Rethinking family caregiving: Tailoring cognitive-behavioral therapies to the hospice experience

Karla T. Washington, Elaine Wittenberg-Lyles, Debra Parker Oliver, Paula K. Baldwin, Jessica Tappana, Jesse H. Wright, George Demiris

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Hospice family caregivers experience significantly higher rates of psychological distress than demographically similar noncaregivers. Interventions based on cognitive-behavioral therapy have been shown to reduce psychological distress in the general population by providing tools to modify thinking patterns that directly affect emotions and behavior. Such interventions might reasonably be incorporated into hospice social work; however, numerous contextual factors must be taken into account to ensure that any interventions are appropriate to the unique needs of clients. The purpose of the study discussed in this article was to contextualize one aspect of the cognitive-behavioral model based on firsthand accounts of hospice family caregivers. Following a modified grounded theory approach, researchers engaged in a secondary analysis of data from a larger study provided in a subsample of 90 audio-recorded conversations between hospice family caregivers and interventionists. Findings indicated that distressed caregivers engaged in five dominant thinking patterns: (1) "should" statements, (2) catastrophizing or minimizing, (3) personalizing, (4) absolute thinking, and (5) making assumptions. Implementing cognitive-behavioral therapies based on identified caregiver thinking patterns will allow hospice social workers to empower caregivers to cope more effectively with the numerous stressors they encounter while caring for a dying loved one.

Original languageEnglish
Pages (from-to)244-250
Number of pages7
JournalHealth and Social Work
Issue number4
StatePublished - Nov 1 2014


  • Caregivers
  • Cognitive-behavioral therapy
  • Hospices
  • Palliative care


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