Applied Gratitude Therapy in Cerebral Palsy’s Caregiver to Reduce Subjetive Burden: A Single-Case Design

Siti Rahmah, Muhana Sofiati Utami
(Submitted 20 February 2023)
(Published 31 May 2023)


The task of caregivers could potentially lead to an experience that produces negative emotions within themselves. The negative emotions will ultimately have implications for creating a subjective burden on caregivers. This study aims to determine the effect of gratitude therapy to reduce the subjective burden on cerebral palsy caregivers. Participants in this study were 3 caregivers of cerebral palsy whose children had motor skills at 3-5 GMFCS levels and had subjective burden based on the Zarit Caregiver Burden Scale (ZCBS). The experimental design uses small n single-case type A-B-A. Hypothesis testing is done quantitatively by using visual inspection technique followed by descriptive analysis. The result of this study shows a decrease of subjective burden in all participants.


gratitude therapy; subjective burden; caregiver; single case

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DOI: 10.22146/gamajpp.82438


Abayomi, O., Akinhanmi, A. O., & Adelufosi, A. O. (2015). Psychiatric morbidity and s burden among carers of outpatients of a psychogeriatric clinic in Southwestern Nigeria. Journal of Cross-Cultural Gerontology, 30(4), 439–450.

Al-Jauziyyah, I. al-Q. (2015). Sabar dan syukur; Mengungkapkan rahasia di balik keutamaan sabar dan syukur. Pustaka nuun.

Anggarani, F. K., Andayani, T. R., & Karyanta, N. A. (2010). Pengaruh pelatihan syukur terhadap subjective well-being pada penduduk miskin di Surakarta. 44–59. Psikologi: Universitas Sebelas Maret

Aschbacher, K., von Kanel, R., Dimsdale, J. E., Patterson, T. L., Mills, P. J., Mausbach, B. T., Allison, M. A., Ancoli-Israel, S., & Grant, I. (2006). Dementia severity of the care receiver predicts procoagulant response in Alzheimer caregivers. The American Journal of Geriatric Psychiatry : Official Journal of the American Association for Geriatric Psychiatry, 14(8), 694–703.

Barker, C., Pistrang, N., & Elliott, R. (2015). Small-N Designs. In Research methods in clinical psychology : an introduction for students and practitioners. (3rd ed., pp. 162–177). John Wiley & Sons, Incorporated.

Barker, J., McCarthy, P., Jones, M., & Moran, A. (2011). Single-case research methods in sport and exercise psychology. In Single-Case Research Methods in Sport and Exercise Psychology.

Bayoumi, M. M. (2014). Subjective burden on family carers of hemodialysis patients. Open Journal of Nephrology, 04(02), 79–85.

Bono, G., & McCullough, M. E. (2006). Positive responses to benefit and harm: Bringing forgiveness and gratitude into cognitive psychotherapy. Journal of Cognitive Psychotherapy, 20(2), 147–158.

Brouwer, W. B. F., van Exel, N. J. A., van de Berg, B., Dinant, H. J., Koopmanschap, M. A., & van den Bos, G. A. M. (2004). Burden of caregiving: Evidence of objective burden, subjective burden, and quality of life impacts on informal caregivers of patients with rheumatoid arthritis. Arthritis and Rheumatism, 51(4), 570–577.

Cahyandari, R., Nashori, F., & Sulistyarini, I. (2015). Efektivitas pelatihan kebersyukuran untuk meningkatkan kualitas hidup pasien penyakit paru obstruktif kronik (PPOK). Jurnal Intervensi Psikologi (JIP), 7(1).

Caqueo-Urízar, A., Gutiérrez-Maldonado, J., & Miranda-Castillo, C. (2009). Quality of life in caregivers of patients with schizophrenia: A literature review. Health and Quality of Life Outcomes, 7(1), 84.

Chou, K. R. (2000). Caregiver burden: A concept analysis. Journal of Pediatric Nursing, 15(6), 398–407.

Cohen, A., Eaton, J., Radtke, B., George, C., Manuel, B., De Silva, M., & Patel, V. (2011). Three models of community mental health services In low-income countries. International Journal of Mental Health Systems, 5(1), 3.

Cooper, C., Balamurali, T. B. S., & Livingston, G. (2007). A systematic review of the prevalence and covariates of anxiety in caregivers of people with dementia. International Psychogeriatrics, 19(September 2006), 175–195.

Corey, G. (2012). Theory and practice of group counseling (8th ed.).

Dambi, J. M., Jelsma, J., Mlambo, T., Chiwaridzo, M., Dangarembizi-Munambah, N., & Corten, L. (2016). An evaluation of psychometric properties of caregiver burden outcome measures used in caregivers of children with cerebral palsy: a systematic review protocol. Systematic Reviews, 5, 42.

DeWall, C. N., Lambert, N. M., Pond, R. S., Kashdan, T. B., & Fincham, F. D. (2011). A grateful heart is a nonviolent heart: Cross-sectional, experience sampling, longitudinal, and experimental evidence. Social Psychological and Personality Science, 3(2), 232–240.

Dewanto, W., & Retnowati, S. (2015). Intervensi kebersyukuran dan kesejahteraan penyandang disabilitas fisik. Gadjah Mada Journal of Professional Psychology, 1(1), 33–47. 2407-7801

Domenech, A. P., Tavares, K. O., & Ruedell, A. M. (2016). Cerebral palsy : the meaning of physical therapy for mother caregivers. Fisioter Mov., 29(4), 757–765.

Emmons, R. A. (2007). Thanks!: How the new science of gratitude can make you happier. Houghton Mifflin Company.

Emmons, R. A., & Kneezel, T. T. (2005). Giving thanks : Spiritual and religious correlates of gratitude. Journal of Psychology and Christianity, 24(2), 140–148. 0733^273

Emmons, R. A., & McCullough, M. E. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subjective well-being in daily life. Journal of Personality and Social Psychology, 84(2), 377–389.

Emmons, R. A., & Stern, R. (2013). Gratitude as a psychotherapeutic intervention. Journal of Clinical Psychology, 69(8), 846–855.

Felizardo, S., Ribeiro, E., & Amante, M. J. (2016). Parental adjustment to disability, stress indicators and the influence of social Support. Procedia - Social and Behavioral Sciences, 217, 830–837.

Gupta, V. B. (2007). Comparison of parenting stress in different developmental disabilities. Journal of Developmental and Physical Disabilities, 19(4), 417–425.

Gutiérrez-Maldonado, J., & Caqueo-Urízar, A. (2007). Effectiveness of a psycho-educational intervention for reducing burden in latin american families of patients with schizophrenia. Quality of Life Research, 16(5), 739–747.

Indonesian Ministry of Health (2014), Bulletin of Health Data and Information Window: Situation of Persons with Disabilities. Jakarta: Indonesian Ministry of Health.

Jones, S. L. (1996). The association between objective and subjective caregiver burden. Archives of Psychiatric Nursing, 10(2), 77–84.

Jonker, L., & Greeff, A. P. (2009). Resilience factors in families living with people with mental illnesses. Journal of Community Psychology, 37(7), 859–873.

Kannan, H., Bolge, S. C., del Valle, M., Alvir, J., & Petrie, C. D. (2011). The association between alzheimer’s disease symptom severity and caregiver outcomes. The Primary Care Companion For CNS Disorders, 13(3), 1–13.

Kheng, S. B. (2005). The impact of schizophrenia: the burden of care. Kent Ridge: University of Singapore.

Krause, N., Bruce, D., Hayward, R. D., & Woolever, C. (2014). Gratitude to god, self-rated health, and depressive symptoms. Journal for the Scientific Study of Religion, 53(2), 341–355.

Kuipers, E., & Bebbington, P. E. (2006). Research on burden and coping strategies in families of people with mental disorders: Problems and perspectives. In N. Sartorius, J. Leff, J. J. Lopez-Ibor, M. Maj, & A. Okasha (Eds.), Families and Mental Disorders (pp. 1–303). John Wiley & Sons, Inc.

Kumar, R., Kaur, S., & Reddemma, K. (2017). Impacts of burden on use of coping styles among stroke caregivers. The International Journal of Indian Psychology, 4(2). 2348-5396 (e) | ISSN: 2349-3429 (p)

Kumari, R., & Singh, S. P. (2013). Stress and coping among mothers of cerebral palsy clients with a view to prepare a management protocol. International Journal of Education and Research, 0033, 9–14. 2348-0033

Landry, M. D., Raman, S. R., Harris, E., Madison, L., Parekh, M., Banks, C., Bhatti, H., & Wijesinghe, C. (2015). Exploring the factors that influence the perceptions of disability: a qualitative study of mothers of children with disabilities at a community-based rehabilitation centre in Sri Lanka. WHO South-East Asia Journal of Public Health, 4(2).

Lau, B. H. P & Cheng, C. (2015). Gratitude and coping among familial caregivers of persons with dementia. Aging & Mental Health, 7863(November), 1–9.

Lies, J., Mellor, D., & Hong, R. Y. (2014). Gratitude and personal functioning among earthquake survivors in Indonesia. Journal of Positive Psychology, 9(4), 295–305.

Listiyandini, R. A., Nathania, A., Syahniar, D., Sonia, L., & Nadya, R. (2015). Mengukur rasa syukur : Pengembangan model awal skala bersyukur versi Indonesia. Jurnal Psikologi Ulayat, 2(2), 473–496.

Lyubomirsky, S., King, L., & Diener, E. (2005). The benefits of frequent positive affect: Does happiness lead to success? Psychological Bulletin, 131


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