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American Journal of Alzheimer's Disease and Other Dementias logoLink to American Journal of Alzheimer's Disease and Other Dementias
. 2004 Mar-Apr;19(2):117–123. doi: 10.1177/153331750401900202

Reducing anxiety in Alzheimer's disease family caregivers: The effectiveness of a nine-week cognitive-behavioral intervention

Rhonda L Akkerman, Sharon K Ostwald 1
PMCID: PMC10833926  PMID: 15106393

Abstract

Although the literature is replete with studies examining the psychological concomitants and interventions for Alzheimer's disease (AD) family caregivers, a surprisingly small amount of research exists on anxiety. Given prevalence rates suggesting that anxiety significantly impacts one in three family caregivers, brief group cognitive-behavioral therapy (CBT) interventions may offer assistance. To assess CBT's effectiveness, 38 anxious AD family caregivers were recruited and randomly assigned to a nine-week group CBT intervention or to a waitlist control. Caregivers randomized to CBT demonstrated less anxiety on self-report and clinician-administered questionnaires than waitlist group participants at posttreatment and six-week follow-up assessments. A subsample of caregivers also demonstrated improved sleep, as assessed through actigraph measurements. Additional study is recommended with diverse anxious family caregiving groups to further investigate the effectiveness of brief CBT group interventions.

Keywords: CBT, cognitive-behavioral therapy, Alzheimer's disease caregiver anxiety

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References

  1. Pearlin LI, Mullan JT, Semple SJ, et al.: Caregiving and the stress process: An overview of concepts and their measures. Gerontologist. 1990; 30(5): 583-594. [DOI] [PubMed] [Google Scholar]
  2. Haley WE, Levine EG, Brown SL, et al.: Psychological, social, and health consequences of caring for a relative with senile dementia. J Am Geriatr Soc. 1987; 35(5): 405-411. [DOI] [PubMed] [Google Scholar]
  3. Lazarus R, Folkman S: Stress, Appraisal, and Coping. New York: Springer, 1984. [Google Scholar]
  4. Cannuscio CC, Jones C, Kawachi I: Reverberations of family illness: A longitudinal assessment of informal caregiving and mental health status in the Nurses' Health Study. Am J Public Health. 2002; 8: 1305-1311. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Flaskerud JH, Carter PA, Lee P: Distressing emotions in female caregivers of people with AIDS, age-related dementias, and advanced-stage cancers. Perspect in Psychiatr Care. 2000; 36(4): 121-130. [DOI] [PubMed] [Google Scholar]
  6. Kiecolt-Glaser J, Preacher K, MacCallum R, et al.: Chronic stress and age-related increases in the proinflammatory cytokine IL-6. Proc Natl Acad of Sci. 2003; 100(15): 9090-9095. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Schulz R, Beach S: Caregiving as a risk factor for mortality: The Caregiver Health Effects Study. JAMA. 1999; 282(23): 2215-2219. [DOI] [PubMed] [Google Scholar]
  8. Schulz R, O'Brien A, Czaja S, et al.: Dementia caregiver intervention research: In search of clinical significance. Gerontologist. 2002; 42(5): 589-602. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Vitaliano P, Schulz R, Kiecolt-Glaser J, et al.: Research on physiological and physical concomitants of caregiving: Where do we go from here? Ann Behav Med. 1997; 19(2): 117-123. [DOI] [PubMed] [Google Scholar]
  10. Collins CE, Given BA, Given CW: Interventions with family caregivers of persons with Alzheimer's disease. Nurs Clin North Am. 1994; 29(1): 195-207. [PubMed] [Google Scholar]
  11. Fisher PA, Laschinger HS: A relaxation training program to increase self-efficacy for anxiety control in Alzheimer family caregivers. Holist Nurs Pract. 2001; 15(2): 47-58. [DOI] [PubMed] [Google Scholar]
  12. Neundorfer MM: Coping and health outcomes in spouse caregivers of persons with dementia. Nurs Res. 1991; 40(5): 260-265. [PubMed] [Google Scholar]
  13. Pruchno R, Resch N: Mental health of caregiving spouses: Coping as mediator, moderator, or main effect? Psychol Aging. 1989; 4(4): 454-463. [DOI] [PubMed] [Google Scholar]
  14. Schulz R, O'Brien AT, Bookwala J, et al.: Psychiatric and physical morbidity effects of dementia caregiving: Prevalence, correlates, and causes. Gerontologist. 1995; 35(6): 771-791. [DOI] [PubMed] [Google Scholar]
  15. Dura JR, Stukenberg KW, Kiecolt-Glasser JK: Anxiety and depressive disorders in adult children caring for demented parents. Psychol Aging. 1991; 6(3): 467-473. [DOI] [PubMed] [Google Scholar]
  16. Vitaliano PP, Russo J, Young HM, et al.: Predictors of burden in spouse caregivers of individuals with Alzheimer's disease. Psychol Aging. 1991; 6(3): 392-402. [DOI] [PubMed] [Google Scholar]
  17. Coope B, Ballard C, Saad K, et al.: The prevalence of depression in the carers of dementia sufferers. Int J of Ger Psychiat. 1995; 10: 237-242. [Google Scholar]
  18. Verbeek I, Klip EC, Declerck AC: The use of actigraphy revised: the value for clinical practice in insomnia. Percept Mot Skills. 2001; 92(3): 852-856. [DOI] [PubMed] [Google Scholar]
  19. Teel CS, Press AN: Fatigue among elders in caregiving and noncaregiving roles. West J Nurs Res.1999; 21(4): 498-520. [DOI] [PubMed] [Google Scholar]
  20. Edell-Gustaffson U: Insufficient sleep, cognitive anxiety and health transition in men with coronary artery disease: A self-report and polysomnographic study. J Adv Nurs. 2002; 37(5): 414-422. [DOI] [PubMed] [Google Scholar]
  21. Morin C, Colecchi C, Stone J, et al.: Behavioral and pharmacological therapies for late-life insomnia: a randomized controlled trial. JAMA. 1999; 281(11): 991-999. [DOI] [PubMed] [Google Scholar]
  22. Espie C, Inglis SJ, Harvey L: Predicting clinically significant response to cognitive behavior therapy for chronic insomnia in general medical practice: analysis of outcome data at 12 months post-treatment. J Consult and Clin Psychol. 2001; 69(1): 58-66. [DOI] [PubMed] [Google Scholar]
  23. Greene VL, Monahan DJ: The effect of a support and education program on stress and burden among family caregivers to frail elderly persons. Gerontologist. 1989; 29(4): 472-477. [DOI] [PubMed] [Google Scholar]
  24. Ostwald SK, Hepburn KW, Caron W, et al.: Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia. Gerontologist. 1999; 39(3): 299-309. [DOI] [PubMed] [Google Scholar]
  25. Burgio L, Lichstein KL, Nichols L, et al.: Judging outcomes in psychosocial interventions for dementia caregivers: the problem of treatment implementation. Gerontologist. 2001; 41: 481-489. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Barlow D, Rapee, R, Brown T: Behavioral treatment of generalized anxiety disorder. Behav Ther.1992; 23: 551-570. [Google Scholar]
  27. Toseland RW, Rossiter CM: Group interventions to support family caregivers: A review and analysis. Gerontologist.1989; 29(4): 438-448. [DOI] [PubMed] [Google Scholar]
  28. Krasucki C, Howard R, Mann A: The relationship between anxiety disorders and age. Int J Geriat Psychiatry. 1998; 13(2): 79-99. [DOI] [PubMed] [Google Scholar]
  29. Hamilton M: The assessment of anxiety states by rating. Br J Med Psychol. 1959; 32(1): 50-55. [DOI] [PubMed] [Google Scholar]
  30. Beck AT, Epstein N, Brown G, et al.: An inventory for measuring clinical anxiety: Psychometric properties. J Consult Clin Psychol. 1988; 56(6): 893-897. [DOI] [PubMed] [Google Scholar]
  31. Riskind JH, Beck AT, Brown G, et al.: Taking the measure of anxiety and depression: Validity of the reconstructed Hamilton scales. J Nerv Ment Dis.1987; 175(8): 474-479. [DOI] [PubMed] [Google Scholar]
  32. Coon DW, Thompson L, Steffen A, et al.: Anger and depression management: Psychoeducational skill training interventions for women caregivers of a relative with dementia. Gerontologist. 2003; 43(5): 678-689. [DOI] [PubMed] [Google Scholar]
  33. Teri L, Gallagher-Thompson D: Cognitive-behavioral interventions for treatment of depression in Alzheimer's patients. Gerontologist. 1991; 31(3): 413-416. [DOI] [PubMed] [Google Scholar]
  34. Cruess DG, Antoni MH, Kumar M, et al.: Reductions in salivary cortisol are associated with mood improvement during relaxation training among HIV-seropositive men. J Behav Medicine. 2000; 23(2): 107-122. [DOI] [PubMed] [Google Scholar]
  35. McCurry SM, Logsdon RG, Vitiello MV, et al.: Successful behavioral treatment for reported sleep problems in elderly caregivers of dementia patients: a controlled study. J Gerontol B Psychol Sci Soc Sci.1998; 53(2): P122-P129. [DOI] [PubMed] [Google Scholar]

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