Phone-based therapy sessions may help dementia caregivers cope

(Reuters Health) - Talk therapy that teaches emotional regulation and coping skills can help people caring for a loved-one with dementia improve their own physical and mental health, German researchers say.

Cognitive Behavioral Therapy (CBT) is a common form of psychotherapy that focuses on using a limited number of sessions to work on skills for responding effectively to stressful or difficult situations and emotions. CBT is usually delivered in face-to-face settings, so it has been unavailable for many homebound caregivers, the study team writes in The Gerontologist.

In 2016, 15.9 million caregivers in the U.S. were taking care of someone with Alzheimer’s disease or some other form of dementia, according to the Alzheimer’s Association. Compared with caregivers of people with other illnesses, twice as many caregivers of those with dementia face substantial emotional, financial and physical difficulties.

Educational materials and support groups are often available for caregivers, but past research has found that CBT has a significant benefit on caregivers’ own health, the study team writes.

“CBT is always better than psycho-educational strategies, or support groups,” said lead author Gabriele Wilz of Freidrich Schiller University in Jena. “Psycho-education is important, but not sufficient, for example, to cope with burdensome emotions, or learn new strategies to cope with challenging behavior, or to change dysfunctional thoughts, or to promote re-creation time for the caregivers,” Wilz told Reuters Health by email.

The researchers designed a CBT program tailored for dementia caregivers that could be delivered by a therapist over the phone. In a trial of this program, researchers randomly assigned 273 family caregivers of a spouse or parent with dementia to either individual telephone-based CBT by trained psychotherapists that was delivered in a dozen 50-minute telephone sessions over six months, or to a control group that just had access to their usual community resources.

Participants were assessed at the start of the study, after six months and again at 12 months. At the outset, all had higher levels of depression and physical aches and pains and heart symptoms, for example, than the general non-caregiving population, the study team notes.

At six months, caregivers in the telephone CBT group reported less depression and fewer physical symptoms, as well as significant positive changes in their emotional wellbeing and ability to cope with the burden of care and with their loved ones’ challenging behaviors.

By the 12-month mark, there was little difference between the CBT group and the control group in depression levels and physical health symptoms. But the CBT group still had greater feelings of wellbeing and felt better able to cope with the burdens of care and behavioral problems.

“Unlike someone who might be depressed in another context, these caregivers have unremitting demands and burdens. Someone is not magically going to make them go to sleep and have a full night,” said Lisa Onken, director of the behavior change and intervention program at the U.S. National Institute on Aging, who wasn’t involved in the study.

“Perhaps booster sessions or a longer duration of CBT might have even more positive effects. We just don’t know. I absolutely think more studies are needed. I think this is promising, but this isn’t the end of it,” she said in a phone interview.

Onken cautioned that CBT is a very complex treatment with many different forms. Ten different therapy modules could be used and combined by the therapists in this study according to the individual needs of each caregiver. CBT is also difficult to implement and requires a lot of training and supervision.

“It fits easily into Germany’s healthcare system, but it’s not clear how it fits in with the healthcare system in the U.S.,” she said.

CBT needs to be tied to insurance coverage for dementia caregivers, said Melissa Aldridge of the Icahn School of Medicine at Mount Sinai in New York City, who wasn’t involved in the study.

“In the big picture this is very important research,” Aldridge told Reuters Health by phone. “There’s a significant uptick in the number of patients with Alzheimer’s disease staying home, but it’s very difficult for individuals with Alzheimer’s or other dementia to meet the eligibility for home-based hospice care which includes, among other things, insurance for caregivers to get home-based support.”

SOURCE: The Gerontologist, online November 28, 2017.