Abstract
Objective: Most individuals with Parkinson's disease live in their own homes cared for by a family member. Providing such long term care can be a source of significant stress, with many carers experiencing sleep difficulty, depression, anxiety, loneliness, and other symptoms of psychological strain. Cognitive behavioural therapy (CBT) is one of the most widely used psychological treatments in clinical use today, with applications across the full range of clinical conditions. It has been previously used in the management of other carer groups. The present study sought to evaluate the efficacy of CBT in treating psychological distress in a group of Parkinson's disease carers.
Method: A total of 30 carers scoring at caseness level on the 28 item General Health Questionnaire (GHQ-28) were randomised to receive either a course of 12–14 sessions of CBT or to a no-treatment control group.
Results: Although some change was observed in both groups, significantly greater improvement on the GHQ-28 was observed after three months in the CBT treated group. Similar findings were observed in measures of caregiver strain and subjective burden, with the benefits being maintained over a subsequent three month follow up period.
Conclusions: These results offer preliminary support to the value of a CBT approach in the management of psychological morbidity in Parkinson's disease carers. Further larger scale research is needed in the future to examine the generalisability of the findings to a broader range of carers, assess the longer term impact on outcome in carers and those with Parkinson's disease, and explore how CBT can be best delivered in the most cost effective manner.
Full Text
The Full Text of this article is available as a PDF (93.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Aarsland D., Larsen J. P., Karlsen K., Lim N. G., Tandberg E. Mental symptoms in Parkinson's disease are important contributors to caregiver distress. Int J Geriatr Psychiatry. 1999 Oct;14(10):866–874. [PubMed] [Google Scholar]
- Aarsland D., Larsen J. P., Karlsen K., Lim N. G., Tandberg E. Mental symptoms in Parkinson's disease are important contributors to caregiver distress. Int J Geriatr Psychiatry. 1999 Oct;14(10):866–874. [PubMed] [Google Scholar]
- Almeida O. P., Almeida S. A. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. Int J Geriatr Psychiatry. 1999 Oct;14(10):858–865. doi: 10.1002/(sici)1099-1166(199910)14:10<858::aid-gps35>3.0.co;2-8. [DOI] [PubMed] [Google Scholar]
- Barrowclough C., Tarrier N., Lewis S., Sellwood W., Mainwaring J., Quinn J., Hamlin C. Randomised controlled effectiveness trial of a needs-based psychosocial intervention service for carers of people with schizophrenia. Br J Psychiatry. 1999 Jun;174:505–511. doi: 10.1192/bjp.174.6.505. [DOI] [PubMed] [Google Scholar]
- Berry R. A., Murphy J. F. Well-being of caregivers of spouses with Parkinson's disease. Clin Nurs Res. 1995 Nov;4(4):373–386. doi: 10.1177/105477389500400404. [DOI] [PubMed] [Google Scholar]
- Carter J. H., Stewart B. J., Archbold P. G., Inoue I., Jaglin J., Lannon M., Rost-Ruffner E., Tennis M., McDermott M. P., Amyot D. Living with a person who has Parkinson's disease: the spouse's perspective by stage of disease. Parkinson's Study Group. Mov Disord. 1998 Jan;13(1):20–28. doi: 10.1002/mds.870130108. [DOI] [PubMed] [Google Scholar]
- Chang B. L. Cognitive-behavioral intervention for homebound caregivers of persons with dementia. Nurs Res. 1999 May-Jun;48(3):173–182. doi: 10.1097/00006199-199905000-00007. [DOI] [PubMed] [Google Scholar]
- Collins C., Jones R. Emotional distress and morbidity in dementia carers: a matched comparison of husbands and wives. Int J Geriatr Psychiatry. 1997 Dec;12(12):1168–1173. [PubMed] [Google Scholar]
- DeVries H. M., Hamilton D. W., Lovett S., Gallagher-Thompson D. Patterns of coping preferences for male and female caregivers of frail older adults. Psychol Aging. 1997 Jun;12(2):263–267. doi: 10.1037//0882-7974.12.2.263. [DOI] [PubMed] [Google Scholar]
- Ellgring H., Seiler S., Perleth B., Frings W., Gasser T., Oertel W. Psychosocial aspects of Parkinson's disease. Neurology. 1993 Dec;43(12 Suppl 6):S41–S44. [PubMed] [Google Scholar]
- Gallagher-Thompson D., Steffen A. M. Comparative effects of cognitive-behavioral and brief psychodynamic psychotherapies for depressed family caregivers. J Consult Clin Psychol. 1994 Jun;62(3):543–549. doi: 10.1037//0022-006x.62.3.543. [DOI] [PubMed] [Google Scholar]
- Happe Svenja, Berger Klaus, FAQT Study Investigators The association between caregiver burden and sleep disturbances in partners of patients with Parkinson's disease. Age Ageing. 2002 Sep;31(5):349–354. doi: 10.1093/ageing/31.5.349. [DOI] [PubMed] [Google Scholar]
- Hoehn M. M., Yahr M. D. Parkinsonism: onset, progression and mortality. Neurology. 1967 May;17(5):427–442. doi: 10.1212/wnl.17.5.427. [DOI] [PubMed] [Google Scholar]
- Hughes C. P., Berg L., Danziger W. L., Coben L. A., Martin R. L. A new clinical scale for the staging of dementia. Br J Psychiatry. 1982 Jun;140:566–572. doi: 10.1192/bjp.140.6.566. [DOI] [PubMed] [Google Scholar]
- Hébert Réjean, Lévesque Louise, Vézina Jean, Lavoie Jean-Pierre, Ducharme Francine, Gendron Carole, Préville Michel, Voyer Louis, Dubois Marie-France. Efficacy of a psychoeducative group program for caregivers of demented persons living at home: a randomized controlled trial. J Gerontol B Psychol Sci Soc Sci. 2003 Jan;58(1):S58–S67. doi: 10.1093/geronb/58.1.s58. [DOI] [PubMed] [Google Scholar]
- MacCarthy B., Brown R. Psychosocial factors in Parkinson's disease. Br J Clin Psychol. 1989 Feb;28(Pt 1):41–52. doi: 10.1111/j.2044-8260.1989.tb00810.x. [DOI] [PubMed] [Google Scholar]
- MacDonald B. K., Cockerell O. C., Sander J. W., Shorvon S. D. The incidence and lifetime prevalence of neurological disorders in a prospective community-based study in the UK. Brain. 2000 Apr;123(Pt 4):665–676. doi: 10.1093/brain/123.4.665. [DOI] [PubMed] [Google Scholar]
- Marriott A., Donaldson C., Tarrier N., Burns A. Effectiveness of cognitive-behavioural family intervention in reducing the burden of care in carers of patients with Alzheimer's disease. Br J Psychiatry. 2000 Jun;176:557–562. doi: 10.1192/bjp.176.6.557. [DOI] [PubMed] [Google Scholar]
- Matthews J. N., Altman D. G., Campbell M. J., Royston P. Analysis of serial measurements in medical research. BMJ. 1990 Jan 27;300(6719):230–235. doi: 10.1136/bmj.300.6719.230. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Miller B., Cafasso L. Gender differences in caregiving: fact or artifact? Gerontologist. 1992 Aug;32(4):498–507. doi: 10.1093/geront/32.4.498. [DOI] [PubMed] [Google Scholar]
- Molloy D. W., Alemayehu E., Roberts R. Reliability of a Standardized Mini-Mental State Examination compared with the traditional Mini-Mental State Examination. Am J Psychiatry. 1991 Jan;148(1):102–105. doi: 10.1176/ajp.148.1.102. [DOI] [PubMed] [Google Scholar]
- Mutch W. J., Dingwall-Fordyce I., Downie A. W., Paterson J. G., Roy S. K. Parkinson's disease in a Scottish city. Br Med J (Clin Res Ed) 1986 Feb 22;292(6519):534–536. doi: 10.1136/bmj.292.6519.534. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Novak M., Guest C. Application of a multidimensional caregiver burden inventory. Gerontologist. 1989 Dec;29(6):798–803. doi: 10.1093/geront/29.6.798. [DOI] [PubMed] [Google Scholar]
- O'Reilly F., Finnan F., Allwright S., Smith G. D., Ben-Shlomo Y. The effects of caring for a spouse with Parkinson's disease on social, psychological and physical well-being. Br J Gen Pract. 1996 Sep;46(410):507–512. [PMC free article] [PubMed] [Google Scholar]
- Ostwald S. K., Hepburn K. W., Caron W., Burns T., Mantell R. Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia. Gerontologist. 1999 Jun;39(3):299–309. doi: 10.1093/geront/39.3.299. [DOI] [PubMed] [Google Scholar]
- Pearlin L. I., Mullan J. T., Semple S. J., Skaff M. M. Caregiving and the stress process: an overview of concepts and their measures. Gerontologist. 1990 Oct;30(5):583–594. doi: 10.1093/geront/30.5.583. [DOI] [PubMed] [Google Scholar]
- Robinson B. C. Validation of a Caregiver Strain Index. J Gerontol. 1983 May;38(3):344–348. doi: 10.1093/geronj/38.3.344. [DOI] [PubMed] [Google Scholar]
- Schrag A., Ben-Shlomo Y., Quinn N. P. Cross sectional prevalence survey of idiopathic Parkinson's disease and Parkinsonism in London. BMJ. 2000 Jul 1;321(7252):21–22. doi: 10.1136/bmj.321.7252.21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Shulman L. M., Taback R. L., Bean J., Weiner W. J. Comorbidity of the nonmotor symptoms of Parkinson's disease. Mov Disord. 2001 May;16(3):507–510. doi: 10.1002/mds.1099. [DOI] [PubMed] [Google Scholar]
- Tarrier N., Barrowclough C. Family interventions for schizophrenia. Behav Modif. 1990 Oct;14(4):408–440. doi: 10.1177/01454455900144003. [DOI] [PubMed] [Google Scholar]
- Teri L. Behavior and caregiver burden: behavioral problems in patients with Alzheimer disease and its association with caregiver distress. Alzheimer Dis Assoc Disord. 1997;11 (Suppl 4):S35–S38. [PubMed] [Google Scholar]
- Teri L., Logsdon R. G., Uomoto J., McCurry S. M. Behavioral treatment of depression in dementia patients: a controlled clinical trial. J Gerontol B Psychol Sci Soc Sci. 1997 Jul;52(4):P159–P166. doi: 10.1093/geronb/52b.4.p159. [DOI] [PubMed] [Google Scholar]
- Thommessen Bente, Aarsland Dag, Braekhus Anne, Oksengaard Anne Rita, Engedal Knut, Laake Knut. The psychosocial burden on spouses of the elderly with stroke, dementia and Parkinson's disease. Int J Geriatr Psychiatry. 2002 Jan;17(1):78–84. doi: 10.1002/gps.524. [DOI] [PubMed] [Google Scholar]