LEADER Principles: Delsuions, Accusations and Anger

This blog, which addresses accusations and extreme anger, continues to follow Mary as she learns to use the LEADER Principles of Interaction to deal with Frank’s dementia-related behaviors. If you haven’t read at least the first blog in this series, an overview of what LEADER stands for, it is a good idea to do so now.

Frank has always trusted me but now he had become very suspicious. He accuses me of wanting to run off to have an affair with the grocery clerk when we go shopping. He thinks the handyman we got to clean our gutters is just hanging around to get close to me when Frank is napping. And so on. When I try to defend myself, he gets very angry. In fact, anger seems to be very close to the surface for him with just about anything. -- Mary

Using the LEADER Principles:

Learn and Lead: Here is some information that Mary needs to know so that she can lead Frank away from his angry delusions of infidelity. 

• Frank’s brain is losing the ability to do complex (abstract) thinking tasks such as comparing, judging or prioritizing. He also can’t do concepts like time or distance.
• Frank’s illness makes him feel insecure, dependent and fearful of being left alone.
• When an event triggers a residual emotion such as that fear, the brain automatically provides a story, a prefabbed reason for the emotion. Normally, the next step is to use complex thinking to accept or reject this story.
• Without the ability to think complexly, Frank must accept this prefabbed story, this delusion, as is, as his only TRUTH. He can’t change it.
• Without complex thinking, Frank’s thinking is “all or nothing,” “is or isn’t.” Likewise, his emotions tend to be either unnoticed or extreme.
• Negative emotions are designed to be alarms, calls to action. They continue to blare until addressed. (See last week’s blog)

Emotions and Empathy. By empathizing with Frank, Mary

• Identifies his underlying emotions and accompanying theme and
• Relates with his fear of abandonment, his fear that she will leave him 
• Recognizes that without the concept of time, “will leave” means “leaving now.” 

Acceptance and Alliance. Mary:

• Quickly accepts the responsibility for his anger. “Oh, honey. You must feel awful. I’m so sorry.”
• Uses words and tones that show affection and caring, even in the face of Frank’s anger, to emphasize that she is with him and not against him.

Deflect and Do. An apology can work wonders to deflect anger! Mary's apology:

• Shows that she accepts Frank's complaint as real
• Decreases his negative feelings. (See previous blog on the magic of apologies.)
• Satisfies Frank's need for action

Entertainment and Enthusiasm. As soon as Frank’s anger decreases, Mary can enthusiastically suggest a distraction—something that will entertain Frank and refocus Frank’s attention away from his negative emotions.

Residual Emotions and Response. Frank will likely forget the incident with the handyman, but his fears remain and can be triggered again and again. The quicker Mary can respond with an apology and then a distraction, the weaker those fears will be.

Next week’s blog will be about dealing with hallucinations.

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.