Emotions Drive Behavior

Last week's blog was about thinking skills. Because we use abstract thinking to evaluate and make decisions about emotions, it is important to know about the different kinds of thinking. If you haven't already read last week's blog, please scroll down and read it now.

This week's blog is about emotions in general. Understanding how they work can help the care partner deal better with the often frustrating behavioral and psychological symptoms of dementia (BPSD).

Emotions drive behavior. This is the case with everyone. We run away or relax, depending on the emotions we have and how we chose to respond to them.

Negative emotions are motivators, and can be quite stressful. These emotions cause the body to secrete those "fight or flight," stress-increasing hormones. They are usually intense, drawing and holding one's attention, and demanding change, and pressing for movement away from the discomfort they cause.

Positive emotions are calming. They cause the body to secrete "feel good," stress-reducing hormones. These emotions are centering, bringing about relaxation and calmness. They are seldom intense; instead their mildness allows a person to stay in a comfortable space.

The ability to feel emotions does not fade. It lasts to the end of life. Apathy can weaken emotions, but they never completely disappear. As the ability to think abstractly fades, emotions take a greater part in a person's decision-making. That is, the PlwD acts on feelings without considering their validity.

It takes about six (6) positive events to counteract one (1) negative event. This is because positive emotions tend to be subtle and negative emotions tend to be intense. Ex: Six complements to counteract one complaint. Because in our culture, we tend to discount positives, it could take even more!

There are drugs that can affect emotions, but they usually have other actions too. Therefore, try non-drug options first. Even if they don't work alone, they will often decrease the amount of drugs needed for the effect you want.

With these principles in mind, a care partner can work to avoid or remove anything that might cause negative feelings while preserving or bringing about anything that might cause positive ones. The more comfortable and relaxed a PlwD is, the fewer BPSD they will have. That's actually the basis for stress management: decrease negative feelings and increase positive feelings.

Of course, it isn't always easy to identify what will elicit the negative feelings. As cognitive ability fades, emotions become more important as they replace reasoning. Normally, a person filters emotions through a variety of thought processes:

An event or thought causes an emotion, followed by an action based on the emotion. Mary, Joe and Dana see a tiger chasing a child on TV.

• Mary, who does not have dementia, has an automatic fear response to the virtual event, but she immediately uses abstract thinking to determine that the tiger is not real and then to makes the decision to reject the fear and relax.
• Joe, a PlwD*, has lost the ability to tell the difference between virtual and real event. He perceives the tiger as real--and becomes very frightened and agitated.
  Helpful hint: An understanding attitude, reassurance that the situation on TV had a happy ending, and lots of TLC is in order. Don't tell the PlwD that is isn't real. That just makes the situation worse. In the future, avoid exciting TV shows.
• Dana, with MCI*, is able to identify the tiger as virtual, but can't get rid of the fear. It was the first piece of information she had about the tiger and she is stuck with it. The fear becomes free-floating agitation, an unpleasant negative feeling that is hard to defuse.
  Helpful hint: This is why even a person with even mild dementia should avoid exciting TV shows.

Interactions are often emotional. Someone says something that feels insulting to Mary and Joe.

• Mary uses her thought processes to determine that she isn't sure about what the person said and so she asks for more information. The new information shows that the comment was meant as a compliment.
• Mary may also decide that her first feeling was accurate, but didn't need action. For instance, the comment was meant to be insulting. She can FEEL insulted without acting on it. She can choose to ignore the feeling and move on.
• Joe hears the insult and is stuck with it. He accepts what he hears literally and reacts automatically. He is unable to evaluate its validity, consider the need for additional information, or choose to ignore the feeling.
  Helpful hint: Distraction can often be a good tool for helping a loved one drop a negative feeling and move on.

Next week, more on emotions.

* Acronyms:
LBD: Lewy body dementia
PlwD: person living with dementia
PlwLBD: person living with LBD
DLB: dementia with Lewy bodies
PDD: Parkinson's disease with dementia
MCI: mild cognitive impairment
MCI-LB: the form of MCI that precedes LBD
BPSD: behavioral and psychological symptoms of dementia

For information about Lewy body disorders, read our books:
A Caregivers’ Guide to Lewy Body Dementia
Managing Cognitive Issues in Parkinson's and Lewy Body Dementia

Helen and James Whitworth are not doctors, lawyers or social workers. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a professional's advice.