Sounds of Difference: A Typology of Reactions of People With Dementia to Individualized Music in the Presence of a Monitoring Person.

BACKGROUND AND OBJECTIVES: Despite promising effects of individualized music listening (IML) for people with dementia, the individualized nature and heterogeneity of reactions to IML remain underexplored. We aimed to develop an empirically derived typology of directly observed reactions of people with dementia to IML and propose recommendations for tailoring the intervention to the respective types. RESEARCH DESIGN AND METHODS: An ideal-type analysis was conducted on 108 video recordings of 45 people with mainly severe dementia (78% female, mean age of 83.02 years, all White participants) listening to recorded individualized music. Dimensions were identified for capturing similarities and differences between types. RESULTS: The analysis yielded 10 types of reactions ("expressing and sharing joy," "self-disclosure stimulated by music," "concentrated, absorbed listening," "blissful enjoyment," "experience of the music as bittersweet," "sharing memories," "releasing tension," "tensing up and rejecting," "predominant search for social exchange," "no interpretable reaction") and 3 dimensions ("valence" from negative to positive, "arousal" from calm to activated, "communicative activity" from defensive/resistant to proactive), resulting in a three-dimensional coordinate system, providing a holistic representation and facilitating a systematic contrast of identified reaction types to IML. DISCUSSION AND IMPLICATIONS: Reactions to IML were influenced by the interaction with the project staff, who monitored the sessions. Based on these observations, we propose recommendations for tailoring both the behavior of the monitoring person (e.g., engaging in synchronous activities like clapping along) and the setup of the intervention (e.g., communal vs individual listening) to each type, which may improve the effects of IML.

Between- and within-person effects of affective experiences on coping in CBT: Direct effects and interplay with therapeutic alliance and resource activation.

OBJECTIVE: The role of affective experiences (AE) in cognitive-behavioral therapy (CBT) has rarely been investigated. We examined between- and within-person effects of AE on coping in CBT for family caregivers and interactions with therapeutic alliance and resource activation. METHODS: 67 family caregivers rated AE, therapeutic alliance, resource activation, and coping after each of 12 sessions of telephone-based CBT. We examined direct session-to-session effects of AE on coping in structural equation modeling and interactions of AE with therapeutic alliance and resource activation in multilevel models. RESULTS: AE did not directly predict coping. Instead, within-person effects of AE interacted with simultaneous within-person emotional bond. Given strong emotional bond, AE positively predicted coping, whereas given weak emotional bond, AE negatively predicted coping. Further, cross-level interactions of between-person AE and within-person agreement on collaboration and resource activation indicated that these positively predicted coping only in dyads with high between-person AE. CONCLUSION: AE may enhance coping when complemented with strong emotional bond. Further, within-person effects of agreement on collaboration and resource activation seem to rely on a certain degree of between-person AE. Results are discussed in relation to current findings on emotional processing in CBT.

Face-to-face versus telephone-based cognitive-behavioral therapy for family caregivers of people with dementia.

OBJECTIVE: The objective was to directly compare the effects and acceptability of telephone-based (TEL-CBT) with face-to-face cognitive-behavioral therapy (F2F-CBT) for family caregivers of people with dementia (PwD). METHOD: Caregivers for whom F2F participation was possible were allocated to F2F-CBT (n = 49). The other participants were randomized to TEL-CBT (n = 139) or CG (n = 134). CBT consisted of 12 sessions over 6 months. RESULTS: TEL-CBT yielded significantly better physical health (d = 0.27) and coping with daily hassles (d = 0.38) at posttest compared to F2F-CBT. Therapist competence, acceptability, and outcomes at follow-up did not differ between TEL-CBT and F2F-CBT. CONCLUSIONS: TEL-CBT is a valuable alternative to F2F-CBT for family caregivers of PwD as TEL-CBT has the advantage of higher accessibility while it does not significantly differ from F2F-CBT in effectiveness and caregivers' evaluation of the setting, their experience with the therapist, and their satisfaction.

Effects of general change mechanisms on outcome in telephone-based cognitive-behavioral therapy for distressed family caregivers.

BACKGROUND: The study investigated the influence of general change mechanisms (GCMs) on outcome in telephone-based cognitive-behavioral therapy (CBT) for family caregivers. METHODS: In a stepped-care intervention approach, highly distressed family caregivers received telephone-based CBT after completing a care counseling intervention. Sixty-six therapist-caregiver dyads rated emotional bond, agreement on collaboration, problem actuation, resource activation, clarification of meaning, and mastery after each of 12 therapy sessions. Outcomes were caregiver burden (SCQ-AV) and depression (CES-D) after therapy. Associations of GCMs with outcome were examined in multilevel regression models. RESULTS: Caregiver burden was significantly predicted by caregiver-rated emotional bond (ß = -0.18) as well as therapist-rated resource activation (ß = -0.26), problem actuation (ß = -0.22), clarification of meaning (ß = -0.18), and mastery (ß = -0.18). None of the GCMs predicted depression from any perspective. CONCLUSION: The findings suggest that GCMs are relevant for reducing caregiver burden in CBT for family caregivers and should be fostered in treatment manuals, in particular therapist-rated GCMs. Since therapist and caregiver perspectives differed in predicting caregiver burden, future research should investigate perspective congruence and its effect on therapy outcome.

Effects of nursing home placement on the mental health trajectories of family caregivers of people with dementia: findings from the Tele.TAnDem intervention study.

OBJECTIVES: The objective was to compare mental health trajectories between family caregivers of people with dementia (PwD) who institutionalize the care recipient (nursing home caregivers [NHC]) and caregivers who continue to provide care at home (at-home caregivers [AHC]) as well as investigate effects of a telephone-based cognitive-behavioral therapy (TEL-CBT) intervention on these trajectories. METHODS: Using linear growth models, we compared the trajectories of depressive symptoms, caregiver grief, anxiety, and quality of life (QoL) over one year (baseline - T0, 6 months - T1, and 12 months - T2) between 28 NHC and 163 AHC who had been randomized to receive 12 sessions of TEL-CBT (n = 99) or to usual care (n = 92). RESULTS: NHC reported significantly higher depression, anxiety, and caregiver grief at T0 and showed significant reductions in depression and anxiety over time compared to AHC. TEL-CBT significantly enhanced overall QoL of NHC. CONCLUSIONS: The study extends previous findings of improved mental health of family caregivers of PwD after institutionalization and emphasizes the need for interventions before nursing home placement. TEL-CBT which has previously been shown to be effective for family caregivers of PwD also seems promising for supporting NHC.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2021.2022598 .

Pragmatic Effectiveness of Face-to-Face Cognitive-Behavioral Therapy for Family Caregivers of People with Dementia.

OBJECTIVES: The objective was to investigate the pragmatic effectiveness of face-to-face cognitive-behavioral therapy (F2F-CBT) for family caregivers of people with dementia (PwD) implemented in a routine care setting relative to usual care in a quasi-experimental study. METHODS: Participants indicating that attendance of F2F-CBT was possible were assigned to F2F-CBT (n = 49). F2F-CBT consisted of 12 sessions over 6 months. Effects were evaluated at posttest and 6-month follow-up on a variety of outcomes relative to usual care (CG; n = 134). RESULTS: At posttest, F2F-CBT yielded significantly fewer symptoms of depression (d = 0.37), better emotional well-being (d = 0.64), and better coping with the care situation (d = 0.52) than CG. At 6-month follow-up, the effect on emotional well-being was retained (d = 0.44) and social relationships were rated significantly better in F2F-CBT than CG (d = 0.34). CONCLUSIONS: F2F-CBT proved to be effective in supporting family caregivers of PwD. However, only relatively few caregivers were able to regularly attend face-to-face sessions. CLINICAL IMPLICATIONS: CBT seems particularly suitable for supporting family caregivers of PwD in coping with the complex psychological burden. Delivery via telephone or internet could be a necessary alternative to F2F-CBT for reducing barriers to participation.

Long-term effects of telephone-based cognitive-behavioral intervention for family caregivers of people with dementia: Findings at 3-year follow-up.

INTRODUCTION: Long-term outcomes are of particular importance in evaluating interventions for family caregivers of people with dementia (PwD). So far, evidence for long-term effects (>6 months postintervention) is limited to four interventions. OBJECTIVE: We examined the long-term effects of Tele.TAnDem, a telephone-based cognitive-behavioral therapy (CBT) intervention, on a variety of outcomes at 3-year follow-up, the longest follow-up of any intervention study for caregivers of PwD (without continuous support). METHODS: Caregivers of PwD were randomly assigned to receive Tele.TAnDem consisting of 12 sessions over 6 months (intervention group [IG]) or usual care (control group [CG]). At 3-year follow-up (i.e., 2.5 years postintervention), 29 caregivers in the IG and 22 caregivers in the CG were still caring at home for a PwD. RESULTS: Caregivers in the IG reported significantly lower caregiver burden and higher quality of life regarding social relationships. CONCLUSIONS: Tele.TAnDem is successful in buffering detrimental effects of caregiving on caregiver burden and social relationships in the long term. The small- to medium-sized effects lie in the range of effect sizes reported in the few previous investigations. The findings add to the scant evidence that interventions yielding long-term outcomes have to date mostly been multicomponent interventions based on CBT principles with structured techniques and at least seven sessions over more than 2 months. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Telephone-Based Cognitive Behavioral Intervention Improves Dementia Caregivers' Quality of Life.

The present study examined the effects of a telephone-based cognitive behavioral intervention on dementia caregivers' quality of life (QoL). A total of 273 caregivers were randomly assigned to an intervention or control group. The intervention comprised 12 telephone sessions of individual cognitive behavioral therapy (CBT) over 6 months. At baseline, postintervention, and 6-month follow-up, QoL was assessed with the World Health Organization QoL-BREF, which measures perceived QoL for the domains physical health, psychological health, social relationships, and environment as well as overall QoL and satisfaction with general health. Intention-to-treat analyses using latent change models were performed. At postintervention, intervention group participants reported better overall QoL and satisfaction with general health as well as better physical and psychological health compared to control group participants. Together with existing evidence, the results suggest that the telephone CBT intervention does not only reduce impairments but also fosters improvements in health-related QoL.