Caring for Caregivers: Cognitive Behavioural Therapy

Although many caregivers cope with their challenging situations quite well, many others go on to develop caregiving-related stress, which can trigger mood-related disorders such as anxiety and depression.

The World Alzheimer Report, released in September 2009, warned that people who are caring for a loved one with dementia are at high risk of developing depression. With dementia prevalence rates steadily climbing around the world, the stress on caregivers is going to climb right along with it.

For a group of depressed and anxious caregivers, their weekly sessions at Toronto’s Baycrest – as part of a clinical study – helped them cope with the difficulties they faced at home on a daily basis.

Dr. Nasreen Khatri, a clinical psychologist at Baycrest who specializes in diagnosing and treating depression and anxiety disorders, and Dr. Corey Mackenzie of the University of Manitoba, led the study that evaluated a group Cognitive Behavioural Therapy (CBT) program for caregivers. The preliminary results demonstrated that two-thirds of the caregivers recovered from their mood disorders with this treatment.

CBT is a form of psychotherapy. It’s a short-term treatment (typically 12 to 20 weeks) that helps a person learn to recognize how their thoughts affect their mood and behaviour. Clients are required to self monitor their thoughts at home and, with practice, start to recognize which types of thoughts cause their depressed or anxious mood.

“It’s not so much a situation that affects our mood, but how we interpret the situation,” said Dr. Kathleen Corcoran, a psychologist with the Mood and Anxiety Program at the Centre for Addiction and Mental Health who presented on the benefits of CBT at a Baycrest conference in 2007.

Prior to taking the group CBT program at Baycrest, all the caregivers met the criteria for a mood, anxiety or adjustment disorder. After finishing the program, only 33% met the disorder criteria, which was a very promising result!

The program consisted of 13 one-hour weekly group sessions led by a CBT therapist. Caregivers discussed their issues with others experiencing the same problems. They were taught relaxation and coping techniques to help them deal with stressful situations.

“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. 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.”

The caregivers were asked to keep a “thought record”, similar to a daily log book, where they could record situations at home that led to a specific mood or automatic thought. The logbook prompted the caregiver to examine the evidence for and against their negative thoughts and to come up with an alternative or balanced thought.

“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,” explained Dr. Khatri, who is head of the Cognitive Behavioral Therapy (CBT) Program in the Mood and Related Disorders Clinic at Baycrest.

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 improved mood and reduced stress and anxiety, said Dr. Khatri. Many of the participants reported continued use of these relaxation techniques three months after the program and found them very helpful.

“We are seeing clinical effectiveness rates in our sample comparable to CBT studies with younger adults with depression and anxiety,” she added.

“This is a very positive and hopeful finding for many older adults who find themselves experiencing serious mood and anxiety symptoms due to their caregiving role.”

Article courtesy Baycrest Centre. Read more articles like this at

Baycrest welcomes the opportunity to share knowledge and expertise that will empower and support individuals through their caregiving journey. An internationally renowned academic health sciences centre, Baycrest is providing innovative and effective solutions — through the power of exemplary clinical care, education and scientific discovery — to help our aging population maintain good health longer in the lifespan.

Photo © Alexander Raths