Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) Applied to Caregivers of Patients With Dementia.

Serena Passoni,Manuela Berlingeri,Alessio Toraldo,Isabel Fernandez,Gabriella Bottini,Teresa Curinga

doi:10.3389/fpsyg.2018.00967

Abstract

Caregivers of patients with dementia experience high levels of stress and burden, with effects comparable to those of a traumatic event. Eye Movement Desensitization and Reprocessing (EMDR) appear to be effective in recovering post-traumatic stress disorder (PTSD). We aimed at investigating the effectiveness of the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol (EMDR-IGTP) on the “caregiver syndrome”. Forty-four primary caregivers entered the study. They were randomly assigned to either the “immediate” branch, who received the treatment soon after recruitment, or to the “delayed” branch, who received it two months after recruitment. The treatment consisted of eight group sessions (one per week) spanning over two months. Emotional distress was measured before the treatment, immediately after the end of it, and two months later (follow-up), by means of several clinical scales (Impact of Event Scale-Revised, IES-R; Caregiver Needs Assessment, CNA; Caregiver Burden Inventory, CBI; Anxiety and Depression Scale-Reduced Form, AD-R). The “immediate” branch improved significantly more than the “delayed” (control) branch on The Impact of Event Scale-Revised, the Anxiety, and the Depression scales; however, after treatment such an improvement was maintained only in the first scale. The “delayed” branch took less advantage of the treatment, showing significant reduction only on the Depression scale, an effect which disappeared at follow-up. These preliminary results show for the first time that EMDR-IGTP reduces stress-related symptoms, anxiety, and depression in caregivers of patients with dementia. Interestingly, caregivers who were inserted in a waiting list after recruitment showed smaller treatment effects. Larger samples are needed to better interpret such differential clinical profiles.

Highlights

Dementia is a degenerative disease with a major impact on the whole family of the patient (Beinart et al, 2012), especially on primary caregivers
Inclusion Criteria - Being a caregiver of a patient with a diagnosis of dementia on grounds of the DSM-IV (American Psychiatric Association [APA], 1994) criteria. - Being the primary caregiver. - Being a relative of the patient. - Having assisted the patient for at least six consecutive months, at home. - Showing evidence of one or more traumatic events causing trauma related symptoms (IES-R > 0, and Subjective Units of Distress, SUD > 5). - Being fluent in Italian and with at least three years of education
To test the appropriateness of such a choice, we ran control per-protocol analyses; given that per protocol-analyses yielded very similar results to those obtained by the intention-to-treat approach, we reported only the latter as they are based on slightly larger sample sizes

Summary

Introduction

Dementia is a degenerative disease with a major impact on the whole family of the patient (Beinart et al, 2012), especially on primary caregivers. Prolonged care of patients with dementia is associated with somatic and psychological symptoms that characterize the “caregiver syndrome” (Gaugler et al, 2005). This syndrome together with wrong coping strategies may culminate in high risk of developing affective disorders, with high levels of stress, anxiety, depression (Cuijpers, 2005; Gaugler et al, 2005), and burden (Vitaliano et al, 2003; Passoni et al, 2010). The caregiver becomes a “secondary victim” of the disease, a problem that in turn reduces his/her competence in caring

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