| Summary: | Background and Aims: Caring for someone with dementia can be a source of significant stress, with many experiencing depression and anxiety (Pinquart & Sorensen, 2006). Despite showing promise for informal care-givers of people with dementia Cognitive Behavioural Therapy has received little systematic appraisal in isolation from other intervention models. The current review aimed to provide a systematic and quantitative appraisal of the evidence for CBT interventions with a primary focus upon anxiety outcomes, and secondary focus upon depression. Methods: A systematic search of relevant databases was conducted. Study characteristics and effect size data were extracted. A series of random-effects meta-analyses were conducted. Subgroup analysis and meta-regression were performed to evaluate impact of intervention and care-giver characteristics. Publication bias and sensitivity analyses were examined. Results: Fourteen studies comparing CBT to active or passive comparators for anxiety in informal dementia care-givers were identified. For both anxiety and depression significant “small” effect sizes, Hedge’s g=-0.15 and g=-0.21 respectively, were identified in favour of CBT over comparators combined. Effect sizes were generally reduced when studies deemed to be outliers were excluded. No significant treatment effects were found for anxiety or depression when CBT was compared to psychoeducation in isolation. Subgroup analysis for anxiety outcomes suggested that care-giver gender and relationship to care-receiver did not impact upon CBT intervention effectiveness. Interventions did not differ significantly according to delivery format; however, the magnitude of the effect was increased when studies without a relaxation component were excluded. Subgroup analyses were limited by lack of clear reporting within studies and therefore should be treated as preliminary. Conclusions: There is a primary need to better understand whether dementia care-givers want help for anxiety and if they do then there is a need to establish what factors are driving their anxiety, specifically whether these factors lend themselves to the CBT model. If the answer is yes to both these questions then further methodologically rigorous clinical trials exploring the effectiveness of CBT for anxiety in informal dementia care-givers are warranted. In particular there is a need for trials employing CBT interventions specifically designed to target anxiety, with theoretically linked and well-defined primary outcomes, with attention given to baseline anxiety symptomatology.
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