A promising service for families and partners
Caregivers of eating disorders patients run a marathon on a very challenging track. The level of stress of caring for an ED patient can surpass that of caring for patients with depression or even those with psychoses. Some difficult areas for caregivers include lack of information about the illness, communication issues and conflicts with the patient, and difficulties grappling with the chronic and long-term nature of most EDs.
Drs. Norbert Quadflieg and Manfred M. Fichter, and colleagues at Ludwig-Maximilians University in Munich and Prien, Germany, recently tested a video-based intervention program offering skills training for caregivers of ED patients (Eur Eat Disorders Rev. 2017; 25:283).The authors’ randomized controlled study measured the effectiveness of video-based programs to help address some of the key challenges in caregiving for a patient with an ED.
The video-based skills training was tested in a group of 285 caregivers who were assigned either to a video intervention group (n=147) or to a control group (n=138). All the participants were caring for inpatients being treated with CBT for at least one month in hospital units specially designed for ED patients. Before and after inpatient treatment, caregivers were involved in daily care of the patient, living in the same household with the patient, or having face-to-face contact with the patient at least once a week.
The program was a German adaptation of a DVD-based intervention for caregivers that was developed by a work group of Dr. Janet Treasure in London. Each study team included clinical psychologists who were at least at the master level in training for psychotherapy.
Caregivers in the study group received a series of 5 DVDs and written materials; an evaluation form for each DVD was then filled out and returned by the caregiver(s). Those in the control group had no intervention from the study team. All patients underwent regular psychotherapy sessions while in the hospital, and caregivers in the study group attended two additional group sessions with a special video intervention moderated by the study team. Several questionnaires, including the Caregivers’ Needs Assessment Measure (Haigh and Treasure, 1999), were then used to assess the caregivers’ burden related to the eating disorder.
At follow-up, decreased levels of stress were reported.
Caregivers reported being very satisfied with their video training, and 90% completed all evaluation forms after viewing the DVDs. Baseline levels of burden and psychological distress were similar among all participants. Caregivers’ burden and psychological distress decreased from baseline levels to follow-up. Caregivers who had professional help or counseling in addition to the video program had increased relief.
The authors were surprised to find that their video intervention did not affect caregivers’ accommodating behaviors, and suggest this may have been a sign that the intervention was not strong enough to change behaviors in caregivers once their loved ones were released from inpatient treatment. The authors further suggest adding active behavioral training for caregivers to help them modify accommodating behavior. One further proposal was that additional professional help for caregivers could increase the effectiveness of video intervention.
These results do show further support for this program to diminish caregiver burden and distress.