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Existential behavioral therapy for informal caregivers of palliative patients: Barriers and promoters of support utilization
- Tamara Thurn, Monika Brandstätter, Veronika Fensterer, Helmut Küchenhoff, Martin Johannes Fegg
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- Journal:
- Palliative & Supportive Care / Volume 13 / Issue 3 / June 2015
- Published online by Cambridge University Press:
- 06 June 2014, pp. 757-766
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Objective:
Several interventions have been developed during recent years to support informal caregivers of palliative patients. However, these trials reported low enrollment rates. Employing a newly developed group intervention, existential behavioral therapy (EBT), one study reported that only 13.6% of approached informal caregivers participated. The purpose of our present study was to identify the reasons for this low enrollment rate in order to improve future support designs.
Method:All participants in the EBT trial (intervention vs. standard-care control group) as well as those who declined participation during a 4-month recruitment period were studied prospectively over 12 months. Andersen's behavioral model of healthcare service use was employed to identify group differences between acceptors and decliners: predisposing (age, gender, education, family status, relationship), enabling (social support, distance to hospital, caring vs. bereaved), and need factors (psychological distress, quality of life) were evaluated in a binary-logistic model.
Results:Some 94 decliners were compared to 160 EBT participants (n = 81 intervention, n = 79 control). Caregivers who took part were significantly more distressed and suffered from a lower quality of life compared to decliners. Not only these need factors but also predisposing (age <55 years) and enabling (use of social/professional support, familiarity with caregiving institution) factors were associated with EBT utilization. At the 12-month follow-up, EBT intervention participants reported greater quality of life improvements than decliners or controls (p = 0.05). While all groups had mean anxiety scores below the cutoff at 12-month follow-up, decliners showed better improvement in anxiety compared to EBT participants (intervention p = 0.04, controls p = 0.03).
Significance of results:On average, decliners are less burdened: they may be more resilient, may have better coping strategies, or already have a sufficient support network in place. Screening caregivers with regard to their experienced quality of life and targeting those in need, especially younger caregivers with low levels of quality of life, may help to allocate resources more appropriately.
Mindfulness in informal caregivers of palliative patients
- Monika Kögler, Monika Brandstätter, Gian Domenico Borasio, Veronika Fensterer, Helmut Küchenhoff, Martin Johannes Fegg
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- Journal:
- Palliative & Supportive Care / Volume 13 / Issue 1 / February 2015
- Published online by Cambridge University Press:
- 17 June 2013, pp. 11-18
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Objectives:
Mindfulness is a concept of growing impact on psychotherapy and has been shown to be effective for stress reduction and to improve psychological well-being. Existential Behavioural Therapy (EBT) was developed to support relatives of palliative care (PC) patients to cope with their situation during caregiving and bereavement. Mindfulness training was a core element of the intervention.
We investigated the relationship between mindfulness, mental distress, and psychological well-being in informal caregivers, and evaluated if the effects of the intervention were mediated by mindfulness.
Methods:Relatives of PC inpatients took part in a randomized-controlled EBT trial and completed the Cognitive and Affective Mindfulness Scale-Revised, items from the Five Facets of Mindfulness as well as the Brief Symptom Inventory, the Satisfaction with Life Scale, the WHOQOL-BREF, a numerical rating scale on quality of life (range 0–10), and the Schedule for Meaning in Life Evaluation at pre- and post-intervention, and a 3- and 12-months follow-up.
Results:One-hundred-and-thirty carers were included, most of them (71.6%) recently being bereaved at the beginning of the intervention. High correlations between mindfulness and mental distress (r = −0.51, p < 0.001) as well as life satisfaction (r = 0.52, p < 0.001) were found. Mindfulness was a significant predictor of improvement in psychological distress, meaning in life and quality of life three months after the intervention. The EBT effects were partly mediated by mindfulness.
Significance of results:Mindfulness seems to be a promising concept in supporting informal caregivers of PC patients. Further research is needed to identify the required format and intensity of mindfulness practice necessary for improvement.
Robust syntaxin-4 immunoreactivity in mammalian horizontal cell processes
- ARLENE A. HIRANO, JOHANN HELMUT BRANDSTÄTTER, ALEJANDRO VILA, NICHOLAS C. BRECHA
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- Journal:
- Visual Neuroscience / Volume 24 / Issue 4 / July 2007
- Published online by Cambridge University Press:
- 20 July 2007, pp. 489-502
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Horizontal cells mediate inhibitory feed-forward and feedback communication in the outer retina; however, mechanisms that underlie transmitter release from mammalian horizontal cells are poorly understood. Toward determining whether the molecular machinery for exocytosis is present in horizontal cells, we investigated the localization of syntaxin-4, a SNARE protein involved in targeting vesicles to the plasma membrane, in mouse, rat, and rabbit retinae using immunocytochemistry. We report robust expression of syntaxin-4 in the outer plexiform layer of all three species. Syntaxin-4 occurred in processes and tips of horizontal cells, with regularly spaced, thicker sandwich-like structures along the processes. Double labeling with syntaxin-4 and calbindin antibodies, a horizontal cell marker, demonstrated syntaxin-4 localization to horizontal cell processes; whereas, double labeling with PKC antibodies, a rod bipolar cell (RBC) marker, showed a lack of co-localization, with syntaxin-4 immunolabeling occurring just distal to RBC dendritic tips. Syntaxin-4 immunolabeling occurred within VGLUT-1-immunoreactive photoreceptor terminals and underneath synaptic ribbons, labeled by CtBP2/RIBEYE antibodies, consistent with localization in invaginating horizontal cell tips at photoreceptor triad synapses. Vertical sections of retina immunostained for syntaxin-4 and peanut agglutinin (PNA) established that the prominent patches of syntaxin-4 immunoreactivity were adjacent to the base of cone pedicles. Horizontal sections through the OPL indicate a one-to-one co-localization of syntaxin-4 densities at likely all cone pedicles, with syntaxin-4 immunoreactivity interdigitating with PNA labeling. Pre-embedding immuno-electron microscopy confirmed the subcellular localization of syntaxin-4 labeling to lateral elements at both rod and cone triad synapses. Finally, co-localization with SNAP-25, a possible binding partner of syntaxin-4, indicated co-expression of these SNARE proteins in the same subcellular compartment of the horizontal cell. Taken together, the strong expression of these two SNARE proteins in the processes and endings of horizontal cells at rod and cone terminals suggests that horizontal cell axons and dendrites are likely sites of exocytotic activity.
Development of glutamatergic synapses in the rat retina: The postnatal expression of ionotropic glutamate receptor subunits
- IRIS HACK, PETER KOULEN, LEO PEICHL, JOHANN HELMUT BRANDSTÄTTER
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- Journal:
- Visual Neuroscience / Volume 19 / Issue 1 / January 2002
- Published online by Cambridge University Press:
- 28 June 2002, pp. 1-13
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We examined the distribution of the AMPA glutamate receptor subunits GluR1 to GluR4, of the kainate receptor subunits GluR6/7 and KA2, and of the glutamate receptor subunits δ1/2, during postnatal development of the rat retina by immunocytochemistry and light microscopy using receptor subunit specific antisera. The various ionotropic glutamate receptor subunits were expressed early in postnatal rat retina, and most of the subunits, with the exception of δ1/2, were found in both synaptic layers of rat retina. The glutamate receptor subunits studied showed differences in their time of appearance, their spatial distribution patterns, and in their expression levels in the developing rat retina. Interestingly, most of the AMPA receptor subunits were expressed earlier than the kainate receptor subunits in the two synaptic layers of the retina, indicating that AMPA glutamate receptors play an important role in early postnatal glutamatergic synaptic transmission. We also studied the ultrastructural localization of the AMPA glutamate receptor subunits GluR1 to GluR4 by immunocytochemistry and electron microscopy in the inner plexiform layer of the mature rat retina. Most of the subunits were found postsynaptic to the ribbon synapses of OFF-cone, ON-cone, and rod bipolar cells. The results of this study suggest an involvement of ionotropic glutamate receptors in processes of synaptic maturation and the formation of synaptic circuitries in the developing plexiform layers of the retina. Furthermore, AMPA and kainate receptors play a role in synaptic processing and in the development of both the scotopic and photopic pathways in the rat retina.