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Cognitive Behavioral Therapy for Depression, Anxiety, and Stress in Caregivers of Dementia Patients: A Systematic Review and Meta-Analysis
Open accessAbstract
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 (Cohen's effect measure, d = 0.34), while no significant overall effect was observed for anxiety [6].”
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“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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“A recent meta-analysis of in-person or telephone CBT for family carers of people with dementia delivered by trained professionals demonstrated a small overall effect of CBT on depression (d = 0.34)”
From Internet-delivered guided self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS): a feasibility study. (2022) · cites this paper as Hopkinson et al., 2019
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“while no significant overall effect was observed for anxiety”
From Internet-delivered guided self-help acceptance and commitment therapy for family carers of people with dementia (iACT4CARERS): a feasibility study. (2022) · cites this paper as Hopkinson et al., 2019
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Metadata
- 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 › Nursing › Research and Theory › 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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