Cognitive behavioral therapy (CBT) for carers of patients with Parkinson’s disease: A preliminary randomized controlled trial
Secker, D. & Brown, R. (2005) Cognitive behavioral therapy (CBT) for carers of patients with Parkinson’s disease: A preliminary randomized controlled trial , 76, 491-497
This study was conducted in the United Kingdom and begins by discussing prevalence of PD in the UK (1/100 under the age of 60 and 20/1000 over the age of 85). They noted that there are approximately 120,000 persons with PD in the UK with around 10,000 new cases each year. They also briefly discussed the typical symptoms and treatment of PD, including the usual need for a carer as the disease progresses and patients lose their ability to be fully independent. They cited a study suggesting that patients early in their course of PD need assistance with approximately 11 care-related activities throughout the day, while later in the disease they may need assistance with up to 30 activities. The type of care varies greatly from feeding and dressing all the way up to toileting and physically lifting the patient up for care. There are also non-motor symptoms (dementia, depression, anxiety, hallucinations, etc.) that require supervision and general support. All of the demands on the caregiver naturally may lead to restriction in other areas of the carers life (e.g. work, social, recreational) that may reduce carer quality of life. This article cited a study that suggests that the psychiatric and behavioral changes in the patient with PD may outweigh the stress caused by the physical symptoms of the disease. Interestingly they also cited a study suggesting that carers that were unprepared for the dramatic changes in their spouse and failed to adjust initially also had significant difficulties coping in the later stages of the disease. Obviously caregiver well being has effects on the patient with PD and if it is not adequately addressed has been found to result in premature placement of the patient. The authors discussed a stress model proposed by Peralin and colleagues (1990) involving "stress containment" and "stress proliferation." They suggested that treatment for caregivers should be aimed at both ideas and that it is beneficial to "reduce the sources of stress proliferation and enhance the resources that lead to containment." Typical treatments included education and well as practical coping strategies to reduce stress and encourage containment. The goal of this study was to evaluate the usage of CBT, a form of therapy emphasizing a cognitive (thoughts and feelings) and behavioral (activities, actions) focus. CBT is a widely accepted and well evaluated therapy for many psychological difficulties. In this study, there were eight treatment areas (education to CBT, accessing community resources, pleasant activity scheduling, relaxation training/sleep improvement, identifying and challenging negative thoughts, challenging maladaptive rules/core beliefs, and planning for the future) addressing difficulties that carers of patients with PD may benefit from. A total of 118 carers were assessed for eligibility and 30 agreed to receive 12 weekly sessions of CBT over the course of 3 months. Fifteen carers (age 59.1 years, education 12.6 years, women/men:13/15) were randomly assigned to CBT and 15 carers (age 58.9 years, education 12.9 years, women/men:14/15) were used as a no treatment control group. There were no statistically significant differences between the randomized groups, however there was a trend that the treatment group showed worse psychological functioning than the control group. Prior to, at the end of treatment (or 3 months later for the controls), and 6 months after the study started, carers were assessed with a self-report questionnaire to measure psychological distress (GHQ-28) as well as other measures of psychological well being (Geriatric Depression Scale-15 item, Caregiver Strain Index, and the Caregiver Burden Inventory). Patient’s with PD were also assessed at baseline and there were no significant differences between the patient groups. The authors found that carers in the treatment group had a greater reduction in total psychological distress, caregiver burden, caregiver strain, somatic symptoms, anxiety, insomnia, and social dysfunction. There was no significant difference between the two groups on measures of depression. These results remained at the 6 month follow-up, suggesting that CBT for carers of persons with PD is a beneficial treatment that should be offered to carers. They also suggested that treatment should address broad issues related to caregiver stress and that outcome measures should be person specific. It is important to note that CBT is only efficacious if the carer can receive the treatment and has the support to take time to focus on his/herself. Carers may not feel that they can leave their spouse for weekly treatments, must travel too far for behavioral health services, etc. In closing, physicians and researchers are noting the importance of caregiver attention and treatment and this study does a good job in addressing carer well being.