Cognitive reframing for carers of people with dementia

Vernooij-Dassen, Myrra; Draskovic, Irena; McCleery, Jenny; Downs, Murna

doi:10.1002/14651858.cd005318.pub2

Cited by 135Dementia and Cognitive Impairment ResearchNursing care and researchFamily Caregiving in Mental Illness

Cognitive reframing for carers of people with dementia

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Vernooij-Dassen, Myrra, Draskovic, Irena, McCleery, Jenny, Downs, Murna·2011·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd005318.pub2PMC PMC12536931

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Abstract

BACKGROUND: The balance of evidence about whether psychosocial interventions for caregivers of people with dementia could reduce carers' psychological morbidity and delay their relatives' institutionalisation is now widely regarded as moderately positive (Brodaty 2003; Spijker 2008). Multi-component, tailor-made psychosocial interventions are considered to be particularly promising (Brodaty 2003; Spijker 2008). These interventions involve multiple mechanisms of action. In this review we focused solely on the effectiveness of one element within psychosocial interventions, cognitive reframing. Cognitive reframing is a component of cognitive behavioral therapy (CBT). In dementia care, cognitive reframing interventions focus on family carers' maladaptive, self-defeating or distressing cognitions about their relatives' behaviors and about their own performance in the caring role. OBJECTIVES: The objective of this review was to evaluate the effectiveness of cognitive reframing interventions for family carers of people with dementia on their psychological morbidity and stress. SEARCH METHODS: The trials were identified by searching (5 April 2009) the Cochrane Dementia and Cognitive Improvement Group Specialized Register, which contains records from major healthcare databases: The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL and LILACS, ongoing trial databases and grey literature sources. For more detailed information on what the Group's specialized register contains and to view the search strategies see the Cochrane Dementia and Cognitive Improvement Group methods used in reviews.The Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS and a number of trial registers and grey literature sources were also searched separately on 5 April 2009. SELECTION CRITERIA: Randomised controlled trials of cognitive reframing interventions for family carers of people with dementia. DATA COLLECTION AND ANALYSIS: Three assessors (MVD, ID, JmC) independently judged whether the intervention being studied was documented in a trial; two assessors assessed trial quality. MAIN RESULTS: Pooled data indicated a beneficial effect of cognitive reframing interventions on carers' psychological morbidity, specifically anxiety (standardised mean difference (SMD) -0.21; 95% confidence interval (CI) -0.39 to -0.04), depression (SMD -0.66; 95% CI -1.27 to -0.05), and subjective stress (SMD -0.23; 95% CI -0.43 to -0.04). No effects were found for carers' coping, appraisal of the burden, reactions to their relatives' behaviors, or institutionalization of the person with dementia. AUTHORS' CONCLUSIONS: Cognitive reframing for family carers of people with dementia seems to reduce psychological morbidity and subjective stress but without altering appraisals of coping or burden. The results suggest that it may be an effective component of individualised, multi-component interventions for carers. Identifying studies with relevant interventions was a challenge for this review. The impact of cognitive reframing might be higher when used alongside other interventions because this offers better opportunities to tailor cognitive reframing to actual everyday carer problems.

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Meta-analyses reveal that CBT reduces ADRD caregiver depressive symptoms but is less effective for ADRD caregiver anxiety.
“Meta-analyses reveal that CBT reduces ADRD caregiver depressive symptoms; however, it is less effective for ADRD caregiver anxiety [17, 19, 20].”
From Feasibility and acceptability of an acceptance and commitment therapy intervention for caregivers of adults with Alzheimer’s disease and related dementias (2021) · cites this paper as [19]
The Main results section reports that cognitive reframing reduced both depression (SMD −0.66) and anxiety (SMD −0.21), consistent with a smaller pooled effect for anxiety. But the review examines cognitive reframing interventions rather than CBT generally, and the Depression section reports a much smaller depression effect (SMD −0.24) after excluding a high-effect study. It does not establish that CBT is generally less effective for caregiver anxiety. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Most existing meta-analyses of carer interventions target one specific approach, such as CBT, educational interventions, support groups, technology-based CBT, or telephone counselling.
“However, most of these reviews target one specific approach such as Cognitive Behaviour Therapy (CBT) (Vernooij-Dassen et al. , 2011), , educational interventions (Jensen et al. , 2015), support groups (Chien et al. , 2011), technology-based CBT (Scott et al. , 2016), and telephone counselling (Lins et al. , 2014).”
From Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions. (2018) · cites this paper as Vernooij-Dassen et al. , 2011
The Objectives section identifies this as a review of one specific approach: cognitive reframing for carers of people with dementia. The Background says cognitive reframing is a component of CBT, but the Discussion says the included interventions also drew on stress-coping and stress-management models. It is therefore an example of a focused review, but not a review of CBT interventions generally. (LLM, conf=0.85)
Experimental — accuracy not yet measured
The overall effect size for anxiety in the current review was larger than the effect size demonstrated in Vernooij-Dassen et al. (2011).
“The overall effect size for anxiety was larger than the effect size demonstrated in the recent review (Vernooij-Dassen et al. , 2011).”
From Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions. (2018) · cites this paper as Vernooij-Dassen et al. , 2011
The effect size for burden was not significant in the current review.
“Similar to the previous review (Vernooij-Dassen et al. , 2011), the effect size for burden was not significant.”
From Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions. (2018) · cites this paper as Vernooij-Dassen et al., 2011
A recent review on CBT based interventions for carers demonstrated only a small effect on anxiety (0.21) and a medium effect on depression (0.66).
“However, there may have been a reporting bias due to the aforementioned criterion as a recent review on CBT based interventions for carers demonstrated only a small effect on anxiety (0.21) and a medium effect on depression (0.66) (Vernooij-Dassen et al. , 2011).”
From Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions. (2018) · cites this paper as Vernooij-Dassen et al. , 2011

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Brodaty 1997 {published data only} Brodaty H, Gresham M, Luscombe G. The Prince Henry Hospital dementia caregivers' trainings programme. International Journal of Geriatric Psychiatry 1997;12: 183-92.

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Authors: Vernooij-Dassen, M., Draskovic, I., McCleery, J., & Downs, M.
Affiliations: Radboud University Nijmegen (NL)
Radboud University Medical Center (NL)
John Radcliffe Hospital (GB)
University of Bradford (GB)
ORCID: Vernooij-Dassen, Myrra
Downs, Murna
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2011-11-09
Volume: 2011
Issue: 11
Pages: CD005318-CD005318
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd005318.pub2
PMC: PMC12536931
OpenAlex: W2113107557
Cited by: 134
References: 107
Citations by year: 2026: 1 · 2025: 2 · 2024: 6 · 2023: 3 · 2022: 12 · 2021: 7 · 2020: 10 · 2019: 9 · 2018: 12 · 2017: 13 · 2016: 14 · 2015: 12 · 2014: 13 · 2013: 12 · 2012: 7
FWCI: 1.34
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed (publishedVersion)
Radboud Repository (Radboud University) (submittedVersion, other-oa)
Bradford Scholars (University of Bradford) (submittedVersion)
Radboud Repository (Radboud University) (submittedVersion)
Topics: Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
Health Sciences › Health Professions › Pharmacy › Nursing care and research
Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
Keywords: cognitive reframing, dementia caregivers, family caregivers, psychosocial interventions, cognitive behavioral therapy, caregiver stress, anxiety, depression, caregiver burden, caregiver self-efficacy, caregiver role ambiguity, caregiver role overload, caregiver role acceptance
MeSH terms: Adaptation, Psychological, Anxiety, Dementia, Depression, Humans, Institutionalization, Stress, Psychological, Cognitive Behavioral Therapy, Caregivers

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