LEADER Principles: Obsession

Last week’s blog introduced our LEADER Principles of Interaction, a guide to relating with your loved ones in ways that decrease rather than increase dementia-related behaviors. This next series of blogs will focus on using these principles to deal with  specific behavioral issues. One of the behaviors that seems to be showing up a lot is obsessions. An obsession is getting so stuck on an idea that you can’t move on. Obsession is often a coping method for dealing with discomfort. With Covid making so many changes in our lives, it not surprising that care partners are seeing more of this.

Frank has been obsessing about a bill that he’s sure hasn’t been paid. Mary has tried to tell him it has been paid, but he is stuck in his belief.

Let’s use the LEADER Principles to address Mary’s concerns:

Learn and Lead.

First Mary must learn how Frank’s dementia damaged brain functions.

• Once a thought is in Frank’s brain, it is his unchangeable TRUTH.
• Frank’s TRUTH comes packaged with a negative emotion (worry) that demands action.
• Frank’s brain can only process in the here and now, and so he needs this action to be immediate.
• Frank’s brain can’t do concepts, and so the action also needs to be physical, something he can experience.
• Frank can't change but he can follow.

Next, Mary can lead by choosing a way of interacting with Frank that:

• deflects his controlling emotions and
• leads with suggestions and invitations

Emotions and Empathy.

Frank’s emotions rule. The stronger the emotion, the more demanding it is. When Mary tried to explain, frustration and other negative emotions:

• Joined his original worry and made his emotions even stronger stronger
• Blocked his ability to hear anything that didn’t support his TRUTH
• Pushed him to increase his efforts to get action.

Mary can use empathy to help her:

• See the issue from Frank’s view—the only one that counts
• Understand his concern that the bill is UNPAID.

Acceptance and Alliance. Acceptance does not mean belief but it does mean understanding that this is Frank’s only TRUTH. In the past, both Frank and Mary felt unheard, frustrated and alone. When Mary accepts that the unpaid bill is a serious issue that needs to be addressed and offers work with Frank to find a solution:

• Frank feels supported
• His defenses lower and
• He can pay attention to Mary’s words.

Deflect and Do. Positive feelings of support and alliance deflect negative emotions and begins the process of refocusing. Then, doing something physical must follow to satisfy any remaining emotional demands for action. Here are some suggestions. Can you think of others?

• Mary can help Frank pay the bill by writing out a check and putting it in an envelope that she sets “to be mailed.” Then this can be tossed when he isn’t looking. (See blog about the value of therapeutic fibs.)
• Mary can help Frank discover that the account is up to date. She might shout, “Hey, come and check out this invoice that I found.” Then when he does, she can ask, “What is the date? Is it for after the bill was due? What’s our balance? Hey, is it positive?” (By using invitations and questions, Mary leads Frank into the physical action of looking at the invoice and discovering for himself what the invoice says.)

Enthusiasm and Entertainment. Dementia shortens a person’s attention span. This makes distractions good tools for refocusing attention towards something that won’t trigger lingering negative feelings. Effective distractions should be something entertaining presented with enthusiasm.

Mary’s upbeat attitude:

• gives Frank a model he can copy
• helps him generate a healthy excitement that keeps his negative emotions at bay
• allows him to use his damaged thinking abilities the best he can.

Then the distraction Mary offers gives Frank a new focus. The more entertaining it is the better he will be able to focus on it and let go of any lingering worries about that bill.

• Ice cream or anything sweet usually works well.
• So might watching a favorite TV show.
• Can you think of others that work with your loved one?

Residual emotions and Response. Sadly, this isn’t the end of the story. Unlike memories of events, the emotions attached to the events are not erased by dementia. They last, ready to be triggered by a new event, or even a word and re-experienced. The stronger the emotion, the longer they last.

• Frank is very likely to become obsessed about the bill again and Mary will have to go through the same LEADER process again—and again.
• Mary’s goal must be to respond quickly so that Frank’s negative emotions get weaker, not stronger. Not only will he be easier to lead away from his obsession this time, but the emotions that trigger the obsession won’t be as strong next time.

The next blog will be about dealing with accusations and irrational anger, which often go together. You may notice a lot of similarity between this blog and the next ones. That’s good. That means that you can then generalize the LEADER Principles to other behaviors.

For more 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
• Responsive Dementia Care: Fewer Behaviors Fewer Drugs
• Lewy Body Dementia: A Manual for Staff

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.