Cognitive Behavioural Therapy for Carepartners

Caring for someone living with Parkinson’s disease (PD) can be both rewarding and demanding, resulting in the carepartner experiencing a range of emotions throughout their journey. While every emotion is valid, carepartners may find that certain ones, like loneliness, anxiety, and sadness, contribute to burnout and depression. Fortunately, there exists a well-studied, evidence-based psychological treatment called cognitive behavioural therapy (CBT) that can help carepartners reframe their thoughts (also called cognitions), which, in turn, will have a positive impact on their emotions and behaviours. The result is that carepartners can lead more fulfilling, happy lives. One study of 30 caregivers of people with Parkinson’s showed that three months of CBT resulted in caregivers reporting less strain and emotional burden. The especially promising finding was that the benefits appeared to persist long after the initial CBT treatment (Secker & Brown, 2005).

At the heart of cognitive behavioural therapy lies the idea that our thoughts, emotions, and behaviours are interconnected. CBT places a strong emphasis on the importance of changing irrational thinking patterns, as they can lead to unhealthy emotions and behaviours. Changing unhealthy patterns also often results in someone feeling better and adopting a more balanced view of themselves and the world. However, it is important to clarify that CBT is not about forcing yourself to think only positive thoughts while ignoring negative feelings.

To demonstrate the link between thoughts, emotions, and behaviours, an example scenario is useful. Let us say a friend calls you and offers to care for your loved one for a few hours so you can have some respite. Using the examples below will help to illustrate the three types of cognitions in the CBT model:

1. Automatic negative thoughts (ANTs): these thoughts occur without our conscious awareness, usually immediately in response to an event. ANTs make up a large portion of self-talk. Because they are often fleeting in nature, it is common to notice the emotions they invoke, not the thoughts themselves. This is why sometimes we feel a negative emotion, but cannot pinpoint the precise thought that led to the feeling. One of the most powerful ways CBT helps us feel better is by breaking a situation down slowly and uncovering the negative thoughts that spark our emotions. In the scenario above, your automatic negative thought might be, “I shouldn’t accept help from my friend. They are probably too busy with their own life, anyway. I should always be able to provide care without anyone’s assistance.”
2. Cognitive distortions: these are irrational, unhealthy thinking patterns that reinforce automatic negative thoughts. Because humans have a tendency to focus on the negative more easily than the positive, our perceptions of reality can easily become distorted. A few types of cognitive distortions include: overgeneralization (seeing a pattern based on a single event), catastrophizing (seeing only the worst possible outcome), all-or-nothing thinking (using absolutes, such as “always” and “never”), mental filtering (only acknowledging information that fits a negative belief system), and jumping to conclusions (imagining you know what others are thinking, as well as predicting something bad will happen without evidence). In the scenario above, the cognitive distortions experienced may be all-or-nothing thinking and jumping to conclusions.
3. Core beliefs: these are thoughts we have adopted as truth about ourselves, others, and the world. Core beliefs are often informed by early experiences, as they were a way we made sense of the world in childhood. They become the lens through which we see everything, but it is important to note that no matter how compelling or true they feel, they are merely beliefs. In the scenario above, a core belief might be, “If I am not perfect, I am not good enough.” Another might be, “People are unreliable, and I cannot depend on them.”

Using the example above, the negative thoughts may lead to feelings of sadness or even irrational anger at your friend for offering their help. As a result, your behaviour might cause you to isolate yourself. If you feel sad and isolated, you are more likely to continue to have negative thoughts – and so the cycle continues.

CBT proposes several interventions that can help you reframe your negative thoughts so you feel better and behave in healthier ways. They include:

• The ABC model: this model helps you understand your irrational and negative beliefs by breaking a situation down into the activating event (what happened), your beliefs (the meanings you assign to the event), and the consequences (the emotions and behaviours you experience). We often think that an activating event directly leads to consequences (ex: “My husband’s behaviour made me so angry!”), but frequently fail to recognize that the meaning we place on the event plays a big role in how we feel and subsequently act. By exploring and challenging negative beliefs, you can actively change how you respond to a situation.
• Cognitive restructuring: this tool can help you identify and reframe irrational beliefs. One way to do this is through decatastrophizing, which can help you examine different outcomes of an event, including the worst-case scenario. By breaking down a frightening or unpleasant event and considering the worst case, we often find we are more prepared and capable of handling the situation than we originally expected. Another form of cognitive restructuring is to challenge negative thoughts by asking questions like: “Is there another way to look at this situation?”, “Am I making assumptions?”, “What would I tell a friend in a similar situation?”, and “Is there any evidence to support this worry?”
• Behavioural experiments: this technique involves identifying any expectations and worries you have about a situation, predicting the outcome you think will occur, and then testing your hypothesis. Many times, you will be surprised that the negative outcomes predicted do not happen or are less severe if they do.

While there are ample self-help resources for cognitive behavioural therapy, you do not have to do it alone. Parkinson Society BC offers free short-term, non-crisis counselling services for people touched by Parkinson’s disease. Counselling can provide you with a safe and structured environment to discuss and process emotions, learn new coping strategies (including CBT), and provide you with the extra support you and your loved one(s) may need. To learn more, visit www.parkinson.bc.ca/counselling. 

Sources

Secker, D.L. & Brown, R.G. (2005). Cognitive behavioural therapy (CBT) for carers of patients with Parkinson’s disease: a preliminary randomized controlled trial. Journal of Neurology, Neurosurgery & Psychiatry, 76(4), 491-497.

This content was published in the Summer 2023 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.