For the past few weeks, Geroge's caregiver, Mary, has been learning ways to decrease her situational depression by using her ability to make changes in the way she thinks and responds to her feelings. She's learned to talk and write about her feelings, good and bad. Last week, she learned to laugh more. This week, she is working on making conscious choices and being grateful.
One of the abilities that LBD takes away is that of being able to make choices. With LBD, what you feel is what you get. While it is still true that Mary will feel whatever comes up for her, she doesn't have to stay with it. She can make a conscious choice to change the way she views the situation and generate a more positive feeling. Conscious choices require thinking. They are different from the automatic reactions that are Mary's (and anyone's) first response, and George's only response, to a feeling. They also require the ability to initiate, something else LBD has stolen from George. But George can still follow, and so when Mary changes the way she responds to a negative feeling, George is often able to follow suit.
Making conscious choices. This ability to change one's view of the situation is especially important when Mary begins to feel overwhelmed and discouraged with her job as caregiver. Doing something for someone else can be very uplifting. However, Mary won't feel better about doing things for George if she feels she has to. Then each chore is just one more burden, one more step deeper into depression. But if Mary steps back and remembers that this is a job she chose, she will be able to deal with it better and her depression won't get worse.
Reaffirming past choices. Like many caregivers, Mary made a choice to be George's caregiver when he was diagnosed. "I don't want anyone else caring for my George. This is my job," she said. Of course, when the caring gets rough, it is easy to forget this. Therefore, Mary must consciously remind herself of that earlier choice. She might prefer to be on the cruise they had planned, but, of the choices available to her now, this IS the one she has chosen--and the one she chooses again now. Mary's conscious reminder gives her back a feeling of being in control. With this, her job feels less burdensome even though nothing else has changed. Then, because Mary is more positive, George's anxiety decreases and so do his symptoms.
Gratitude. Like making choices, gratitude requires conscious thinking. That is, Mary has to consciously choose to be grateful--it is not a reflex action. But when she does choose to feel grateful, it helps to unblock Mary's depression-suppressed production of the pleasure-enhancing chemical, dopamine. When Mary's gratitude is directed towards others, it triggers paths in her brain that increase her ability to enjoy other people, something else that depression suppresses. As with any feeling, it also works better when she puts what she is grateful about into words. Because it is a positive feeling, Mary can share her gratefulness with George and he will feel better too. Then, Mary reinforces this by writing about it in her diary.
The best part is that like laughter, gratitude doesn't have to have a reason. Just looking for something to be grateful about triggers the dopamine, and those pleasurable feelings. It also requires Mary to think about the positive aspects of her life which triggers the production of serotonin, another "feel-good" chemical. Mary has now added "the attitude of gratitude" to her routine, along with the laughter yoga she learned last week. Every day, she takes a few minutes to think about what she's grateful for. Even if the day has been awful and she can't think of a thing, the searching for it is enough to help. Of course, finding something is even better.
Of course, these techniques aren't the whole answer. Mary must still take care of herself in other ways like having enough help, getting enough exercise and maybe even talking to her doctor about antidepressants.
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. As informed caregivers, they share the information here for educational purposes only. It should never be used instead of a physician's advice.