Table 1 Description of sessions
No | Topic | Therapeutic strategies | Setting |
|---|---|---|---|
Module 1: Diagnosis and goal setting | |||
1 | Diagnostic investigation | Diagnostic interview: comprehensive assessment of affective and behavioural symptoms, burden of caregiver, resources | Joint |
2 | Behaviour analysis and goal setting | Analysis of situation, behaviours, emotion, cognition, consequences; setting individual goals; planning interventions for joint and separate sessions | Joint |
Module 2: Psychoeducation | |||
3 | Psychoeducation | Providing information regarding disease, course, cause, medication, psychosocial interventions, support possibilities; adopting external memory aids (notebook, lists, signs for orientation, etc.); introducing mood journal | Joint |
Module 3: Engagement in pleasant activities | |||
4 | Setting the stage for pleasant activities | Explaining relation of behaviour (e.g., inactivity), mood (e.g., depression), neuronal degeneration and cognitive decline; developing a personal list of pleasant activities; introducing activity journal | Joint |
5 | Planning of pleasant activities | Selection of pleasant (social, physical, leisure) activities; planning of pleasant activities in a structured weekly schedule | Possibly without caregiver |
6 | Establishing regular activities | Discussing problems and progress with regular pleasant activities; motivation strategies to form habits (reinforcing by rewards; positive self-talk); introducing thought journal | Joint |
Module 4: Cognitive restructuring | |||
7 | Setting the stage for cognitive restructuring | Assessing typical negative (depression, anxiety, or anger related) and positive thoughts; completing the event–thought–emotion schema on the basis of recent examples; finding alternative thoughts | Joint |
8 | Challenging negative thoughts | Repetition of event–thought–emotion schema; challenging dysfunctional thoughts; repetition of finding alternative thoughts; describing thought control techniques (card and signal techniques) | Possibly without caregiver |
9 | Practising helpful thoughts | Discussing problems and progress with thought control techniques; strategies for practising helpful thoughts; introducing life review: structure and tools (e.g., photographs) | Joint |
Module 5: Life review | |||
10 | Childhood | Reminiscence of positive experiences in childhood | 1 or 2 sessions joint, 2 or 3 sessions without caregiver |
11 | Adolescence | Reminiscence of positive experiences in adolescence | |
12 | Young adulthood | Reminiscence of positive experiences in young adulthood | |
13 | Older adulthood | Reminiscence of positive experiences in older adulthood; integration: review significant successes, reframe difficult times | |
Module 6: Training caregiver in behaviour management techniques | |||
14 | Setting the stage for behaviour management | Identifying problem behaviours, their precursors and consequences; describing the techniques: planning and implementing an intervention; evaluating an intervention; providing the caregiver (and patient) with methods to change precursors and consequences of behaviour (part 1) | Joint |
15 | Changing problem behaviour, part 1 | Discussing the methods to change precursors and consequences of behaviour (part 1); discussing progress; discussing methods to change precursors and consequences of behaviour (part 2) | Joint |
16 | Changing problem behaviour, parts 2 and 3 | Discussing progress; discussing the methods to change precursors and consequences of behaviour (part 3) (or repetition of behaviour parts 1 and 2) | Possibly without patient |
Module 7: Interventions for the caregiver (parallel to sessions 4–16) | |||
i | Stress management and emotion regulation | Analyzing stressors, thoughts, emotional and behavioural reactions; self-monitoring of thought and behaviour; training in problem solving, cognitive reframing, relaxation techniques | Only caregiver |
ii | Pleasant activities | Developing a personal list of pleasant activities; keeping an activity journal; selection of pleasant (social, physical, leisure) activities; planning of pleasant activities in a structured weekly schedule; discussing problems and progress with regular pleasant activities | Only caregiver |
iii | Social support | Analyzing social support network; acceptance of formal and informal support (including cognitive restructuring); strategies of utilization of social support; communication with others about burden | Only caregiver |
iv… | Approximately four sessions, but as many as needed | Only caregiver | |
Module 8: Couples counselling | |||
17 | Setting the stage for couples counselling | Analyzing emotions regarding relationship, wishes, expectations, fears, typical conflicts, etc.; identifying core problems; oral history interview | Joint |
18 | Communication and joint problem-solving training | Improving communication style (roles as speaker and listener), training communication sequences; identify old and new coping strategies; establishing joint activities; maintaining important elements | Joint |
19 | Acceptance and planning for the future | Gradually challenging the view that everything is continuing normally; adapting to new roles (dependence, responsibility); joint planning of future care with a discussion of uncertainties and worries experienced by patient and caregiver | Joint |
Closing of therapy | |||
20 | Summary and reflection | Goal attainment scaling; evaluation of strategies; future planning | Joint |