN registry, ISRCTN59052178.

Effects of nursing home placement on the mental health trajectories of family caregivers of people with dementia: findings from the Tele.TAnDem intervention study

OBJECTIVES

The objective was to compare mental health trajectories between family caregivers of people with dementia (PwD) who institutionalize the care recipient (nursing home caregivers [NHC]) and caregivers who continue to provide care at home (at-home caregivers [AHC]) as well as investigate effects of a telephone-based cognitive-behavioral therapy (TEL-CBT) intervention on these trajectories.

METHODS

Using linear growth models, we compared the trajectories of depressive symptoms, caregiver grief, anxiety, and quality of life (QoL) over one year (baseline - T0, 6 months - T1, and 12 months - T2) between 28 NHC and 163 AHC who had been randomized to receive 12 sessions of TEL-CBT (n = 99) or to usual care (n = 92).

RESULTS

NHC reported significantly higher depression, anxiety, and caregiver grief at T0 and showed significant reductions in depression and anxiety over time compared to AHC. TEL-CBT significantly enhanced overall QoL of NHC.

CONCLUSIONS

The study extends previous findings of improved mental health of family caregivers of PwD after institutionalization and emphasizes the need for interventions before nursing home placement. TEL-CBT which has previously been shown to be effective for family caregivers of PwD also seems promising for supporting NHC.

Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.2022598 .

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.

Pragmatic Effectiveness of Face-to-Face Cognitive-Behavioral Therapy for Family Caregivers of People with Dementia

OBJECTIVES

The objective was to investigate the pragmatic effectiveness of face-to-face cognitive-behavioral therapy (F2F-CBT) for family caregivers of people with dementia (PwD) implemented in a routine care setting relative to usual care in a quasi-experimental study.

METHODS

Participants indicating that attendance of F2F-CBT was possible were assigned to F2F-CBT (n = 49). F2F-CBT consisted of 12 sessions over 6 months. Effects were evaluated at posttest and 6-month follow-up on a variety of outcomes relative to usual care (CG; n = 134).

RESULTS

At posttest, F2F-CBT yielded significantly fewer symptoms of depression (d = 0.37), better emotional well-being (d = 0.64), and better coping with the care situation (d = 0.52) than CG. At 6-month follow-up, the effect on emotional well-being was retained (d = 0.44) and social relationships were rated significantly better in F2F-CBT than CG (d = 0.34).

CONCLUSIONS

F2F-CBT proved to be effective in supporting family caregivers of PwD. However, only relatively few caregivers were able to regularly attend face-to-face sessions.

CLINICAL IMPLICATIONS

CBT seems particularly suitable for supporting family caregivers of PwD in coping with the complex psychological burden. Delivery via telephone or internet could be a necessary alternative to F2F-CBT for reducing barriers to participation.

[Burden experienced by caregiving relatives during the corona pandemic]

Hintergrund

Bereits vor der Coronapandemie waren pflegende Angehörige mit einer Vielzahl an Herausforderungen und Belastungen konfrontiert. Erste Onlineerhebungen zeigten eine Zunahme der Pflegebelastung während der Pandemie. Ergänzend hierzu wurde eine Erhebung zu Auswirkungen der Pandemie auf bereits belastete pflegende Angehörige in Deutschland durchgeführt.

Methode

Im Rahmen einer Evaluationsstudie zu einem gestuften Beratungsansatz für hochbelastete pflegende Angehörige wurden von 165 Pflegenden quantitative und qualitative Daten zum Belastungserleben, zu Ängsten und Wünschen in der Coronapandemie bezüglich der Pflege erhoben. Die Auswertungen erfolgten deskriptiv und mittels qualitativer Inhaltsanalyse.

Ergebnisse

Von den Angehörigen gaben 26 % starke Ängste an, sich mit SARS-CoV‑2 zu infizieren, 50 % befürchteten, dass die gepflegte Person erkranken könnte. Die Hälfte berichtete deutliche Auswirkungen auf den Pflegealltag (47 %) und nahm eine deutliche Erhöhung der Pflegbelastung (51 %) wahr. Als häufigste negative Auswirkungen auf den Pflegealltag wurden der Ausfall von Pflegedienstleistungen und ein Mangel an Zeit für sich selbst genannt. Dementsprechend wurde am häufigsten der Wunsch nach Unterstützung geäußert. Der Pflegegrad, das Alter der Pflegenden und die vorherige Nutzung des Pflegedienstes erwiesen sich als Prädiktoren für das durch die Pflegenden eingeschätzte Belastungserleben der Erkrankten.

Diskussion

Die Ergebnisse verdeutlichen die negativen Auswirkungen der Coronapandemie auf die Belastung pflegender Angehöriger eindrücklich. Zur Bewältigung der komplexen Zusatzbelastungen benötigen Angehörige Angebote, die zu deren Teilhabechancen sowie zur Verbesserung der Versorgung und sozialen Teilhabe der Pflegebedürftigen während der Pandemie beitragen.

Clients' and therapists' experiences of five general change mechanisms during an Internet-based cognitive behavioral intervention for family caregivers

OBJECTIVES

Despite its efficacy, little is known about what makes Internet-based cognitive behavioral therapy (iCBT) effective. We, therefore, analyze participants' and therapists' experiences of Grawe's five general change mechanisms (alliance, resource activation, clarification, problem actuation, mastery) during an iCBT intervention for family dementia caregivers, and how their experiences were related to treatment outcomes.

METHOD

Participants (N = 30) exchanged eight weekly messages with a therapist via an Internet platform. We used the Bern Post Session Report to assess participants' and therapists' experiences of the general change mechanisms after each session.

RESULTS

Treatment outcomes were associated with therapists' overall experiences of alliance, clarification, and mastery. Participants experienced more problem actuation than therapists. Only participants' and therapists' experiences of clarification over time differed.

CONCLUSIONS

Grawe's general change mechanisms are also relevant for iCBT. We recommend considering Grawe's framework when designing Internet-based therapeutic interventions and when training therapists to deliver such interventions.

Does age matter? Initial treatment goals of older adults with major depression in outpatient cognitive behavioural therapy

BACKGROUND

Personal treatment goals (PTG) are important means to tailor psychotherapy to the needs of the patient, leading to increased engagement and greater improvement in relevant outcomes. According to lifespan developmental research, motivational goals in old age differ from goals of younger people, with management of losses rather than growth becoming more prevalent. However, this study is the first to systematically investigate age-specific differences in PTGs.

METHOD

We used routine data from patients with major depression assessed at the beginning of outpatient cognitive behavioural therapy. Initial high-priority PTGs were assessed using the Bern Inventory of Treatment Goals (BIT-C). Older patients (≥60 years, n = 52) were matched to younger patients (<60 years, n = 52) with regard to severity of depression, number of comorbidities, gender and level of education.

RESULTS

Using a mixed method approach, high-priority PTGs of both age groups were focused most strongly on reducing depressive symptoms and, subsequently, anxiety. At the same time, older patients focused more strongly on PTGs related to well-being and functioning, while younger patients' emphasis was on personal growth. Furthermore, better coping with the ageing process and physical losses emerged as important PTGs for some older patients.

CONCLUSION

Initial PTG themes are specific to diagnosis, but also seem to differ in regard to age. Thus, it is important to develop age-sensitive measures that allow appropriate and efficient tailoring of psychotherapy to meet older patients' needs and preferences.

Long-term effects of telephone-based cognitive-behavioral intervention for family caregivers of people with dementia: Findings at 3-year follow-up

INTRODUCTION

Long-term outcomes are of particular importance in evaluating interventions for family caregivers of people with dementia (PwD). So far, evidence for long-term effects (>6 months postintervention) is limited to four interventions.

OBJECTIVE

We examined the long-term effects of Tele.TAnDem, a telephone-based cognitive-behavioral therapy (CBT) intervention, on a variety of outcomes at 3-year follow-up, the longest follow-up of any intervention study for caregivers of PwD (without continuous support).

METHODS

Caregivers of PwD were randomly assigned to receive Tele.TAnDem consisting of 12 sessions over 6 months (intervention group [IG]) or usual care (control group [CG]). At 3-year follow-up (i.e., 2.5 years postintervention), 29 caregivers in the IG and 22 caregivers in the CG were still caring at home for a PwD.

RESULTS

Caregivers in the IG reported significantly lower caregiver burden and higher quality of life regarding social relationships.

CONCLUSIONS

Tele.TAnDem is successful in buffering detrimental effects of caregiving on caregiver burden and social relationships in the long term. The small- to medium-sized effects lie in the range of effect sizes reported in the few previous investigations. The findings add to the scant evidence that interventions yielding long-term outcomes have to date mostly been multicomponent interventions based on CBT principles with structured techniques and at least seven sessions over more than 2 months. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Relieving distressed caregivers (ReDiCare study): study protocol of a randomized pragmatic trial

BACKGROUND

Providing care for someone with a disease or chronic condition can have a negative psychological, physical, social, and economic impact upon informal caregivers. Despite the socio-economic relevance and more than three decades of caregiver intervention research only very few translational efforts of successful interventions are reported. Still less of these interventions have been implemented into routine services. The aim of the ReDiCare study (German acronym BerTA) is to evaluate the effectiveness of a stepped counselling approach for burdened caregivers delivered by care counsellors of two long-term care insurances and registered psychotherapists.

METHODS/ DESIGN

A pragmatic randomised controlled trial with 572 caregivers of older adults (≥ 60 years) receiving benefits of one of the two participating long-term care insurances. Participants are assigned (t0) to either the ReDiCare intervention or a control group receiving routine care and counselling. Data are collected at baseline (-t1), 3-month (t1), 9-month (t2) and 15-month (t3). The 9-month post-intervention assessment (t2) is the primary endpoint to evaluate the results on the primary and secondary outcomes, measured by self-reported questionnaires. Depressive symptoms measured with the CES-D are the primary outcome. The main secondary outcomes are physical complaints, utilization of psychosocial resources, caregiver self-efficacy and burden, positive aspects of caregiving and perceived care quality. A process evaluation, including audio tapes, self-report questionnaires and documentation will be conducted to examine internal and external validity of the intervention. Data on direct and indirect costs are collected for the (health) economic evaluation, using a health care perspective and a societal perspective.

DISCUSSION

While comparable previous caregiver interventions have been developed and evaluated for specific caregiver groups (e.g. dementia caregivers, stroke caregivers), the ReDiCare study will indicate whether a stepped approach will be effective also in a broader group of caregivers. The intervention is one of the very few translational studies in caregiver intervention research and will provide valuable insights into relevant factors for training, intervention protocol adherence, effectiveness, and costs for future implementation steps.

TRIAL REGISTRATION

Deutsches Register Klinischer Studien (German Clinical Trials Register), DRKS00014593 ( www.drks.de,  registered 14 May 2018) and International Clinical Trials Registry Platform, DRKS00014593  ( https://apps.who.int/trialsearch/ ).

Unmittelbare Reaktionen von Menschen mit Demenz auf individualisierte Musik - Analyse von Verhaltensbeobachtungen im Pflegeheim

Immediate reactions of people with dementia to individualized music - Analysis of behavioral observations in a nursing home Abstract. Background: Due to the increasing prevalence of dementia, there is an urgent need for effective non-pharmacological interventions to improve the quality of life of people with dementia (PwD) and to relieve their carers. Studies show evidence for the benefits of individualized music. However, the immediate reactions to individualized music have not yet been adequately investigated.

AIM

The research objective of the study was the investigation of the immediate effects of an individualized music intervention in a nursing home using a newly developed systematic behavioral observation rating scale.

METHODS

In 153 behavioral observations of 20 PwD, 32 different experiences and behaviors pertaining to 11 categories such as emotional and motor changes which indicate immediate reactions to listening to music were rated.

RESULTS

Participants showed significantly more positive reactions (e. g. joy or relaxation) and less negative reactions immediately after listening to the music compared to before. Moreover, in the course of listening to music, participants showed significantly more positive reactions, most often smiles, movements to music, attentive listening, relaxation and general vigilance / interest / social contact.

CONCLUSIONS

The systematic behavioral observation rating scale proved to be a suitable method for rating the experiences and behaviors of people with dementia. Listening to individualized music seems to be a helpful intervention for PwD in institutional care settings.

Psychotherapie im höheren Lebensalter in der Psychotherapieausbildung

Zusammenfassung. Theoretischer Hintergrund: Psychotherapie im höheren Lebensalter (PihL) gewinnt in Deutschland in den letzten Jahrzehnten zunehmend an Bedeutung. Dennoch ist dieses Feld trotz des großen Bedarfs weiterhin unterrepräsentiert. Fragestellung: Wie werden angehende Psychotherapeut_innen aktuell in Bezug auf die psychotherapeutische Behandlung älterer Menschen ausgebildet? Methode: Sämtliche Ausbildungsinstitute in Deutschland mit dem Schwerpunkt Verhaltenstherapie sowie Dozierende mit Seminaren zu PihL wurden im Jahr 2018 zu einer Befragung eingeladen. Ergebnisse: Von 48 Instituten boten zum Zeitpunkt der Befragung 64.6 % gerontopsychlogische Unterrichtsstunden (M = 13.03 h) an (2.2 % des Theorieunterrichts). In den ausfindig gemachten Seminaren zeigen sich zu einem großen Teil die von Knight et al. (2009 ) vorgeschlagenen Themenschwerpunkte von allgemeinen und pathologischen Alterungsprozessen über diagnostische Besonderheiten bis hin zu konkreten Interventionsmethoden. Diskussion: Sowohl die Weiterbildungsstudiengänge als auch die neuen psychotherapeutischen Bachelor- und Masterstudiengänge sollten mehr Inhalte zum Thema PihL ähnlich wie die hier ausfindig gemachten Seminare berücksichtigen. Eine Orientierung für eine Basiswissensvermittlung bieten die vorgeschlagenen Themenschwerpunkte.

[Evaluation of the Factor Structure of a German Questionnaire Version of the Behavioral Pathology in Alzheimer's Disease Scale]

The present study examined the factor structure of a German questionnaire version of the Behavioral Pathology in Alzheimer's Disease Scale (BEHAVE-AD), which originally assesses behavioral disturbances in people with dementia independent from cognitive symptoms in a clinical interview with a caregiver. The 7-factor structure of the interview version of the BEHAVE-AD (i. e., Paranoid and Delusional Ideation, Hallucinations, Activity Disturbances, Aggressiveness, Diurnal Rhythm Disturbances, Affective Disturbances, Anxieties and Phobias) could not be confirmed in a Confirmatory Factor Analysis (N=322). Therefore, an Exploratory Factor Analysis was conducted in a second sample (N=118). Results suggested a 4-factor-solution for the German questionnaire version. Factors were named Paranoid Ideations and Aggression, Hallucinations and Agitation, Anxieties and Phobias and Affective Disturbances.

Wirkt kognitive Verhaltenstherapie unter Praxisbedingungen?

Zusammenfassung. Theoretischer Hintergrund: In zahlreichen randomisiert-kontrollierten Studien wurde die Wirksamkeit kognitiver Verhaltenstherapie (KVT) bei depressiven Patient_innen bereits bestätigt. Allerdings existieren bisher nur wenige naturalistische Studien unter Praxisbedingungen. Fragestellung: Wie hoch sind die Therapieeffekte und Responseraten bei depressiven Patient_innen einer Hochschulambulanz? Methode: 141 Patient_innen mit einer depressiven Episode oder rezidivierenden depressiven Störung wurden zu Therapiebeginn und -ende untersucht. Von 35 Patient_innen lagen zusätzlich Katamnesedaten vor. Ergebnisse: Prä-Post-Analysen zeigten signifikante Effektstärken im Brief Symptom Inventory (BSI) von d = 1.23 (Intention-to-Treat) bzw. d = 1.24 (Completer). Im Beck Depressions-Inventar– II (BDI) lagen die Prä-Post-Effektstärken bei d = 1.85 (Intention-to-Treat) bzw. bei d = 1.84 (Completer) und blieben katamnestisch stabil. Die Responseraten befanden sich im BSI bei 46.1 % und im BDI bei 70.6 %. Schlussfolgerungen: Die ambulante Behandlung mit KVT bei depressiven Patient_innen ist auch unter Praxisbedingungen wirksam.

[Quality of sleep in caregiving relatives of people with dementia: investigation of the prevalence and possible predictors]

BACKGROUND

Caregiving relatives of people with dementia (PwD) are exposed to exhausting tasks all day long. The results of a current study suggest that personality traits, sociodemographic and caregiving variables could be associated with poor sleep quality of caregivers of PwD. Nevertheless, the detailed impact of these variables on sleep quality of caregivers is still unknown.

METHOD

This study is based on secondary data from the Tele.TAnDem project. First, descriptive data of 322 caregivers were analyzed regarding prevalence rates of poor sleep quality and high rates of daytime sleepiness in comparison to non-caregivers. Second, hierarchical regression analyses were conducted to calculate the predictive effect of interpersonal and caregiving related variables on subjective sleep quality and daytime sleepiness.

RESULTS

With respect to the prevalence, descriptive data indicate a poorer subjective sleep quality and higher rates of daytime sleepiness of caregivers of PwD compared to non-caregivers. Regression analyses revealed significant effects for gender, disturbed day-night rhythm, burden of caregiving, stress coping strategies and depressive symptoms regarding subjective sleep quality. The number of disturbed behavior patterns, the burden of caregiving and depressive symptoms were significantly associated with higher rates of daytime sleepiness.

CONCLUSION

Caregiving of PwD affects subjective sleep quality as well as daytime sleepiness of caregiving relatives. Both dimensions of sleep quality were associated with several personal and caregiving related variables. Chronic poor sleep quality is a high-risk factor for psychological and physical health problems and should be considered in further research and development of interventions for caregiving relatives of PwD.

Telephone-Based Cognitive Behavioral Intervention Improves Dementia Caregivers' Quality of Life

The present study examined the effects of a telephone-based cognitive behavioral intervention on dementia caregivers' quality of life (QoL). A total of 273 caregivers were randomly assigned to an intervention or control group. The intervention comprised 12 telephone sessions of individual cognitive behavioral therapy (CBT) over 6 months. At baseline, postintervention, and 6-month follow-up, QoL was assessed with the World Health Organization QoL-BREF, which measures perceived QoL for the domains physical health, psychological health, social relationships, and environment as well as overall QoL and satisfaction with general health. Intention-to-treat analyses using latent change models were performed. At postintervention, intervention group participants reported better overall QoL and satisfaction with general health as well as better physical and psychological health compared to control group participants. Together with existing evidence, the results suggest that the telephone CBT intervention does not only reduce impairments but also fosters improvements in health-related QoL.

Acceptance and treatment effects of an internet-delivered cognitive-behavioral intervention for family caregivers of people with dementia: A randomized-controlled trial

OBJECTIVES

The study evaluated the efficacy of an internet-delivered cognitive-behavioral intervention for caregivers of people with dementia and examined acceptance of program characteristics.

METHOD

Thirty-nine caregivers (M _age  = 62.11 ± 9.67, 78.4% female) were enrolled in a 2 × 3 randomized-controlled trial (RCT) that compared an intervention and wait-list control group. A cognitive-behavioral intervention program was adapted for delivery via an internet platform. Participants exchanged eight weekly messages with a therapist.

RESULTS

Treatment satisfaction and acceptance of the program were high. Well-being increased over the intervention duration and intervention group participants were better able to cope with the anticipated death of the care recipient and utilized more psychosocial resources after the intervention ended. Effects were not maintained until follow-up and there were no treatment effects for depression and burden of care.

CONCLUSIONS

Internet-delivered cognitive-behavioral interventions are suitable for caregivers. A larger RCT needs to investigate possible combinations of classic and internet-delivered programs and confirm efficacy.

Study protocol: individualized music for people with dementia - improvement of quality of life and social participation for people with dementia in institutional care

BACKGROUND

People with dementia (PwD) experience a range of negative behavioral and psychological symptoms which can lower their quality of life. Because of the increasing prevalence of dementia, interventions that maintain and enhance the quality of life for PwD are needed. Listening to individualized music constitutes a promising non-pharmacological intervention for PwD. However, despite some preliminary results, evidence regarding the effectiveness of such interventions has been mixed and previous studies have shown a number of methodological limitations. In a randomized controlled trial, we address the limitations of previous research and assess the feasibility, efficacy, and acceptability of an individualized music intervention for PwD living in a nursing home.

METHODS

Residents with dementia from four to five nursing homes in Germany will be randomly assigned to either an intervention or control group. The intervention group will listen to personally-relevant music for 20 min every other day for six weeks. Nursing staff will assess participants' quality of life and problem behavior at the six-week baseline, pretest, posttest, and at the six-week follow-up. Additionally, the participants' behavior will be observed during the intervention period by project staff. The implementation, acceptance, and applicability of the intervention will also be evaluated.

DISCUSSION

The study results will show whether an individualized music intervention can improve the quality of life for PwD living in a nursing home. Additionally, it will provide valuable insight into the acceptability and implementation of an individualized music intervention in the institutional care setting. If the individualized music intervention proves to be effective and widely applicable, it could be implemented on a large scale in institutional care as an easy-to-administer intervention.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00013793 ; ISRCTN registry, ISRCTN59052178 , date applied 27 February 2018, date assigned 4 April 2018, retrospectively registered.

[Care of parents with dementia: comparison of caregiving sons and daughters]

BACKGROUND

In view of the demographic changes and the associated increasing need for care, the role of caregiving sons will also become more important; however, little is known about the caregiving experiences of sons.

OBJECTIVE

Potential differences between caregiving sons and daughters were investigated with respect to the style of caregiving, the feeling of stress and burden and the utilization of support offers.

MATERIAL AND METHODS

Baseline survey data from the interventional study Tele.TAnDem conducted from September 2012 to January 2014 were analyzed. From the total sample of 322 caregiving relatives of people suffering from dementia the participating sons (n = 17) were selected. For comparison 17 participants from the subsample of daughters (n = 111) were selected by propensity score matching. The analyses were conducted using t‑tests, Mann-Whitney tests and χ²-tests.

RESULTS

The analyses regarding the style of caregiving, the feeling of stress and burden and the utilization of professional and informal assistance did not reach statistical significance. Daughters scored on average higher than sons only with respect to the acceptance of the caregiving situation (p < 0.05).

CONCLUSION

Overall caregiving daughters and sons did not differ with respect to caregiving experiences as strongly as previously assumed. Perhaps earlier studies found more gender differences because caregiving sons compared to daughters already have different initial situations, which however remained uncontrolled.

Tele.TAnDem Increases the Psychosocial Resource Utilization of Dementia Caregivers

Abstract. Tele.TAnDem is a telephone-based cognitive-behavioral therapy (CBT) intervention for dementia caregivers which incorporates resource activation as a superordinate heuristic. We investigated whether Tele.TAnDem increased the utilization of psychosocial resources in dementia caregivers. To this end, 273 dementia caregivers were randomly assigned to receive the Tele.TAnDem intervention (n = 139) or usual care (n = 134). Compared to the control group, at posttest caregivers in the intervention group had utilized more resources related to well-being and coping with daily hassles. Treatment effects on the utilization of resources related to social support were only marginally significantly greater at posttest for caregivers with higher baseline resource utilization. Treatment effects were not maintained at 6-month follow-up. Results indicate that Tele.TAnDem can successfully activate the psychosocial resources of dementia caregivers.

The Tele.TAnDem Intervention: Telephone-based CBT for Family Caregivers of People With Dementia

Background and Objectives

This study evaluated the effectiveness of a telephone-based cognitive-behavioral therapy for family caregivers of people with dementia in existing health care provision structures.

Research Design and Methods

Two hundred seventy-three family caregivers of people with dementia were randomly assigned to receive the intervention or usual care. Usual care included unrestricted access to community resources. Intervention group participants received twelve 50-min sessions of individual cognitive-behavioral therapy by trained psychotherapists within 6 months. Symptoms of depression, emotional well-being, physical health symptoms, burden of care, coping with the care situation and challenging behavior were assessed after the intervention ended and at a 6-month follow-up. Intention-to-treat analyses using latent change models were applied.

Results

Intention-to-treat analyses showed improved emotional well-being (γ = 9.59, p = .001), fewer symptoms of depression (γ = -0.23, p = .043), fewer physical health symptoms (γ = -0.25, p = .019), improved coping with the care situation (γ = 0.25, p = .005) and the behavior of the care recipient (γ = 0.23, p = .034) compared with usual care. Effects for coping (γ = 0.28, p = .006 and γ = 0.39, p < .001, respectively) and emotional well-being (γ = 7.61, p = .007) were also found at follow-up.

Discussion and Implications

The CBT-based telephone intervention increased mental and physical health as well as coping abilities of family caregivers of people with dementia. The intervention can be delivered by qualified CBT therapists after an 8-h training session in existing health care provision structures.

Intervention Helps Family Caregivers of People With Dementia Attain Own Therapy Goals

INTRODUCTION

Caregiver intervention studies typically assess whether participants attain general goals (eg, improved mental/physical health) but not their own individual goals. We used goal attainment scaling to evaluate whether participants of a telephone intervention based on cognitive behavioral therapy (CBT) attained their personal goals. We also evaluated treatment compliance and implementation.

METHODS

A sample of 139 family caregivers of people with dementia received 12 telephone sessions over 6 months. Participants personal goals were specified during the first and second sessions. Participants and therapists assessed goal attainment at the end of the intervention.

RESULTS

Nearly all participants reported meaningful improvements with regard to their personal goals. Specifically, 20.9% exceeded, 56.4% completely attained, and 21.8% partially attained at least one of their personal goals. There was high agreement between self- and therapist ratings. Treatment compliance and implementation were highly satisfactory.

CONCLUSIONS

The CBT telephone intervention successfully helped participants attain their personal goals.

Dementia caregivers' coping with pre-death grief: effects of a CBT-based intervention

OBJECTIVES

Pre-death grief plays a significant role in dementia caregiving, and has adverse impacts on caregivers. It was the purpose of the present study to examine whether a cognitive-behavioral intervention including a grief intervention module could increase caregivers' coping with pre-death grief and whether these effects could be maintained as of a six-month follow-up assessment.

METHOD

In a randomized-controlled trial examining the effectiveness of a cognitive-behavioral intervention, 273 caregivers were allocated to either an intervention or control group. Intervention group participants received 12 therapy sessions over six months; all participants completed a measure of pre-death grief. The analysis was conducted using latent change models. In the first model, study group was included as a predictor of change in pre-death grief; subsequent models also included care situation and sociodemographic variables.

RESULTS

The burden due to pre-death grief was reduced for intervention but not control group participants at the time of the six-month follow-up assessment (Cohen's d = -0.361). When controlling for changes in the care situation and sociodemographic variables, the treatment effect was also found in the assessment completed post intervention (Cohen's d = -0.248).

CONCLUSION

Results indicate that a cognitive-behavioral intervention including grief-specific strategies can successfully foster caregivers' coping with loss and reduce burden of pre-death grief.

Moving through predeath grief: Psychological support for family caregivers of people with dementia

When caring for a family member with dementia, continuous losses and predeath grief can adversely affect the caregivers’ physical and mental health. Interventions for caregivers should therefore also aim at coping with loss and managing predeath grief. It was the objective of the present study to describe sources of grief caregivers report during therapy and to investigate how therapists can support caregivers. Two caregivers who participated in a randomized controlled trial were selected for this case study. Both caregivers received an intervention based on the principles of cognitive-behavioral therapy with grief-focused content that consisted of 12 sessions within six months. Three therapy sessions per participant were transcribed, coded, and analyzed using qualitative content analysis. Results illustrate that both caregivers experienced a loss of companionship with their respective care recipient and ambiguous loss that resulted in intense grief that they found difficult to manage. Therapists responded by supporting the caregivers to acknowledge their losses and identify individual ways to cope with and accept loss and grief. Both caregivers reported higher well-being and an increased ability to manage their grief-related emotions after the therapy ended. The identified intervention strategies fit well into a theoretical framework for grief interventions for dementia caregivers, i.e. the dementia grief model.

[Psychotherapy with older caregivers]

Nursing and caring for a relative can be regarded as an important developmental task, which mainly affects elderly people who provide care for their very old parents or their (spouse) partners. Being responsible for the care of someone can be associated with a severe caregiver burden and experienced as a crisis. Possible psychological consequences are pronounced depressive symptoms or maladaptive stress reactions. For these caregivers, psychotherapeutic counselling can be sensible and helpful in addition to other resources of caregiver support. This applies in particular to improving coping with problematic everyday situations, stressful emotions, and strengthening resources. Multimodal interventions that address methods of cognitive behavioral therapy and acceptance as well as commitment therapy could show good evidence for this target group but have so far received little attention in healthcare programs. Because it is often difficult for caregivers to organize regular visits to the psychotherapist's practice, psychotherapeutic offers would be desirable in more flexible settings (e. g. by telephone or internet-based). The extent to which such supplementary interventions can be embedded and financed in the context of chronic care models is still unclear.

Are psychotherapeutic effects on family caregivers of people with dementia sustainable? Two-year long-term effects of a telephone-based cognitive behavioral intervention

OBJECTIVES

Evaluation of long-term effects of an individualized short-term telephone intervention (seven sessions), based on a comprehensive cognitive behavioral therapy (CBT) approach. The study goal was to evaluate the maintenance of intervention effects regarding well-being, quality of life, and health at two years post treatment.

METHOD

Participants (n = 105) were (partly) randomized after baseline assessment in a two-arm study (intervention, control group/usual care). Depressive symptoms were assessed with the German version of the Center for Epidemiologic Studies Depression Scale (CES-D). Caregivers' physical complaints were measured with the Gießener Beschwerdebogen (GBB-24), and quality of life with the World Health Organization quality of life -BREF (WHOQOL-BREF). Emotional well-being and perceived health status were assessed using thermometer scaling. Data were analyzed by intention-to-treat analyses, including for those who terminated the intervention prematurely but still delivered data, using ANCOVAs.

RESULTS

Long-term intervention effects were found for emotional well-being (p = 0.019). For the subgroup of caregivers who were still caring at home at follow-up, the intervention led to an increased health status (p = 0.023), fewer bodily complaints (global measure p= 0.014, rheumatic pain p = 0.027, heart trouble p = 0.042), and a higher quality of life (overall p = 0.044 and subscale environment p = 0.030).

CONCLUSION

The short-term CBT intervention via telephone showed long-term effects two years after treatment on emotional well-being, health status, bodily complaints, and quality of life.

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

OBJECTIVES

To develop a new measure of dysfunctional thoughts for family caregivers of people living with dementia. These thoughts can contribute to negative outcomes, but they may be modifiable.

METHOD

A stepwise process was used to develop the Thoughts Questionnaire, commencing with item generation, concept mapping, and pilot testing in a sample of professional and nonprofessional caregivers of people with dementia (n = 18). Next, an independent sample of 35 family caregivers of people with dementia (30 female; M_age = 64.30, standard deviation = 10.65) completed: (a) the Thoughts Questionnaire; (b) an existing measure of dysfunctional thoughts, the Dementia Thoughts Caregivers Questionnaire; and (c) separate validated measures of depressive symptoms, caregiver stress, and coping, respectively.

RESULTS

The level of agreement with dysfunctional thought statements from the Dementia Thoughts Caregivers Questionnaire and Thoughts Questionnaire was low. However, a small number of Thoughts Questionnaire statements were strongly endorsed by over 85% of the sample. Both dysfunctional thought measures had adequate reliability, but total scores were not significantly intercorrelated (r = .287, p = .095). Only the Thoughts Questionnaire was significantly, positively correlated with most caregiver stress measures. Thoughts Questionnaire items required a much lower reading level than the Dementia Thoughts Caregivers Questionnaire items.

DISCUSSION

This study provides preliminary data on a tool for assessing the negative role-related thoughts that family caregivers of people with dementia may experience. Given that these thoughts are implicated in depression but they may be modified, the capacity to identify dysfunctional thoughts may prove useful in caregiver support programs.

Managing Loss and Change: Grief Interventions for Dementia Caregivers in a CBT-Based Trial

Dementia caregivers often experience loss and grief related to general caregiver burden, physical, and mental health problems. Through qualitative content analysis, this study analyzed intervention strategies applied by therapists in a randomized-controlled trial in Germany to assist caregivers in managing losses and associated emotions. Sequences from 61 therapy sessions that included interventions targeting grief, loss, and change were transcribed and analyzed. A category system was developed deductively, and the intercoder reliability was satisfactory. The identified grief intervention strategies were recognition and acceptance of loss and change,addressing future losses,normalization of grief, and redefinition of the relationship Therapists focused on identifying experienced losses, managing associated feelings, and fostering acceptance of these losses. A variety of cognitive-behavioral therapy-based techniques was applied with each strategy. The findings contribute to understanding how dementia caregivers can be supported in their experience of grief and facilitate the development of a manualized grief intervention.

The effects of treatment adherence and treatment-specific therapeutic competencies on outcome and goal attainment in telephone-based therapy with caregivers of people with dementia

OBJECTIVES

Contradictory results have been found for the impact of therapist's adherence and competence on intervention outcomes. Most studies focus on generic aspects of competence and adherence, rather than taking into account treatment-specific aspects or specific challenges of the clientele. Appropriate analyses are lacking for cognitive behavioral therapy (CBT) with caregivers of people with dementia.

METHOD

In a sample of 43 caregivers, we examined adherence and different competence ratings of 80 complete sessions, as predictors of symptom change and goal attainment. Therapist's competence was evaluated by four raters, using an adapted version of the cognitive therapy scale (CTS) on three subscales of competence: General therapeutic (GT), session-structuring (SS), and treatment-specific CBT technique (CT). Therapist's adherence to the manual was also assessed.

RESULTS

The results show that GT competencies were associated with lower post-test depression scores and that CT competencies predicted a decrease in caregiver burden and higher goal attainment, while SS competencies predicted higher post-test burden. Therapist's adherence had no relationship to outcome, but the higher application of modifying dysfunctional thoughts was associated with higher goal attainment.

CONCLUSION

The results suggest the importance of treatment-specific competencies for outcome. Future research should identify empirically what kind of therapeutic behavior is appropriate to the challenges of a specific clientele such as caregivers of people with dementia.

The Tele.TAnDem intervention: study protocol for a psychotherapeutic intervention for family caregivers of people with dementia

Background

Family caregivers are confronted with high demands creating a need for professional support and at the same time hindering its utilization. Telephone support allows easier access than face-to-face support because there is no need to leave the person with dementia alone or find an alternative carer. It is also independent of transport possibilities or mobility. The objectives are to evaluate whether telephone-based cognitive-behavioral therapy, which is implemented in established care provision structures, improves outcomes compared to usual care and whether it is as effective as face-to-face cognitive-behavioral therapy.

Methods/Design

If participants live in the area of one of the study centers (Jena, Berlin, Munich) and indicate that attendance of a face-to-face therapy is possible, they will be assigned to the face-to-face group. The other participants will be randomized to receive either telephone-based cognitive-behavioral therapy or usual care. Data will be collected at baseline, post-intervention, and at a 6-month follow-up. The primary outcomes will be depressiveness, burden of care, health complaints, and problem-solving ability. The secondary outcomes will be anxiety, quality of life, violence in caregiving, utilization of professional assistance, and cost effectiveness.

Discussion

This paper describes the evaluation design of our telephone-based cognitive-behavioral therapy in a randomized controlled trial. If this intervention proves to be an effective tool to improve outcomes, it will be made accessible to the public and the use of this support service will be recommended.

Trial registration

German Clinical Trials Register DRKS00006355.

Ressourcentagebuch: Verbesserung der Emotionsregulation und der Ressourcenrealisierung durch therapeutisches Schreiben im Anschluss an eine Psychotherapie

Theoretischer Hintergrund: Defizite in Emotionsregulation und Ressourcenrealisierung können auch nach Behandlung und Remission der psychischen Störung bestehen bleiben und langfristig Rückfälle verursachen. Fragestellung: Können mittels einer vierwöchigen Schreibintervention in Form eines Ressourcentagebuchs Stimmung, Emotionsregulation und Ressourcenrealisierung bei Patienten nach stationärer Psychotherapie verbessert werden? Methode: 41 Patienten wurden randomisiert entweder der Interventionsgruppe (N = 21) oder der unbehandelten Kontrollgruppe (N = 20) zugeteilt. Die Ergebnisvariablen wurden im Abstand von fünf Wochen erhoben. Ergebnisse: Die Interventionsgruppe zeigte gegenüber der Kontrollgruppe einen signifikanten Anstieg der positiven Stimmung, sowie der Emotionsregulationsstrategie Neubewertung. Unterschiede in der Ressourcenrealisierung zeigten sich nicht zwischen den Gruppen. Schlussfolgerungen: Die Ergebnisse dieser Pilotstudie geben erste Hinweise auf eine Verbesserung der Stimmung und der Emotionsregulation durch das Schreiben eines Ressourcentagebuchs.

[Evaluation of a cognitive-behavioral group intervention for family caregivers of persons with dementia]

International studies have revealed that dementia caregivers' health deteriorates as a result of intensive at-home care. A cognitive-behavioral group intervention concept was therefore tailored to the needs of dementia caregivers and aimed at an increase in psychological well-being and the prevention of adverse effects on psychological health. The group concept was evaluated with an intervention-control group design (N=86 IG; N=92 CG) in a prospective longitudinal study. Outcome variables, assessed at 3 point of measurement, were depressive symptoms, symptoms of anxiety, health-related quality of life, and physical health. Compared to caregivers in the control group, caregivers in the intervention group showed significantly lower symptoms of depression and anxiety at follow-up, which was consistent with the hypotheses. Furthermore, nursing home placement was delayed.