Family caregivers of people with dementia experience more burden and are at greater risk of developing depression than caregivers of people with a chronic illness. A new evidence review from the Netherlands finds that a psychotherapy technique called cognitive reframing can help reduce caregivers' stress when they are caring for loved ones with dementia.
Cognitive reframing focuses on thinking differently by "reframing" negative or untrue assumptions and thoughts into ones that promote adaptive behavior and lessen anxiety and depression. Cognitive reframing can be offered by a trained primary health care provider or by a mental health care professional.
Several studies have focused on psychosocial intervention in dementia care, but this is the first review that focused on the effectiveness of cognitive reframing in particular. The review appears in the latest issue of The Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.
Led by Myrra Vernooij-Dassen Ph.D., of the Radboud University Nijmegen Medical Centre in the Netherlands, the review looked at whether caregivers benefited from various interventions to provide education about dementia and whether their beliefs about caregiving responsibilities and their own needs could be changed.
"We found that changing their thinking and understanding helps a lot to allow more positive feelings to emerge and to reduce distress," Vernooij-Dassen said.
Caregivers who received a cognitive reframing intervention had fewer symptoms of anxiety and depression and felt less stress or distress related to their caregiving. While reframing helped caregivers manage their stress, it didn't change the burden of being a dementia caregiver or their coping skills. However, reframing may also lead to a more positive relationship with the person who has dementia. "When a caregiver is able to reframe self-defeating cognitions into more constructive reasoning, it is a major change," said Vernooij-Dassen.
The evidence review comprised eleven randomized controlled trials involving family caregivers of people with dementia. None of the trials focused solely on cognitive reframing, but they all used cognitive reframing as the main component in their intervention. Caregivers ranged in age from 19 to 84. The majority of participants—40.2 percent—were caring for a spouse.
Dementia symptoms include diminished reasoning, memory, social and language skills that can alter a person's ability to function in daily life. Alzheimer's disease is the most common form of advanced dementia.
"Alzheimer's is a chronic, progressive, fatal disease and caregiving at home for someone with the disease is fraught with many challenges but also rewards," said, Beth Kallmyer, M.S.W., senior director of constituent services for the Alzheimer's Association, a non-profit advocacy organization.
Kallmyer said the Alzheimer's Association encourages caregivers to reach out for assistance and take care of themselves. "Because of the progressive, debilitating nature of the disease and the extended length of the caregiving process, multiple services are needed to provide comprehensive support and education to dementia caregivers."
Tools to decrease stress for family dementia caregivers will be even more important in years to come as people continue to live longer. Kallmyer said cognitive reframing is one among many appropriate interventions as part of a package of individual support for caregivers. "More research is needed overall for improving our knowledge of how to best support and educate caregivers."
Vernooij-Dassen emphasized dementia caregivers don't need to go it alone. "When they need support, reframing their thinking and understanding about dementia can yield positive results."
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