Cognitive behavioral therapy for depression, anxiety, and stress in caregivers of dementia patients: a systematic review and meta-analysis
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BACKGROUND AND OBJECTIVES: There is limited evidence for the efficacy of cognitive behavioral therapy (CBT) in managing psychological morbidities in caregivers of dementia patients. To evaluate changes in dementia caregivers' depression, anxiety, and stress following CBT. Also to assess quality of life, intervention adherence/satisfaction and therapy effectiveness using different formats, frequencies, and delivery methods. RESEARCH DESIGN AND METHODS: Studies were identified through electronic bibliographic searches (MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Library) and from gray literature (Conference Proceedings Citation Index and clinicaltrials.gov). Data were pooled for meta-analysis. RESULTS: Twenty-five studies were included. Depression (standardized mean difference [SMD] = -0.34; 95% confidence interval [CI] -0.47 to -0.21; p < .001) and stress (SMD = -0.36; 95% CI: -0.52 to -0.20; p < .001) were significantly reduced after CBT, relative to comparator groups, while anxiety was not (SMD = 0.10; 95% CI: -0.18 to 0.39; p = .47). A subgroup analysis demonstrated that statistically significant reductions in depression and stress were limited to group, but not individual, formats. An additional subgroup analysis revealed that eight CBT sessions or fewer were equally effective as more than eight sessions at significantly reducing depression and stress, relative to comparator groups. Furthermore, analysis with independent samples t-tests demonstrated no statistically significant differences between mean changes in depression (MD = 0.79; 95% CI: -0.45 to 2.03; p = .21) and stress (MD = 0.21; 95% CI: -1.43 to 1.85; p = .80) when directly comparing CBT groups of ≤8 and >8 sessions. DISCUSSION AND IMPLICATIONS: Group CBT provides small but significant benefits to caregivers' depression and stress. Therapy cost-effectiveness may be improved by limiting therapy to group formats and eight sessions.
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A previous meta-analysis of in-person CBT for dementia family carers delivered face-to-face or via telephone demonstrated a small overall effect of CBT on depression (d = 0.34), while no significant overall effect was observed for anxiety.
“A previous meta-analysis of in-person CBT for dementia family carers delivered face-to-face or via telephone demonstrated a small overall effect of CBT on depression (Cohen's effect measure, d = 0.34), while no significant overall effect was observed for anxiety [6].”
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 [20]
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Hillebrand, M. C., Töpfer, N. F., Weise, L., & Wilz, G. (2021) · Psychotherapie im Alter · doi:10.30820/1613-2637-2021-3-349 · Cited by 4 · see citing works
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Analysis of dementia research trends in nursing using text mining approach
Atay, E., Yılmaz, E. B., & Atay, M. (2024) · Psychogeriatrics · doi:10.1111/psyg.13097 · Cited by 4 · see citing works
Kishita, N., Gould, R. L., McCracken, L. M., Khondoker, M., Turner, D. A., Ashford, P.-A., Flanagan, E., Czyznikowska, B., Richmond, E., Riggey, M., et al. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107685 · Cited by 3 · see citing works
“A previous meta-analysis of in-person CBT for dementia family carers delivered face-to-face or via telephone demonstrated a small overall effect of CBT on depression (Cohen's effect measure, d = 0.34), while no significant overall effect was observed for anxiety [6].”
InfluentialDicker, E. E., Jones, J. S., Kunik, M. E., & Denny, B. T. (2025) · Journal of Health Psychology · doi:10.1177/13591053251354882 · Cited by 3 · see citing works
Nie, J.-H., Xu, Y. Q., Liu, Q., & Yan, C. (2025) · Clinical Gerontologist · doi:10.1080/07317115.2025.2544933 · Cited by 3 · see citing works
Wawrziczny, É., Picard, S., Buquet, A., Traversac, E., Puisieux, F. L., Pasquier, F., Huvent‐Grelle, D., & Doba, K. (2022) · Journal of Alzheimer s Disease · doi:10.3233/jad-220430 · Cited by 3 · see citing works
Understanding the Religion, Mental, and Social Health Relationship
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0016 · Cited by 5 · see citing works
Huertas‐Domingo, C., Losada‐Baltar, A., Gallego‐Alberto, L., García‐Batalloso, I., García-García, L., & Márquez‐González, M. (2024) · The Spanish Journal of Psychology · doi:10.1017/sjp.2024.15 · Cited by 3 · see citing works
Stone, S. M., Giraldo‐Santiago, N., Miller, A., O’Donnell, A. E., Travis, A., Ritchie, C. S., & Vranceanu, A. (2025) · The Gerontologist · doi:10.1093/geront/gnaf058 · Cited by 3 · see citing works
Kashimura, M., Rapaport, P., Nomura, T., Ishiwata, A., Tateno, A., Nogami, A., Yamashita, M., 川西智也, Kawashima, Y., Kitamura, S., et al. (2020) · Dementia · doi:10.1177/1471301220919938 · Cited by 3 · see citing works
Pythagorean Self Awareness Intervention in Caregivers of Patients with Motor Disabilities
Voulgari, F., Bacopoulou, F., Artemiadis, A., Kokka, I., Vlachakis, D., Tigani, X., Chrousos, G. P., & Darviri, C. (2021) · EMBnet journal · doi:10.14806/ej.26.1.970 · Cited by 3 · see citing works
Psychological Well-Being and Positive Emotions
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0012 · Cited by 2 · see citing works
Mapping the burden on caregivers of people with epilepsy during the COVID-19 pandemic – pilot study
Búřilová, P., Búřil, J., Pokorná, A., Hejníková, L., Padělek, J., Sklenárová, B., Zedníčková, M., & Doležalová, I. (2024) · Ceskoslovenska psychologie · doi:10.51561/cspsych.68.1.96 · Cited by 2 · see citing works
Manevich, A. (2025) · Frontiers in Medicine · doi:10.3389/fmed.2025.1576298 · Cited by 2 · see citing works
Factors related to social disconnectedness among older unpaid caregivers
Yoo‐Jeong, M., Singer, J., Bergeron, C. D., Southerland, J. L., Chai, H. W., Pickett, A. C., Zhou, Y., Vazquez, C. E., Bacsu, J.-D., Kwong, K., et al. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1589103 · Cited by 2 · see citing works
Family caregivers’ perspectives on dementia prevention: A mixed-methods systematic review
Wu, Y., Zhi, S., Zhong, Q., Song, D., Gao, S., Fang, S., Jing, B., & Sun, J. (2025) · Geriatric Nursing · doi:10.1016/j.gerinurse.2025.05.004 · Cited by 2 · see citing works
Raising nursing student awareness of how it feels to have dementia with the use of 360º video
Newman, K., Kahlon, P., & Li, S. (2020) · Journal of Nursing Education and Practice · doi:10.5430/jnep.v11n2p7 · Cited by 2 · see citing works
Gul, M., Kanwal, A., & Chaudhry, H. A. (2024) · The Journal of Adult Protection · doi:10.1108/jap-12-2023-0038 · Cited by 1 · see citing works
Ferreira, M. G., Caetano Vieira de Faria, R., Kishita, N., & Caramelli, P. (2026) · Clinical Gerontologist · doi:10.1080/07317115.2026.2615707 · Cited by 2 · see citing works
“Moreover, while interventions such as Cognitive Behavioural Therapy (CBT) have demonstrated promising effects for reducing depressive symptoms, their efficacy for anxiety symptoms in family caregivers of people with dementia remains limited (Hopkinson et al., 2019; Kishita et al., 2018).”
Zhou, X., Zou, N., Shi, C., Chen, S., & Shi, J. (2026) · Aging & Mental Health · doi:10.1080/13607863.2025.2573071 · Cited by 1 · see citing works
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0025 · Cited by 1 · see citing works
Substance Use and Substance Use Disorders
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0010 · Cited by 1 · see citing works
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0014 · Cited by 4 · see citing works
Koenig, H. G., VanderWeele, T. J., & Peteet, J. R. (2023) · Oxford University Press eBooks · doi:10.1093/oso/9780190088859.003.0015 · Cited by 1 · see citing works
Ren, D., Wang, X., Shen, H., Li, T., & Sun, X. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07038-1 · Cited by 1 · see citing works
Gitlin, L. N., Roth, D. L., & Marx, K. (2025) · Journal of the American Geriatrics Society · doi:10.1111/jgs.70020 · Cited by 1 · see citing works
Zarzycka, B., Krasiczyńska, B., & Wojtasiński, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14165806 · Cited by 1 · see citing works
Cognitive Behavioral Therapy for Menopause Symptoms
Wilkins, V. M. (2025) · Current Obstetrics and Gynecology Reports · doi:10.1007/s13669-025-00452-y · Cited by 1 · see citing works
Alçay, A., & Çutuk, Z. A. (2026) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-026-00656-y · Cited by 1 · see citing works
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Public Health and Human Flourishing
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Understanding the Religion–Physical Health Relationship
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Psychotherapeutic Support for Family Caregivers of People With Dementia
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Depressive Disorders Among Family Caregivers of People Living with Dementia
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- Authors
- Hopkinson, M. D., Reavell, J., Lane, D. A., & Mallikarjun, P.
- Affiliations
- University of Birmingham (GB)
- Sandwell & West Birmingham Hospitals NHS Trust (GB)
- Corresponding author
- Mallikarjun, Pavan
- Venue
- The Gerontologist
- Publisher
- Oxford University Press (OUP)
- Published
- 2018-02-24
- Volume
- 59
- Issue
- 4
- Pages
- e343-e362
- ISSN
- 0016-9013 (ISSN-L)
- 1758-5341
- OpenAlex
- W2790970921
- Cited by
- 142
- References
- 49
- Citations by year
- 2026: 8 · 2025: 24 · 2024: 18 · 2023: 48 · 2022: 12 · 2021: 16 · 2020: 11 · 2019: 4 · 2018: 1
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- The Gerontologist (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Funders
- University of Birmingham
- 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 › Mindfulness and Compassion Interventions
- Keywords
- cognitive behavioral therapy, dementia caregivers, caregiver depression, caregiver anxiety, caregiver stress, group therapy, quality of life, intervention adherence, cost-effectiveness
- MeSH terms
- Anxiety, Dementia, Depression, Humans, Psychotherapy, Brief, Psychotherapy, Group, Quality of Life, Stress, Psychological, Cognitive Behavioral Therapy, Treatment Outcome, Caregivers, Patient Satisfaction
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