Lévesque L, Gendron C, Vézina J, Hébert R, Ducharme F, Lavoie J-P, Gendron M, Voyer L, Préville M
Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Université de Montréal, Province de Québec, Canada.
Aging Ment Health. 2002 Aug;6(3):239-47. doi: 10.1080/13607860220142468.
Most earlier group interventions for caregivers of demented persons lacked a theoretical basis to guide the intervention process and focused on providing information and practical advice and encouraging the expression of feelings. This article presents the process of a group intervention with emphasis on its conceptual framework, components and characteristics. As caregivers are exposed to numerous daily stressful demands, the intervention's conceptual framework was derived from Lazarus and Folkman's transactional theory of stress and coping and Folkman's Coping Effectiveness Training Program. The central aim of the intervention was to improve the ability of caregivers to cope with the stressful demands at the core of caring for a demented person, rather than to focus on information and the task-oriented aspects of caring. The two components of the intervention deal with the cognitive appraisal of stressors and coping strategies, with a view to determining which strategies are most appropriate on the basis of the changeability of stressors. Three coping strategies were proposed: problem solving (problem-focused coping to deal with changeable stressors), reframing (emotion-focused coping to manage the emotional response to unchangeable stressors), and seeking social support (problem- or emotion-focused coping). The most salient characteristics of this group intervention were its intensity (15 meetings) and its focus on the caregivers' daily reality, which provided concrete reference points for the discussion of conceptual notions.
大多数早期针对痴呆患者照料者的团体干预缺乏指导干预过程的理论基础，且侧重于提供信息和实用建议以及鼓励情感表达。本文介绍了一种团体干预的过程，重点阐述其概念框架、组成部分和特点。由于照料者面临众多日常压力需求，该干预的概念框架源自拉扎勒斯和福克曼的应激与应对交互理论以及福克曼的应对效能训练项目。干预的核心目标是提高照料者应对照料痴呆患者核心压力需求的能力，而非专注于照料的信息和任务导向方面。干预的两个组成部分涉及对应激源的认知评估和应对策略，旨在根据应激源的可变性确定哪些策略最为合适。提出了三种应对策略：解决问题（以问题为导向的应对方式来处理可变应激源）、重新构建认知（以情绪为导向的应对方式来管理对不可变应激源的情绪反应）以及寻求社会支持（以问题或情绪为导向的应对方式）。这种团体干预最显著的特点是其强度（共15次会面）以及对照料者日常实际情况的关注，这为概念性观念的讨论提供了具体的参考依据。
