Development and Validation of an Implicit Relational Assessment Procedure (IRAP) to Measure Implicit Dysfunctional Beliefs about Caregiving in Dementia Family Caregivers

Isabel Cabrera,Naoko Kishita,Carlos Vara-García,María Márquez-González,Andrés Losada

doi:10.1007/s40732-020-00445-8

Abstract

Caregivers of people with dementia who endorse dysfunctional beliefs about caregiving are at high risk of experiencing higher levels of distress. These dysfunctional beliefs are presented in the form of rules, verbal statements that specify what responsibilities one should expect in order to be a “good caregiver,” and are characterized as rigid, unrealistic, or highly demanding. Previous studies relied exclusively on self-report measures when assessing such dysfunctional beliefs about caregiving. The objectives of this study were: 1) to develop and validate an Implicit Relational Assessment Procedure (IRAP) to measure implicit dysfunctional beliefs about caregiving (CARE-IRAP), and 2) considering the relatively high age of the sample, to analyze the adaptation of the IRAP for older adults, comparing the IRAP performance between older adult caregivers and middle-aged caregivers. Participants were 123 dementia family caregivers with a mean age of 62.24 ± 12.89. Adaptations were made to the IRAP by adjusting the accuracy and response time criteria. The sample was split into middle-aged caregivers (below 60 years) and older adult caregivers (60 or older). The CARE-IRAP scores presented significant positive correlations with explicit measures of dysfunctional beliefs about caregiving and experiential avoidance in caregiving. A similar pattern of results was observed across the two age groups. The results revealed that caregivers endorse implicit dysfunctional beliefs about caregiving and offer preliminary support for the use of the IRAP as a valid measure of implicit caregiving beliefs. This exploratory study is the first to adapt the IRAP criteria to older adults, and future studies should further explore criteria suitable for this population.

Highlights

Caregivers of people with dementia who endorse dysfunctional beliefs about caregiving are at high risk of experiencing higher levels of distress
The present study is the first to explore implicit dysfunctional beliefs about caregiving in a sample of dementia family caregivers. These beliefs about caregiving may be regarded as verbal relations, or rules that specify what responsibilities one should expect in order to be a “good caregiver” and are characterized as rigid, unrealistic, or highly demanding
Regarding implicit dysfunctional beliefs about caregiving, the whole sample and both age groups showed shorter response latencies for consistent blocks than for inconsistent blocks. This result shows that caregivers were quicker to relate the “good caregiver” label with all the target stimuli included in the “rigid” style of care, and the “bad caregiver” label with all the target stimuli of the “flexible” style of care, as compared to the opposite combination

Summary

Introduction

Caregivers of people with dementia who endorse dysfunctional beliefs about caregiving are at high risk of experiencing higher levels of distress These dysfunctional beliefs are presented in the form of rules, verbal statements that specify what responsibilities one should expect in order to be a “good caregiver,” and are characterized as rigid, unrealistic, or highly demanding. The results revealed that caregivers endorse implicit dysfunctional beliefs about caregiving and offer preliminary support for the use of the IRAP as a valid measure of implicit caregiving beliefs This exploratory study is the first to adapt the IRAP criteria to older adults, and future studies should further explore criteria suitable for this population. Research shows that caregivers experiencing higher levels of distress are more likely to endorse dysfunctional verbal rules about caregiving, which are often characterized as rigid, unrealistic, or highly demanding (Losada et al, 2010). Others may feel guilty when they express emotions such as sadness or anger because this behavior is inconsistent with the rule “a good caregiver should not complain nor express any negative feelings related to their loved ones” (Gallagher-Thompson, Solano, Coon, & Areán, 2003)

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