Cognitive Reframing Can Help Dementia Caregivers with Depression, Stress

Release Date: November 9, 2011 | By Sharyn Alden, Contributing Writer
Research Source: The Cochrane Library

KEY POINTS

  • Cognitive reframing, a psychotherapy technique that teaches people to think differently about the challenges they face, can help people acting as caregivers for a family member with dementia.
  • Carers for family members with dementia who received a cognitive reframing intervention were less stressed and had fewer symptoms of anxiety and depression.
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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.”

TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required. While the information provided in this news story is from the latest peer-reviewed research, it is not intended to provide medical advice or treatment recommendations. For medical questions or concerns, please consult a health care provider.

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For More Information:

Reach the Health Behavior News Service, part of the Center for Advancing Health, at hbns-editor@cfah.org or (202) 387-2829.

The Cochrane Library (http://www.thecochranelibrary.com) contains high quality health care information, including Systematic Reviews from The Cochrane Collaboration. These reviews bring together research on the effects of health care and are considered the gold standard for determining the relative effectiveness of different interventions. The Cochrane Collaboration is an international nonprofit, independent organization that produces and disseminates systematic reviews of health care interventions and promotes the search for evidence in the form of clinical trials and other studies of interventions. Visit http://www.cochrane.org for more information.

Vernooij-Dassen, M. et al. Cognitive reframing for carers of people with dementia. Cochrane Database of Systematic Reviews 2011. Issue 11.

Tags for this article:
Alzheimers Disease/Dementia   Caregiving   Mental Health   Depression/Anxiety   Aging Well  



Comments on this article
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Scharlotte Coulter says
November 19, 2011 at 4:32 AM

I have taken care of my mother for nearly a year now. I am not depressed or feel that I am suffering anything but fatigue. However, my husband is. He says he is depressed, feels trapped (not his words - I can't recall his exact words). He says he doesn't feel good or like doing anything. He says it is because my mother is here. I'm not sure what to do about this situation.

Kelly Malcom, HBNS Editor says
November 21, 2011 at 9:34 AM

Hi Scharlotte, thanks for writing and I'm sorry to hear about your husband's difficulties. The National Family Caregivers Association and the Family Caregiving Alliance offer detailed information and resources on caregiver depression that you and your husband may find helpful. The links can be found at http://www.nfcacares.org/improving_caregiving/depression.cfm and http://www.caregiver.org/caregiver/jsp/content_node.jsp?nodeid=393. Good luck and I wish you all the best.