Evaluation of a Workshop to Build Caregiving Capacity and Supports for Families with a Relative with Emotion Dysregulation Symptoms

Background: Family educational interventions have narrowly focused on caregiver burden and specific disorders such as bipolar disorder or borderline personality disorder. However, these interventions have not addressed the needs and challenges of family members who are caring for a loved one with clusters of symptoms involving mood and behavioral dysregulation (such as a major mood disorder with co-occurring borderline personality disorder (BPD)). In response, Mental Health Partnerships (MHP), a local affiliate of Mental Health America, developed and implemented an intervention to meet these unmet needs of families. Because persons with these complex emotional and behavioral challenges are more likely to self-harm and/or be high utilizers of emergency services, family support is critical for this population given the potential for their symptoms to induce a great deal of stress among caregivers. These families encounter high financial cost and encounter much discrimination from society in general and providers in specific. The purpose of this study was to determine the effectiveness of a 10 week Getting Off the Emotional Roller Coaster skills training workshop for family members. This intervention was developed to improve self-efficacy in key skill areas and reduce burden in a context of mutual sharing among family members of people with emotion dysregulation and major mood disorders.

Methods: This quasi-experimental study evaluated the effectiveness of a workshop (Getting Off the Emotional Roller Coaster) in increasing caregiver knowledge, attitudes and skills and reducing caregiver burden. Participants were recruited through emails, virtual flyers, and direct mailings and were assessed for eligibility by staff at MHP. 217 participants in the workshop and 53 participants on a waitlist were asked to complete a pre- and post-questionnaires, which included the Self-Assessment of Attitudes, Knowledge, and Skills (SSAKS) an adapted measure and Burden Assessment Scale (BAS), a psychometrically sound measure. Data were compared using t-tests and ANCOVAs.

Results: The results showed a significantly greater improvement in attitudes, knowledge, and skills (t= 3.42, p=.001) and greater reduction in caregiver burden (F= 12.25, p=.001) for the workshop participants than those on the waitlist, while controlling for differences in pre-test scores. 

Conclusions: These results indicate that the intervention shows great promise for family members who are struggling to provide support for a loved one with BPD, bipolar, and/or major depression. Increasing caregiver skills and decreasing burden help family members better assist loved ones with their recovery and prevent some of the devastating effects of these disorders, such as self-harm, anger problems and high utilization of emergency services that too often precipitate negative reactions toward this population from society and providers, including social workers. Such interventions have the potential of reducing financial costs to families and society in reducing hospitalizations, crisis care and discriminatory practices towards those with these symptoms and their family caregivers.