Grief-specific interventions in cognitive-behavioral therapy for dementia caregivers : towards managing pre-death grief, loss, and change

Among the most debilitating aspects of dementia caregiving is the experience of pre-death grief, i.e., caregivers’ emotional response to losses over the caregiving trajectory. Yet, caregivers are often unaware that their symptoms can be attributed to grief or try to avoid painful reactions. In the light of results that found pre-death grief to be related to caregiver burden and depression, interventions that facilitate dementia caregivers’ coping with pre-death grief are called for. Against this background, the objectives of this dissertation were threefold: It was the first objective to provide insights into how intervention strategies rooted in CBT principles can be applied by therapists to specifically target pre-death grief. Based on these results, a grief-specific intervention module was developed and integrated into an intervention program. The second objective was to evaluate this intervention’s effectiveness regarding caregivers’ coping with pre-death grief. As an important prerequisite for the analysis of treatment effects, it was the third objective to develop an instrument for the measurement of pre-death grief. These objectives were met in three empirical studies that were conducted within the scope of two randomized-controlled trials evaluating the effectiveness of a cognitive-behavioral intervention for dementia caregivers in Germany. The results of these studies illustrate how grief-specific interventions can be designed to facilitate caregivers’ coping with pre-death grief, and support the effectiveness of the comprehensive intervention program. The dissertation further adds two instruments to the field of pre-death grief: A category system for the qualitative assessment of grief intervention strategies and a scale for quantitative measurement of pre-death grief, the Caregiver Grief Scale. Implications for clinical practice as well as future directions of research to support caregivers’ management of grief are outlined.