Table 1

 Modules used in the trial of CBT for Parkinson’s carers

Education and introduction to cognitive behavioural therapyFactual misperceptions are a common source of carer stress and should be dealt with outright. In the first session questions about Parkinson’ s disease were discussed fully and relevant information was given to take home. The module progressed to a discussion about the therapy itself, and a review of the carer’s goals and expectations. This provides a non-threatening forum for the initial development of rapport and set a constructive collaborative precedent for the coming sessions
Accessing community resources and supportsA central characteristic of Parkinson’s disease carers who cope well is a full understanding of the multidisciplinary network and other support systems. In this module, the carer’s support network was reviewed and information provided where necessary. The carer worked on how to access and communicate effectively with available services
Pleasant activity schedulingThis module consisted primarily of (a) encouraging the carer to make designated times for recreation without the person they care for, doing things they themselves enjoy and (b) designating times to engage in enjoyable things with the person they care for that do not involve normal care duties
Relaxation trainingThis module focused on practical strategies for the relief of anxiety and tension
Sleep improvementA common problem for caregivers of chronically ill patients is the lack of restorative unbroken sleep. This module covered several basic skills to help the carer to improve their own sleep-preparation behaviour and also ways to manage the sleep problems of the individual with Parkinson’s disease
Identifying and challenging negative thoughts and feelingsThis module was targeted at those carers with recurrent negative thinking patterns contributing to stress. This was most suitable for carers presenting with depression, anxiety, and persistent worry. Skills taught included identifying and rating negative feelings, automatic thought recording, and rationalising guilt
Challenging maladaptive rules and core beliefsCarers who benefited from module 6 were encouraged to progress to a more complex level of cognitive therapy, including awareness of intermediate beliefs such as rules and conditional assumptions around caring, and to the restructuring of core schematic beliefs (for example, “I am a bad carer”, and “There is no future”)
Review, planning for the future, and ending of treatmentThis final module reviewed all of the previous modules, and created a therapeutically appropriate termination of therapy for the carer. The need for supplementary sessions was addressed at this stage. Long term goal planning was addressed. Extra assistance was provided to those carers supporting someone in the near-palliative or very advanced stages of Parkinson’s disease, such as approaching the issues of nursing home placement, legal issues such as will making, and structured planning for the future