Ann M. Steffen

The relationship between caregiving self-efficacy and depressive symptoms in dementia family caregivers

The present study was intended to replicate the findings of Steffen et al. (2002) of a negative relationship between caregiving self-efficacy and depressive symptoms among family dementia caregivers. Female family caregivers (N = 74) of community-dwelling individuals diagnosed with dementia completed a telephone interview and self-report assessment packet that included measures of caregiving self-efficacy and depressive symptoms. There was a direct negative relationship between caregiving self-efficacy and depressive symptoms after controlling for objective stressors. There was no support, however, for the hypothesis that caregiving self-efficacy would operate as a moderator, such that the relationship between objective stressors (cognitive impairment and behavior problems) and caregivers’ depressive symptoms would be strongest for caregivers reporting lower levels of self-efficacy. The results of this study suggest that caregiving self-efficacy has a strong, direct relationship with depressed symptoms for dementia family caregivers. Longitudinal research is needed to determine if it is an appropriate focus of future intervention research.

Anger Management for Dementia Caregivers: A Preliminary Study Using Video and Telephone Interventions

Data are presented on a preliminary study investigating the efficacy of an angermanagement video series and workbook for dementia family caregivers. Materials from a previously developed intervention (Gallagher-Thompson & DeVries, 1994) were used to create a videotaped version of the treatment program. Women and men (N = 33) caring for a relative with dementia were randomly assigned to one of two formats for the video and bibliotherapy intervention (home-based viewing with weekly telephone sessions or class-based viewing) or to a wait-list comparison condition. The 8-week intervention focused on cognitive and behavioral skills to manage anger and frustration (i.e., relaxation training, cognitive restructuring, and assertion training). Compared to control participants, caregivers in both of the treatment conditions had lower posttreatment levels of anger and depression, and higher ratings of caregiving self-efficacy. Results from this preliminary study suggest that innovative multicomponent anger interventions can be effective for middle-aged and older caregivers of dementia patients; investigations using larger sample sizes are needed to confirm these findings.

Handbook of Behavioral and Cognitive Therapies with Older Adults

Behavioral and Cognitive Treatments for Geriatric Depression: An Evidence-Based Perspective.- Treating Generalized Anxiety in a Community Setting.- Treatment of Late-Life Generalized Anxiety Disorder in Primary Care Settings.- Cognitive-Behavior Therapy for Late-Life Insomnia.- A Relapse Prevention Model for Older Alcohol Abusers.- Cognitive-Behavioral Pain Management Interventions for Long-Term Care Residents with Physical and Cognitive Disabilities.- Reducing Psychosocial Distress in Family Caregivers.- Integrated Psychosocial Rehabilitation and Health Care for Older People with Serious Mental Illness.- Cognitive Therapy for Suicidal Older Adults.- Cognitive Therapy for Older People with Psychosis.- Behavioral Interventions to Improve Management of Overweight, Obesity, and Diabetes in Patients with Schizophrenia.- Dialectical Behavior Therapy for Personality Disorders in Older Adults.- Treating Persons with Dementia in Context.- Cognitive Behavioral Case Management for Depressed Low-income Older Adults.- Post-Stroke Depression and CBT with Older People.- Cognitive Behavioral Therapy for Older Adults with Bipolar Disorder.- Meaning Reconstruction in Later Life: Toward a Cognitive-Constructivist Approach to Grief Therapy.- PTSD (Post-Traumatic Stress Disorder) in Later Life.- Training of Geriatric Mental Health Providers in CBT Interventions for Older Adults.- The Role of Positive Aging in Addressing the Mental Health Needs of Older Adults.- How Medicare Shapes Behavioral Health Practice with Older Adults in the US: Issues and Recommendations for Practitioners.

Treatment issues with elderly clients

Most older adults are well suited to cognitive and behavioral (CB) intervention approaches utilizing a collaborative relationship between client and therapist, explicit goal setting, and acknowledgment of the clients personal strengths. Therapists need to utilize a biopsychosocial model in working with older adults and to plan treatment with awareness of interdisciplinary principles and resources. Effective cognitive and behavioral work with the elderly depends on understanding changes in cognitive processing and learning that may be associated with age. Some modifications of cognitive and behavioral techniques to consider in work with older adults are proposed, in response to differences in learning styles, sensory deficits, and chronic health problems and to capitalize on the life experience of older adults.

Comparative outcomes of two distance-based interventions for male caregivers of family members with dementia.

Data are presented on a preliminary study investigating the efficacy of 2 distance-based psychosocial interventions (N = 32) for male family dementia caregivers. Male caregivers were randomly assigned to either a basic education intervention (ie, educational booklet and biweekly check-in telephone calls) or a video intervention (ie, set of 10 videos, an accompanying workbook, and weekly telephone coaching sessions using behavioral strategies to manage challenging caregiving situations). Results did not support the greater efficacy of the video condition in reducing psychosocial distress (eg, negative affect, upset and annoyance following behavior problems) or increasing positive affect or caregiving self-efficacy. There was, however, a statistically significant effect for postintervention improvement in both the video/coaching and the educational booklet/check-in conditions. Potential reasons for the lack of differential treatment effects are discussed, along with implications for recruitment of male dementia caregivers.

Physical and Psychosocial Correlates of Hormone Replacement Therapy with Chronically Stressed Postmenopausal Women

Objectives: This study investigated the relationship between hormone replacement therapy (HRT) use and physical and psychosocial functioning in a sample of chronically stressed older women. Methods: Participants (N= 94) were postmenopausal women caring for a parent or spouse with dementia. Caregivers were evaluated using both psychological and physical health indices. Results: Caregivers receiving HRT reported lower levels of hostility and were less likely to report unpleasant interactions with members of their support network; these findings were unrelated to demographic variables, caregiving-related indices, or health behaviors. HRT recipients had lower 10-year risk scores for cardiovascular disease, but there were no group differences in stroke risk. The largest effects on hostility, depression, heart and stroke risk were observed in caregivers receiving a combination of estradiol and progesterone. Discussion: HRT for postmenopausal women may promote positive outcomes for some, but not for all, affective states and cardiovascular variables vulnerable to chronic life stressors.

Relationship Differences in Anger Intensity During Caregiving-Related Situations

ABSTRACT This study examined the experience of anger during recent caregiving situations. Women (N = 180) caring for a husband or parent with dementia described and rated the intensity of their reactions during the three most annoying caregiving events of the previous month. Anger items all loaded on one general factor, and had strong internal consistency. Wives and daughters differed in several ways; daughters had higher composite anger scores and more frequently identified interactions with family members and service providers as problematic. Results suggest that these differences were not due to potentially confounding variables such as age, education, income, or caregiving-related indices. Assessment and treatment planning may be facilitated by having detailed information about anger-eliciting events in the lives of family caregivers.

A telehealth behavioral coaching intervention for neurocognitive disorder family carers.

This study examined the differential impact of two telehealth programs for women caring for an older adult with a neurocognitive disorder. Outcomes examined were depressive symptoms, upset following disruptive behaviors, anxious and angry mood states, and caregiving self‐efficacy.

Physical and Mental Health Correlates of Self-Efficacy in Dementia Family Caregivers

This study examined whether self-efficacy for controlling upsetting caregiving thoughts would longitudinally predict mental and physical health as well as utilization of psychotropic medications in help-seeking dementia family caregivers (N = 53). Positive associations were found between self-efficacy and self-reported mental health and physical health subscales of the Short Form Health Questionnaire-12, and negative correlations were found between self-efficacy for controlling upsetting thoughts about caregiving and the number of psychotropic medications being utilized both cross-sectionally and longitudinally. These results suggest that self-efficacy for controlling upsetting thoughts may be a fruitful target area for further intervention research with dementia family caregivers.

The Sandwich Generation Diner: Development of a Web-Based Health Intervention for Intergenerational Caregivers

Background Women are disproportionately likely to assist aging family members; approximately 53 million in the United States are involved with the health care of aging parents, in-laws, or other relatives. The busy schedules of “sandwich generation” women who care for older relatives require accessible and flexible health education, including Web-based approaches. Objective This paper describes the development and implementation of a Web-based health education intervention, The Sandwich Generation Diner, as a tool for intergenerational caregivers of older adults with physical and cognitive impairments. Methods We used Bartholomew’s Intervention Mapping (IM) process to develop our theory-based health education program. Bandura’s (1997) self-efficacy theory provided the overarching theoretical model. Results The Sandwich Generation Diner website features four modules that address specific health care concerns. Our research involves randomly assigning caregiver participants to one of two experimental conditions that are identical in the type of information provided, but vary significantly in the presentation. In addition to structured Web-based assessments, specific website usage data are recorded. Conclusions The Sandwich Generation Diner was developed to address some of the informational and self-efficacy needs of intergenerational female caregivers. The next step is to demonstrate that this intervention is: (1) attractive and effective with families assisting older adults, and (2) feasible to embed within routine home health services for older adults.