Dealing with depression in family caregivers

For a group of depressed and anxious caregivers, their weekly sessions at Baycrest helped them cope with the difficulties they faced at home on a daily basis.

Research suggests that although many caregivers cope with their challenging situations quite well, many others have significant difficulty with mood and anxiety and need more help.

During the past two years, Dr. Nasreen Khatri, psychologist and Head of the Cognitive Behavior Therapy (CBT) Program in the Mood and Related Disorders Clinic at Baycrest, along with collaborator, Dr. Corey Mackenzie of the University of Manitoba, completed a trial of several Cognitive Behaviour Therapy (CBT) groups for spousal caregivers of individuals with dementia.

“Research suggests that caregiver support groups are helpful, but that certain types of therapy can be more beneficial for individuals with clinical symptoms of depression and anxiety,” explains Dr. Khatri. “Our research study is the first to examine the effectiveness of CBT to help spousal caregivers of people with dementia with caregiving-related mood and anxiety disorders.”

The expected benefits of taking part in the study included enhanced coping skills, reductions in anxiety and depression, and reductions in the distress associated with caring for dementia-related challenging behaviours.

The program consisted of group treatments in 13 one-hour weekly sessions led by a CBT therapist. Participants were able to discuss their issues with others experiencing the same the same problems. Group members learnt relaxation and coping techniques to help them cope with stressful situations.

CBT incorporates elements of a support group, such as allowing group members to talk with others about shared problems in a confidential and emotionally supportive environment. However, CBT goes beyond the functions of a support group because the group therapist provides the participants with a structured, short-term talk therapy that involves homework between sessions and has demonstrated clinical effectiveness for problems with mood and anxiety. The premise of CBT is that dysfunctional thinking and beliefs underlie the development, maintenance and relapse of depression and anxiety disorders.

CBT uses specific techniques, in a standardized way, to change the way a person thinks to help eliminate or reduce clinical symptoms of depression and anxiety. CBT teaches clients to become their own therapist by guiding them through techniques to develop problem solving, social and cognitive skills that they may be lacking or which may have become compromised due to experiencing a mood or anxiety disorder.

In younger adults, CBT has been shown to be as effective as antidepressant medication for depression and anxiety. It is an important treatment for older adults, who may not be able to tolerate the side effects of antidepressant medication or who may already be on several medications for other medical disorders. The Mood and Related Disorders Clinic is one of the few outpatient clinics in Canada to provide CBT for mood disorders in older adults.

“Learning how others in the same situation were coping was very beneficial,” said one of the participants. “Each session focused on a different topic. I found that this helped organize my thoughts about caregiving into manageable chunks and I learned many useful tips as well. For example, others told me that I don’t have to take my husband with me everywhere. I didn’t consider this before. It made me realize the importance of taking care of myself.”

“An important aspect of the treatment is the behavioral interventions that are assigned as homework and that clients can practice between sessions, such as relaxation techniques,” explains Dr. Khatri. “At the end of each session, the group practiced deep breathing exercises focused on reducing muscle tension and ended with visualization of a positive, peaceful scene. The use of these behavioural methods improve mood and reduce stress and anxiety. Many of the participants reported continued use of these relaxation techniques at 3-month follow-up post-treatment and found them very helpful.”

The results of the research from these groups demonstrated that CBT treatment showed significant drops in depression and anxiety ratings, as well as a decline in caregiver burden. Prior to the treatment, 100 per cent of the participants met the criteria for a mood, anxiety or adjustment disorder, while post-treatment only 33 per cent met disorder criteria.

“We are seeing clinical effectiveness rates in our sample comparable to CBT studies with younger adults with depression and anxiety. This is a very positive and hopeful finding for the many older adults who find themselves experiencing serious mood and anxiety symptoms due to their caregiving role,” adds Dr. Khatri.

To contact the Mood Clinic at the Brain Health Centre at Baycrest, please phone 416.785.4359.

Photo © Troels Graugaard

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