Cognitive reframing may help reduce anxiety, depression and stress in carers of people with dementia


Cognitive reframing is a technique used to reduce unrealistic or irrational thoughts and think in a more constructive way instead. It’s used as part of cognitive behavioural therapy.

Carers of people with dementia sometimes respond inappropriately to the behaviour of the person with dementia. The stress and pressure of caring for their loved one may produce a self-defeating attitude or a lack of confidence in their own performance as a carer.

This systematic review from the Cochrane Dementia Group set out to evaluate the effectiveness of cognitive reframing interventions for family carers of people with dementia on their psychological morbidity and stress.

The reviewers conducted a comprehensive literature search and found 11 randomised controlled trials to include in their review.

When they combined the results of the trials they found a beneficial effect of cognitive reframing interventions on carers’ psychological morbidity, specifically:

  • Anxiety (standardised mean difference (SMD) -0.21; 95% confidence interval (CI) -0.39 to -0.04)
  • Depression (SMD -0.66; 95% CI -1.27 to -0.05)
  • Subjective stress (SMD -0.23; 95% CI -0.43 to -0.04)

No effects were found for carers’ coping, appraisal of the burden, reactions to their relatives’ behaviors, or institutionalization of the person with dementia.

The reviewers concluded:

Cognitive reframing for family carers of people with dementia seems to reduce psychological morbidity and subjective stress but without altering appraisals of coping or burden. The results suggest that it may be an effective component of individualised, multi-component interventions for carers. Identifying studies with relevant interventions was a challenge for this review. The impact of cognitive reframing might be higher when used alongside other interventions because this offers better opportunities to tailor cognitive reframing to actual everyday carer problems.

Vernooij-Dassen M, Draskovic I, McCleery J, Downs M. Cognitive reframing for carers of people with dementia. Cochrane Database of Systematic Reviews 2011, Issue 11. Art. No.: CD005318. DOI: 10.1002/14651858.CD005318.pub2.

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Andre Tomlin

André Tomlin is an Information Scientist with 20 years experience working in evidence-based healthcare. He's worked in the NHS, for Oxford University and since 2002 as Managing Director of Minervation Ltd, a consultancy company who do clever digital stuff for charities, universities and the public sector. Most recently André has been the driving force behind the Mental Elf and the National Elf Service; an innovative digital platform that helps professionals keep up to date with simple, clear and engaging summaries of evidence-based research. André is a Trustee at the Centre for Mental Health and an Honorary Research Fellow at University College London Division of Psychiatry. He lives in Bristol, surrounded by dogs, elflings and lots of woodland!

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