Coon David W, Thompson Larry, Steffen Ann, Sorocco Kristen, Gallagher-Thompson Dolores
Institute on Aging, San Francisco, CA, USA.
Gerontologist. 2003 Oct;43(5):678-89. doi: 10.1093/geront/43.5.678.
This study examines the short-term impact of two theoretically based psychoeducational small group interventions with distressed caregivers, and it also examines the role of specific moderator and mediator variables on caregiver outcomes.
Female participants (N = 169) aged 50 and older who were caring for a community-dwelling relative with a dementing illness were randomly assigned to one of three treatment interventions: anger management, depression management, or a wait-list control group. These interventions took place over a 3- to 4-month period. The primary outcomes examined were anger or hostile mood, depressed mood, frequency of use of positive and negative coping strategies, and perceived caregiving self-efficacy.
Significant main effects in the expected direction were found for changes in most of these measures. Participants in both anger management and depression management groups had significant reductions in their levels of anger or hostility and depression from Time 1 to Time 2 in comparison to participants in the wait-list control group. Use of positive cognitive coping strategies increased in the anger management group only. Self-efficacy significantly increased for participants in both intervention groups, and it was also demonstrated to function as a mediator of intervention effects. Pretreatment levels of depressive symptoms and anger expression style (Anger Expression-Out) moderated the relative effects of the two interventions on mood and coping.
These data are consistent with a growing body of evidence supporting the effectiveness of skills training, in small groups, to improve both the affective states and the type of coping strategies used by caregivers. In addition, this study underscores the need to evaluate key pretreatment variables in order to determine which form of treatment may be more compatible with caregiver characteristics and thus more likely to be beneficial to individuals.
本研究考察了两种基于理论的心理教育小组干预对处于困境中的照料者的短期影响，同时也考察了特定调节变量和中介变量在照料者结果方面的作用。
年龄在50岁及以上、照料患有痴呆症的社区居住亲属的女性参与者（N = 169）被随机分配到三种治疗干预措施之一：愤怒管理、抑郁管理或等待名单对照组。这些干预在3至4个月的时间内进行。所考察的主要结果包括愤怒或敌对情绪、抑郁情绪、积极和消极应对策略的使用频率以及感知到的照料自我效能感。
在这些测量指标中的大多数变化上都发现了预期方向上的显著主效应。与等待名单对照组的参与者相比，愤怒管理组和抑郁管理组的参与者从时间1到时间2，其愤怒或敌意以及抑郁水平都有显著降低。仅愤怒管理组中积极认知应对策略的使用有所增加。两个干预组的参与者自我效能感都显著提高，并且还证明自我效能感起到了干预效果的中介作用。抑郁症状的预处理水平和愤怒表达风格（外向愤怒表达）调节了两种干预对情绪和应对的相对影响。
这些数据与越来越多支持小组技能培训有效性的证据一致，技能培训可改善照料者的情感状态和所使用的应对策略类型。此外，本研究强调了评估关键预处理变量的必要性，以便确定哪种治疗形式可能更适合照料者的特征，从而更有可能对个体有益。
