Gabriele Wilz

Evaluation of a Short-Term Telephone-Based Cognitive Behavioral Intervention for Dementia Family Caregivers

ABSTRACT This study evaluates a short-term telephone-based Cognitive Behavioral Therapy (CBT) for family caregivers. The study goal was to analyse whether caregivers of the intervention group reported better well-being and health at post treatment than participants of an untreated control group and an attention control group (treated with progressive muscle relaxation [PMR]), and whether these benefits maintained at 6-month follow-up. Participants (n = 229) were assigned to the study groups after baseline assessment. Most were female (82.2%), with a mean age of 62 years. As outcome measurements, the study assessed depressive symptoms, body complaints, emotional well-being, and perceived health. The intervention group showed short-term effects in improving well-being when compared with the PMR and the untreated control groups. Furthermore, in comparison to the untreated controls CBT was effective in decreasing body complaints at post treatment and in improving perceived health at 6-month follow-up. Improvements for CBT in comparison to the PMR group could be shown for depressive symptoms at 6-month follow-up. CBT for family caregivers is applicable via telephone and has shown promising short and long-term effects. A prolongation of the intervention might enhance the effects.

The Assessment of Treatment Integrity in a Cognitive Behavioral Telephone Intervention Study With Dementia Caregivers

Assessment of treatment integrity, such as therapists’ adherence and competence, is essential for the development and evaluation of evidence-based therapeutic interventions, but in most intervention studies proof of treatment integrity has not been considered on a regular basis. One reason is that there is a lack of appropriate assessment instruments. For dementia caregiver trials treatment adherence and competence scales do not exist. To evaluate treatment integrity in a cognitive behavioral therapy (CBT) telephone intervention with dementia caregivers, we developed a new adherence scale and adapted the Cognitive Therapy Scale (CTS) for CBT with dementia caregivers. We also analyzed whether CBT can be delivered with treatment integrity for interventions with dementia caregivers and by telephone. Eighty-six entire sessions with 45 caregivers in a randomized-controlled intervention study were judged by four independent raters. Inter-rater reliability was high for overall score on the adherence scale (intraclass correlation [ICC] = .85) and the CTS (ICC = .82). Overall adherence was moderate and competence was high. Both scales proved to be reliable; thus they can be used for assessing treatment integrity in other research fields with dementia caregivers, including measuring the impact of treatment on outcome criteria. The results also reveal that CBT can be delivered with adherence to the manual and competently to dementia caregivers and by telephone, opening up new options for future research and practice.

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.

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

ABSTRACT 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.

Resource diary: A positive writing intervention for promoting well-being and preventing depression in adolescence

Depression in adolescence is a widespread problem and leads to extensive psychosocial impairments. For these reason, a resource diary has been developed as a four-week positive writing intervention. The aims of this intervention were to enhance well-being, to promote emotion regulation and resource realization, as well as to prevent symptoms of depression in adolescence. Seventy-seven students of 8th form were randomized either to a positive writing group (n = 38) or to a neutral writing group (n = 39). At the post-test, the positive writing group showed a lower dysphoric mood, fewer worries and less rumination in comparison with the neutral writing group. No effects on resource realization were detected. This study provides the first evidence of the beneficial effects of positive writing on indicators of well-being and depressive symptoms. In conclusion, the resource diary represents an economical intervention for preventing depression in adolescence.

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

BackgroundFamily 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/DesignIf 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.DiscussionThis 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 registrationGerman Clinical Trials Register DRKS00006355.

The Caregiver Grief Scale: Development, Exploratory and Confirmatory Factor Analysis, and Validation

ABSTRACT Objective: Pre-death grief is among the most debilitating aspects of dementia caregiving and can have adverse impacts on caregivers’ physical and mental health. The specific assessment of grief is therefore an important prerequisite for both clinical and research settings. The present study aimed to build upon previous research and develop a scale for the measurement of grief in dementia caregivers.Methods: An initial pool of 21 items was created through both the selection of appropriate items from existing instruments and the development of new items. 229 caregivers (Mage = 63.8 years ±10.5) completed the scale along with measures of construct validity. The sample was randomly split in half and exploratory factor analysis was conducted on the first data set. The established factor structure was then subjected to confirmatory factor analysis on the second data set.Results: Convincing goodness-of-fit indices emerged for a four-factor model, with factors reflecting different aspects of caregiver grief (i.e., Emotional Pain, Relational Loss, Absolute Loss, and Acceptance of Loss). The total scale and subscales yielded high internal consistency reliabilities (Cronbach’s α = .67–.89) and construct validity coefficients.Conclusions: The Caregiver Grief Scale is now available for use in clinical and research settings to aid therapists and researchers in assessing the burden caregivers experience due to grief and evaluating the effects of grief-specific interventions.

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

ABSTRACT 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 (Cohens 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 (Cohens 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.

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 therapists 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. Therapists 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). Therapists 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. Therapists 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.

Einbezug von Familienangehörigen chronisch Kranker in die Arzt-Patient-Kommunikation

Involving family members in the patients treatment is central for coping with chronic diseases. The familys functioning and their involvement in the treatment process have a significant influence on compliance as well as on the patients coping and quality of life. This article illustrates this broad topic through selected aspects. First, the importance of the family for the patients coping and quality of life is highlighted in certain examples. Criteria for the familys involvement and important topics for the doctors encounter with family members are introduced. Second, the necessities, problems, and consequences of doctor-family communication are illustrated for the examples of stroke and dementia. Overall, there is only limited time to include the family in in-patient as well as out-patient care. As a result, physician-family communication is not integrated sufficiently in general care, even for chronic diseases.ZusammenfassungDer Einbezug der Familie in die Behandlung hat eine zentrale Bedeutung bei der Bewältigung chronischer Erkrankungen. So beeinflussen die Funktionsfähigkeit der Familie und die Einbindung der Angehörigen in den Behandlungsprozess maßgeblich die Compliance sowie die Krankheitsverarbeitung und Lebensqualität der Patienten. Dieses umfassende Thema wird im vorliegenden Beitrag hinsichtlich einiger ausgewählter Aspekte betrachtet. So wird erstens die Bedeutung der Familie für die Krankheitsverarbeitung und Lebensqualität der Patienten an ausgewählten Beispielen verdeutlicht. Hierbei werden Kriterien für den Einbezug der Familie sowie wichtige Themen für das ärztliche Gespräch mit Bezugspersonen vorgestellt. Im zweiten Abschnitt werden am Beispiel der Erkrankungen Schlaganfall und Demenz der Bedarf an sowie Probleme und Konsequenzen der ärztlichen Kommunikation mit Bezugspersonen dargestellt. Insgesamt bestehen sowohl im stationären als auch im ambulanten Setting in der Regel kaum zeitliche Ressourcen für den Einbezug der Familien. Somit ist die ärztliche Kommunikation mit der Familie selbst bei chronischen Erkrankungen bisher nicht ausreichend in die Regelversorgung integriert.AbstractInvolving family members in the patient’s treatment is central for coping with chronic diseases. The family’s functioning and their involvement in the treatment process have a significant influence on compliance as well as on the patient’s coping and quality of life. This article illustrates this broad topic through selected aspects. First, the importance of the family for the patient’s coping and quality of life is highlighted in certain examples. Criteria for the family’s involvement and important topics for the doctor’s encounter with family members are introduced. Second, the necessities, problems, and consequences of doctor–family communication are illustrated for the examples of stroke and dementia. Overall, there is only limited time to include the family in in-patient as well as out-patient care. As a result, physician–family communication is not integrated sufficiently in general care, even for chronic diseases.