|Year : 2014 | Volume
| Issue : 2 | Page : 70-72
Psychosocial therapeutic techniques to reduce family care burden in psychiatric disorders
Sateesh R Koujalgi1, Shobhadevi R Patil2, Raghavendra B Nayak3, Nanasaheb M Patil1
1 Department of Psychiatry, KLE University's J.N. Medical College, Belgaum, India
2 Department of Social Work, Karnataka University, Dharwad, India
3 Department of Psychiatry, Dharwad Institute of Mental Health and Neuro Sciences, Karnataka, India
|Date of Web Publication||7-Jan-2015|
Dr. Sateesh R Koujalgi
Department of Psychiatry, KLE University's J.N. Medical College, Nehru Nagar, Belgaum 10, Karnataka
Source of Support: None, Conflict of Interest: None
The purpose of this review was to address current psychosocial therapeutic techniques which reduce family care burden in psychiatric disorders. Various types of psychosocial/psychotherapeutic techniques have been developed to reduce the family burden in key caregivers and to provide support. These techniques include training programs, spiritual support, religious coping, psychotherapy, cognitive-behavioral family intervention, enhancing social support, and a combination of education and emotional support.
Keywords: Family care burden, psychosocial therapeutic techniques, therapeutic techniques
|How to cite this article:|
Koujalgi SR, Patil SR, Nayak RB, Patil NM. Psychosocial therapeutic techniques to reduce family care burden in psychiatric disorders. Indian J Health Sci Biomed Res 2014;7:70-2
|How to cite this URL:|
Koujalgi SR, Patil SR, Nayak RB, Patil NM. Psychosocial therapeutic techniques to reduce family care burden in psychiatric disorders. Indian J Health Sci Biomed Res [serial online] 2014 [cited 2019 Jul 22];7:70-2. Available from: http://www.ijournalhs.org/text.asp?2014/7/2/70/148797
| Introduction|| |
In severe mental disorders, the caring process can be very taxing and exhausting. Significant stress is found commonly in those providing long-term care. Mental disorders are more often associated with behavioral problems that further increase the stress level of the caregiver and further it significantly reflects on their mental health. When compared with the general population, caregivers experience a higher rate of mental health problems, which are direct consequences of their caring role. This result in an adverse effect on the quality-of-life of caregivers, therefore, standard care services are delivered.
| Coping Strategies and Therapeutic Techniques|| |
Ballard et al.  reported that a structured and higher level of education about dementia enhances a caregiver's feeling of sufficiency. These interventions were more promising to minimize their expectations of their dependents' abilities. Coppel et al.  reviewed previous studies regarding coping strategies used by caregivers and reported that unrealistic expectations of dependents increased caregivers' risk of depression. Saad et al.  reported conversely that minimizing the key caregivers expectations is shown lower rates of depression. Balancing positive feelings toward their relatives that shown a greater level of commitment to caring and lower level of perceived strain Horowitz and Shindelman.  Higher level of depression is seen in those caregivers who experience a feeling of powerlessness, lack of control, and unpreparedness Coppel et al. 
Studies show that in older African Americans and Older Mexican-Americans, spiritual support is a one of the techniques that can be considered as a coping resource Levin et al.  African American reports that spiritual support is the higher level of reward in caregiving Picot et al.  Church support and reliance on prayer is considered as a spiritual support Dilworth et al. 
Fewer depressed patients are seen in those groups who use more coping techniques such as problem solving than those who rely on more submissive methods Haley et al.  The caregiver who experiences a lesser level of depression is one who uses both positive and active strategies, positive meaning managing disturbed behavior and active related to managing the meaning of illness.
Caregivers find some positive association in caregiving, including pleasure in accomplishing spousal responsibilities, intensified closeness with a care receiver, and gratification of desire with one's competence. These perceived intellectual of caregiving are connected with lower level of caregiver burden and depression Pinquart and Sörensen. 
Lower caregiver depression is associated with high quality of informal relationship and the presence of informal support Cox.  Caregivers need to inculcate a deeper understanding to alleviate stress Haley et al.  In one of the studies it was found that the perceived burden was not received by the family members and caregivers reported worthy limitation on their social phenomena and social activities. Higher level of unemployment was reported when compared to the general population and also reported they were over represented in lower income groups. Mental health challenges and high risk of social and economic disadvantages were found in family cares Smith et al. Social support may not be able to benefit those who are highly stressed as much as it would moderately stress person Biegel et al. 
An effective way of coping with stress is necessary for caregivers. Once they learn new ways of coping behaviors, their level of anxiety and depression may be reduced, and they become reliant on treatment. Behavioral skills and effective self-management training were found to reduce patient behavioral problems and helps to improve the caregiver's mood Bourgeois et al.  Behavioral management promises intervention that reduces the problem exhibited by individual with a mental disorder and also it enhances pleasurable activities of the caregivers Stevens and Burgio.  Depression and interpersonal conflict are more seen when a person is found to be using escape-avoidance coping mechanisms. Active participation of the caregiver in the intervention is required, and cognitive behavioral intervention can result in a remarkable reduction in the burden.
| Negative Factors Associated with Caregiver Burden|| |
Regardless of psychiatric problem of their relatives, family carers are themselves prone to develop physical and psychiatric problems, and, as a result, they may utilize more medical resources. High rate of depressive disorders has been reported among the family caregivers of people with psychiatric illnesses than in the general population, particularly when the rate of disability is more Jungbauer and Angermeyer. 
The literature suggests that in the presence of a mentally ill person in the house, families experience symptoms like insomnia, headache, irritability, anxiety, depression, fatigue, neck pain, and shoulder pain. The manifestation of symptoms is predominant indictor of psychosomatic complaints in caregivers and compared with the general population they are seen to consult physicians more repeatedly, specifically general practitioners as well as psychiatrists and psychotherapists. In a study, it was reported that mothers and wives, and respondents with low incomes or who are in under poverty, in particular, were at high risk of developing depression. The impact on health and the need for health care resources may vary depending on the nature of the mental disorders.
Negative factors that commonly connected are with key caregiver burden include self-blame and guilt experienced by parents, the financial difficulties of treatment, and the parents' role to give more supervision for the patients. Reinhard and Horwitz  did report the important factors like severity of mental illness, caregiving, and the burden are relatively connected each other, which impact on caring of the ill person. To illustrate many studies Dixon et al.  Tessler and Gamache  have noticed that the affinity between the caregiver and ill relative is more intense when mentally ill person exhibit erratic behavior (e.g. verbal and physical aggression) due to which caregiver experience difficult, which may be unbearable. The nature of symptoms may contribute to the family burden. For example, positive symptoms such as hallucinations and delusions are together with a more social dysfunction and recurrent relapses are often connected with severe family burden than negative symptoms like apathy and social withdrawal.
Caregiving can lead to psychological, mental, physical and material burden, and stress, but many caregivers experience satisfactory role. Few studies reported that the looking after their children make them happier and closer to the children, heighten caregiver's self-esteem, and relative gain insights about their personal strengths and values Abelenda and Helfrich.  The literature reveals that male caregivers were more satisfied than their female counterparts. Male caregivers reported that caregiving broadened their horizons and inspired them to grow as people.
It is worthwhile to note that there are both recompenses and difficulties associated with caregiving; nevertheless, the positive aspects may take no notice. Reinforcement of the positive aspects of caring can be markedly associated with lesser family burden. Caregiver reports that providing care for their ill relative may benefit in the form of feeling of gratification, pride, and love. Irrespective of intervention benefit some of the relatives undergo considerable distress but as consequences relative did not escape from their caring responsibilities. It is reported that when a support is provided adequately by professional, 92% of relatives continued to maintain contact with friends and relatives Samele and Manning.  Similar findings are reported in research area of carers of older people with cognitive problems. Cohen et al.  provided evidence-based report that 73% of caregivers could recognize at least one positive aspects of caregiving.
In a survey of nearly 1000 informal carers, nearly half of them found to express positive aspects of caring and felt that their happiness can be reduced if they can shift their responsibilities to someone else Brouwer et al.  In spite of the illness-related burdens, most of the spouses take a positive aspect of living together. The perceived impairment, if it is moderate or moderately severe, partnership seems to be stable and achievable. Spouses who suffer from a psychiatric problem themselves often experience the partnership as an appropriate and satisfactory way of life.
| Conclusion|| |
Chronic psychiatric disorders are life long illness consequences of which caregivers experience greater burden. Nevertheless, continuous and early interventions of the family care burden may be successfully reduced and family may be rehabilitated to the functional level.
| References|| |
Ballard CG, Saad K, Patel A, Gahir M, Solis M. The prevalence and phenomenology of psychotic symptoms in dementia sufferers. Int J Geriatr Psychiatry 1995a; 10:477-85.
Coppel DB, Burton C, Becker J, Fiore J. Relationships of cognitions associated with coping reactions to depression in spousal caregivers of Alzheimer's disease patients. Cognit Ther Res 1985;9:253-66.
Saad K, Hartman J, Ballard C, Kurian M, Graham C, Wilcock G. Coping by the carers of dementia sufferers. Age Ageing 1995;24:495-8.
Horowitz A, Shindelman LW. Reciprocity and affection: Past influences on current caregiving. J Gerontol Soc Work 1983;5:5-20.
Levin JS, Chatters LM, Taylor RJ. Religious effects on health status and life satisfaction among black Americans. J Gerontol B Psychol Sci Soc Sci 1995;50:S154-63.
Picot SJ, Debanne SM, Namazi KH, Wykle ML. Religiosity and perceived rewards of black and white caregivers. Gerontologist 1997;37:89-101.
Dilworth-Anderson P, Williams IC, Gibson BE. Issues of race, ethnicity, and culture in caregiving research: A 20-year review (1980-2000). Gerontologist 2002;42:237-72.
Haley WE, Levine EG, Brown SL, Bartolucci AA. Stress, appraisal, coping, and social support as predictors of adaptational outcome among dementia caregivers. Psychol Aging 1987;2:323-30.
Pinquart M, Sörensen S. Associations of stressors and uplifts of caregiving with caregiver burden and depressive mood: A meta-analysis. J Gerontol B Psychol Sci Soc Sci 2003;58:P112-28.
Cox C. Comparing the experiences of black and white caregivers of dementia patients. Soc Work 1995;40:343-9.
Smith B Rosanne, McVilly, Keith R, Yazbeck, Marie, et al
. Quality of life of Australian family carers: Implications for research, policy, and practice. J Policy Pract Intellect Disabil 2009;6:189-98.
Biegel D, Sales E, Schulz R. Family Caregiving in Chronic Illness: Alzheimer's Disease, Cancer, Heart Disease, Mental Illness and Stroke. Newbury Park, CA: Sage Publications; 1991.
Bourgeois MS, Burgio LD, Schulz R, Beach S, Palmer B. Modifying repetitive verbalizations of community-dwelling patients with AD. Gerontologist 1997;37:30-9.
Stevens AB, Burgio LD. Issues in training home-based caregivers of individuals with lzheimer's disease. Alzheimers Care Q 2000;1:55-68.
Jungbauer J, Angermeyer MC. Living with a schizophrenic patient: A comparative study of burden as it affects parents and spouses. Psychiatry 2002;65:110-23.
Reinhard SC, Horwitz AV. Caregiver burden: Differentiating the content and consequences of family caregiving. J Marital Fam Ther 1995;57:741-50.
Dixon L, Adams C, Lucksted A. Update on family psychoeducation for schizophrenia. Schizophr Bull 2000;26:5-20.
Tessler R, Gamache G. Continuity of care, residence, and family burden in Ohio. Milbank Q 1994;72:149-69.
Abelenda J, Helfrich CA. Family resilience and mental illness: The role of occupational therapy. Occup Ther Men Health 2003;19:25-39.
Samele C, Manning N. Level of caregiver burden among relatives of the mentally ill in South Verona. Eur Psychiatry 2000;15:196-204.
Cohen CA, Colantonio A, Vernich L. Positive aspects of caregiving: Rounding out the caregiver experience. Int J Geriatr Psychiatry 2002;17:184-8.
Brouwer WB, van Exel NJ, van den Berg B, van den Bos GA, Koopmanschap MA. Process utility from providing informal care: The benefit of caring. Health Policy 2005;74:85-99.