Spinal cord injury (SCI) may result in physical limitations such that receiving assistance from others is critical to maintaining health and facilitating full social integration. The assistance ranges from helping with basic daily activities such as bowel and bladder management, hygiene and dressing, to instrumental activities of daily living, including managing household finances, shopping, or transportation. The challenges that accompany a caregiving role may result in a caregiver's inability to balance responsibilities at home and in the workplace. In addition, there is a tendency for caregivers to neglect their own health, which may jeopardize the ability of the person with SCI to obtain the necessary care and support required for optimal independent functioning. Vulnerability and resilience to the ongoing stresses associated with caregiving for a loved one with SCI may be influenced by personal beliefs about the caregiver's capabilities for coping with them. People's belief about their capabilities for successfully performing tasks that affect their lives has been termed "self-efficacy".

For family caregivers of individuals with SCI, self-efficacy beliefs are essential for coping with the stressors that are experienced in the caregiving role. Anxiety, depression, and a sense of "losing" one's own identity are frequently reported by family caregivers. However, there has been relatively little research regarding caregiving in SCI and even fewer treatment options to enhance self-efficacy for these caregivers. The proposed study involves a randomized clinical trial to examine the effect of an intervention specifically designed by and for family caregivers to help improve self-efficacy and reduce emotional distress associated with it. The goal of this project is to test a six-week manualized, cognitive-behaviorally based group educational intervention to improve family caregivers' self-efficacy beliefs and skills, improve their resilience to the ongoing stresses associated with caregiving, and enhance their overall quality of life with the potential added benefit of improving the quality of life for their family members with SCI. Investigators hypothesize that by providing family caregivers with this educational intervention, the intervention can improve their self-efficacy skills as well as general life satisfaction, and minimize depression, stress and anxiety associated with caregiving. The proposed intervention consists of weekly facilitator-led sessions for a total of 6 weeks and includes didactic presentations of 8 key principles, discussion topics and experiential exercises such as goal setting and problem solving with extensive group discussion. At the end of each session, tasks are assigned to participants to be completed outside the group prior to the next meeting. Session content is organized around concepts of identifying and building character strengths, cultivating positive emotion through focusing on gratitude and on the good in one's life, experientially engaging in pleasurable activities, and accomplishing personal goals. The innovation of the proposed intervention lies in its integration of positive psychotherapy concepts into structured group CBT to develop optimistic self-efficacy beliefs, thereby strengthening the caregiver's resilience to emotional distress, enhancing a sense of well-being in the caregiver which, in turn, may benefit the family member with SCI.