"I Feel Guilty". Exploring Guilt-Related Dynamics in Family Caregivers of People with Dementia.

Objectives: Family caregivers of people with dementia often report feelings of guilt. However, the number of studies analyzing guilt and the factors associated with its appearance are scarce. The aim of this study is to explore the subjective experience of guilt in the family care of people with dementia.Methods: A qualitative analysis of the narratives of 13 family caregivers of people with dementia about their feelings of guilt was done.Results: Seven categories for understanding guilt in caregiving were obtained: guilt derived from actions themselves; guilt derived from one's limitations; guilt for feeling negative emotions; guilt associated with the change in the relationship with the person cared for; guilt for neglecting other areas; guilt induced by the person cared for, and guilt induced by others. The results showed the existence of cases in which guilt is absent by distress-avoiding processes.Conclusions: Guilt is a relevant variable in understanding caregiver distress, and its analysis is necessary for therapeutic work in the field of care.Clinical implications: Psychological interventions aimed at family caregivers should include specific techniques in order to address guilt feelings.

Tailored versus manualized interventions for dementia caregivers: The functional analysis-guided modular intervention.

Caregiver distress is a complex, multicausal phenomenon. Most of the available interventions for caregivers are protocolized or manualized. A case formulation approach may be more appropriate, as it provides the opportunity for assessing and treating specific dysfunctional mechanisms explaining each caregiver's needs and causes of distress, through the design of an individualized modular intervention. In the present study, a randomized controlled study has been done in which a functional analysis-guided modular intervention (FAMI) was developed. The FAMI was compared with two manualized intervention (cognitive-behavioral therapy and acceptance and commitment therapy) which have received preliminary support, and a control group (waiting list). Mixed-effect models and clinical significance analyses were performed. Results suggest that all the interventions were effective in reducing depressive and anxious symptomatology at postintervention assessment, with large effect sizes, and with reductions in depression being maintained at follow-up. Regarding anxiety, long-term effects have been found only for the FAMI intervention. Results also suggest positive effects associated with the FAMI intervention in the long term with regards to comorbidity between depressive and anxious symptomatology. FAMI presents great potential for reducing dementia caregivers' levels of distress, being especially effective in maintaining therapeutic effects in the long term. (PsycINFO Database Record (c) 2020 APA, all rights reserved).