A systematic review of intervention studies about anxiety in caregivers of people with dementia
Open accessAbstract
BACKGROUND: There is considerable literature on managing depression, burden and psychological morbidity in caregivers of people with dementia (CG). Anxiety has been a relatively neglected outcome measure but may require specific interventions. OBJECTIVE: To synthesise evidence regarding interventions that reduce anxiety in CGs. METHODS: Twenty-four studies met our inclusion criteria. We rated the methodology of studies, and awarded grades of recommendation (GR) for each type of intervention according to Centre for Evidence Based Medicine guidelines, from A (highest level of evidence) to D. RESULTS: Anxiety level was the primary outcome measure in only one study and no studies were predicated on a power calculation for anxiety level. There was little evidence of efficacy for any intervention. The only RCT to report significantly reduced anxiety involved a CBT and relaxation-based intervention specifically devised to treat anxiety, and there was preliminary evidence (no randomised controlled trials) that caregiver groups involving yoga and relaxation without CBT were effective. There was grade B evidence that behavioural management, exercise therapies and respite were ineffective. LIMITATIONS: Many interventions were heterogeneous, so there is some overlap between groups. Lack of evidence of efficacy is not evidence of lack of efficacy. CONCLUSIONS: CBT and other therapies developed primarily to target depression did not effectively treat anxiety. Good RCTs are needed to specifically target anxiety which might include relaxation techniques. Some of the interventions focussed on reducing contact with the care recipients but caregivers may want to cope with caring and preliminary evidence suggests strategies to help CGs manage caring demands may be more effective.
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CBT is less effective for ADRD caregiver anxiety or suffering.
“CBT is less effective at addressing ADRD caregiver anxiety or suffering (Cheng et al., 2019; Cooper, Balamurali, Selwood, et al., 2007; Gitlin et al., 2015; Olazarán & et al., 2010; Walter & Pinquart, 2020).”
From Feasibility and acceptability of a telephone-based ACT intervention for caregivers (TACTICs) of adults with Alzheimer's disease and related dementias (ADRD): a randomized pilot during the COVID-19 pandemic. (2025) · cites this paper as Cooper, Balamurali, Selwood, et al., 2007
The Abstract concludes that CBT developed primarily to target depression did not effectively treat caregiver anxiety. But the Discussion and Conclusions say the one trial of CBT specifically targeting anxiety significantly reduced it. The claim omits that distinction, and these passages do not establish an effect on suffering more broadly. (LLM, conf=0.86)
Experimental — accuracy not yet measuredAbout 40% of family carers of people with dementia have clinically significant depression or anxiety, while others have significant psychological symptoms.
“About 40% of family carers of people with dementia have clinically significant depression or anxiety, while others have significant psychological symptoms.5,6”
In a further systematic review, CBT and other therapies developed primarily to target depression did not effectively treat anxiety.
“In a further systematic review of evidence about treating dementia carer anxiety, we found that cognitive–behavioural therapy (CBT) and other therapies developed primarily to target depression did not effectively treat anxiety.5”
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“Anxiety disorders were recognised in 25% of caregivers of persons with dementia (Cooper, Balamurali, Selwood, & Livingstone, 2007 ; Mahoney et al, 2005 ).”
BackgroundCaring for a centenarian parent: an exploratory study on role strains and psychological distress
Brandão, D., Ribeiro, Ó. M., Oliveira, M., & Paúl, C. (2017) · Scandinavian Journal of Caring Sciences · doi:10.1111/scs.12423 · Cited by 37 · see citing works
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“Cooper et al. (2006) identified a mean HADS anxiety score of 7.2 (standard deviation (SD) = 4) in a pilot study with dementia carers.”
BackgroundInfluentialInterventions for caregivers of patients with dementia.
Martı́n-Carrasco, M., Ballesteros-Rodríguez, J., Domínguez-Panchón, A. I., Muñoz-Hermoso, P., & González–Fraile, E. (2014) · PubMed · Cited by 30 · see citing works
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“Depression (17), anxiety (18), subjective or emotional well-being (19, 20), and carer burden (21) have been frequently measured in a plethora of studies about the psychological well-being of carers.”
BackgroundPassos, J., Sequeira, C., & Fernandes, L. P. N. S. (2012) · International Journal of Alzheimer s Disease · doi:10.1155/2012/638267 · Cited by 27 · see citing works
“suggest the existence of a high level of psychological distress in carers of patients with dementia, when compared to carers of patients with other chronic diseases [30–33].”
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“Such reports have focused on caregivers managing long-term illnesses like Alzheimer’s [10], dementia [11] and cancer [12].”
BackgroundMeasuring Impact of Stress in Sandwich Generation Caring for Demented Parents
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Experience of companionship among family caregivers of persons with dementia: A qualitative study
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What would help me stop abusing? The family carer's perspective
Selwood, A., Cooper, C., Owens, C., Blanchard, M. R., & Livingston, G. (2009) · International Psychogeriatrics · doi:10.1017/s104161020800834x · Cited by 25 · see citing works
“Psychoeducational and cognitive behavioral-based interventions that teach coping strategies have the strongest evidence base for reducing distress in carers of people with dementia (Gallagher-Thompson et al., 2003; Cooper et al., 2007).”
BackgroundSelf-citationYoga in Male Sexual Functioning: A Noncompararive Pilot Study
Dhikav, V., Karmarkar, G., Verma, M., Gupta, R., Gupta, S. K., Mittal, D., & Anand, K. S. (2010) · The Journal of Sexual Medicine · doi:10.1111/j.1743-6109.2010.01930.x · Cited by 25 · see citing works
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“Dementia affects the mood of people with dementia but also of their family caregivers [1,2].”
BackgroundGuilt Focused Intervention for Family Caregivers. Preliminary Results of a Randomized Clinical Trial
Romero‐Moreno, R., Márquez‐González, M., Gallego‐Alberto, L., Cabrera, I., Vara‐García, C., Pedroso‐Chaparro, M. D. S., Barrera‐Caballero, S., & Losada‐Baltar, A. (2022) · Clinical Gerontologist · doi:10.1080/07317115.2022.2048287 · Cited by 20 · see citing works
A Customized Intervention for Dementia Caregivers: A Quasi-Experimental Design
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Multicomponent Intervention for Distressed Informal Caregivers of People With Dementia
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An Exploration of Mindfulness in Speech-Language Pathology
Medina, A. M., & Mead, J. S. (2020) · Communication Disorders Quarterly · doi:10.1177/1525740120942141 · Cited by 15 · see citing works
“As highlighted in the synthesis of findings of the literature on caregivers of clients with dementia, more randomized controlled trials with sound methods need to be conducted to firmly establish the efficacy of mindfulness as a technique for reducing the negative affect experienced by caregivers (Cooper et al., 2007).”
BackgroundGenerational differences in knowledge, recognition, and perceptions of elder abuse reporting
Aday, R. H., Wallace, J. B., & Scott, S. J. (2017) · Educational Gerontology · doi:10.1080/03601277.2017.1376382 · Cited by 13 · see citing works
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The Psychology of Respite Care for People with Dementia in Australia
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Self-Administered Intervention for Caregivers of Persons With Alzheimer’s Disease
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The immigrant paid caregivers' role in the care of patients with severe dementia
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“In this ever-aging society, the care of demented people is an emerging social problem mainly involving familial dynamics (Cooper et al., 2007).”
BackgroundNegovanska, V., Hergueta, T., Guichart-Gomez, E., Dubois, B., Sarazin, M., & Bungener, C. (2010) · Revue Neurologique · doi:10.1016/j.neurol.2010.07.002 · Cited by 12 · see citing works
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“The second variable used to measure intervention efficacy was anxiety, a measure of caregiver well-being that has been responsive to other types of interventions (Cooper et al., 2007).”
MethodHout, E. V., Contreras, M., Mioshi, E., & Kishita, N. (2022) · Journal of Geriatric Psychiatry and Neurology · doi:10.1177/08919887221093359 · Cited by 9 · see citing works
“Current evidence suggests that Cognitive Behavioural Therapy (CBT), the most commonly used psychological approach in dementia carer research, is effective for targeting depression but does not effectively treat anxiety in family carers of people with dementia.(10,13) Understanding factors affecting anxiety can help re…”
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The Functional Ability of MCI and Alzheimer’s Patients Predicts Caregiver Burden
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“An important finding from this study indicates the need for caregivers to receive more support and resources in their caring for a patient (Cooper et al., 2007).”
Psicoeducação familiar na demência: da clínica à saúde pública
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“A recent review found that approximately 25% of dementia caregivers manifest clinically significant symptoms of anxiety (Cooper et al., 2007).”
BackgroundThe Need for Dementia Care Services
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Self-citationRomero-Moreno, R., Márquez-González, M., Barrera-Caballero, S., Vara-García, C., Olazarán, J., Pedroso-Chaparro, M. D. S., Jiménez-Gonzalo, L., & Losada-Baltar, A. (2021) · Journal of Alzheimer's Disease · doi:10.3233/jad-210348 · Cited by 5 · see citing works
“According to Cooper and colleagues [32], intervention strategies aimed at reducing caregivers’ depression levels may not show the same effect for anxiety levels, and different specific strategies may be required for this purpose.”
InfluentialRenewing caregiver health and wellbeing through exercise (RECHARGE): A randomized controlled trial
Cuthbert, C. A., King‐Shier, K. M., Tapp, D. M., Ruether, D., Jackson, C., & Culos-Reed, S. N. (2016) · Contemporary Clinical Trials · doi:10.1016/j.cct.2016.08.007 · Cited by 5 · see citing works
Informing Informal Caregivers About Dementia Through an Experience-Based Virtual Reality Game
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Hockemeyer, N. G., Johns, S. A., Judge, K. S., Baucco, C., Gowan, T., Slaven, J. E., & Fowler, N. R. (2025) · Aging & Mental Health · doi:10.1080/13607863.2025.2453823 · Cited by 4 · see citing works
“Meta-analyses and systematic reviews have highlighted the variability in intervention designs and measured outcomes, indicating a potential misalignment (Cooper, Balamurali, Selwood, et al. 2007; Olazarán et al. 2010; Selwood et al. 2007).”
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“…is therefore a need to increase the number of investigations in which the physical benefits of these interventions are also analyzed, since the physical well-being of family caregivers is also affected by the provision of care and influences their quality of life and functional capacity [6–13].”
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Current Issues in Informal Caregiving Research
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Research Priorities in Late-Life Mood Disorders
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- Authors
- Cooper, C., Balamurali, T. B. S., Selwood, A., & Livingston, G.
- Affiliations
- University College London (GB)
- Camden and Islington NHS Foundation Trust (GB)
- Corresponding author
- Cooper, Claudia
- Venue
- International Journal of Geriatric Psychiatry
- Publisher
- Wiley
- Published
- 2006-09-27
- Volume
- 22
- Issue
- 3
- Pages
- 181-188
- ISSN
- 0885-6230 (ISSN-L)
- 1099-1166
- OpenAlex
- W1984938086
- Cited by
- 117
- References
- 33
- Citations by year
- 2025: 4 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 7 · 2019: 5 · 2018: 9 · 2017: 12 · 2016: 5 · 2015: 9 · 2014: 12 · 2013: 11 · 2012: 6
- FWCI
- 0.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Geriatric Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (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
- caregiver anxiety, dementia caregivers, anxiety intervention, cognitive behavioral therapy, relaxation techniques, yoga, respite care, behavior management, exercise therapy, caregiver burden, caregiver depression
- MeSH terms
- Anxiety, Dementia, Humans, Psychotherapy, Relaxation Therapy, Respite Care, Yoga, Cognitive Behavioral Therapy, Caregivers
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