This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Aging baby boomers, long life spans, and rising levels of chronic, debilitating disease will result in a major caregiver crisis in the near future. Although family caregivers perform an incredibly valuable service for their relatives and the formal health care system, they do so at a considerable cost to themselves both emotionally and physically. If the caregiving system collapses under the weight of unsupported responsibilities, increased acute care and institutionalization of the patients will be likely outcomes. New programs are vitally needed to support and sustain family caregivers. Effective stress management techniques can 1) help to decrease the caregivers' feelings of burden and stress, 2) improve the emotional and physical health of caregivers, and 3) empower caregivers to gain control of their lives. The overall goal of this randomized clinical trial is to determine the effectiveness of a stress-busting program (SBP) for caregivers of patients with chronic neurological diseases including stroke, Alzheimer's disease, multiple sclerosis, and Parkinson's disease. Specific research objectives include: 1. Prospectively determine the effects of a SBP compared to a standard support group (SSG) on quality of life and immune response in caregivers of patients with chronic neurological diseases. Subjects will be tested at baseline, at completion of 6 weeks of SBP or SSG, and at 2- and 4-month follow-up sessions. 2. Determine subjects' relaxation response as well as their response to acute laboratory stressors using bioinstrumentation. Muscle tension, electrodermal response, skin temperature, blood volume pulse, and blood pressure will be measured. Subjects will be tested at baseline, at completion of 6 weeks of a SBP or SSG, and at 2- and 4-month follow-up sessions. 3. Compare the effectiveness of SBP or SSG for adult children caregivers as compared to spousal caregivers based on quality of life measurements, immune parameters, and relaxation response. The proposed multimodal SBP will focus on a variety of approaches based on cognitive behavioral and relaxation response theories. SBP will consist of a 6-week program with 1 1/2-hour sessions per week. The setting will be an educational support group with topics related to stress, stress and challenges of caregiving, depression, coping strategies, positive thinking, and taking time for oneself. In addition, subjects will be taught simple relaxation strategies that they can practice at home. The SSG will meet for 6 weeks for 1 hours per session. A repeated measures design will be used to determine the effectiveness of SBP compared to SSG. Outcomes will be measured using psychosocial instruments as well as state-of-the science technology including bioinstrumentation and immune parameters to measure biological responses. Follow-up testing will be done 2 and 4 months after the end of the SBP or SSG to determine the long-term effectiveness of the intervention. The SBP is proposed as a way to decrease the level of stress experienced by caregivers and teach them effective coping strategies. The hypothesized outcome is an improvement in emotional and physical well-being. If SBP is found to be more effective than SSG in decreasing stress, improving quality of life, promoting relaxation, and/or enhancing immunocompetence in family caregivers, these findings could have important clinical significance for providing a cost effective health promotion strategy for a group of people who experience tremendous ongoing stress.
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