Magic Tools 3: Empathy

Last week, we started a series of blogs about the magic of using the right tools with LBD. If you haven’t read last week’s blog, do go back and read it. It lists some of the most important ways that dementia changes your loved one’s brain. Doing your homework and learning about these changes is a requirement if you are going to use these tools well. Last week’s blog also emphasized that the way you respond can make magic changes in your loved one’s reactions. At first, your response likely isn’t going to be automatic. It needs to be a carefully thought out choice, a conscious choice based on what you’ve learned about the dementia-damaged brain.

This week, we take the next step and talk about how important emotions are. Once dementia sets in, emotions rule. Last week, you learned that your loved one must accept the first information they receive about a situation as their TRUTH. That first information always has an accompanying emotion, and since the brain doesn’t like the unknown, it makes up a story to justify the emotion. This is a normal process—we all do it.

• Something happens. You see a dog or hear someone talking on the phone or….
• This information travels to the brain and picks up an emotion along the way. Since negative emotions like fear, worry, frustration or anger are the strongest and most urgent, the chances are that it will be one of these.
• The brain doesn’t tolerate uncertainty, and so it automatically adds a reason for the emotion.
• These strong and urgent emotions function as a natural alarm, a call to action that blares until the “reason” is addressed.
• Then the brain uses complex thinking to evaluate the situation: Is the need for action real or false? If it is real, is it mild or severe? Should I act on it now or can I postpone action until later?

Up to the last step, that’s what we all do. Last week we introduced Frank, who is living with LBD. He can no longer take that last step. His brain doesn't have the ability to evaluate or decide on an action. Instead:

• He must accept the emotional alarm and the reason for it as real and urgent—his TRUTH.
• He will continue to feel the negative emotions until he believes that they have been physically addressed. (A mental solution will no longer work… “it was already taken care of” or “I’ll do it later” or even “that’s Jane’s job” just doesn’t compute.)
• Stuck with this blaring negative emotion that demands action, Frank does his best to address it with behavior that is likely extreme and appears irrational.

Empathy is an essential dementia care partnering tool. That underlying negative emotion driving your loved one’s behavior MUST be addressed. Nothing else will work.

• Ask yourself what you would feel if you believed as he does? Allow yourself to feel that.
• And then, go deeper. What else might you feel in his place? For example, yes, you would feel angry if your believed that your spouse was unfaithful. But what else would you feel?
• There is usually an underlying emotion causing the anger. For example, belief in a spouse’s infidelity is often based on a fear of abandonment.
• Speak to that emotion, not the words or the actions. This is what you must name and share and deflect. (More about this next week)

The Magic of Self-Awareness. Self-awareness is another tool that focuses on emotion. Although Frank can’t empathize, he is super-sensitive to the emotions of others, and especially his wife, Mary's emotions. He doesn’t see them as hers however. Anything he feels, he owns.

And so if Mary shows up feeling angry at their neighbor, Frank feels her emotion, identifies it correctly as anger and correctly relates it to Mary.

But then, he owns it. That is, Frank’s brain:

• picks up Mary’s anger as his and, as always,
• adds a “reason” based on a residual feelings like fear or loss. 

Thus, Frank experiences Mary’s anger at the neighbor as his anger AT HER for something hurtful that he now believes she did to him.

You can avoid passing your negative feelings on to your loved one by being more aware of your own emotions.

• Routinely check your emotional attitude before you interact with your loved one—or even before you enter a room where your loved one is.
• What are you feeling? If it is something negative, take a moment to consciously choose something else to focus on.
• The something else doesn’t have to be super positive, just not negative. (YOU can do this. It isn’t easy, but with practice it gets easier.)
• When you just can’t stop feeling negative (and no one can all the time!), take feelings into the bathroom or at least, out of the room until you CAN feel more positive.

The next blogs will address other “magical” dementia care partnering tools, including acceptance, apologies and distractions.

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.

When Nothing Seems to Work, Part 3

Two weeks ago, the blog was about how the dementia-riddled brain causes a person to:

• be stuck with the first, often negative view of an event
• have very little empathy

Today's blog is about how emotions drive behaviors. Dementia doesn't damage emotions like it does thinking and memory. Emotions can remain long after the person living with dementia (PlwD) has forgotten what caused them in the first place. And then they get attached to a future event.

Many dementia-related behaviors are driven by a these residual negative emotions. If you can identify the emotion and speak to it instead of your loved one's words or actions, you will have much better chance of success. Many of these emotions are going to be about things like loss, fear of abandonment and lack of respect.

Being calm and patient is a good first step, but that alone may not be enough. You need to really listen to what your loved one is feeling, not just saying. Look deeper than the anger or frustration. These are secondary emotions. Look for the feeling behind them. Helplessness? Fear? Loss? Often it is loss. For example, when the PwlD is railing about a lost driver's license, It might really be a loss of independence, of adulthood, of manhood even.

When the doctor reported John's dementia to the DMV and he lost his license, he was very angry. "Why did she that do that?" he asked. Mary told him, "She's required to." That kept John from being quite so mad at his doctor, but he was still fuming. He complained "I don't have any say over my life at all any more." Speaking to his sense of loss, Mary said, "That Lewy, taking one more thing away from you. It just isn't fair" and even let herself sound a little angry. Mary was doing two things here. She was validating John's feelings, showing "I'm on your side" support, and she was giving him a target for his anger besides her or the doctor--"that Lewy." It did help. John calmed down and said, "Yes, it is, it's not for sissies," a phase they used often about the disease.

You may have been warned not to show anger for fear of increasing your loved one's angry behaviors. However, a mild show of anger can work if you are clearly expressing it in support of your loved one, not at them or at the situation they have caused. This makes them feel heard and supported, not discounted or controlled. Just make sure your anger is less intense then your loved one's. You don't want them to escalate their anger to match yours! Also be sure to follow up such expressions with more soothing expressions of support. "I love you just the way you are," Mary might tell John with a loving pat on the arm or even a hug.

This same technique can work with any other feeling of loss. The goal is to validate the feeling so that the PlwD can calm down. Without the negative feelings reigning, a person can think more clearly. This is true for anyone, including a PlwD. Mary may have to play out the above scene several times if John doesn't remember and again, wants to drive.

Of course, this won't work for everyone. For example, some PlwD don't want to own the disease and so it is difficult to make it the scapegoat. And that's what the next blog is about.

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
Riding A Roller Coaster with 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.

Lewy Body Phrase for 10-15: What's Left

Dementia takes away a lot. Here are three functions that are left:

The senses: Seeing, hearing and touching may be affected by other issues, but not dementia, although it can change one's perception of what the senses deliver.

• Communication tools: Smiles and gentle touch.

Emotions remain long after thinking has faded. When the senses deliver information about an experience, be aware that the emotion attached to that information is often one left over from a previous experience.

• Communication tools: Hugs and loving words.

Concrete thinking: This basic, unfiltered thinking lasts to the end. It accepts what the senses deliver and the attached emotion and does its best to make sense of the experience. The result is often a delusion, or a faulty belief.

• Communication tools: Simple words and acceptance. (Uh, huh, acceptance...not belief, but definitely acceptance!)

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

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.

Lewy Body Dementia Word for 10-14: Emotions

Emotions drive behavior.

• Emotions remain after abstract thinking fades. A person will respond to the first emotion they experience during an event.
• Negative emotions are motivators. They are stressful, strong and intense. Their job is to drive you away from a perceived danger or discomfort.
• Positive emotions are comforters. They are centering, calming and relaxing. Their job is to encourage us to stay in a comfortable space.
• The first emotion experienced is often residual, left over from an earlier event. Residual emotions are usually negative; they are stronger and last longer.

Make care partnering easier by avoiding negative emotions and promoting positive ones.

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

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.

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.

Be a Better Storyteller

Our 3 for 2 book special honoring the 2016 World Parkinson's Congress. Good until Nov, 1, 2016.

Buy Now!

***

Be a Better Storyteller

In Eric Barker’s blog, Neuroscience Of Mindfulness: How To Make Your Mind Happy, he talks about how our brain is divided into two parts: The right brain, which collects facts, and the left brain, which interprets these facts. Thus, your right brain sees a person glance at their watch. Your left brain tells you, “She’s bored” or even more likely, “I’m boring her.”

We all do this. But in most cases, we also check our interpretations against facts.“Oh, yes, she has an important appointment and needs not to be late.” If I have dementia, I’m not going to be able to do this. I accept my left brain’s interpretation without question. I live in the moment and can’t apply such information, even if I remember it, to what’s happening right now.

Eric Barker suggests that we become aware of how our brains work…that we understand how creative, and often incorrect, the left brain can be in its interpretation of the facts that the right brain collects. Well, that’s fine for the average person, but it doesn’t work for me if I have dementia. I can’t do that. I’m stuck with what my left brain tells me. So how can you help me avoid this?

First, if I come to a conclusion, flow with it. I’m not going to change. Explaining the facts, arguing or defending isn’t going to work. Accept, agree and deflect or distract. But maybe there are some things you can do to help me avoid some of these conclusions before they happen.

Eric Barker suggests that you help the left brain build better stories. Now, there’s a thought! What can you do to help me build better, more positive stories?

Make me comfortable. As discussed in the March 12, 2016 blog, Emotions, it is human nature to pay more attention to negative messages. They are more intense and get our attention more easily. We need them to motivate us to move away from danger, or often, just from being uncomfortable. Being uncomfortable and danger are on the same plane, only danger is just more intense. Dementia takes away my ability to judge intensiveness, and so I respond similarly to both. The more comfortable you can help me to be the better I will react to my environment, i.e., the more positively I will interpret what my right brain feeds me.

Improve my self-esteem. As my condition worsens, as my ability to think, remember, or do things for myself diminishes, so does my self-esteem. Thus, I’m more likely to think I’m boring, or that I’m not good enough for you to hang around, or that I’m too much trouble, or…. To counteract this, use lots of physical reassurance on a regular basis: hugs, kisses, anything you can do or say to show me that I’m important to you. This won’t work during an event when I’m convinced of something negative…then I’m stuck. Your actions must happen at times when I can accept them at face value, not as an avoidance of my, to me, accurate statements.

Help me to feel useful. The better I feel about my contributions to our daily life, the happier I will be and the fewer negative emotions my left brain will have to build into its stories. Look around. What can I do? It doesn’t matter if I can do it well. Can I help with the dishes? Fold the laundry? Sweep the floor. I don’t need to hear that it is good for me to be keeping busy. I need to hear that I’m helping you, making your job easier. OK, so maybe I’m not. But that’s what I need to hear. So, if you want me to feel useful, tell me that!

Help me to feel creative. Creativity is very uplifting, and adds all kinds of positive feelings. What did I do before dementia? Was I a photographer? An artist? A musician? A seamstress? A carpenter? A cook? I don’t me professionally, but how did I express my creativity? What was important to me? Family? Work? Hobbies like dancing, or golf or knitting? How can you help me to continue to do some form of this same thing? Even looking at photo albums can be helpful if that is all I can still do. Ask questions about the photos, but don’t push for names, etc. or anything that makes me agitated. Music can be very helpful. So can art work like finger painting. Use your own creativity to come up with ideas and try them out.

None of these suggestions are likely to keep my left brain from telling negative stories altogether. But they may help enough that I may need less medication…and that’s a real plus!

* Acronyms:
LBD: Lewy body dementia
PlwD: person living with dementia
PlwLBD: person living with 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.

Guilt, Worry and Anger

These three negative emotions cause caregivers--and your loved ones--a lot of pain and stress. In recent blogs, Mary, George's caregiver, has been learning how to deal with negative emotions. But these three, guilt, worry and anger still trip her up...a lot.

Guilt

Feeling guilt is how people try to control the past. Mary can't change that she was impatient with George, but she can at least, feel guilty it. Mary's brain accepts this as an immediate solution, but it doesn't accomplish anything and so this triggers more guilt. This adds stress, so that Mary will likely be even more impatient in the future. To deal with guilt,

• As with any other negative feeling, recognize your feelings of guilt and put them into words. And then LET THEM GO. Consider guilt a toxic feeling that you don't want hanging around.
• Look for the underlying feelings. Guilt is a "secondary feeling." That is, it is usually a response to other feelings like resentment or fear or feeling inadequate. Recognize these and put them into words too.
• Be compassionate with yourself. You are human and you have a very stressful job. Give yourself the same consideration you'd give someone else in your position.
• Align your future behavior with your values. While you can't change what has already happened, you can set yourself up to behave differently in the future. For instance, if you made a commitment to make weekly contact with your daughter but have been letting it slide, set up a special time and put it on your calendar.
• Ask for help. A lot of caregiver guilt comes from feeling you should be able to do it all. You can't. Caregiving is not a single person job. Call a friend or relative to come "visit" with your loved one while you take some "me time." Hire help for a few hours a week, or more if you need it. This is money well spent.
• Accept that taking care of yourself is "being a good caregiver." A loved one with a happy, healthy caregiver has less stress, and is happier and safer.

Worry

Mary used to worry a lot. That's how she tried to control a future that felt uncontrollable. Like guilt, worry is a temporary fix but adds stress because it doesn't actually accomplish anything. To deal with worry,

• As with guilt, put feelings of worry into words, and then let them go.
• Look the underlying feelings. Worry is another secondary feeling, often following feelings of fear and uncertainty. Turn these into words too.
• Think about what you can do. Make a list things you can actually do to change a situation. Thinks like asking for help or going to a support group. Then follow through.
• Once you've done what you can, let it go. If this is difficult, set a timer and allow yourself to worry of 5 minutes. Then move on.

Anger

This is a feeling that Mary often buries under guilt and worry. But it too, is a secondary feeling, which usually follows emotions like frustration, inadequacy and fear. When Mary can't do anything else about it, she can at least feel angry. As with the other feelings, feeling angry is a temporary fix that doesn't solve anything...and often makes matters worse. Unlike guilt and worry, both of which can be immobilizing, anger tends to move Mary into action, resulting in words or behaviors that she may regret later. Therefore, the first step for dealing with anger is to learn how to express it in constructive ways--or avoid expressing it.

• Get enough rest and take care of your health. This is a big one. If you are rested and healthy, you will be better able to respond to the frustration of a balky loved one or an unhelpful doctor more rationally. You may feel the anger, but you won't have to express it.
• Practice deep breathing. Taking three deep, cleansing breaths gives you some time to calm down and adds oxygen so that you can think clearly.
• Self-talk. Have some soothing chants that you can use in a hurry: "It's okay." "Let it go." "He isn't doing this on purpose." "It's the disease, not my loved one."
• Laugh. Step outside of the situation and see its absurdities and silliness.
• Later, you can do your homework of putting angry feelings into words and looking for underlying feelings. This may make it easier to deal with future anger.

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.

Using Humor and Laughter

Mary, George’s caregiver, is learning how to use the connections between feelings and thinking to decrease her bouts of situational depression. Last week, she learned about how talking about unpleasant events and giving names to negative emotions decreases their power. She also learned the talking about happy events made her feel even better…and that writing about both could also be helpful. She learned to do her work with the negative emotions away from George because he’d take it all personally, but to include him in her positive stuff because it would make him feel better too.

Mary is still working on using emotions to decrease her depression. This week, humor is the subject. Humor is a multi-part process:

1. Something "funny" – “How do you stop an elephant from charging? Take away his credit card.” This joke contains something that doesn’t fit our preconceptions, and a resolution. Mary knows she can’t stop an elephant with a piece of plastic, but when she changes the meaning of the word “charge” then it works—and she laughs. Humor can also be simpler, or “slapstick.” Someone else gets a pie in the face, stumbles and falls, or gets embarrassed. Mary sees someone in one of these uncomfortable situations and laughs, mainly as a response to the relief that it's “not me.”
2. Perception and understanding. Obviously, understanding the elephant joke requires thinking skills. That’s why George often doesn’t see the humor in things. But he still understands slapstick humor which requires less thinking.
3. Appreciation: When Mary “gets” a joke, her brain rewards her with dopamine, which among other things, makes her happier. However, depression tends to attack the areas of the brain that secrete this neurotransmitter. Thus Mary may get the joke, but won’t be able to appreciate it. The good news is that if the joke is funny enough, other areas of the brain come into play to help the normal dopamine secreting centers overcome the blockage. George has PDD, the kind of Lewy body dementia that starts with Parkinson’s. With PD, Lewy bodies attack dopamine and so there is already a limited amount available. Thus, even if George understands the joke, it may not seem funny to him. His dopamine production isn’t blocked, it is depleted.
4. Expression: Laughter and smiling require motor and language abilities that Mary has but George is losing. Depression seldom affects motor abilities. George’s PD does. He may be able to understand a joke and even appreciate it but have difficulty demonstrating that he can. Mary can watch for other non-verbal cues, like a thumbs-up signal.
5. Better mood—and health. Laughter is healing. It stimulates Mary’s brain to secrete endorphins like serotonin which increase happiness and decrease depression. These chemicals also improve Mary’s general health by boosting the immune system. Finally, the very act of laughing brings more oxygen into Mary’s body and stimulates motion, stability and balance.

Now all of this may sound very complicated. But actually, there’s a shortcut. Mary can skip to step 4, and simply laugh. It doesn’t really matter what she laughs about. She can just laugh, laugh til her sides split. Her brain cannot differentiate between pretend and genuine laughter. And the more she laughs, the better she will feel.

Laughter is contagious and so if she does it with George, he’ll soon be laughing too…or doing his best to do so. Of course, Mary must be careful that George doesn’t think she is laughing at him. A good way to do this is to laugh at LEWY, and the problems IT causes…not George.

Mary has become a convert to “Laughter Yoga,” started in Florida in 1995 by Dr. Madan Katarina. It is a combination of clapping, breathing and laughing. Motion creates emotion. Breathing increases the oxygen in the blood. And laughter, well, we already know what it does!

Give Laughter Yoga a try—It’s easy and fun. You can do it in a group or at home, alone or with your loved one. It is almost too easy to be effective. But try it and see what you think.

• Clap your hands in rhythm: One, Two -- One-Two-Three! (repeat 2 times--or more)
• Now laugh in rhythm while you clap: "Ho, Ho — Ha-Ha-Ha!" (repeat 2 times--or more)
• Expel all the air from your lungs and pretend you're smelling a flower." (Hold an imaginary flower to your nose and exhale and inhale several times…remember to breath out longer than you breath in to prevent hyperventilation.)
• Now, laugh from your heart: Place your hands on your heart and laugh…and laugh.
• Now, laugh like you don’t care:. Throw up your arms high and laugh even louder. And laugh and laugh.

I'll bet you feel better, happier, more energetic, less stressed.

There’s more! Next week, I have still more to share about making emotions work for you instead of against you.

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.

Emotions!

For the next few weeks, these blogs will be about ways for caregivers to interact with their loved one that make life easier—for both people.

Meet Geroge, a composite of many of our LBD friends. As you read, substitute your own loved one’s name for his. As George’s reasoning ability wanes, his dependence on emotions increases. He will be very sensitive to your emotions, while his own emotions, unfiltered by reason, drive his thoughts, decisions and actions.

But let's back up and talk about emotions in general.

• That part of the brain where emotions are controlled is also involved with music and rhythm, and smell. Therefore, these tend to be all mixed together. A tune or a smell easily evokes emotions.
• The more intense the emotion you have about an event, the more important it is to you and the longer you will remember it.
• Positive emotions encourage us to relax and stay put, to enjoy what we have. They are calming and comforting, but seldom intense.
• Negative emotions are more intense and draw our attention more quickly. It is a safety issue. The cave man needed to react with strong physical actions when seeing something fearful like a saber-toothed tiger. Today, we react the same way to psychological fears. Negative emotions encourage us to react, make changes, move away from the discomfort they cause.
• Experts in critiquing say that it takes about six positive comments to equal one negative comment.
• An event usually evokes an emotion, which is tested by your reasoning ability, often before you are even aware of its presence. You gather information from your surroundings and from your memory to decide whether to accept the feeling at all.
• You also test for intensity, and decide how afraid or happy are you about this event.

For example: you see a dog and feel an instant jolt of fear. You see that he is wagging his tail and you know from your own history that tail-wagging means "friendly." But you also have a piece of information in your brain that says that a dog might feel threatened if you try to pet it and so you don't. You have judged your initial fear to be far too intense, but not completely inaccurate.

Now add dementia.

George sees the dog, feels the fear and start screaming. He is not able to test to see if the fear is appropriate or not. This is true for any event, hallucination, dream, TV show, etc. that elicits an emotion. He can't test for reality.

George also can't test for how fearful the situation is. He’s either afraid or I'm not afraid.

• George is a mirror. He will pick up whatever emotions you project, and mirror my version of them back to you.
• However, George’s version will center around him. He takes everything personally. And so to him, if you are angry, you are angry at him. If you are sad, you are sad because of him. If you are happy, that's because of him too.
• George will react to negative emotions with increased LBD symptoms, increased acting out and less cognitive ability. And because they tend to start out more intense, he will react strongly.
• George will react to positive emotions with fewer LBD symptoms, less acting out and more awareness.

George’s emotions are raw, unfiltered by reason. His damaged brain will make up stories to account for those feelings and he’s stuck with this. He can't test the stories for reality. This is his truth, his reality. He can't change that.

He can't initiate change, and seldom sees a need to do so. Why would he want to deny his truth? You CAN change. Instead of trying to get him to accept your truth, your reality, start with an acceptance of where he is. Then you can model a change of behavior that he can mirror. He will always believe his truth, but you can help him to move to more a more peaceful, comforting emotional space.

Next week, will be about acceptance and how to use it for a better quality of life for both caregiver and loved one.

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

For wonderful information and videos about interacting with a person with dementia, go to teepasnow.com

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.