Elsa Marziali

The Contribution of Group Cohesion and Group Alliance to the Outcome of Group Psychotherapy

The contribution to outcome of two group-process factors, group cohesion and group therapeutic alliance, was tested in the context of a randomized, controlled treatment trial for borderline personality disorder. Group members from four time-limited groups of an experimental model of group psychotherapy completed measures of group cohesion and group alliance at prespecified intervals across the 30-session therapy. Outcome was measured in terms of psychiatric symptoms, social adaptation, and indicators of behavioral dysfunction. The results showed that cohesion and alliance were correlated significantly and separately contributed to outcome on most of the dependent measures. Stepwise regression analyses showed, however, that when compared with cohesion, alliance accounted for more outcome variance on the dependent measures. The clinical implications of the findings and the limitations of the study are discussed.

Dementia Caregivers’ Responses to 2 Internet-Based Intervention Programs

Purpose: The aim of this study was to examine the impact on dementia caregivers’ experienced stress and health status of 2 Internet-based intervention programs. Design and methods: Ninety-one dementia caregivers were given the choice of being involved in either an Internet-based chat support group or an Internet-based video conferencing support group. Pre-post outcome measures focused on distress, health status, social support, and service utilization. Results: In contrast to the Chat Group, the Video Group showed significantly greater improvement in mental health status. Also, for the Video Group, improvements in self-efficacy, neuroticism, and social support were associated with lower stress response to coping with the care recipient’s cognitive impairment and decline in function. Implications: The results show that, of 2 Internet-based intervention programs for dementia caregivers, the video conferencing intervention program was more effective in improving mental health status and improvement in personal characteristics were associated with lower caregiver stress response.

Internet-Based Caregiver Support for Chinese Canadians Taking Care of a Family Member with Alzheimer Disease and Related Dementia

The aim of this study was to assess the usability of a new Internet-based Caregiver Support Service (ICSS) and evaluate its effects on health outcomes of Chinese Canadians who cared for a family member with dementia. Demographic and questionnaire data were collected from 28 participants, and in-depth interviews were conducted with 10 participants. Results showed that non-users reported higher levels of burden post-intervetion, and frequent users showed postintervention reduction in experienced burden. Traditional beliefs shaped caregivers’ needs; also, ethno-cultural-linguistic contexts affected system usability and were associated with usage behaviour. This study indicates that caregivers can benefit from receiving professional support via asynchronous e-mails and a dedicated information web site. The ICSS is a feasible approach for supporting caregivers who prefer an alternative service model. This emerging service requires more research in: enhanced technology design, service delivery models for immigrant caregivers, and evaluation of effectiveness and cost-effectiveness. L’objectif de cette étude était d’évaluer la facilité d’utilisation d’un nouveau service de soutien pour personnel soignant basé sur Internet (ICSS) et d’évaluer ses effets sur la santé des Canadiens chinois qui ont soigné un membre de la famille atteinte de démence. Les données démogaphiques et de questionnaire ont été recueillies auprès de 28 participants, et des entrevues approfondies ont été realisées avec 10 participants. Les résultats ont démontré que ceux qui n’ont pas participé à ICSS ont revelé plus hauts niveaux de charge après l’intervention, lors que les participants fréquents a montré une réduction en charge après l’intervention. Les croyances traditionelles ont formées les besoins des soignants; de plus, les contextes ethnoculturelle-linquistiques ont touchées la facilité d’utilisation et ont été associées au comportement pendant l’utilisation. De même, l’utilisation d’ICSS a été influencée par la compétence informatique et par préferences linguistiques. Cette étude indique que les soignants peuvent bénéficier du soutien professionnel par e-mails asynchrones et un site Web dedié d’informations. L’ICSS est une approche possible pour soutenir les soignants qui préferent un modèle de service alternative. Ce service emergent nécessite plus de la recherche sur: la conception technologique amélioré, les modèles de prestation de services pour les immigrants soignants et l’évaluation de l’efficacité et rentabilité.

The role of coping humor in the physical and mental health of older adults

Objectives: This study examined the associations among coping humor, other personal/social factors and the health status of community-dwelling older adults. Method: Survey questionnaires were completed with 73 community-dwelling older adults. Included were measures of coping humor, spirituality, self-efficacy, social support and physical and mental health status. Results: Correlations across all variables showed coping humor to be significantly associated with social support, self-efficacy, depression and anxiety. Forward stepwise regression analyses showed that coping humor and self-efficacy contributed to outcome variance in measures of mental health status. Contrary to expectation, neither social support nor spirituality contributed to the total outcome variance on any of the dependant measures. Conclusion: The importance of social support, self-efficacy and spirituality in determining the quality of life of older adults is well supported in the literature. Coping humor as a mechanism for managing the inevitable health stresses of aging has received less attention. This study shows that coping humor and self efficacy are important factors for explaining health status in older adults. Correlations among coping humor, self efficacy and social support suggest that a sense of humor may play an important role in reinforcing self-efficacious approaches to the management of health issues.

Internet-Based Clinical Services: Virtual Support Groups for Family Caregivers

ABSTRACT Objectives: An internet-based psychotherapeutic support group intervention for family caregivers of persons with neurodegenerative diseases was developed in a series of pilot studies and subsequently evaluated in a feasibility study with 34 participants. The aim was to duplicate online group interactions typical of face-to-face support groups. Methods: A user-friendly web site was developed according to usability criteria for older adult users. Unique features of the web site included video conferencing in two formats, one-on-one and a group format with up to 6 participants and a facilitator. Following ten professionally facilitated sessions, each group evolved into a web-based self-help support group facilitated online by a group member. Results: Qualitative analyses of early, middle and late group video conferencing sessions yielded themes congruent with face-to-face group process. Follow up interviews six months following the initiation of the online groups showed overall positive participant responses in each of the following areas: learning to use computers, negotiating the web site links, obtaining disease-specific information from the website, using technology to communicate, bonding with group members, providing mutual guidance and support, and benefiting in terms of coping with the stresses of caregiving.

The Effects of the Therapeutic Alliance on the Outcomes of Individual and Group Psychotherapy with Borderline Personality Disorder

The contribution to outcome of the therapeutic alliance was tested in a randomized controlled trial of Interpersonal Group Psychotherapy versus Individual Dynamic Psychotherapy for borderline personality disorder. Therapeutic alliance was measured at pre-specified intervals. The dependent outcomes were self-reported symptoms and social adjustment and clinician-rated behavioral dysfunction and service utilization. We found that (1) patients in both treatments rated the alliance positively at early and later points in their treatments, (2) for the individual psychotherapy cohort, early and later alliance ratings were related to all outcome measures at 12-month follow-up, but not at 24-month follow-up and (3) for the group psychotherapy cohort, both early and later alliance were unrelated to outcome at 12-month follow-up but were significantly associated with outcome at 24-month follow-up. The clinical implications of the study findings are presented in the context of the studys limitations. Der Beitrag der...

Caring for Others: Internet Health Care Support Intervention for Family Caregivers of Persons with Alzheimer's, Stroke, or Parkinson's Disease:

The purpose of the project was to emulate face-to-face psychosocial support group process in an Internet videoconferencing environment and explore the benefits for 34 family caregivers of persons with neurodegenerative disease. Caregivers were provided with computer equipment and trained to access a password-protected Web site. Using videoconferencing software, each group of 6 members met with a facilitator online weekly for 10 weeks. Each caregiver was interviewed at 6-month follow-up. Participant response data were generated through qualitative analysis of group process and follow-up interviews. The analysis showed that the virtual group process closely paralleled face-to-face group interactions. At follow-up, 90% of the caregivers reported that the online group experience had been “very” or “overall” positive and that the group had helped them cope with the stresses of caregiving. The professional and ethical implications of providing a clinical intervention using the Internet are discussed.

A systematic review of practice standards and research ethics in technology-based home health care intervention programs for older adults.

Objective: The purpose of the review is to assess frequencies of reporting adherence to professional practice standards and research ethics in studies of technology-based home health care programs. Methods: Key databases were searched to yield 2,866 abstracts that were independently rated by two reviewers using inclusion-exclusion criteria, resulting in 107 articles that were then reviewed for reports of practice standards and research ethics. Results: Issues related to professional practice standards and research ethics were not well reported. When reported, adherence to practice standards included preintervention training, use of intervention protocols, supervision, and mechanisms for risk management. Research ethics most commonly reported were informed consent, REB/IRB approval, and protection of privacy. Discussion: The results raise questions as to whether practice standards and research ethics are addressed sufficiently when health service delivery occurs in technology-based environments. Guidelines for professional accountability in e-health service delivery are needed.

Designing interactive life story multimedia for a family affected by alzheimer's disease: a case study

In this paper we present a design project involving primary end users who have declining cognitive abilities such as memory, communication, and problem solving. We are designing interactive multimedia with personalized life stories for individuals with Alzheimers disease. We conducted a case study to discover and address the design challenges for this project. A particular challenge is a limited ability to communicate with the primary end users. In this paper, we present design methods that take this challenge into consideration. Our goal is to contribute insight into designing for users with cognitive disabilities, and to present methodologies that are useful for designers who have a limited ability to interact or communicate with end users.

Multimedia Biographies: A Reminiscence and Social Stimulus Tool for Persons with Cognitive Impairment

The multimedia biography tells the story of the life of an elderly person with a cognitive impairment in motion picture format. The multimedia biography combines family photographs, film clips, audio narration, and music. It is intended to be screened on an ongoing basis to provide spaces for reminiscence and communication between cognitively impaired persons and their families. Using a production process in which we collaborated with family caregivers, we created 12 multimedia biographies for persons having Alzheimers disease or mild cognitive impairment. This article describes our production and screening processes. We also share lessons learned from the multimedia biography research to assist practitioners, families, or researchers who wish to use similar technologies and processes for eliciting and sharing life stories.