The Whitworths of Arizona, bringing science to you in everyday language.

Friday, June 24, 2016

Using Improv with Dementia, Part 3

The previous two blogs have been about using improvisational theater, or improv, as a tool for dealing with irrational statements or behavior. But it can also be used by the person living with dementia (PlwD) as a way to stimulate the mind while being creative and social. As other creative activities do, participation in improv acting increases a person's feelings of accomplishment, self-worth and enjoyment. These pleasant feelings last and improved mood--and thus, behaviors--for hours after the experience is over.

"Improv is all about being in the moment, which for someone with memory loss, is a very safe place to be." says Mary O'Hara, a social worker involved with an improv project for people with early dementia. When a person with dementia feels safe, they are less stressed and their symptoms decrease. This in itself, makes improv a valuable stress management tool. But improv seems to improve mood for an extended period of time as well.

Improv players collaborate to create the action, which unfolds in present time, without a script. It plays out in the here and now, with no memorized lines, and no experience required. Since the story goes wherever the players take it, there is no set story line and no special sequence to follow. This makes it perfect for people whose memory is failing, who live in the present, and who have difficulty following sequential steps to a goal.

Research supports the use of improv. People who participate in cognitively stimulating activities and are socially engaged have a better quality of life and suffer less depression. In fact, social interactions may be as important for maintaining cognitive abilities as exercise, long known to be "more effective than drugs" for dementia care. This is especially important with LBD, where a degeneration of thinking leads to delusions and other BPSD (behavioral and psychological symptoms of dementia) and where LBD's drug sensitivity makes using BPSD drugs a concern.

Guidelines for using improv with PlwD are similar to those for any other improv acting:
  1. At least two people participate in an impromptu skit. One says something and the other responds, and so on. Physical action, such as dancing or pretending to throw a ball, is fine, but so is simply sitting in a wheelchair and talking.
  2. Say yes. Whatever your partner says, you accept it at face value. You never disagree. Be positive--negativity blocks.
  3. Encourage. This is the "Yes, and..." part of improv. Always support your partner by taking what was said--or done--and adding something to it that keeps the conversation going and moves the action on.
  4. Go with the flow. Always just move on, no matter how zany the idea is or how weird the conversation gets. Nothing is scripted and so there are no "wrong" responses.
  5. Accept failure. As dementia encroaches, failure becomes a full-time resident. Failure at things you used to be able to do well, failure at remembering the right word, failure at understanding what's said, and so on. In improv, failure is expected and celebrated with laughter and another attempt, or a twist in the action. You are responding on the fly and don't have time to worry about if it is right or not.
Participants in the eight-week improv project reported feeling more confident and able to cope with their diagnoses, as well as less isolated and depressed. Players commented:
"I don't know what I'm doing, but it's freeing."
"I've learned that I am imaginative, playful and creative...I can be funny."
Care teams can do improv by themselves--it only takes two people. However, it might be more energizing and fulfilling if a group of people with early dementia get together and interact. Talk to local improv groups and see if they would be willing to sponsor such an event. That way, you get knowledgeable people to guide the action.

For an example of PlwD using improv, view "Improv and Alzheimer's: Helping patients remember." 

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

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.

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